05/06/12 Donald Abrahms

Printer-friendly versionPrinter-friendly version

Dr. Donald Abrahms a scientist at the Univ of Calif, San Francisco speaks to Cannabis Therapeutics Conference in Tucson + Rev Kenny Glasgow re prisoner's right to vote & more

Share on Facebook Share on stumbleupon digg it Share on reddit Share on del.icio.us

Transcript

Transcript

Century of Lies / May 6, 2012

-----------------------

DEAN BECKER: The failure of Drug War is glaringly obvious to judges, cops, wardens, prosecutors and millions more. Now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century of Lies.

-----------------------

DEAN BECKER: Thank you for joining us on this edition of Century of Lies. Again, today, we’re reporting from Tucson, Arizona where I attended the Cannabis Therapeutics convention sponsored by Patients Out of Time. Their website is http://medicalcannabis.com.

I’m going to allow one of the founders of Patients Out Of Time to introduce the first speaker. This is Al Byrne.

-----------------------

AL BYRNE: …ought to go to a lawyer - even better, a congress full of lawyers. Look at what we get there.

So I would recommend to the American public that the next time they want to get a real opinion about medical cannabis that they go to a cannabis expert. That doesn’t mean some talking head on TV. That doesn’t mean a legalization outfit like MPP or ASA or NORML. It means that you go to a medical cannabis expert.

We have one of those coming up again. Dr. Donald Abrahms, as we know, has led the education effort in his area in San Francisco. He, by the way, I learned when we were in Providence, is one of the most respected, honored graduates of Brown University. And this is because of his pioneering work with medical cannabis and other areas.

So please welcome Dr. Donald Abrahms.

DONALD ABRAHMS: I would like to speak about cannabinoids in cancer care and with the theme of the meeting being the endocannabinoid system I use this slide from my friend the late Billy Martin who described some of the changes that occur when the endocannabinoids complex with the various cannabinoid and vanaloid receptors.

I just want to point out the ones that I think are relevant for people living with malignant disease. Certainly the CB1 receptor – control of appetite, immune function, pain, emmasis, reward – are relevant for people with cancer.

With regard to the CB2 functions certainly immune function, cell proliferation (very important), inflammation and pain.

The as yet unidentified cannabinoid receptor probably also related to pain, vasodilation may also be important and with the interaction between endocannabinoids and the vanaloid receptor pain and inflammation.

So, many ways that you can see physiologically our bodies and are cannabinoid receptors are set up to help us manage cancer, perhaps itself, but certainly the symptoms associated with cancer.

So if the endocannabinoids work then I would suggest that probably the plant cannabinoids may as well.

Now, before I focus on only the cannabinoids in cancer we need to appreciate the fact that there are also a multitude of other chemicals that are present in the plant. Andy is right. When I started saying that I wanted to study cannabis my colleagues said, “Well, Donald, it’s a plant. Nobody smokes foxglove anymore. We give people digitalis so you don’t use the whole plant.”

But it’s actually cannabis that brought me to Andy’s program at the University of Arizona where I did my fellowship in integrated medicine. There I learned of cultures that use whole plants.

For example, in traditional Chines medicine because when you extract the single active moitity and put it in a sesame capsule, for example, then you remove the you remove the yin and the yang – the things that support the benefit of that components and the things that decrease some of the side effects.

So I think before we just focus on cannabinoids we need to appreciate that there are other components in the plant that make medicinal activity.

And certainly the terpenoids which provide the plant with its characteristic aroma are also important in medicine. I turn to Ethan Russo’s fabulous entourage effect paper which lists for us some of the main cannabis terpenoids also that are involved in giving cannabis its smells – the citrus, the pine, the hops – many, many terpenoids that are there not only to perhaps improve the effects of the cannabinoids and decrease their side effects but have activity in of themselves that are relevant to people with cancer.

The flavonoids are also aromatic and cannabis contains about 20 flavonoids. These also may be involved in the pharmacokinetics of the plant. These are, again, just some of the flavions in cannabis that are also useful in among themselves from other plant forms of our treatment of patients with malignant disease.

Quercegen, for example, a very common and potent antioxidant that many of my patients seek to supplement with. Again, as Andy said, there’s poison in everything. The difference between a remedy and a poison is the dose.

Turning to cancer - and again, I’m an oncologists and I have been an oncologist for 32 years now so I do have a bit of a oncologic perspective in my take on this question. But I do want point out some of the common symptoms that we deal with on a day to day basis when dealing with patients with cancer. As I list them think about cannabis and its potential utility.

Weight loss, cachexia is wasting, releasitity (getting full quickly), anorexia (loss of appetite), pain, anxiety, depression, and nausea and vomiting.

So all things that we think may have some potential applications for the plant that we’re talking about.

We heard yesterday about anandamide and a little bit about its involvement with appetite. In low concentrations in mice anandamide leads to potent enhancement of appetite. The CB1 receptor which is implicated in control of food intake is located in the sort of area of the brain involved in reward. In mice who genetically lacked the CB1 receptor they tend to eat less than their wild-type litter mates. So it’s felt that the CB1 receptors are involved in motivational and reward aspects of eating.

-----------------------

DEAN BECKER: Want to interrupt to remind you that we’re listening to Dr. Donald Abrahms of the University of California, San Francisco. He’s speaking to the Patients Out of Time conference, Cannabis Therapeutics conference in Tucson, Arizona last week.

-----------------------

DONALD ABRAHMS: In 1986 Dronabinol or Delta-9-THC, synthetic THC in the sesame seed oil was licensed and approved for treatment of nausea and vomiting associated with chemotherapy. The indication was expanded in 1992 for treatment of loss of appetite associated with the AIDS Wasting Syndrome.

In placebo-controlled trials Dronabinol actually did not lead to increased weight gain so it couldn’t be licensed for increased weight in these patients but it led to increased appetite for whatever that’s worth. So that’s why it got approved.

It got approved, I think, for many political reasons.1992 was the year that Bush I closed the Compassionate Use program because they were concerned that people living with HIV and suffering from the Wasting Syndrome were going to demand that the government supply them with cannabis for this condition. So they basically closed down that Compassionate Use program that provides cannabis to a small number of people today, as we’ve heard, and some people have those cans from last night’s auction, but it also approved cannabis (Dronabinol) so they could say, “See, there is cannabis or marijuana available in this form so we don’t need to have that program anymore.”

But when we first started prescribing Dronabinol to patients in 1992 when it became available our HIV patients said, “I don’t really like that. It takes a long time for it to have an onset and it lasts a really long time and I feel much more altered than when I just inhale cannabis.”

From what we know about the pharmacokinetics our patients were right. When taken by mouth either as Dronabinol or as a baked product the absorption of the THC is low and variable – about 6 to 20%.

The peak concentration of the THC in the blood after taken by mouth occurs in 2 and one-half hours in our clinical trials. When taken by mouth Delta-9-THC passes through the liver and gets metabolized into a psychoactive metabolite (11-hydroxy-THC).

So when Dronabinol is taken or when people eat a baked product there is increased psychoactivity because of the formation of this second bio-active metabolite in addition to Delta-9 which is the main psychoactive component.

Also the terminal half-life for how long it takes for half of it to leave our body is quite long when taken by mouth compared to when it’s inhaled.

When cannabis is inhaled – and I say inhaled as opposed to smoked because we know that there are other options with regards inhalation, vaporization for example – the THC is readily absorbed in the blood stream and the peak concentration occurs in 2 and one-half minutes as opposed to 2 and one-half hours. It declines rapidly over 30 minutes.

Also when inhaled you get less of this 11-hydroxy psychoactive metabolite so it’s a little bit of the cleaner affect and people have much greater ability to titrate when it comes on and how much of an effect there is.

With regards to cannabis and chemotherapy-related nausea and vomiting. In the 70s which was about when I began my training as an oncologist - I was an intern and resident and a fellow then - it was a decade when we were a little more accepting of the cannabis use and we had fewer anti-nausea medicines for chemotherapy patients than we do today. In treating a number of young people - particularly with Hodgkin’s Disease – we would learn that the pharmaceutical anti-nausea drugs that we prescribed were felt to be inferior to smoked cannabis from the patients that we were treating.

That’s what led to investigations of whether or not, in fact, there may be some potential in treating chemotherapy-related nausea and vomiting. In randomized trials oral THC was felt to be better than placebo and equivalent or superior to the most common drug that we were using for nausea and vomiting. Some felt that smoked THC or cannabis was better than the oral preparation.

If we line up where cannabis stands today as far as potency as an anti-emetic for cancer patients it’s probably the least potent of what we have available in our armamentarium. But, as I often say, in cancer we approve chemotherapy drugs if they work in 10% of people with cancer.

We know there are many patients for whom our anti-emetics don’t work and they only thing that may work is cannabis. I think it was Melissa Etheridge who was the last celebrity to come out and make that proclamation that she never would have been able to tolerate her chemotherapy for her breast cancer if she didn’t have her cannabis.

So if it works for some people I think it should be available.

I mentioned when I showed you the endocannabinoid system that many of the cannabinoid receptors seems to be linked to pain. The CB1 receptor that we heard yesterday is the most heavily-populated G-protein receptor in the brain. Elevated levels of the receptor like that of the opioid receptor are found in areas of the brain that process noxious stimuli.

CB1 and CB2 agonist also seem to have peripheral analgesical or pain relieving actions. A third way that cannabinoids may influence pain is by anti-inflammatory affects. Again the cannabinoids as well as the terpenoids and flavonoids may have some anti-inflammatory affects.

So in the past it was felt that these cannabinoid pain relief was linked to opioid pain relief but analgesic of the cannabinoids are not blocked when you use opioid antagonist.

-----------------------

DEAN BECKER: Again, this is Dr. Donald Abrahms, a scientist at the University of California, San Francisco, speaking at the Patients Out Of Time cannabis therapeutics conference last week in Tucson, Arizona.

-----------------------

DONALD ABRAHMS: We did a clinical trial a number of years back in patients with a painful HIV-related nerve damage or peripheral-neuropathy. The current treatment for this problem which was particularly devastating in the last decade was unclear. Opiates were generally ineffective. Most people turned to using Gabapentin, an anticonvulsant, which has its own side-effects as well as its potential to interact with HIV drugs.

Cannabis in pre-clinical trials, the raptelslic model that Andrew Holman has done much of the work with animal models with neuropathic pain, suggested that cannabis may be useful. In addition patients anecdotally told us that using cannabis decreased their neuropathic pain.

So we did a clinical trial in patients with HIV peripheral-neuropathy and then we exposed them to inhaling three times a day either a placebo cannabis or real cannabis. Our threshold was a 30% decrease in the level of their pain. What we found was that 54% of the patients inhaling the real cannabis had a decrease of greater than 30% pain compared to only 24% of the patients inhaling the placebo. This was statistically significant.

When they left our clinical research center we asked them not to smoke for the next week and you could see that the pain returned to baseline in those patients who had been treated with the real cannabis.

On smoking the first cannabis cigarette of the clinical trial at the time that we did the experimental pain model the placebo patients reported that their neuropathic pain decreased 19% compared to 79% in those smoking their first cannabis cigarette. So from the first cigarette we could discriminate the difference between the placebo and the real cannabis.

These on the bottom are the results of the experimental pain model. The top line is the placebo group. You can see the area of weird feeling increased or stayed the same whereas in the cannabis groups the area decreased bout 30% which is about what the decrease in pain was as well.

So we concluded that smoked cannabis is an effective treatment in patients with painful HIV-related neuropathy and was also effective in the experimental pain model.

The magnitude of the pain reduction from smoked cannabis is comparable to that reported in trials of Gabapentin which is the anti-seizure drug that generally use to treat peripheral-neuropathy. That is we needed to treat 3.6 people in our study for one to have a benefit and that’s pretty much what they found in studies of Gabapentin.

This study that we did which was funded by the Center for Medicinal Cannabis Research at the University of California – they also funded a neuropathy crossover, randomized control trial that was conducted at the University of California, San Diego – this looked at 28 patients who received placebo or actual cannabis with changes in the dose of the cannabis and there was inhalation 4 times a day for 5 days and then a 2 day washout period.

You can see when patients smoked the real cannabis their pain decreased but when they smoked the placebo it didn’t. A very interesting aspect of this study was that the number needed to treat with cannabis for one person to have a benefit was exactly what it was in our clinical trial.

So those are 2 clinical trials in patients with HIV-related neuropathy that showed the same outcome.

-----------------------

DEAN BECKER: We’re tuning in to a speech given at the cannabis therapeutic convention, the Patient Out Of Time gathering in Tucson, Arizona last week. The speaker from the University of California, San Francisco, scientist Dr. Donald Abrahms.

-----------------------

DONALD ABRAHMS: Mark Weir and his group in Canada reported on a randomized, double-blind, four-period crossover study in patients who had post-traumatic and post-surgical neuropathic pain. So a different sort of neuropathic pain but essentially they found the same – that cannabis, particularly at their higher dose which is a dose that our government doesn’t even carry (9.4% THC) to study – was effective in reducing neuropathic pain and they also noticed that sleep improved in these patients as well.

So, why am I stressing neuropathic pain in HIV in this…how does that relate to cancer? Well, nowadays I can cure a number of patients with cancer who are disabled by neuropathic pain from their chemotherapy.

So Andea Holman told us yesterday that there’s a mouse model of neuropathic pain that’s responsive to cannabinoids. It has been one of my goals to do a clinical trial not only to see if we can treat neuropathic pain in patients who have it but to see if we can prevent it by prophylactically using cannabis in patients receiving chemotherapeutic agents that cause pain.

However I have tried to do four clinical trials of cannabis in cancer patients in San Francisco and have failed in all of them. Cancer patients in San Francisco for some reason are not interested in participating in controlled clinical trials in cannabis in the way, for example, HIV patients seem to be. Why that is is a good question that one of our social anthropologists wanted to do a study of itself.

Cannabinoids and opioids potentially can interact. They share several pharmacologic properties, decreasing pain, lowering the temperature, sedation, lowering blood pressure, inhibition of bowel function.

Although they were initially thought to act on the same pathways we now know that they don’t. In animal studies THC itself greatly enhances the analgesic effect of morphine in a synergistic fashion. So 1 + 1 does not equal 2, it equals 5.

There’s the possibility then that if we use cannabinoids with opioids that we could have enhanced and persistent analgesic effects of the opiates at lower dosages.

So we did a pharmicokinetic interaction study.

Let me just digress for a moment. What I learned many years ago when I first started trying to do cannabis research was that the government. The only legal source of cannabis in the government is NIDA (the National Institute on Drug Abuse) – they have a congressional mandate I was told by Alan Leshner who was the head of NIDA to only supply cannabis for research that looks at it as a substance of abuse. So they are forbidden by congress to provide cannabis or to fund studies that look at cannabis as a potential therapeutic agent.

In 1999 the state of California – if anyone can remember back that far – had a budget surplus. One of our state senators, John Vasconcellos, appropriated 3 million dollars a year for 3 years to establish a Center for Medicinal Cannabis Research at the University of California. That money funded the neuropathy studies, for example, where we were looking at cannabis as a treatment for something. But that money disappeared.

So originally I had a pain study in cancer patients looking to see if cannabis boosted opiates but I couldn’t enroll patients so the Center for Medicinal Cannabis took my money away.

I thought it was still an important so CMCR doesn’t have any money anymore – I went to NIDA. I said I want to study if it’s safe for patients on opiates to add cannabis.

“OK. That’s good because…”

[laughter]

So we had 10 participants who were on sustained-release morphine and 11 who were on sustained-release oxycodone. You can see that the dose was slightly higher in the patients with morphine compared to the patients with oxycodone and they actually came in with slightly less pain - 35 out of 100 compared out 44 out of 100. But remember this wasn’t a pain study. NIDA will not fund to see if there’s any effect on pain. I was only looking at what happened to the amount of morphine or oxycodone in the bloodstream is what I told them.

-----------------------

DEAN BECKER: Again, that was Dr. Donald Abrahms speaking at the Patients Out Of Time cannabis therapeutics conference last week in Tucson, Arizona. You can hear more from Dr. Donald Abrahms by checking out the 420 reports for this week and that’s available at http://DrugTruth.net – just look on the right-hand column.

Also this week I went to Washington, D.C. to talk to the staff of my congresswoman, Sheila Jackson Lee, as well as my Senators Kay Baily Hutchinson and John Cornon. You should have seen their faces droop when I shared the magic 50 words that will end the drug war. I’d like to share those words with you, once again.

Considering the corruption of the drug war which includes empowering our terrorists, enemies, enriching the barbarous Latin cartels, and enticing more than 30,000 violent gangs to prowl our neighborhoods selling contaminated drugs to our children – what is the benefit? What have we derived from this policy that offsets this horrible blowback?

Well, it’s 51 words but it still works. I urge you to use them at every opportunity.

While in D.C. I conducted a couple of interviews with other supporters of the Drug Policy Alliance. Their website: http://drugpolicy.org. Here’s one such interview.

-----------------------

KENNETH GLASGOW: I’m pastor Kenneth Glasgow. My organization…I’m the founder of Ordinary People’s Society and the Prodigal Child Project. I’m based out of Dothan, Alabama but we are primarily have a big, big margin of following in Georgia, Florida, Alabama and most of the southern states.

We are very well known for being the first and only organization and person, I will say, that ever won the X-felon voters rights lawsuit in the state of Alabama to where people can vote whether they’re in prison or out. If they have crimes not including, not involving moral turpitude. Those crimes consist of possession of illegal drugs, felony DUIs, doing business without license, attempt to this or attempt to that – crimes that, you know, do not cause hurt, harm, danger, suffering upon somebody else.

Only two states that you can vote in prison – that’s mainly Vermont and we make up the third state because of the lawsuit we won in October 2008.

A lot of other things we do…we do mentoring and monitoring under the Prodigal Child Project of our young people and our School to Prison Pipeline work. We also do what is called H & H which is feeding the hungry and the homeless.

We do all of this as a public safety measure and we concentrate on a lot of drug policy issues - mass incarceration and different issues that causes people to look at the criminal justice system and mostly the disparity.

What I want say to my elected officials is I want them to really look at the drug laws – how they are unequal. I want them to really look at medical marijuana. I want them to look at we got 5 major mental institutions closing in Alabama right now so I want them to look at that. We got budgetary issues in Alabama, in Georgia and in Florida and also in all three of those states are all very much over capacitated in their criminal justice system.

So if we look at the fact at them minimizing at doing some alternative system – especially treatment instead of incarceration – it’ll start helping the budget, it’ll start helping taxpayers and it would diminish the overcrowding issues.

We got a criminal justice system that has so many flaws in it. I thank God for all of you who are starting to look at it in a more progressive way. We thank God for organizations like LEAP (Law Enforcement Against Prohibition). These are officers who have been in the career of law enforcement and see the errors of their ways and the errors of the system. So if they are law enforcement officers who see the errors in the system then why don’t you?

My website is http://ordinarypeoplesociety.com. Thank You.

-----------------------

DEAN BECKER: Check out more from Donald Abrahms on this week’s 420 reports. Next week we’ll hear from Howard Woolridger<?> riding his bicycle across America. He rode his horse across twice – why not? He’s trying to end marijuana prohibition.

As always I remind you there’s no truth, justice, no reason for this drug war to exist. Please visit our website http://endprohibition.org. Do it for the children. Prohibido istac evilesco!

-----------------------

For the Drug Truth Network, this is Dean Becker asking you to examine our policy of Drug Prohibition.

The Century of Lies.

This show produced at the Pacifica Studios of KPFT, Houston.

Transcript provided by: Jo-D Harrison of www.DrugSense.org