Pubdate: Wed, 16 Jul 2003 Source: Anderson Valley Advertiser (CA) Copyright: 2003 Anderson Valley Advertiser Contact: http://www.mapinc.org/media/2667 Author: Fred Gardner Cited: Dr. Tod Mikuriya http://www.mikuriya.com/ Medical Board http://www.medbd.ca.gov/ Bookmarks: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal) http://www.mapinc.org/find?154 (Conant vs. McCaffrey) http://www.mapinc.org/people/Tod+Mikuriya (Dr. Mikuriya) http://www.mapinc.org/find?323 (GW Pharmaceuticals) http://www.mapinc.org/people/Alison+Myrden (Alison Myrden) REVENGE OF THE NARCS (THE NEVER-ENDING SAGA) 7/11/ was not a lucky day for California cannabis consumers. The morning papers described a Bush Administration challenge to the ruling (in Conant v. McCaffrey) that confirmed the right of doctors to discuss marijuana with their patients. San Francisco AIDS specialist Marcus Conant, MD, and co-plaintiffs had sought such confirmation in January, 1997, after the Drug Czar, on behalf of the Clinton Administration, threatened to revoke the prescription-writing licenses of any California doctors who approved cannabis use. Federal Judge Fern Smith (a Reagan appointee!) temporarily enjoined the feds (on First Amendment grounds!) from carrying out or repeating this threat. Then Judge William Alsup made the injunction permanent and the 9th Circuit Court of Appeals upheld his ruling. Now Bush's lawyers are asking the U.S. Supreme Court to overturn it. Also on July 11, Tod Mikuriya appeared in an Oakland courtroom trying to fend off an attempt by the state Medical Board to suspend or revoke his license. Mikuriya is accused of violating the Board's "standard of care" in 17 cases (although the Board has yet to issue practice standards pertaining to the recommendation and approval of cannabis use). Mikuriya, 70, has devoted a long, successful career to the study - -clinical and scholarly-of cannabis. In 1967 he was the first director of marijuana research for the National Institute of Mental Health. In 1969 he published a case study of a problem drinker who successfully substituted cannabis for alcohol. He has resided and practiced in Berkeley, and consulted at local hospitals, since 1970. In 1972 Mikuriya published a collection of papers on cannabis from the pre-prohibition medical literature, keeping alive the flickering flame of knowledge. When Dennis Peron launched the San Francisco Cannabis Buyers Club in the early 1990s, he told Mikuriya "There are people with diseases I never heard of." Mikuriya signed on as medical consultant and began interviewing club members. He determined that cannabis was being used to treat a wide range of conditions, including post-traumatic arthritis, rheumatoid and osteoarthritis, fibromyalgia, seizure disorders, degenerative diseases of the central and peripheral nervous systems, cerebral palsy, multiple sclerosis, post-viral encephalopathy and neuropathies, post-injury pain, glaucoma, Meniere's disease, migraine, gastritis, ulcers, Crohn's disease, colitis (spastic and ulcerative), cystitis, thyroiditis, scleroderma, lupus, premenstrual syndrome, intractable itching, motion sickness, sinusitis, allergic rhinitis... "Cannabis appears to be a unique immunomodulator analgesic that is useful in the control of automimmune inflammatory diseases throughout the body," Mikuriya generalized in a 1995 interview. Mikuriya played an advisory role to Peron and the co-authors of Prop 215. He was one of the few MDs to endorse Prop 215 in '96 (when the California Medical Association was still opposed) and his quotes added credibility to the campaign literature. The Drug Warriors came to see Mikuriya -correctly- as an indispensable figure in the medical marijuana movement. Almost immediately after 215 passed, Attorney General Dan Lungren, who had led the opposition campaign, told an "emergency all-zones meeting" of California police chiefs, sheriffs, and district attorneys to ignore doctors' letters of approval and to keep arresting and prosecuting citizens for marijuana possession and cultivation. Lungren's objective was to force doctors to testify in open court in support of every cannabis approval (wasting their time, costing them money, exposing them to reprisals from the feds and the state medical board). Lungren's top assistant, John Gordnier, subsequently sent out a memo to the DAs asking to be notified of any cases in which Mikuriya testified for the defense. Lungren flew to Washington in mid-December 1996 to help the feds plan their opposition to California's new law. (A treacherous thing for California's top law enforcer to do.) Lungren met with DEA Administrator Thomas Constantine and top aides to the Drug Czar and the Attorney General. On Dec. 30, 1996, Gen. McCaffrey -flanked by Reno, HEW Secretary Donna Shalala, and Alan Leshner of the National Institute on Drug Abuse-held the nationally televised press conference at which they threatened California doctors. McCaffrey pointed to a large chart headed "Dr. Mikuriya's (Prop 215 Medical Advisor) List of Medical Conditions" that included a misspelling ("migrane") and a crude falsification ("recovered memories"). McCaffrey ridiculed the range of conditions for which Mikuriya recommended cannabis. "This isn't medicine," he declared, "this is a Cheech and Chong show." He bluntly threatened: "a practitioner's action of recommending [marijuana]... will lead to administrative action by the DEA to revoke the practitioner's registration." And it might, yet, despite Judges Smith, Alsup and the 9th Circuit and the former First Amendment. The Case Against Mikuriya The Medical Board of California's case against Mikuriya involves no complaints from patients or caregivers. All the complaints that MBC Investigators pursued came from district attorneys, police, and sheriffs (many of whom had failed to put certain citizens in jail because the citizens had Mikuriya's approval to use and/or cultivate cannabis). According to attorney Bill Simpich, "The Conant ruling, which is still law, and applies to the states, prevents any entity from initiating any investigation solely on the ground that a doctor recommends marijuana to a patient based on a sincere medical judgment. The Medical Board didn't care about Dr. Mikuriya's judgment, they used the knowledge of his recommendations - obtained from the cops and DAs - to start the investigation of 46 patients whose records they subpoenaed." Mikuriya has approved cannabis use by some 7,300 patients since Prop 215 passed.. He says that "99.9 percent" of his patients had been self-medicating successfully with cannabis prior to consulting him. They were treating chronic pain (27%), spasticity (26%), and mental disorders (26%), and using cannabis as a substitute for alcohol and to induce appetite. "It is remarkable how there have been no reports of adverse interactions with any other medications," says Mikuriya. " There is no comparing the safety of cannabis to any other medication available." The MBC accusation against Mikuriya rests on two definitions in the state's Business & Professions Code. "Unprofessional conduct" is defined as "Prescribing, dispensing, or furnishing dangerous drugs... without a good faith prior examination and medical indication..." And "dangerous drug" is defined as "any drug unsafe for self-use, except veterinary drugs that are labeled as such, and includes... any drug that bears the legend: 'Caution: federal law prohibits dispensing without prescription,' 'Rx only,' or words of similar import." Mikuriya's lawyers contend that the Medical Board is making an illegal leap in applying statutes that pertain specifically to prescribing dangerous drugs to Mikuriya's approval of cannabis. They say it's the Board's fault -not Mikuriya's-that requirements for physicians' approving cannabis use have not been specified in the almost seven years since California voters passed the medical marijuana law. Mikuriya's lawyers also cite the "absolute immunity" provided by Prop 215: "Not withstanding any other provision of law, no physician in this state shall be punished, or denied any right or privilege, for having recommended marijuana to a patient for medical purposes." According to Mikuriya, who was nearby at the creation, "The authors of Prop 215 put in this immunity clause precisely because they anticipated what has happened: a witch hunt aimed at doctors by law enforcement officials who resent limits being put on their power to punish." Mikuriya says he's willing to abide by practice standards, and in fact has drafted and proposed to the California Medical Association a set of requirements for physicians who consult with patients about cannabis use. The 7/11 hearing was conducted by Administrative Law Judge Jonathan Lew and attended by some 30 Mikuriya supporters, including three other Bay Area physicians. (It was preceded by an hour-long, behind-closed-doors settlement conference at which Mikuriya was offered probation with conditions he considered unacceptable.) Administrative law judges don't make final rulings, they make "recommended decisions" to the government agencies that employ them, which the agencies can then adopt, reject, or revise. If Lew allows the case against Mikuriya to go forward, he will conduct a hearing on the facts of the 17 disputed cases. That hearing, at which Mikuriya is prepared to defend his approach, file by file, is scheduled to begin on Sept. 3 If Lew decides that the case should be dropped, the Medical Board could pursue it nevertheless by asking a Superior Court judge to order or conduct a hearing on the facts. Add Promising Results for GW Pharmaceuticals Two papers and a poster presented at the recent International Cannabinoid Research Society meeting in Cornwall, Ontario described successful tests of whole-plant cannabis extracts developed by G.W. Pharmaceuticals in the U.K. Steve McKerral of the Royal National Orthopaedic Hospital in Stanmore, Middlesex, reported on a study involving 48 patients (46 men, average age 38.5) who had suffered an extremely painful tearing away of nerves from the spinal cord (brachial-plexus avulsions). Treatments such as opioids, anticonvulsants and antipressants are partially effective at best... Patients in McKerral's study were allowed to keep using their other drugs. They were given three different sublingual sprays over three two-week stretches: a placebo, a high-THC extract, and a THC-CBD mix. Neither they nor the staff conducting the study knew who was getting what. Subjects' pain levels and sleep quality were assessed by questionnaire. "Both the THC and THC:CBD extracts decreased pain and improved sleep," McKerral et al concluded. "The medications were well tolerated.... Patients' ability to self-titrate allowed them to take higher doses to promote sleep, and to avoid dosing if they needed to drive... Given the refractory nature of this central neuropathic pain, this study shows that cannabis based medicinal extracts (CBMEs) may represent a significant advance in treatment." Ciaran Brady of the National Hospital for Neurology and Neurosurgery, Queen Square, London, tested GW's CBMEs on 21 multiple sclerosis patients with lower urinary tract symptoms. He concluded, "The number of incontinence episodes, nocturia episodes [getting up in the night to pee], and daytime urinary frequency all decreased significantly. The incidence of urinary urgency decreased significantly and the number of 'planned or normal' voids increased significantly... This open-label study of self-titrated CBME, in a select group of such patients, demonstrated amelioration of these problems with few troublesome side effects, suggesting that CBME may prove to be a safe and effective additional treatment." Psychologists Richard A. Deyo (Winona State University in Minnesota) and Richard E. Musty (University of Vermont, Burlington) assessed the anti-depressant potential of a GW extract rich in cannabichromene (CBC). They worked with mice whose tails were taped to a bar to induce "behavioral despair." Anti-depressant effect was adduced from the extent to which the mice struggled. And sure enough, mice administered CBC put up high-amplitude resistance. "The present data suggest that CBC may induce anti-depressive effects," the authors concluded. P.S. The radiant Canadian MS patient whose presence at the ICRS meeting moved many members was named Alison Myrden... The new head of NIDA (Trotsky's great-granddaughter!) is Nora Volkow, not Nina... I'd planned a follow-up column on the ICRS meeting, but developments in the Mikuriya case took precedence this week. Here we have an example of how, by attacking our movement, the Drug Warriors win even if they ultimately lose in court. They put us on the defensive, which takes time, energy, money, and resources (column inches that could have gone towards an account of scientific progress). Next week: an interview with Geoffrey Guy of G.W. Pharmaceuticals - --- MAP posted-by: Derek