My Trip to the Pot Shop

PUEBLO WEST, Colo. -- It's 9 a.m. on a weekday, and I'm at the Marisol Therapeutics pot shop. This is serious business. Security is tight. ID checks are frequent. Merchandise is strictly regulated, labeled, wrapped and controlled. The store is clean, bright and safe. The staffers are courteous and professional. Customers of all ages are here.

There's a middle-aged woman at the counter nearby who could be your school librarian. On the opposite end of the dispensary, a slender young soldier in a wheelchair with close-cropped hair, dressed in his fatigues, consults with a clerk. There's a gregarious cowboy and an inquisitive pair of baby boomers looking at edibles. A dude in a hoodie walks in with his backpack.

The dispensary is split in two: "recreational" on one side, "medical" on the other. Medical customers must have state-issued cards and doctor's approval. The inventory is not taxed, so prices are lower on that side. On the recreational side, where I'm peering at mysterious jars of prickly green goods, "Smoke on the Water" is thumping from stereo speakers. Yes, there's a massive banner advertising a Tommy Chong appearance, and issues of "High Times" are on display. But the many imposing signs posted on the wall emphatically warn: No smoking, no open drug consumption, and absolutely no entry allowed into the locked lab where the cannabis plants sit under bright lights.

Before I tell you how and why my hubby and I ended up at Marisol Therapeutics, some background about my longtime support of medical marijuana: More than 15 years ago in Seattle, while working at The Seattle Times, I met an extraordinary man who changed my mind about the issue. Ralph Seeley was a Navy nuclear submarine officer, pilot, cellist and lawyer suffering from chordoma, a rare form of bone cancer that starts in the spine. He had undergone several surgeries, including removal of one lung and partial removal of the other, and was confined to a wheelchair.

Chronically nauseous from chemotherapy and radiation, weak from a suppressed appetite, and suffering excruciating pain, Seeley turned to marijuana cigarettes for relief.

Contrary to cultural stereotype, Seeley was far from "wasted." While smoking the drug to reduce his pain, he finished law school -- something he couldn't have done while on far more powerful "mainstream" narcotics, which left him zonked out and vomiting uncontrollably in his hospital bed after chemo. Seeley had the backing of his orthopedic doctor and University of Washington School of Medicine oncologist Dr. Ernest Conrad. He took his plight to the Washington state supreme court, where he asserted a constitutionally protected liberty interest in having his doctor issue a medical pot prescription.

The court rejected Seeley's case for physician-prescribed marijuana, arguing that the government's interest in preserving an "interlocking trellis" of costly and ineffective War on Drug laws trumped his right to individual autonomy and physician treatment. After a decade-long battle with cancer, Seeley died in 1998. But his spirit persevered. Seeley bravely paved the way for medical marijuana laws in nearly two dozen states, including Washington's Initiative 692, approved by voters 10 months after he died, and Colorado's Amendment 20, passed by popular referendum in 2000.

Support for these ballot measures and similar efforts (like the newly enacted Charlee's Law in Utah legalizing medical cannabis oil) transcends political lines. Why? Because cancer, epilepsy, multiple sclerosis and other chronic and terminal diseases have no partisan affiliations.

This brings us back to Pueblo. For the past three months, my mother-in-law, Carole, whom I love with all my heart, has battled metastatic melanoma. After a harrowing week of hospitalization and radiation, she's at home now. A miraculous new combination of oral cancer drugs seems to have helped enormously with pain and possibly contained the disease's spread. But Carole's loss of appetite and nausea persist.

A month ago, with encouragement from all of her doctors here in Colorado, she applied for a state-issued medical marijuana card. It still hasn't come through. As a clerk at Marisol Therapeutics told us, there's a huge backlog. But thanks to Amendment 64, the marijuana drug legalization act approved by voters in 2012, we were able to legally and safely circumvent the bureaucratic holdup. "A lot of people are in your same situation," the pot shop staffer told us. "We see it all the time, and we're glad we can help."

Our stash included 10 pre-rolled joints, a "vape pen" and two containers of cheddar cheese-flavored marijuana crackers (they were out of brownies). So far, just one cracker a day is yielding health benefits. Carole is eating better than she has in three months. For us, there's no greater joy than sharing the simple pleasure of gathering in the kitchen for a meal, with Grandma Carole at the head of the table.

Do I worry about the negative costs, abuses and cultural consequences of unbridled recreational pot use? Of course I do. But when you get past all the "Rocky Mountain High" jokes and look past all the cable-news caricatures, the legalized marijuana entrepreneurs here in my adopted home state are just like any other entrepreneurs: securing capital, paying taxes, complying with a thicket of regulations, taking risks and providing goods and services that ordinary people want and need. Including our grateful family.

http://www.jaoa.org/content/111/3/166.full

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Cannabinoid hyperemesis syndrome
From Wikipedia, the free encyclopedia
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Cannabinoid hyperemesis syndrome is a disorder that is characterized by recurrent nausea, vomiting and colicky abdominal pain. These symptoms have been reported to be alleviated temporarily by taking a hot shower or bath or more permanently by abstaining from the use of cannabis. The syndrome was described by Allen and colleagues (2004), and Sontineni and colleagues (2009) who offer simplified clinical diagnostic criteria.[1][2] A subsequent, larger study reported a case series of 98 subjects with cannabinoid hyperemesis syndrome, confirming the earlier reported findings.[3]

Contents
[hide]
1 Epidemiology
2 Clinical presentation
3 Pathogenesis
4 References
5 Further reading

Epidemiology[edit]
Cannabinoid hyperemesis was first reported in the Adelaide Hills of South Australia.[1] Since then, several cases have been recognized worldwide.[4] Cannabis is by far the most widely cultivated, trafficked and used illicit drug. In the present decade, cannabis use has grown more rapidly than cocaine and opiate use. The most rapid growth in cannabis use since the 1960s has been in developed countries in North America, Western Europe and Australia. Cannabis has become more closely linked to youth culture and the age of initiation is usually lower than for other drugs.[5]

Clinical presentation[edit]
Cannabis has been used recreationally for millennia. Some chronic negative health effects of the drug have only recently surfaced. The long-term and short-term toxicity of cannabis abuse is associated with pathological and behavioural effects leading to a wide variety of effects on the body systems and physiologic states.[2] The phenomenon of cannabinoid hyperemesis and clinical diagnosis remained obscure until recently even though its features were beginning to be understood by leading physicians worldwide. In spite of these early reports, uncertainty remained among the doctors and scientists regarding the existence of the cannabinoid hyperemesis syndrome.[6] Sontineni and colleagues (2009) discuss the cannabinoid hyperemesis syndrome to offer guidelines for the clinical diagnosis.[2] The “suggested criteria for the diagnosis” are: Essential feature: 1) history of regular cannabis use for years; Major clinical features of syndrome: 2) severe nausea and vomiting, 3) vomiting that recurs in a cyclic pattern over months and 4) resolution of symptoms after stopping cannabis use. In addition diagnosis has supportive features of - 1) compulsive hot baths with symptom relief; 2) colicky abdominal pain; and 3) no evidence of gall bladder or pancreatic inflammation. Since the publication of these clinical guidelines, the syndrome is more easily recognized and treated. A series of 98 cases and review suggested modifications to original set of criteria that are listed below.

Sontineni et al. criteria for the diagnosis of “cannabinoid hyperemesis syndrome”[2]

Essential Cannabis use for years
Major Severe nausea and vomiting
Vomiting that recurs in a cyclic pattern over months

Resolution of symptoms after stopping cannabis use.

Supportive Compulsive hot baths with symptom relief
Colicky abdominal pain

No evidence of gall bladder or pancreatic inflammation

Modified criteria for the diagnosis of “cannabinoid hyperemesis syndrome”[3]

Essential Long-term cannabis use
Major Severe cyclic nausea and vomiting
Resolution with cannabis cessation

Relief of symptoms with hot showers or baths

Abdominal pain, epigastric or periumbilical

Weekly use of marijuana.

Supportive Age less than 50 y
Weight loss of >5 kg

Morning predominance of symptoms

Normal bowel habits

Negative laboratory, radiographic, and endoscopic test results

Pathogenesis[edit]
Various pathogenic mechanistic theories attempting to explain symptoms have been put forward. These theories fall into two themes: 1) dose dependent build up of cannabinoids and related effects of cannabinoid toxicity, and 2) the functionality of cannabinoid receptors in the brain and particularly in the hypothalamus (which regulates body temperature and the digestive system). But the mechanisms by which cannabis causes or controls nausea and the adverse consequences of long-term cannabis toxicity remain unknown and organic disease should not be ruled out as a possible cause.[7]

The neurobiology of the compound has led to the discovery of an endogenous cannabinoid system.[8] The therapeutic potential of cannabinoids has been recognized and these compounds are utilized as anti-emetics. Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS.[5]

References[edit]
^ Jump up to: a b Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). “Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse”. Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264. PMID 15479672.
^ Jump up to: a b c d Sontineni, Siva-P; Chaudhary, S; Sontineni, V; Lanspa, SJ (2009). “Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse”. World Journal of Gastroenterology 15 (10): 1264–6. doi:10.3748/wjg.15.1264. PMC 2658859. PMID 19291829.
^ Jump up to: a b Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). “Cannabinoid Hyperemesis: A Case Series of 98 Patients”. Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024.
Jump up ^ Roche, E; Foster, PN (2005). “Cannabinoid hyperemesis: Not just a problem in Adelaide Hills”. Gut 54 (5): 731. PMC 1774504. PMID 15831930.
^ Jump up to: a b World health Organization, Cannabis - epidemiology.
Jump up ^ Byrne, A; Hallinan, R; Wodak, A (2006). “’Cannabis hyperemesis’ causation questioned”. Gut 55 (1): 132; author reply 132. PMC 1856368. PMID 16344581.
Jump up ^ “NCPIC.Cannabinoid hyperemesis syndrome”. Ncpic.org.au. Retrieved 2012-05-24.
Jump up ^ Davis, Mellar; Maida, Vincent; Daeninck, Paul; Pergolizzi, Joseph (2006). “The emerging role of cannabinoid neuromodulators in symptom management”. Supportive Care in Cancer 15 (1): 63–71. doi:10.1007/s00520-006-0180-0. PMID 17139494.
Further reading[edit]
http://www.ch.missouri.edu/fleisher/ (link redirected)
http://www.ch.missouri.edu/fleisher/2008EmpiricGuidelines2045EJF.pdf (link redirected)
http://www.ch.missouri.edu/fleisher/CVS%20in%20adults%209-6-03.pdf (link redirected)
http://www.biomedcentral.com/content/pdf/1741-7015-3-20.pdf
http://www.ch.missouri.edu/fleisher/Opiates071908_1611.pdf (link redirected)

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