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OfflineAsclepius
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Registered: 02/17/18
Posts: 4
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Cannabis: not approved by the FDA; not profitable for big pharma
    #831844 - 02/17/18 02:15 PM (2 years, 3 months ago)

The following statement is not, nor is it intended to be, medical advice; this is not a substitute for proper medical care under the guidance of a licensed physician:






    In 2016, more than 42,000 people died from opioid overdoses, a number that has quadrupled over the past two decades (Centers for Disease Control and Prevention [CDC], 2017).  Although there has been an influx of illegal synthetic opioids entering the U.S., particularly in recent years, legal prescriptions account for more than 40% of all opioid related overdose deaths (CDC, 2017).  These data reflect a medical system that allows for the careless dispensing of addictive prescription opioids, one that is lacking in adequate regulation of pharmaceuticals, and an indifference toward safer pain management treatments.



    Chronic pain has always posed a unique challenge to physicians.  They must assess the extent of their patients’ pain, in the absence of any quantifiable methodology, and simultaneously introduce pain management treatments that improve quality of life.  Until the 1990’s, there was not much that could be done to address the symptoms experienced by chronic pain sufferers, absent the use of NSAIDs (non-steroidal anti-inflammatory drugs) which were often reported by users to be ineffective (Morone & Weiner, 2013).  That all changed in 1995 with the introduction of pain as the 5th vital sign, a policy proposed by the American Pain Society, that was adopted by physicians nationwide (Morone & Weiner, 2013). 


    After the adoption of pain as the 5th vital sign policy, which allowed for physicians to liberally prescribe opioids for pain management, Purdue Pharma financed a marketing campaign to promote their newest drug: OxyContin – a drug they falsely claimed to be non-habit forming (Zee, 2009).  The FDA would not rebut Purdue Pharma’s spurious claim of OxyContin’s relative safety until 2002, nearly 6 years after the drug’s initial release on the market (Zee, 2009).  Sadly, the deleterious effects of Purdue Pharma’s prescription opioid push, coupled with the FDA’s prolonged oversight, had already taken its toll: nationwide increases in opioid abuse, spread of communicable diseases, medical costs, and prescription opioid-related overdose deaths (Zee, 2009)



    Ironically, the same year Purdue Pharma released OxyContin on the market, something revolutionary was taking place in the State of California: voters were casting their ballots for Proposition 215 – a policy that would provide California physicians the authority to recommend marijuana to their patients for medical use (Mead, 2011).  The initiative passed on November 5th, 1996 but did not come without its obstacles; there seemed to be an ambiguity concerning specific medical conditions that would qualify for a recommendation of medical marijuana, and, irrespective the preclusions of potential legal ramifications that were afforded to physicians by the proposition, the federal government threatened to convict physicians who recommended use of medical marijuana to their patients (Mead, 2011).



    Notwithstanding the legal hurdles supporters of Proposition 215 were confronted with – physicians, lawmakers, patients seeking medical marijuana treatments, and the like – legislation permitting the use of medical marijuana in the State of California prevailed.  It would also go on to change the nationwide landscape of marijuana research and gradually shape public perception of the potential medical applications of marijuana.



    Since 1996, 28 states and the District of Columbia have legalized medical marijuana (“Does marijuana have medicinal properties?,” n.d.).  More importantly, a sundry of medical trials has been conducted to test the efficacy of marijuana for treatment of pain management, and the results are nothing short of astonishing.  Contrary to antiquated beliefs surrounding marijuana, it has been shown to effectively alleviate pain in chronic sufferers to the same degree as prescription opioids and does not produce any lethal side-effects ((Reiman, Welty, & Solomon, 2017). 



    Regardless of the advantages marijuana has over prescription opioids, with respect to its effectiveness and relative safety, the federal government is “blocking the clinical trials necessary to turn the marijuana plant into an FDA-approved prescription drug” (“Does marijuana have medicinal properties?,” n.d.).  The other limitation of marijuana, regardless of its effectiveness in treating chronic pain, is that it fails to adequately address the existing problem of those already addicted to opioids.  While it has been shown to ease the symptoms of opioid withdrawals (Marijuana a gateway drug?,” n.d.), there appear to be more suitable treatments available – one such treatment of opioid addiction is the administration of ibogaine.



    Ibogaine is derived from West African plant Tabernanthe iboga, is non-addictive, reduces withdrawal symptoms experienced by people addicted to opioids (Mash, 2018), and, because it is a KOR (k-opioid receptor) agonist, contains anti-addictive properties that combat opioid dependency (Maillet, et al., 2015).  Unfortunately, ibogaine is a Schedule 1 drug, and unlike marijuana, it cannot be administered for medical treatments in the United States.  Paradoxically, addictive drugs such as methadone and buprenorphine, both of which have high potentials for abuse if used improperly (Ling, Mooney, & Torrington, 2012), have been cleared by the federal government for use and are covered by many insurance providers’ plans (“Insurance covers cost of Suboxone?,” n.d.).



    It is my opinion that non-traditional treatments (e.g., marijuana and ibogaine) and policy prove efficacious when compared to traditional approaches that facilitated the current opioid epidemic.  The notion that treating opioid addiction with the introduction of more opioids, simply because the FDA provides a seal of approval, is nothing short of a facile examination of the facts – one that ignores the complexities of opioid addiction and oozes unabashed, willful ignorance in the face of data that prove the contrary to be true.



    Since the late 1990’s, access to opioid-containing pharmaceutical drugs have exacerbated the opioid epidemic: increases in opioid abuse, rising medical costs, and opioid-related deaths are indicative of this policy failure.  In addition to physical dependency, opioid addiction places an emotional burden on users’ families because of potential legal consequences associated with the misuse of the highly addictive substances.  Incarceration for opioid-related use serves to separate the family unit, increases costs to the tax payers, and all the while enriches the pharmaceutical companies. 



    Furthermore, I believe current U.S. policy should expand the use of medical marijuana for treating chronic pain disorders, to all 50 states, as it is proven to be as effective in treating pain as prescription opioids; moreover, it is nowhere near as habit forming and is non-lethal.  In summation, the barrier is the FDA places its trust in pharmaceutical companies whose focus appears to be profits.  Hence laws are favorable towards corporations instead of the well-being of chronic pain sufferers and individuals already combating opioid addiction.





Warning: Although ibogaine is effective in treating opioid addiction, I do not want to give off the false impression that this substance is entirely harmless.  Ibogaine can prove fatal if it is not dosed properly.  If you are considering the use of ibogaine, and live in a country where it is legal, I highly suggest you first consult a physician prior to consuming it.  If you live in a country where its legality is questionable, approach this substance with extreme caution.  Make sure you perform adequate research, have a friend monitor you on the day you decide to consume it (in the event they must call emergency services), and consume less than what the peer-reviewed, scientific literature indicates is a low-to-moderately low dose.  This is a powerful drug, and like with anything else, it must be given the proper respect.  If you do not suffer from opioid addiction, I suggest that you not even consider consuming this substance.   
   







References



Centers for Disease Control and Prevention. (2017). Drug overdose deaths in the United States, 1999–2016. Retrieved from: https://www.cdc.gov/drugoverdose/data/statedeaths.html.


Does Medicaid or Insurance Cover the Cost of Suboxone? (n.d.). Retrieved January 25, 2018, from https://americanaddictioncenters.org/insurance-coverage/suboxone/.


Is it true that marijuana has medicinal properties? (n.d.). Retrieved January 23, 2018, from http://www.drugpolicy.org/it-true-marijuana-has-medicinal-properties.


Is marijuana a gateway drug? (n.d.). Retrieved January 24, 2018, from http://www.drugpolicy.org/marijuana-gateway-drug.


Ling, W., Mooney, L., & Torrington, M. (2012). Buprenorphine for opioid addiction. Pain Management, 2(4), 345–350. http://doi.org/10.2217/pmt.12.26.


Maillet, E. L., Milon, N., Heghinian, M. D., Fishback, J., Schürer, S. C., Garamszegi, N., & Mash, D. C. (2015). Noribogaine is a G-protein biased κ-opioid receptor agonist. Neuropharmacology, 99, 675-688. doi:10.1016/j.neuropharm.2015.08.032.


Mash, D. (2018) Breaking the cycle of opioid use disorder with Ibogaine. The American Journal of Drug and Alcohol Abuse 44:1, pages 1-3.


Mead, A. (1998) Proposition 215: A Dilemma, Journal of Psychoactive Drugs, 30:2, 149-153.  https://doi.org/10.1080/02791072.1998.10399684.


Morone, N. E., & Weiner, D. K. (2013). PAIN AS THE 5TH VITAL SIGN: EXPOSING THE VITAL NEED FOR PAIN EDUCATION. Clinical Therapeutics, 35(11), 1728–1732. http://doi.org/10.1016/j.clinthera.2013.10.001.


Reiman, A., Welty, M., & Solomon, P. (2017). Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Cannabis and Cannabinoid Research, 2(1), 160–166. http://doi.org/10.1089/can.2017.0012.


Van Zee, A. (2009). The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy. American Journal of Public Health, 99(2), 221–227. http://doi.org.libproxy1.usc.edu/10.2105/AJPH.2007.131714


--------------------
"Cogito ergo sum"


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