By Robert C. Goethe, MD
Several months ago, I was scheduled to do anesthesia for a young man having a spinal cord stimulator placed in his spine. He was around 40 years old. What started his problem was back pain. He had been through chiropractic care, epidural steroid injections and multiple medications including Percocet, gabapentin and an antidepressant, as well as Xanax, for sleep. None of these things really helped and he was miserable.
This guy’s history of being over-operated and over-medicated isn’t uncommon. Other similar scenarios may involve ineffective over-tretment
of fibromyalgia, PTSD, Crohn’s disease – maladies that can be stubborn to treat. And then these patients end up getting multiple procedures and medications which don’t really help and may actually make things worse or have debilitating side effects.
So, before we went back into the operating room, I asked this young guy “Have you ever considered medical marijuana?” He looked at me and exclaimed, “No, I don’t do drugs!”
I looked again at his chart filled with a history of failed surgeries and a huge list of medications that essentially rendered him a zombie and just thought, “OK, we will go back to the operating room and put an electrical wire down your spine with a generator implant. Good luck with that.”
Why is it that has some people are so closed minded about cannabis? Well, here is some history about that.
Cannabis has been used as a medicine going back as far as we can get historical records. The Egyptians used it, Chinese medicine had it as well as the Middle East. George Washington and Thomas Jefferson grew it as a medicine. It was the most common ingredient in elixirs (along with cocaine and morphine) right up until the 1930s. References to its usefulness in Parkinson’s, GI problems and pain control are numerous in early American medical literature.
Something happened in the 1930s in America that rather suddenly turned public opinion against cannabis. There was a strong anti-Mexican immigrant movement at the time as well as a backlash against the inIluence of black jazz musicians. Both these groups were known to use cannabis (renamed marijuana in order to imply the Mexican nature of the weed).
There was also some financial interest in outlawing not just cannabis, the medical plant, but also hemp, which is the same plant as cannabis but is a subspecies that has very low THC. Hemp was a very valuable plant grown for its fibers and could compete very effectively against trees for paper, which William Randolph Hearst wasn’t fond of, because of his pulp tree farms. And the DuPont company was just coming out with nylon and would be happy to see competition from the hemp industry gone. Anyway, they captured the ear of Harry Anslinger, the very first commissioner the Federal Bureau of Narcotics. Just as the prohibition of alcohol was ending, Anslinger found he had a whole department of agents with not a lot of work. Busting heroin and cocaine addicts, was at that time, a small percentage of the population. Most of the public didn’t know much about cannabis either, except that it was popular with Mexican immigrants and black jazz musicians. In fact, in 1936 a movie “Reefer Madness” was produced as a low budget film by a church group to show the decadence and dangers of using marijuana, complete with murder, rape and insanity. Although people in the 1930s just watched it and accepted it at the time, this movie is now considered amongst the worst movies ever made. It became popular again in the 1960s and 70s as a satire. People familiar with cannabis know it actually has a tendency to render people peaceful and happy, not violent and crazy.
Maybe Harry Anslinger did in fact believe the misinformation being fed to him or maybe he just was playing politics, but he convinced congress to outlaw cannabis, in the Marijuana Tax Act of 1937, and just like that, it was illegal.
The American Medical Association had lobbied very hard not to lose cannabis as a medicine but when they did, they still had opium, cocaine and hypodermic needles were just coming into vogue.
I personally saw how in the 60s and 70s, smoking marijuana became a big thing. Sort of a hippy, anti-establishment movement, and it again became contentious. So, in 1972, under the Nixon Administration, marijuana was classified as a Schedule 1 drug. Which meant, according the Drug Enforcement Agency at the time, marijuana just as bad as heroin, LSD, ecstasy and quaaludes. At this time, a lot of Americans had or were using it and knew that this was a misclassification but were powerless to do anything.
People continued to use it even though it was illegal because they knew it was safer than alcohol and pretty much any other drugs. Many people also used it medically.
One problem with this misclassification was that people using marijuana became exposed to the “War on Drugs” which costs $50 Billion dollars a year. This has resulted in a lot of people in prison for victimless crimes. The USA has, by far, the largest percentage of its population locked up than any other major country. According to the ACLU, 52% of drug arrests involve marijuana.
Well, some other parts of the world didn’t throw cannabis out. Israel, in particular, did some scientific research on it in the 1990s and discovered the Endocannabinoid system, and the reasons some of the compounds in the plant give cannabis it’s remarkable benefits. They have used medical cannabis for years, so has Canada, Australia, Germany, Italy, Mexico, Spain, and a quickly growing list of other countries.
Meanwhile, in the US, amongst the people using it illegally, it became apparent that not only was it a safe drug but actually had some noteworthy medicinal properties. Like stopping seizures, reducing pain, GI problems, severe anxiety, and other things. Recognizing this, California became the first medical marijuana state in 1996 and has had some really good results. So much so, that they just recently voted to allow recreational use for adults. Just like alcohol, the second prohibition is crumbling.
Anyway, now 30 out of the 50 states have medical marijuana available. Even though the federal government still considers it illegal and refuses to change the status as a Schedule 1 drug, they are hands off when it comes to states allowing people access to medical cannabis. We have the unusual situation where the Federal Government doesn’t want to recognize the writing on the wall, they are wise enough to know that most people now see cannabis as a wrongly demonized plant.
If the federal government were to try to defend their stubborn position, they would be seen to be maybe a little hypocritical. In 1986 the FDA allowed a pharmaceutical company to market Marinol, a pure THC product prescribed for nausea in certain conditions like cancer and AIDS. It’s still around, but patients don’t like it, because it makes them feel high and it costs about $700 for a month’s supply. Then in 2003 our own federal government obtained the patent (#6630507) for the second most common ingredient from marijuana, CBD. CBD has a lot of valuable properties but it’s most well known as the stuff that controls seizures. Like the Charlotte’ Web strain.
In June of this year the FDA approved a drug called Epidiolex, which is that CBD I mentioned, but in a pharmaceutical grade drug. Although, I don’t think prices have been announced, but the estimates are it will cost $2,500 to $5,000 a month. But that’s what insurance is for, right? *sigh*
That same medicine, minus the huge pharmaceutical markup, could easily be obtained from extracts from a cannabis plant for a small fraction of that price. If only they would remove the legal brouhaha that encompasses this plant, people could save a lot of money.
So, in this country and the world it seems, medical cannabis has seen a resurgence in popularity primarily because it works and to a large degree avoids the strange world of medical economics, where medical treatment can get really expensive.
I encourage patients, if they want to explore an option for your health condition as over 100,000 Floridians have done, learn more about medical cannabis and be open minded that it might work for you.
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If you’re interested, please call 352-601-4200 or email DrBobGoethe@gmail.com – Check out our website: www.compassionclinicflorida.com
Dr. Bob Goethe is a board certified anesthesiologist, with over 40 years of medical experience who is now semi-retired in Citrus County and chooses to support the medical marijuana initiative because he has seen it’s benefits in patients and strongly believes in the cause.