If cannabis contributes to (this) mood elevation, should patients be deprived of it?

Dr Lester Grinspoon is Associate Professor Emeritus of Psychiatry at Harvard Medical School. For 40 years, he acted as Senior Psychiatrist at the Massachusetts Mental Health Center, and supports the use of marijuana for a variety of ailments.

If you want to learn more about treating chronic pain with cannabis, visit this website:

Patients Out Of Time

If you want to learn more about the medical uses of marijuana, here are some sources:

Abrams, D. I., Jay, C. A., Shade, S. B., Vizoso, H., Reda, H., Press, S., et al. (2007). Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology, 68(7), 515-521.

Ellis, R. J., Toperoff, W., Vaida, F., van den Brande, G., Gonzales, J., Gouaux, B., et al. (2008). Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology, 34(3), 672-680.

Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4(1), 245-259.

Russo, E. B., Guy, G. W., & Robson, P. J. (2007). Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex((R)), a Cannabis-Based Medicine. Chem Biodivers, 4(8), 1729-1743.

Wallace, M., Schulteis, G., Atkinson, J. H., Wolfson, T., Lazzaretto, D., Bentley, H., et al. (2007). Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology, 107(5), 785-796.

Additional Research

Karsak, M., Gaffal, E., Date, R., Wang-Eckhardt, L., Rehnelt, J., Petrosino, S., et al. (2007). Attenuation of allergic contact dermatitis through the endocannabinoid system. Science, 316(5830), 1494-1497.

Lynch, M. E., & Clark, A. J. (2003). Cannabis reduces opioid dose in the treatment of chronic non-cancer pain. J Pain Symptom Manage, 25(6), 496-498.

Lynch, M. E., Young, J., & Clark, A. J. (2006). A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations. J Pain Symptom Manage, 32(5), 497-501.

Neff, G. W., O’Brien, C. B., Reddy, K. R., Bergasa, N. V., Regev, A., Molina, E., et al. (2002). Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease. Am J Gastroenterol, 97(8), 2117-2119.

Notcutt, W., Price, M., Miller, R., Newport, S., Phillips, C., Simmonds, S., et al. (2004). Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 “N of 1″ studies. Anaesthesia, 59, 440-452.

Notcutt, W. G., Sharief, M., Mutiboko, I., Hawkes, C., Bolt, J., & Sarantis, N. (2006). Cannabis based medicine (Sativex) for chronic pain due to multiple sclerosis or other neurological dysfunction: a randomised controlled trial. European Journal of Pain, (in press).

Nurmikko, T. J., Serpell, M. G., Hoggart, B., Toomey, P. J., & Morlion, B. J. (2005). A multi-center, double-blind, randomized, placebo-controlled trial of oro-mucosal cannabis-based medicine in the treatment of neuropathic pain characterized by allodynia. Neurology, 64(6, Suppl. 1), A374.

Pertwee, R. G. (2001a). Cannabinoid receptors and pain. Prog Neurobiol, 63(5), 569-611.

Rog, D. J., Nurmiko, T., Friede, T., & Young, C. (2005). Randomized controlled trial of cannabis based medicine in central neuropathic pain due to multiple sclerosis. Neurology, 65(6), 812-819.

Russo, E. B. (2004). Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinol Lett, 25(1-2), 31-39.

Russo, E. B. (2006). The role of cannabis and cannabinoids in pain management. In B. E. Cole & M. Boswell (Eds.), Weiner’s Pain Management: A Practical Guide for Clinicians.(7th ed., pp. 823-844). Boca Raton, FL: CRC Press.

Wilsey, B., Marcotte, T., Tsodikov, A., Millman, J., Bentley, H., Gouaux, B., et al. (2008). A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain. J Pain, 9(6):506-21.

source of information

DCIPA, UHA Need to Follow A Well Known Doctor's Lead!

Yesterday, well know doctor, Sanjay Gupta had the courage to admit he had been duped by the DEA and its war on marijuana.  After listening to the science, the good doctor realized that we have been lied to because the Schedule I designation of marijuana is not based on science.  

Our local doctors need to listen to what Dr. Gupta has to say.  It does not take a brain surgeon to understand the medical benefits of THC.  It is true that not all medical practices need to know the science behind the effective use of this medication, but we should be able to expect our local community doctors to refrain from making uninformed medical opinions and using them to drive local medical practices, like the current situation in Douglas County.

Doctors in our community need to start living up to patient expectations that their medical opinions are based on science and what is in the best interest of each patient, which includes taking into consideration patient choice.  The issue of medical marijuana is a start.  Many of the doctors in our community may have been misguided like Dr. Gupta.  If so, it seems to be good time to follow the TV doctor's lead.


http://www.cbsnews.com/8301-204_162-57597645/sanjay-gupta-backs-medical-marijuana-apologizes-for-previous-views/


http://www.cnn.com/2013/08/09/health/gupta-weed-reaction/index.html

Are FQHC Boards Truly Representative of the Consumer Population?

According to a recent report in the Journal of Health Politics and Law, "Despite the requirement that a majority of board members must be consumers, the results of this study suggest that descriptive representation is lacking on most FQHC governing boards. While nearly two-thirds of board members are consumers, only about one-fourth are representative of typical FQHC patients. What is more, the method used to categorize consumer board members is likely to have overestimated the degree of descriptive representation. It is reasonable to assume that the true proportion of representative consumer board members may be closer to one in five. By contrast, the majority of consumer board members are not representative. While the board members in this group do report being FQHC patients, they also belong to a high-status group that includes physicians, lawyers, and other professionals."*

In order to determine how representative our local FQHC, Umpqua Community Health Center board of directors is, two OPRA folks requested information about who the current UCHC board members are.   Unfortunately UCHC has not been forthcoming, inspite of the fact that federal law requires that they provide certain information, which includes names of the individuals on their board, to  the public.  It makes one wonder if UCHC is one of those FQHC discussed in the report that fails to fulfill the intent of the mandatory requirement of majority representation by their consumers. 

So is the Umpqua Community Health Center (UCHC) board truly representative of the consumers UCHC serves?  Are policies being made that represent these patients' interests?

 

 

 

 

 

 

 

 

 

*Excerpted from: Brad Wright, Who Governs Federally Qualified Health Centers?, 38 Journal of Health Politics, Policy & Law 27 (February, 2013)

Corporatization of Medicine

Sound familiar?

Cooking for Health Class Starts Tomorrow

The Seventh Day Adventist Church in Winston is holding a four week course about healthy eating.  Below was the calendar event posted on KPIC's website.  It does not say if it cost to attend, but if you want to learn to eat healthier, particularly a plant based diet, this religious group has been doing it for years.  Everyone should be able to learn something from their experience.  

 

 

Cooking for Health

Event Details

Date(s) & Time(s):

Weekly on Sunday at 4:00 PM until 6:00 AM from June 30, 2013 until July 28, 2013

Location: 1730 Winston Section Rd, Winston, OR 97496

Event Description

Our health is benefited by the nutrition in the food we eat. Learn about new choices we can make in the way we cook which will improve our lives. With good health, vibrant energy, and clear thought our lives will be desirable to live. Join us for five classes that take a look at topics such as: weight loss, diabetes, high blood pressure, and cancer. There will also be nutritious dishes demonstrated that favor good health. For the recipes shown there will be small samples given. Come and learn how to eat to your health. Starting on Sunday, June 30, at 4:00, they will be held at the Winston Seventh-day Adventist church - fellowship hall.

We the People Deserve CCO Transparency!

Oregon Patients Rights Association was formed late last year in response to concerns about policies being implemented by our new local Coordinated Care Organizations (CCO), Umpqua Health Alliance (UHA).  We quickly learned that although there seems to be a means to ensure local accountability, in practice there really is not.

Umpqua Health Alliance is solely owned by Douglas County Independent Practice Association (DCIPA).  Although there is a “board of directors” made up of people representing various providers under the Oregon Health Plan, as well as a county commissioner and at least one “community member”, according to the Secretary of State (as of today), UHA is owned by DCIPA.  This means that the “board of directors” is really only advisory in nature and does not have the legal authority or right to set policy for the CCO.

In a rush to get a handle on escalating cost for the state’s Medicaid program, the state jumped on the CCO bandwagon.  Unfortunately they failed to ensure CCO operate in the open or with sufficient safeguards for local accountability were in place.  The structure of our local CCO is just one example. 

There are two experiments going on today in Oregon regarding access and delivery to medical services.  One revolves around implementation of health insurance exchanges provided for under the Patients’ Rights and Affordable Care Act (ACA).  The other revolves around the ACA provision to expand Medicaid coverage to those whose household income is 133% or below of the federal poverty line. 

Oregon already has expanded Medicaid coverage, to those not otherwise eligible under federal Medicaid rules, via the experiment known as the Oregon Health Plan.  However those more will be added in 2014 when the ACA expands eligibility to those not currently covered under OHP. 

Although a May 2, 2013 New England Journal of Medicine Special Article, The Oregon Experiment-The Effects of Medicaid on Clinical Outcomes, reveals that the benefits of having Medicaid verses being uninsured in Oregon shows little in the way of overall health care improvements,  the state hopes to change this with implementation of the Coordinated Care Organization model.   The state has high hopes for this new delivery system:  they believe they will provide better care, with better health care outcomes, and save money too. 

The CCO is based upon provisions in the ACA for Accountable Care Organizations (ACO) to serve Medicare fee-for-service beneficiaries, particularly those with chronic health conditions.  Although the CCO is now just a Medicaid program, its set up is such that they can easily become recognized for Medicare as an ACO.   The concept is a good one.

Coordinated care is important for people with chronic health conditions and may be critical for people with multiple chronic conditions.  Coordinating care, making appropriate referrals, and doing follow-up has always been the model for good quality medical care, mental health services, and social services.  Having a way to make sure that happens is welcome. 

What is not welcome is the fact that how this will all happen is being done without the public’s knowledge or input.  Currently there is no means for us to know what policies, procedures, or plans are being made by our local Coordinated Care Organization:  Umpqua Health Alliance (UHA). 

Our group, OPRA came together because of some policies being enacted by several UHA members and although there are ways we are addressing some of our concerns through program appeals etc, we believe that the best way to address the basis of our concerns is through an open and public process for the development of plans, policies, and procedures regarding how coordinate care will take place in our community. This will not only serve our interest, it will serve everyone’s interest. 

This is not just the demand of a few disgruntled, OHP clients, but is based upon proven social psychology models that recognize the rights of the population being served, as well as their ability to help design programs that work to accomplish long term goals.  It is also based upon sound principles of good governance. 

So we have been working to get CCOs, particularly our local CCO, Umpqua Health Alliance (UHA), to operate in the open and be accountable to the public by promoting state legislative efforts that would accomplish this.  Now that the legislative session is almost over and there is little hopes in getting anything passed that will protect our right to know, OPRA will be asking our local CCO to voluntarily comply with Oregon Public Records & Meeting law.  

If UHA needs examples to follow, they can look to other CCO in Oregon who are open and transparent without being told to be.  These include Trillium and CareOregon, both are similar to UHA, where private doctors group owns the CCO, and they are able to operate in the open.  We should demand no less of our local CCO, Umpqua Health Alliance (UHA).  

 

 

 

CITED:  (n engl j med 368;18 nejm.org may 2, 2013)

Umpqua Health Alliance Looking for Community Advisory Council Members

Douglas County’s local Coordinated Care Organization (CCO), Umpqua Health Alliance (UHA) is taking applications through Friday, June 7, 2013 for people interested in serving on its Community Advisory Council (CAC).   The CAC is mandated by state Medicaid law and provides a means for community input into the operation of the CCO.

The CAC is open to anyone, but state law requires that a majority of the board represent Medicaid health care consumers. 

You can get more information and apply online at Umpqua Health Alliance website: 

http://www.umpquahealthalliance.org/recent-news/143-umpqua-health-alliance-uha-is-seeking-applicants

According to Umpqua Health Alliance, the “role of the Council is to provide advice to the UHA Board on various issues” including such things as “identifying preventive care practices, assessing the community’s current health status and needs, improving member engagement and providing recommendations to the transformation plan”, as well as help review our local CCO’s operations during the annual progress report process. 

You can also contact Patti LaFreniere at UHA for more information or assistance:  pattilafreniere@chiwest.com, 541-375-4612.