Policies and Position Statements
This paper describes our clinic policies with regard to the use of the drug tetrahydrocannabinol, otherwise known as marijuana, medical cannabis. In summary, the use of THC is not permitted. With physician approval, the use of CBD (cannabidiol)
and/or the over the counter supplement PEA (palmitoylethanolamide) are permitted.
What is THC?
THC stands for tetrahydrocannabinol, the active ingredient in marijuana. It is psychoactive, meaning that it causes alteration in state of consciousness. There is ample evidence from good quality studies in the medical research literature, that use of THC is detrimental to the health of the brain, with damage to memory, motivation, cognitive function and interpersonal relationships.
What is CBD?
CBD stands for cannabidiol, a molecule found in hemp; hemp does not contain THC, is legal in all states, and is a reasonable source of CBD, which has many potential medicinal benefits. There is a considerable volume of research showing benefit fromCBD in the following areas:
- Reduction of inflammation by binding to the CB2 receptors
- Reduction of anxiety symptoms
What is cannabis?
Cannabis is the name of a plant family. Plants in the cannabis family that contain over 99.7% CBD are called hemp. Plants in the cannabis family that have more than .3% THC are classified as marijuana.
What is medical marijuana?
Medical marijuana is the term applied to strains of the cannabis plant that contain more than .3% THC, and also contain some amount of CBD. lts medical properties stem from the CBD. We see no reason to utilize these products in that good quality preparations of hemp with CBD are available at a reasonable cost.
Clinic procedures for urine screens (LCMS) positive for THC
The policy is reviewed on admission to clinic. If the urine does not become normal afteradmission, or if the urine LCMS is positive for THC, our procedure is to give this statement again with the expectation that the THC levels in the LCMS sample will reach zero within a month and will be continually declining. A physician appointment will be scheduled to discuss alternatives that are acceptable. This could include:
- Non drug modalities to manage anxiety such as CES (cranial electrical stimulation therapy), yoga, mindfulness meditation, reiki massage, referral for psychotherapye etc.)
- Non prescription modalities to support the brain GABA system
- Prescription modalities as indicated such as hormone replacement therapy if appropriate.
Position Statement and Clinic Policy with regard to Kratom and its Use
Kratom refers to a plant from Southeast Asia that has a number of molecules that have effects in the human body. Specifically, it contains mitragynine which can mimic opiate effects in a manner like that of the natural human molecules endorphin, engagement of the human mu opioid receptor giving block of withdrawal, some pain relief, and occasionally euphoria.
However, its effects are unpredictable, and it can have untoward (bad) consequences, including fatalities.(deaths). The quality and purity of the over the counter products vary greatly, and are not reliable. For both of these reasons, its use is strongly discouraged by SAMHSA, the Substance Abuse and Mental Health Services Administration in a recent policy statement emailed to US physicians. The US Food and Drug Administration does not endorse it as safe or effective for treating any condition (Feb 2018). Its use is prohibited in the addiction treatment program, and in the management of chronic pain which includes any prescription medications. Patients who seek only general medical care in the direct primary care program are discouraged from using kratom, for the simple reasons listed above. It is still legal, and it is a free country, therefore if these patients choose to use kratom, we will simply make available to them the most current scientific information, as we do for the use of marijuana/THC, alcohol and tobacco (other substances that are legal but damaging to the human body).
The formal name for the kratom plant is Mitragyna speciosa. It is in the coffee family. The nature of the active molecules in kratom give both opioid like and stimulant like effects.
IT CAN CAUSE WITHDRAWAL SYMPTOMS.
Side effects become more common at the doses causing opioid type effects: problematic for patients is the increase in heart rate. The deaths reported involving kratom mainly were with a mixture of kratom and other opiates. At high doses, or when combined with other substances, liver toxicity can occur. Seizures and coma have occurred, particularly when kratom is combined with alcohol.
Kratom is currently legal and over the counter in Oregon. This does not imply safety. I consider its use a concern and a risk to health; there are far safer ways to obtain any beneficial effects. Its use is not acceptable in the addiction treatment program or in pain care. If it or its metabolite are detected in urine drug screening, we will notify the patient of the abnormal drug screen results by letter, and schedule an appointment with a drug and alcohol counselor. If the substance does not clear from the urine, they will again be referred to the CADC to intensify their level of treatment (i.e., Phase I of the addiction treatment program, chronic pain education).