Why Cannabis Is Not A Schedule 1 Drug MD 420 May 1, 2019 Medical DEPENDENCE Almost fifty years ago, US President Richard Nixon declared drug abuse as public enemy number one starting an unprecedented global campaign for the War on Drugs with the Controlled Substance Act (CSA). In 1972, the federal government passed the CSA establishing five different drug schedules based on three categories; Dependence (addiction), Abuse (danger) and Medical Use. As schedules change, so does the potential of dependency and abuse. SCHEDULE 1 DRUGS are the highest category of prohibited drugs and have the highest potential for dependence and abuse with no accepted medical use. These would include heroin, psychedelics (mushrooms, ecstasy and LSD), and cannabis. SCHEDULE 2 DRUGS still have high dependency and high abuse potential, and are still considered dangerous, but have documented medical use. Crystal meth and cocaine are Schedule 2 along with opiods. Did you know there were medical uses for cocaine and meth? Yeah, me neither. SCHEDULES 3 THROUGH 5 DRUGS show lower potential of dependency and abuse as the drugs drop each category. Now that we have defined the DEA “Drug Schedules” to you, let us apply updated cannabis information to each of the three categories. SCHEDULE 1 CLAIM: HIGH DEPENDENCE (ADDICTION) POTENTIAL In 1994, the National Institute on Drug Abuse and the University of California at San Francisco ranked six substances based on five problem areas. They found that full spectrum cannabis (with THC) actually had the lowest ranking of dependence than any other drug as well as the lowest withdrawal and tolerance score. The cannabis score for Reinforcement explains why cannabis is great for handling stress and depression, and its Intoxication score is half that of alcohol. Here are the details of the scoring and its results. DEPENDENCE: How difficult it is for the user to quit, the relapse rate, the percentage of people who eventually become dependent, the rating users give their own need for the substance and the degree to which the substance will be used in the face of evidence that it causes harm. WITHDRAWAL: Presence and severity of characteristic withdrawal symptoms. TOLERANCE: How much of the substance is needed to satisfy increasing cravings for it, and the level of stable need that is eventually reached. REINFORCEMENT: A measure of the substance’s ability, in human and animal tests, to get users to take it again and again, and in preference to other substances. INTOXICATION: Though not usually counted as a measure of addiction in itself, the level of intoxication is associated with addiction and increases the personal and social damage a substance may do. ADDICTION POTENTIAL COMPARISON BETWEEN COMMON PRODUCTS A 1994 study called “The Comparative Epidemiology of Drugs”, cited by the National Institute on Drug Abuse, tells us that about a third (31.9%) of the people who try tobacco become dependent on it, another confirmation that nicotine is the most addictive product on the market. Almost a quarter (23.1%) of the people who try heroin, an addictive opioid drug, become dependent. According to the National Survey on Drug Use and Health, patients that are addicted to opioids are 40 times more likely to become addicted to heroin than any other “gateway” drug. In comparison, cannabis users are only 3 times more likely to become heroin addicts. This shows that the largest gateway drug on the planet are prescription pain medications. In fact, in New York and Illinois, cannabis is now considered “the exit drug” for opioid addiction and is listed as a Qualifying Condition for medical cannabis in those states. Cannabis has the potential to significantly improve public health by diminishing patient reliance on opioids. • Cocaine caused dependence for about one- sixth (16.7%) of the people who tried it. • Alcohol scored in at 15.4% user dependence rate, just under cocaine. • Sugar caused a 12% dependence, but high fructose corn syrup is a potent concentrated sugar that can be as addictive as heroine (23%) and have the same withdrawal symptoms. • Stimulants, like meth, came in at about one- in-nine (11.2%) Marijuana was down at the bottom with caffeine, with only about 9.1% becoming dependent on the herb. Less than 1 out of 10 people show psychological dependence to cannabis. RESULT: CANNABIS PROVEN TO HAVE THE LEAST AMOUNT OF DEPENDENCE. Research like this is difficult to refuse. Many other recreational and medical drugs show a much higher dependence score than cannabis. According to this information and to the current Schedule descriptions, full-spectrum cannabis (full cannabinoid profile with THC) should be a Schedule-4 drug. As of April 5th, Texas removed CBD from the Schedule all together because there is no risk of dependence, no risk of abuse, and no way anyone can die from it. Highly addictive products like cigarettes and alcohol are available anywhere with no restrictions. Highly addictive high fructose corn syrup is available in children’s drinks causing childhood obesity and early on-set diabetes in children. None of these products show any medical use. Technically, these products should be a Schedule-1. Not Cannabis. The Exit Drug (YouTube) is a great medical based documentary, explores the course of opioid addiction, from initial usage (typically after an injury) to drug relapse, and how cannabis could be the solution to reduce addiction and harm, and promote advanced help for patients suffering from various forms of addiction. DANGER & ABUSE We have explained that cannabis is less addictive than a double grande, non-fat extra hot caramel macchiato (caffeine plus sugar). Now let’s focus on the perceived “danger” of cannabis and prove can- nabis is also the least dangerous of all recreational drugs. Contrary to what Lt Gov Dan Patrick continues to preach, the fastest growing group of cannabis users are not under 18, they are OVER 50! As attitudes towards cannabis become more mainstream, adults that reach retirement are no longer concerned about drug tests as much as they are about their health. Seniors are more open minded to using cannabis to supplement or replace expensive Medicare part D prescriptions, which follows a national trend showing a major drop in overall prescriptions in legal cannabis states. A 2016 study found that in states with access to medical marijuana, those using Medicare part D – a benefit primarily for seniors – received fewer prescriptions for other drugs to treat depression, anxiety, pain, and other chronic issues. As far as opioid use, a study published last year in in the Journal of the American Medical Association found opioid prescriptions for Medicare part D recipients dropped 14% after a state legalized medical marijuana – a hopeful sign amid the opioids crisis. We should fully expect that number to continue to drop as cannabis becomes more popular and available. The key takeaway here is that when the number of prescriptions start dropping (figure 1), so do the death rates. In a world where prescriptions kill more patients than car accidents (figure 2), that is a welcome change. Figure 1. Figure 2. SCHEDULE-1 STATUS: HIGH ABUSE (DANGER) POTENTIAL We will define “abuse” as overdose potential or “death” risk. According to comparative risk assessment research by UCLA, Harvard and Temple Universities, cannabis is the least risky recreational drug on the planet. Using a novel method to measure the risk of mortality associated with the use of various legal and illegal drugs, scientists have confirmed what earlier studies have indicated: alcohol is the deadliest, while marijuana is the least risky. (Figure 3) Figure 3. According to the study, at the individual level, booze presents the highest risk of death, followed by nicotine, cocaine and heroin, suggesting the risks of alcohol consumption have likely been underestimated in the past. This also complies with previous research which has consistently ranked cannabis as the safest of all recreational drugs. According to the results, cannabis is around 114 times less deadly than alcohol and was the only drug out of those examined to pose a low risk of death – which is directly opposite of Schedule-1! #1. TOBACCO: According to the “Annual Average Death Rankings” chart, tobacco kills almost 1/2 million Americans per year and tops the chart as the most deadliest and most addictive drug in the US. Also, National Institute of Drug Abuse research shows Tobacco to be the most costly ($300 billion total cost) related to crime, lost work productivity and healthcare. #2. ALCOHOL: Alcohol kills over 150,000 Americans per year (not including alcohol related car accidents, violence or abuse) making it the second most deadly drug, and costs $249 billion per year. #3. OPIOIDS: According to 2017 statistics by the National Institute on Drug Abuse, national drug overdose deaths reached another record high with more than 70,200 Americans dying in 2017, including illicit drugs and prescription opioids—a 2-fold increase in a decade. The number of deaths involving any opioid for all ages and all genders totaled 47,600, leaving the balance of over 22,600 deaths related to illicit drugs. #4. SUGARY DRINKS: As we learned in the dependency scale, sugar has a 12% addiction rate, then almost doubles to 23% if the sugar is high fructose corn syrup. According to research, sugary drinks cause 184,000 deaths worldwide annually and 25,000 deaths in the US each year. These deaths come from diabetes, heart disease and cancer that scientists say can be directly attributed to the consumption of sweetened sodas, fruit drinks, sports/energy drinks and iced teas. #5. ILLICIT DRUGS: Refer to #3 – Illicit drug related deaths (22,600) are almost half of the prescription drug related deaths (47,600). It is important to note that the increase of heroin related deaths are linked directly to patients who were addicted to opioids and cut off from physicians’ orders. The addiction still remained. #6. NSAIDS: Non-steroidal anti-inflammatory drugs are assumed to be well tolerated and are widely used as an initial therapy for common inflammation, but have increased like opioids to manage pain – in epidemic proportions. Everyone is familiar with these types of drugs with millions using them for pain relief. They range from over the counter aspirin and ibuprofen to a whole host of prescription brands. These pharmaceutical agents constitute one of the most widely used class of drugs, with more than 70 million prescriptions and more than 30 billion over-the counter tablets sold annually in the United States alone. These drugs cause over 100,000 hospitalizations per year and kill over 20,000 Americans per year from side effects like GI bleeding and liver and/or kidney failure. #7- #9 I just thought I would poke some unfortunate fun at very rare things that can kill more Americans than cannabis like lightning strikes (49), bee strings (40) and shark attacks (6). In fact, there is a higher chance from dying from a falling TV (41) than smoking cannabis. #10. CANNABIS: Everything else in the US seems to kill more Americans than pot! No one has ever died from a marijuana overdose. In fact, studies suggest it is impossible to die from smoking too much marijuana. But indirect deaths are possible — and documented. Of course, what some people mean when they say “overdose” is simply taking too much of a drug. When using this definition, it’s certainly possible to overdose on marijuana, which can lead to unpleasant symptoms like anxiety, dizziness, and vomiting, but never fatal. Result: Cannabis has the least amount of Abuse or Danger. It is important to recognize that Science is not a static endeavor, thus our understanding of the world must be constantly reassessed as to what is scientifically backed. Drugs like opioid pain killers that were once regarded as benign and very common many years ago are now known to be dangerous and highly addictive. Drugs that were once regarded as dangerous, like cannabis, might, in fact, be safer and more effective medicine. It’s time for Texas to reassess its own path based on facts not fiction. In light of what we just reviewed, maybe we should stop fighting marijuana legalization and focus on prohibiting alcohol and tobacco as the Schedule-1 list instead? Yeah, good luck with that! MEDICAL USE The U.S. Drug Enforcement Administration (DEA) is still sticking to the outdated 1970 law and its long-held belief that “marijuana is not medicine.” Despite the fact that medical marijuana has been approved as medicine for certain qualifying medical conditions in 33 states — and the District of Columbia, we now wait for Texas to figure out what side of the coin are they going to land on. As we have discussed in detail with “Part 1: Dependence”, and “Part 2: Danger & Abuse”, we have a better understanding as to why cannabis should not be a Schedule-1 drug. We have shown you that cannabis is much less addictive and far less dangerous than cigarettes, opioids, alcohol and sugar, and even safer than a random lightning strike or falling TV. This leads us to the third and final part of the hypocritical Schedule-1 status – No Medical Use. DEA acting Administrator Chuck Rosenberg said the agency had concluded that marijuana still has a high potential for abuse, has no accepted medical use, and is not safe even under medical supervision. You have learned by now these statements are false. What I am about to show you is how completely out of touch the DEA is with the Justice Department, current research, the medical profession, patients and the general public. THE DEA-FDA MARRY-GO-ROUND Before the DEA will even consider changing the drug schedule on cannabis to a lesser status, it wants proof from the FDA that cannabis is safe and effective. However, the FDA needs the DEA to release it from Schedule-1 to analyze research because nobody is allowed to do research on a Schedule-1 drug. This is the ultimate “chicken and the egg” scenario. You can’t get data because it’s a Schedule-1, and it’s a Schedule-1 because you can’t get enough data. Neither agency will budge until the other does something first – so the Federal approval of cannabis hangs in eternal purgatory until one of the agencies actually does something on its own. However, now that many states have fully legalized cannabis, we are finding clinical research being done in medical schools all over the country – other than Texas. This is proven by all of the PubMed articles regarding THC, CBD, cannabinoids, terpenes and a host of qualifying conditions cannabis is being proven to heal in many states – other than Texas. In 2015, when Chuck Rosenberg was the acting DEA chief under the Obama administration, Rosenberg called medical marijuana “a joke” during a Q&A session with reporters. “What really bothers me is the notion that marijuana is also medicinal—because it’s not,” Rosenberg said at the time. “We can have an intellectually honest debate about whether we should legalize something that is bad [addictive] and dangerous, but don’t call it medicine—that is a joke.” He continued, “There are pieces of marijuana— extracts or constituents or component parts—that have great promise [medicinally.] But if you talk about smoking the leaf of marijuana—which is what people are talking about when they talk about medicinal marijuana—it has never been shown to be safe or effective as a medicine.” Really, Chuck? First of all, the director of the DEA has the same nonchalant dismissal of “cannabis is medicine” as a certain Lt Governor in a big state that puts a Star on everything. I wonder if their attitudes toward cannabis would change if they, or a loved one, suffered from chronic pain or cancer and their only option is deadly and addictive pharmaceutical drugs? Second, I hate to be the guy that points out the obvious Chuck, but nobody smokes the leaf, they smoke the flower – showing the lack of knowledge Rosenberg possesses about cannabis in general. Imagine the millions of patients, inmates, addicts, families and friends that are paying the price for such dismissive attitudes by government officials pushing their own personal anti-cannabis agenda instead of what is best for their state or their country. I am hoping the leadership at the Texas Capital will be more respectful about the truths about cannabis as a real medical alternative that is worthy of controlled clinical research from medical schools across Texas. However, there is one silver lining – the “extract” Rosenberg mentioned is referring to CBD and has substantial medical application – just ask the Department of Health & Human Services. The HHS owns a 2003 patent on CBD titled “Cannabinoids as antioxidants and neuroprotectants” (filed in 1999). Could the U.S. government be exhibiting hypocrisy by owning a cannabis-related medical use patent for 20 years while denying marijuana’s medical use? Chuck, can you please explain this one to me? Good News: As of April 5th, The Texas Department of State Health Services removed hemp from Schedule I drugs bringing it in line with federal law, but possibly feeding confusion about the legality of some hemp- based products like CBD. Good job guys, I think? OK – let the timeline continue… In 2015, the Center for Disease Control realized there was a link between the increase of heroin overdose deaths from patients who got their start from using opioid prescriptions as the “gateway” to their addiction. In 2016, the CDC then came out with a set of guidelines to curb the opioid epidemic from getting out of control. One of the suggestions was to switch to “non-opioid based drugs for most cases of chronic pain”. The door was officially opened to look at alternative options like cannabis. 2017, The National Academies of Sciences Engineering Medicine looked at 10,000 scientific abstracts to reach its nearly 100 conclusions regarding the medicinal use of cannabis – one being the therapeutic effects to treat pain. The committee found evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms. RESULT: CANNABIS HAS PROVEN AND DOCUMENTED MEDICAL USE In recent years, scientific research has determined that cannabis has a wide range of medicinal benefits for conditions as diverse as cancer, traumatic brain injuries, and epilepsy. Much of this research is coming from outside the US as a result of its classification in the states or from medical schools in states who are already “green.” Until the US changes this classification, the world’s largest economy is unable to mobilize its resources to further develop and maximize a life-saving industry. Until Texas changes its perspective, it will continue to follow what other states do instead of lead the charge. Have you ever met a Texan who is satisfied with being in second place? Yeah, me neither. BOTTOM LINE: CANNABIS SHOULD NOT BE A SCHEDULE 1 DRUG It is time to be smart and stop being ridiculous. Medical cannabis is the safest, least habit forming, and most effective medication to come along in decades. It was the number one drug recommended by doctors for centuries – until the 1930s when cannabis prohibition started. We have already proven that recreational cannabis is less toxic and less addictive than cigarettes, alcohol and sugar, but let me put it in a different light. Let’s focus on cigarettes only… 1. Cigarettes are the most addictive product on the market because of nicotine, 2. Kills almost 500,000 Americans each year (is the number one cause for all cancer), 3. Has zero medicinal use. 4. By the DEAs own definition, Cigarettes are defined under Schedule-1 status… 5. Cigarettes are availab le at any convenient store or gas station. Option 1: If it is the goal of Texas to offer patients a safer and more effective alternative to prescription medications, then cannabis is an obvious choice. CBD should be treated like an over the counter version while THC (intoxication compound) should be treated with a behind the counter prescription from cannabis certified doctors (State Certificate course with CMEs) as a concentrate (not as flower) so dosing can be standardized. Option 2: If it is the goal of Texas to continue to restrict cannabis by holding fast to old conservative “values” – despite all of the evidence showing the opposite being true – then we deserve another two years of misery because we refuse to do what is right. You can’t fix stupid, but you can certainly vote it out. HOW DOES CANNABIS WORK ON PAIN? The simple medical explanation is that both cannabinoid and opioid receptors reside in the cortex of the brain, which makes them both effective in regulating pain. The difference is cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration (breathing), which is why lethal overdoses from Cannabis (cannabinoids) do not occur. With opioids, the human body builds a tolerance which requires more and more opioids to be effective. Eventually, opioids deactivate the brainstem and your main body functions stop functioning – and you die. Opioids are a Schedule-2 drug. The Endocannabinoids System is a relatively new system discovered in the late 1990s. In a nutshell, the ECS regulates homoeostasis in the body. The ECS is responsible for “turning on” and “turning off” systems to keep balance. When endo-cannabinoids (lipid based compounds our bodies make internally) become deficient, our body starts to “short circuit” and body functions stop working properly. Neurological cells have cannabinoid-1 receptors (CB1 receptors bind with THC) and autoimmune cells have cannabinoid-2 (CB2 receptors that works with CBD). This shortage of Endocannabinoids causes inflammation which is basically the root cause of just about every physical problem you can imagine – chronic pain, heart disease, cancer, diabetes, neurological disorders (Alzheimer’s, ALS, MS, Epilepsy, PTSD, Depression, Anxiety) and other unexplained inflammation like migraines, fibromyalgia, irritable bowel syndrome and other treatment resistant conditions. The chronic condition of not having enough endocannabinoid compounds to keep your body running efficiently is called Endocannabinoid Deficiency. Phytocannabinoids (plant based cannabinoids like THC and CBD) from cannabis basically fills in the gaps and picks up the slack that our bodies cannot produce on their own. This is why people get better when they use cannabis for many chronic conditions, replacing multiple medications, reducing cost of overall care and start feeling better.