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Greetings and thanks a moment of your time!

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As medical director of the North Carolina Cannabis Patients Network (NCCPN) and as a physician certified in cannabinoid medicine by the American Academy of Cannabinoid Medicine (AACM) who has practiced cannabinoid medicine part time in the state of Hawaii for over 4 years, I have a unique perspective on Carolina's need to make medical cannabis a legal option.

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First of all, let's be honest. Cannabis is a safe medicine. Relatively and factually speaking, sugar is more dangerous than cannabis. Over-the-counter medications like tylenol and aspirin are more dangerous than cannabis. Not a single death has ever (EVER!) been attributed to cannabis use. Compare that to the one death every 24 minutes from prescription pharmaceuticals (People. 1/28/2013). And yet this safe healing herb with thousands of years of effective medical use has been demonized for political (and even worse) reasons.

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Second, cannabis effectively treats a wide range of health conditions, generally with less side effects than the pharmaceutical drugs routinely prescribed by physicians to treat those conditions. My patients generally prefer cannabis both in terms of efficacy and (its relative lack of) side effects to the pharmaceutical alternatives, and they routinely report that it actually helps them get their lives back – actually increasing productivity at work and at home. Patients are waking up to the dangers and costs of pharmaceutical drugs, and a growing number of them feel safer and more empowered with a plant they can cultivate in their own garden.

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My role here as medical director of NCCPN puts my “finger on the pulse” of countless Carolinians whose stories would touch your heart if you gave them your attention. I urge you to visit our “testimonials” page on our website: NCCPN.org. The need and demand is here.

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North Carolina voters overwhelmingly support allowing doctors to decide if our terribly sick and suffering patients should use marijuana for medicinal purposes. Despite this strong support, our legislature has either ignored or killed legislation that would amend our state statutes to allow just that. Thankfully, Rep. Kelly Alexander continues to champion for the rights of those less fortunate.

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Rep. Alexander has introduced a bill that, if passed by a three-fifths majority of both the House and Senate, will put a question to the people this November. The question asked of the voters would be whether the state should add a section to our constitution allowing for medical marijuana. The bill in question is HB 1161, and I am writing you to ask for your support. All you have to do is vote “yes” to putting a constitutional amendment on November’s ballot. Please vote “yes” on HB 1161.

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Sincerely,

Kevin Baiko, MD

AACM Certified Diplomat

NCCPN Medical Director

For many medical cannabis patients, getting high is a desired part of the treatment. This desire troubles critics both in states which sanction medical cannabis use and in states yet considering to do so. I recently participated in an interview for a North Carolina based radio broadcast exploring the question of whether or not a medical cannabis program is right for Carolina, and not surprisingly one concern raised by my interviewer was that mind-altering effects of cannabis use, namely “the high”, might somehow undermine the legitimacy of the medicine and, by extension, the legitimacy of the true motivations of patients who would choose to medicate with cannabis in a manner imparting psychoactive effects. Implied in this concern is the opinion that getting high is at best a necessary evil side-effect of medical cannabis use, an effect best done away with if ever possible. However, at the risk of the exposing one of the many double standards still circling the cannabis bowl after nearly a century of baseless anti-cannabis propaganda, I must ask: What's so wrong with getting high?

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I should say right away that cannabis offers so much more than getting high to the patients who use it. I can testify as a professional witness: this herb is one powerful medicine! I've seen patients with autoimmune disorders successfully prevent their symptoms without the use of harsh anti-inflammatory and immunosuppressant drugs. I've had cancer patients not just treat, but beat their disease without surgery, radiation or chemotherapeutic agents. I've watched sufferers of chronic debilitating pain conditions not only wean off addicting, mind-numbing constipating opiate medications, not only manage their pain, but actually regain function and activity. And the list of success stories attributed to cannabis goes on and on. I never truly loved being a doctor until I started practicing cannabinoid medicine. It blesses so many lives. It treats so many health conditions so well, and it does so with minimal risk. I realize that some people smoke marijuana simply for the high, but I don't see how that fact belittles the healing power of cannabis in any way. The veteran treating his phantom limb pain and post-traumatic stress disorder (PTSD) with cannabis finds relief no less when his stoner neighbors light up for fun. The patient wasting away with acquired immune deficiency syndrome (AIDS) stimulates his appetite no less when his cat gets a little silly on secondary smoke. So, I ask again, what's so wrong with getting high?

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Some condemn getting high on religious grounds. While I'm not aware of any of the world's major religious texts specifically condemning cannabis use or its high, I hold the utmost respect for spiritual ascetics who shun the “pleasures” of this world in their efforts to atone with God. I have a much harder time respecting logic which regards a cannabinoid high as sinful while a caffeine buzz or a sugar rush or an alcohol tipsiness as somehow non-sinful. Patients, doctors and onlookers who claim getting high from medical cannabis is somehow immoral, while the psychoactive effects of medications used to treat pain, insomnia, anxiety, depression, etc. are just fine by God, strike me as hypocrites. What about the natural high felt after prolonged exercise, and now attributed to an activated endocannabinoid system? Is physical exercise immoral? Religious morality is often influenced by civil law. The criminalization of cannabis, along with nearly a century of baseless fear-mongering propaganda, has led to widespread condemnation of its use within the ranks of organized religion, at great cost to our collective advancement as an informed, compassionate civilization. Fortunately, the more the general population sees through the politically motivated lies about cannabis, the more spiritually minded folks are opening up to its true virtues as one of Creation's natural healing wonders.

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Medical professionals are no less influenced by belief. There is a certain dogma held by many medical researchers and practitioners alike that the ideal medicine treats an illness and/or its symptoms safely with little to no side effects. Given that most medical side effects are unpleasant and considering that some side-effects can be so pleasant as to be addicting, this seems a reasonable ideal, but what about non-addicting pleasant side effects? I suppose it could be argued that a medicine's enjoyability possibly undermines a truly unbiased scientific assessment as to whether it is treating the symptoms targeted or just helping the patient feel good enough to not care about said symptoms, but upon further consideration, such arguments betray an heartless non-holistic paradigm of medicine which certainly shouldn't apply to a non-addicting substance like cannabis. I want my patients to feel good, to laugh, to relax, to sleep well... You see, I don't just treat symptoms in isolation, I seek to treat the body-mind of each of my patients both as a whole and as part of the whole. That cannabis' 60+ naturally occurring cannabinoids safely treat an almost unbelievable array of symptoms should not overshadow their fundamental supplementation to our general population's characteristically depleted endocannabinoid system, the very system that fine tunes physical and mental homeostasis. On the contrary, this fact helps explain why cannabis treats so many symptoms and disease processes so effectively. Why on earth so many doctors believe they should avoid helping their patients feel good is beyond me, especially if it contributes to medication compliance, a primary reason patients prescribed medications with unpleasant side effects fail to get better. Fortunately, the more research and anecdotal reports that come in confirming the safety and efficacy of medical cannabis, the more doctors on the whole are opening up to its healing potentials, not only as a means to treat specific ailments and symptoms, but even on a more holistic scale. Cannabinoid medicine is transforming the practice of medicine in this country.

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Even beyond dogmatic objections to getting high, both “religious” and “scientific”, some view the habit as an avoidance of responsibilities. The stereotype of a middle-age slacker squandering his potential is no less pitiful than that of his teenage counterpart, and to be sure this stereotype accurately describes a small subset of regular users, just as it does a statistically larger subset of “couch potatoes” procrastinating on Facebook or any number of popular brain drains. We all find ways to escape or at least temporarily delay the inevitable, and that's probably not such a bad thing. As the Type-B personality advice for Type-A personalities wisely goes: “1) Don't sweat the small stuff. 2) It's all small stuff.” While cannabis physiologically helps its users “sweat the small stuff” less, a majority of my patients report that cannabis helps them meet their responsibilities at work, at home and at play, not only achieving their non-medicated potential, but actually exceeding it. If the mind-altering properties of cannabis somehow undermine motivation to excel in life in a certain subset of users, I can only conclude that this subset is not inclined to seek my services, as I witness a very different quality in my patients on the whole. My patients consistently praise cannabis for the life restoring properties it provides. It helps them sleep, and this helps their bodies heal naturally, while restoring the body and mind to face the following day's challenges. It not only treats their debilitating symptoms of pain, nausea and the like, it also works at underlying disease mechanisms through its anti-inflammatory, antioxidant and homeostatic influences on the psycho-neuro-immunologic axes. On the whole, patients and their loved ones consistently report that medicating with cannabis helps them accomplish far more with their lives. Rather than being the gateway drug to destructive and addictive lifestyle choices, cannabis has continually impressed me as an herbal gateway to empowering attitudes, abilities, behaviors and healing breakthroughs.

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Drugs which lead to addiction, both illicit and prescription, are worthy of concern, if not outright condemnation. It's no surprise that patients voice such concerns and condemnation so much, especially over regularly prescribed opiates (like hydrocodone and oxycodone). They commonly describe opiates as being far more psychoactively debilitating than cannabis at any dose, and they're afraid to get hooked on them. Addiction is a horribly disempowering state, and all the more so when caused by chemicals that can lead to damaging or deadly overdose. Addiction alters judgment, leading to devastating repercussions to the addict and those nearby, all to relive the original high, or at least avoid anxiety and withdrawal symptoms in its absence. The high that patients experience from cannabis is, to my knowledge, in no way dangerous. No one has ever died or suffered organ damage from cannabis over-dose. It does not cause addiction or physiologic craving to relive the experience like heroin or methamphetamine. It does not “fry” the brain like an egg on a hot skittle, literally or figuratively. If anything, cannabis has been shown to be beneficial to the nervous system. In fact, the U.S. Government holds a patent (U.S. Patent 6630507) for its neuroprotectant and antioxidant properties. Most users generally find the experience pleasant and relaxing. Medical science's technical term for it is “euphoria”, which translates as “feeling good.” Now what's so bad with feeling good?

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Granted, not everyone enjoys getting high. Some find it unpleasant. Some don't like feeling out of control. Some get nauseous. Some get paranoid. And some are just afraid of the sensation. If there is any common complaint patients mention about medical cannabis (besides perhaps not having an adequate supply), it is that they wish they could enjoy its medicinal benefits without getting high. Even more common are patients who enjoy the high, but not during the day as it effects them too much to satisfactorily attend to responsibilities at home and especially at work. Like it or not, being high at work is generally frowned upon in our stress-ridden society, and so the majority of working medical cannabis patients abstain from their medicine until night time, when it helps them relax, rest and recover with a clear head the following morning. That so many adopt such a discipline, rather than just getting high all the time, speaks volumes on true motivations of medical cannabis patients on the whole. Their goal is to live more fully. Often that requires not being high.

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Fortunately, a variety of ways exist to medicate with cannabis without the high. The most obvious is to use it topically. Cannabinoids are oil soluble, and human skin absorbs oil. Whether applied as a concentrate as “Rick Simpson oil” to skin cancers or applied as an diluted oil infusion over aching arthritic joints, topical cannabis generally fails to dose the central nervous system sufficiently enough to induce mind altering effects, but it can treat local symptoms and lesions. Another clever way to avoid the high is to ingest the cannabis raw, before the non-psychoactive THC-acid degrades into its psychoactive chemical form (THC), a process triggered by drying and heating after harvest. Ingested as freshly harvested leaves and flowers or as a fresh juice, (much like wheat grass juice,) this non-psychoactive form of cannabis enables patients to consume substantially higher and more therapeutic quantities of the other non-psychoactive cannabinoids (most notably CBD & CBD-acid) than tolerated when THC is present in its inhaled and cooked edible forms. Of course, a third option is to use medicine derived from a growing list of cannabis cultivar strains containing insignificant quantities of THC when compared to the other cannabinoids (as exemplified by strains like recently popularized “Charlotte's Web”.) However, while a great many of my patients would be thankful to just have these options, a great many more would describe a decrease in satisfaction with cannabis as a medicine if they were limited to such non-euphoric options.

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THC, the cannabinoid with notorious mind-altering effects, has medicinal value too. It stimulates the appetite, relieves pain, muscle spasm and nausea, and plays a synergistic role with its non-mind-altering counterparts, which is to say it potentiates their medicinal effect. Not to be overlooked, the high itself can be therapeutic, especially in the context of physical therapy, because rather than numbing the body-mind as its opiate counterparts do, it seems to refocus body awareness, facilitating therapeutically directed stretching and exercise while the pain is rendered less immobilizing, muscles looser and the mind calmer. It's not uncommon to hear patients describe activities like yoga, Tai Chi, Pilates and even martial arts as making more sense and feeling more body-centered when practiced while high, with such enhancements becoming incorporated into their disciplines even when practiced in a non-high state. Cannabis is truly a mind-body medicine. Its ability to ease such symptoms as insomnia, anxiety and irritability is regularly reported, especially amongst sufferers of depression, psychosis and PTSD. It is obnoxious for critics who have never experienced nor witnessed such benefits to discount them.

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Let it be clear that I am speaking about patients using cannabis as a medicine. As a physician who helps patients go through a process that enables them to medicate with cannabis legally, I only approve those who present valid subjective and/or objective evidence that they are legally qualified by state law. People use cannabis recreationally all the time simply to get high, and it's not too far fetched to assume that some patients apply to participate in the state's medical cannabis program for no other reason than to get high “legally”. This is often cited by critics as an abuse of the program, and I don't deny the possibility that some patients might misrepresent themselves to me for this very reason. Naturally, in defense of my own professional reputation, the legitimacy of my patients' needs and the viability of the state medical cannabis program, I cannot condone nor enable such fraudulent behavior. However, to put it in perspective, the drug war, and more specifically the government's systemic terrorization of cannabis users, inflicts far more physical, psychological and economic abuse upon individuals, families and communities than any damage cannabis has ever been shown to cause. For all its faults, Hawaii's medical cannabis program provides a legal safe haven for at least some of the people who benefit from its use, and I'm thankful to be a part of it, despite the double standards attached to it.

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The criticism of cannabis for its enjoyability is one double standard most people now reject. The notion that medical cannabis should be avoided when it causes a high is about as ridiculous as the notion that driving in a car should be avoided when it causes enjoyment. Driving is without question far more dangerous than cannabis use, yet many enjoy the experience, at times traveling without practical purpose, merely for the joy of taking a trip in their vehicle. Why do so many condemn the relatively safe source of enjoyment (and healing) medical cannabis can provide while simultaneously accepting far more dangerous sources of nonclinical entertainment? The answer is ignorance. People have been conditioned by decades of false propaganda to believe that getting high generally undermines human and medicinal potential. But what of our potential to feel good in the context of our healing journey? Must therapeutic massages be pleasureless? Must healthy foods be rendered bland for our well-being? Even if the euphoria known as getting high is viewed as a side-effect of medical cannabis use, shouldn't we leave its tolerability to the judgment of the patient experiencing it? While some don't like the sensation of being high, most clearly prefer it to the side-effects, both psychoactive and otherwise, of this herb's pharmaceutical alternatives. A growing number of my patients are sincerely scared of pharmaceutical drugs, both prescription and over-the-counter, knowing full well that such substances are statistically hazardous to one's health. Frankly, I am reassured by this trend as evidenced in patient feedback and in expressions of public opinion the world over. Though a few retarding holdouts remain, we as a species are in the process of collectively realizing how the cannabis plant is far more empowering to human and planetary health than its prohibition. It's high time we reprioritize our concerns.

Since I am a doctor specializing in cannabinoid medicine, some of you may wonder how I practice as a primary care physician to my patients.  Drugs are dangerous.  They're deadly at the wrong dose, often addictive, and I much prefer not to prescribe them.  Cannabis, on the other hand, is not a drug.  It is an ancient herbal medicine.  It's safer than pure cane sugar, and its cannabinoid healing properties are awe-inspiring.  This is my kind of medicine... a safe and amazingly versatile (not just medicinally speaking!) plant.  People can grow it in their own yards, use it to treat a wide variety of ailments, and they often find the experience of using it enjoyable, perhaps because cannabis supplements a chronically stressed out endocannabinoid (eCB) system, restoring its ability to maintain proper psycho-neuro-immunological function of mental and physical homeostasis.  In other words, it helps us feel more of the relaxed and balanced version of ourselves again.  Be that as it may; whereas my pharmacopeia primarily consists of cannabis, most of my fellow physicians specifically avoid the whole medical marijuana thing, preferring instead to specialize in the prescription of chemicals patented by a pharmaceutical industrial complex with vested interests in keeping health care providers, lawmakers and the general public conditioned and in line with their profit-making agenda.  Quite a few physician employers actually prohibit their doctors from helping people, however qualified, apply for the state medical cannabis privilege.  And so I enjoy a successful practice (spanning two islands in Hawaii.)  I witness healing miracles on a daily basis.  I love my patients and am so thankful for the Aloha reflected back.
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Year after year, I take note of how my patients progress in response to their medical cannabis treatment.  Often times they tell me that they much prefer it to pharmaceutical medication.  Not surprisingly, I commonly notice my patients successfully managing their conditions on fewer and fewer pharmaceutical drugs, visit by visit, as these pharmacy purchased pills and capsules become to be seen as the less desirable alternatives to the cannabis they can grow in their own garden.  Doesn't it make sense that natural medicines like cannabis be seen as our primary, first line medicines, only turning to pharmaceuticals (and their concentrated dangers) when absolutely necessary?  I certainly think so!  And my patients tend to agree.  I see patients throughout the year as necessity demands, though I usually follow-up with them on a annual basis, which conveniently matches the effective life span of the state issued medical cannabis (“blue” - because it's blue) card.  Whether my patients are applying or reapplying to get registered with the state to legally use cannabis as a medicine, they generally must endure the same treatment each time from Doctor Baiko.  I perform the mandatory history and physical to determine whether or not one is qualified, strictly in accordance with the Hawaii Revised Statutes.  I discuss my findings with them and recommend treatment options, including, but not limited to methods and routes of administration, physical and mental exercises to complement medication, even recipes for home-crafted healing remedies.  Qualified applicants, even those renewing, get to hear me review the state medical cannabis laws before completing the application with me.  Basically, my goal is to empower my patients to take care of themselves through the customization of care.
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To my recollection the term “Primary Care Physician” (or alternatively “Primary Care Provider” or just “PCP”) is a term originally coined by the health insurance agency, but I like the term because it's descriptive of the continuity and customization of care I provide the patients in my cannabinoid medicine practice.  Patients are lucky to see their assigned health insurance PCP more than once – if ever – and, for the lucky ones, seldom does one doctor manage all the medicines and therapies utilized by a patient, particularly when herbal remedies and alternative therapies (like chiropractic, bodywork, acupuncture, etc) are factored into the patient's healing resources along with other insurance paid-for specialists.  While I do charge for my services at typical physician rates, I refuse to involve myself with the health insurance industry and its bottom-line - make money at patient's expense – prime directive, which, not coincidentally, nearly always refuses to reimburse for cannabinoid medicine services anyways.  Our cannabis certification service prices incorporate office visit fees, state application fee, and the cost of dealing with the state throughout the year on our patients' behalf (=“...priceless”).  The term “Primary Care Physician” is descriptive of the doctor who considers the “big picture” of each patient so as to counsel the whole patient in one's management of his or her own health matters.   Education is key to this empowerment process, and while every patient's case is unique, there are a few topics I find myself sharing with my patients on a regular basis, and I believe they're worthy of mentioning here as well.
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Cannabis as a de-stressor...
Perhaps the greatest challenge a primary care physician faces is to inspire his patients to reduce the stress in their lives.  I am convinced that chronic stress is the number one contributor to acute and chronic illness.  Stress is best understood as a physiologic response to a perceived threat.  Whether or not any real threat exists, when we hear a police siren behind us, most experience a rush of the stress hormone, adrenaline, signaling our bodies to fight or flee.  Of course, neither option tends to be constructive in modern society. And so we mount stress response after stress response, often ruminating upon perceived threats for hours, days, even years at a time, as our bodies suffer and gradually break down in the aftermath. The eCB system is on the front lines of this perpetual barrage of stress responses.  While endogenous eCBs promote the relaxation of the nervous system, stress hormones actually down-regulate the expression of eCB receptors throughout the nervous system, so over time chronic stress can lead to dysfunctional nervous regulation of every system in the body.  And this is why cannabis helps people de-stress.  It supplements an overly taxed, down-regulated eCB system.  This property alone make cannabis an invaluable aid in both treatment and prevention of a wide variety of chronic illnesses.
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While a majority of my patients report that cannabis helps them relax, I cannot emphasize enough the importance of addressing the underlying causes of their stress.  If you're stressed about not having a job, smoking a joint might help you sleep, but tomorrow you're still out of a job.  As the Serenity Prayer goes: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference.”  Here, simplifying life and stream-lining its responsibilities goes a long way, but there's more to it, because stress is our response to a perceived threat.  Perception can be re-trained, so much so that we really can learn to live by the credo: “1. Don't sweat the small stuff.  2. It's all small stuff.”  Cannabis use can actually aid in this cognitive perceptual re-training process.   Think about it... If a situation seems less stressful after using cannabis, was it really a threatening situation to start with?  This re-training occurs naturally in many cannabis users, helping to explain why chronic cannabis users are characteristically mellow even without cannabis in their system.  On the other hand, many chronic partakers of cannabis use the herb as an escape from real life responsibilities, which is generally fine on a short term basis, but generally disempowering in the long run.
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Cannabis as a superfood...
Another great challenge a primary care physician faces is to inspire his patients to eat right.  Food can be both medicine and its antithesis.  In addition to meeting the body's basic fuel requirements, our diet ideally supplies us with the essential vitamins, minerals, fatty acids, anti-oxidants, and so on, required for healthy maintenance of the body's tissues, organs and inter-dynamic systems.  Not all foods are equal.  Some do more harm than good, as in the majority of overly processed, refined, carbonated, fried, and “fast” foods and beverages readily available for mass consumption - not that I'm the food police.  As noted above, it doesn't help to stress over our diet, but given that we are surrounded by less than ideal, unnatural food choices, we certainly stand to benefit from growing more healthful food items for consumption.  Cannabis is actually a superfood.  Its seeds alone “contain all the essential amino acids and essential fatty acids necessary to maintain healthy human life. No other single plant source has the essential amino acids in such an easily digestible form, nor has the essential fatty acids in as perfect a ratio to meet human nutritional needs” (For more details, see: www.ratical.org/renewables/hempseed1.html), but the seeds aren't the only consumable part of this plant.
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The leaves and flowers are also edible and, when consumed raw, are non-psychoactive.  Before the herb is allowed to dry/cure or to be heated, its THC (delta-9-tetrahydrocannabinol), that notorious cannabinoid that gets people high or stoned, rests in the non-psychoactive acidic state (THC-a).  While THC-a lacks its non-acidic counterpart's ability to alter how we perceive pain, along with its appetite stimulant properties, it does possess direct analgesic (pain-killing) and anti-proliferative (anti-tumor) properties.  However, as in its smoked form, the real healing magic in raw cannabis lies in its content of CBD (cannabidiol), the cannabinoid boasting anti-oxidant, analgesic, anti-spasmodic, anti-emetic (anti-nausea), anti-cancer, neuro-protective, anti-diabetic, anti-ischemic, and still more, effects.  And, with the THC in in its acidic non-psychoactive state, much more of the herb can be consumed, maximizing the potential of beneficial CBD effects.  Most mammals (including humans) would probably benefit from the ingestion of cannabis in its raw form, though I especially recommend it to my patients suffering from auto-immune disorders (like Lupus and Crohn's disease), neurodegenerative conditions (like multiple sclerosis and Parkinsons's disease), fibromyalgia and all forms of cancer.  Even when used in its cured/smoked form upon such notoriously difficult-to-treat conditions, I regularly witness healing results substantial enough as to make the standard-of-care pharmaceutical alternatives seem barbaric in comparison.  Cannabis in its raw form promises even more phenomenal results!  And all you have to do is grow cannabis and consume its leaves and flowers raw, juicing them like wheat grass, blending them into fruit smoothies or just grazing off the plant while tending to it.  Frozen raw juiced cannabis seems to hold its medicinal integrity for at least a month.  One of the world's leading proponents of raw cannabis consumption, Dr. William Courtney generally recommends the ingestion of 15 leaves + 2 (1 inch) buds spread out throughout each day.  For a more detailed overview of the subject, please visit:  www.medicaljane.com/cannabis-the-foundation-of-health/
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Cannabis as a complement to physical therapy...
Yet another great challenge a primary care physician faces is to inspire his patients to exercise right.  I am a firm believer in the osteopathic concept that pain associated with structural abnormalities should be addressed by correcting the abnormalities – not just by treating the symptoms.  While a good “crack” of a joint sometimes does the trick, generally more work is required to successfully correct pain stemming from somatic dysfunction.  As I frequently tell my patients, “Cannabis can help treat pain, as can chiropractic, acupuncture, bodywork or prescription medications, but unless you work on this yourself, the pain will just come back, requiring more cannabis, chiropractic, acupuncture, bodywork or prescription medications.”  By “work” I mean both directed exercise and stretching, but also the maintenance and awareness of posture, both on and off the job.  To these ends, I have found cannabis a remarkable complement to physical therapy.  As cannabis eases pain and relaxes muscles, it also calms mental restlessness, increasing body awareness, while simultaneously rendering much of the perceived pain to be a less threatening experience – almost like a curiosity to push through.  While these effects are in themselves therapeutic, they lend the body-mind the capacity and patience to stretch far more deeply, for greater and longer lasting therapeutic effect, leading to increased range of motion with less pain.  I daresay, that many chronic debilitating pain conditions can be effectively overcome by this method.  Of course, professional direction helps, and I always aim to customize my medicated therapeutic stretch prescriptions, but as mentioned above, cannabis helps the patient become more aware of how the body wants to stretch.  It's almost like we have our own personalized yoga master locked up inside our bodies, and cannabis is the key.
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Of all the reasons people in this country visit their doctor, the treatment and management of pain ranks consistently amongst of the most common.  According to data compiled by the Institute of the National Academies, 100 million Americans suffer from some sort of (acute and/or chronic) pain.  That's almost 1-in-3!  Is it any wonder, then, that more patients present to my cannabinoid medicine practice with chronic pain than all other chief complaints combined?
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Cannabis is a remarkable pain medication.  Many people, even folks who smoked "weed" recreationally "back in the day" (before moving on to other vices, generally speaking) are happily surprised when they discover first hand, often at the encouragement of a loved one, just how well it alleviates their chronic pain.  It also treats the inflammation and muscle spasms commonly contributing to the pain, and it does so with a minimum of side-effects and an unbeaten safety record (no deaths, ever!).  Many patients claim it helps them partially or totally wean off their addictive, dangerous and often side-effect ridden prescription pain-killers.  All this from a plant that can be grown in one's garden, which may explain why its extracts were an integral part of the American pharmacopeia prior to its prohibition in the 1930's.
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For all its healing virtues and ever growing public appreciation, this herbal medicine remains a highly controlled substance.  A majority of states fail to recognize its value enough to legislate it as a legal option to their residents.  Those states with medical cannabis laws on their books generally require some sort of physician certification of qualification coupled with a state registration before patients can medicate with or even cultivate this plant legally.  As with the majority of such state laws, Hawaii's Uniform Controlled Substances Act lists “severe pain” (in the context of a “chronic or debilitating disease or condition or its treatment”) as one of the few qualifying conditions for registering to use medical cannabis.
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Since pain is totally subjective, its management presents some of the most intimidating challenges to today's primary care physician (PCP).  While its presence can indicate serious injury or illness, it can also present absent any recent trauma or detectable disease process.  Whereas physicians generally prefer to deal in physiological terms, pain is meta-physiological, being influenced by interpersonal and social context, emotion, cognition and memory.  Pain is a highly personal form of suffering -  so much so that patient self-report is considered by the National Institutes of Health, to be the most reliable measure of pain quality and intensity.  So, on one hand we doctors are told that, unless we are given compelling evidence to the contrary, our standard of care is to believe our patients and treat them, and not only out of compassion.  An increasing body of evidence suggests that pain, left untreated, can lead to long-lasting maladaptive sensory processing, resulting in chronic pain syndromes.  In other words, our nervous systems possess neural plasticity – the ability to adapt and learn – which, in the case of prolonged pain, essentially equates to learning to stay in pain.  This fact alone underlines the importance of treating pain when it presents.  On the other hand, pharmaceutical pain medications are dangerous and many are rather addictive, so most doctors, even the prescription-happiest of us, overcompensate with reluctance when it comes to prescribing narcotics.  This reluctance leads to scarcity, encouraging a profitable and potentially dangerous black market, inspiring “drug seekers” to con doctors into prescribing them narcotics, which only incites further physician reluctance, and so a vicious cycle emerges in which legitimate pain sufferers are immediately suspect of ulterior motive.  Understandably, many PCPs harbor mixed feelings about chronic pain management.
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I too have developed strong reservations towards managing my patients' chronic pain with pharmaceutical drugs, (though I apply cannabinoid medicine to the full range of chronic pain presentations with great optimism!)  The rare exception of treating an acute condition for a week or two not withstanding, I personally refuse to prescribe narcotics any more.  Time and again, I've seen them do more harm than good.  Of course, there are many more physicians willing to prescribe narcotics than there are physicians willing to practice cannabinoid medicine, the latter of which I have witnessed, with impressive predictability, to generally bring about more wellness than harm.  Cannabis seems to be especially well suited to the treatment and management of chronic pain.  Since the endocannabinoid system mediates the extinction of aversive memories and adaptive processes, its supplementation with cannabis helps reset neural plasticity and thereby helps the nervous system extinguish maladaptive neural programs contributing to chronic pain syndromes (and, no doubt, PTSD related syndromes, to which chronic pain syndromes may well be neurologically related.)  In other words, cannabis use can contribute to the rendering of dysfunctional habits in a nervous system plagued with chronic pain literally forgettable.
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Even when treating patients primarily complaining of pain, cannabis is more than just a "pain medication".  By supplementing a generally down-regulated endocannabinoid system, it relaxes chronically-stressed  nervous and immune systems, allowing the body's self-restorative functions to do their healing work. Not only does it help patients rest despite their pain condition; it also enables many to engage in their activities of daily life, their work duties and even their recreational pursuits despite their pain condition.  Pain management strategies focused on treating pain alone have never demonstrated superiority to strategies focused primarily on restoration of function.  Cannabis advances on both fronts, and, as previously stated, it's an incredibly safe medicine.
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As remarkable a pain medicine as cannabis may be, it is by no means the medication of choice for everyone suffering from chronic pain.  Some find cannabis inadequate as a pain-killer altogether, and as far as I can tell there's no predicting who these people will be.  Others say that while cannabis has no effect on their pain, it does provide a distraction from it, enabling them to sleep or otherwise carry on without the pain crippling them.  Still others describe a sense of being removed from the pain, as if it's still there but not so intolerable.  These varied effects may well be attributable to THC, that infamous cannabinoid with psychoactive effects.  Concerns over social stigmata, spiritual repercussions and work safety/acceptance aside, perhaps the most common reason people avoid medical cannabis is that they don't enjoy or react well to the mind-altering effects that often accompany its use.  Fortunately for such folks, there are ways to medicate with cannabis without the "high", including juicing raw cannabis and topical application of cannabis-infused oils and tinctures, as well as the development of cannabis strains with high content of CBD (that amazing cannabinoid with strong analgesic, anti-inflammatory and anti-spasmotic effects, to name a few) and negligible THC content.  Furthermore, I've only just become aware of a new legal industrial hemp extract on the market containing CBD and virtually no THC, and though I have yet to study its effects, it occurs to me that cannabis may well be on its way to regaining its primacy in the American pharmacopeia.
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(References available by request.)
Kevin Baiko, M.D.
Medical Director of the North Carolina Cannabis Patients Network
Board Certified Diplomat of the American Academy of Cannabinoid Medicine
  
February 13, 2013
 
To:         Rules Committee Members
From:     Kevin Baiko, M.D.
RE:        HB84 – The North Carolina Medical Cannabis Act
Position: Support

I am testifying today in strong support of HB84 – The North Carolina Medical Cannabis Act.  As you may be aware, this Bill has been referred to the Rules Committee for the third time in four years.  The last two times it was effectively ignored.  I attach the results of a poll conducted by Public Policy Polling just last month, which shows that 58% of our state's population believes that doctors should be allowed to prescribe cannabis for medical use. If the majority of Carolinians are in favor of a well regulated medical cannabis program in North Carolina, don't you think this bill at least deserves a better fate than merely dying again in the Rules Committee? I urge you to give your personal attention to HB84 and forward it along so it can at least receive a floor vote THIS session.
 
As Medical Director of the North Carolina Cannabis Patients Network, I speak on behalf of thousands of Carolinians who already medicate with cannabis or who would do so if it were allowed.  Unfortunately, current state policy criminalizes these good folks for turning to an ancient herbal remedy whose efficacy and safety are only validated by the most advanced scientific research.   While the mere existence of HB84 offers so much hope to so many, the lack of compassion their representatives have demonstrated in past years by avoidance of its discussion, allowing it to die in the Rules Committee again and again, has driven many remarkable Carolinians to move away to states already authorizing medical cannabis use.  What other choice do they have?
Go directly to jail? Rely on the black market for their medicine? States with medical cannabis programs typically enroll about 1% of their population.  That would translate to nearly 95,000 people in North Carolina!  HB84 offers a safer, more sensible, compassionate choice for the thousands upon thousands here who already regard cannabis as their treatment of choice.  I'm not talking about getting high!  I'm talking about real people with real medical conditions who find that cannabis alleviates their suffering more effectively and with less side effects than the conventional medicines generally available.
 
Many Representatives, including the Democratic Party Chairman, stand in support of this legislation.  Of ourse, this is not really a partisan issue.  This is a patients rights issue. Upon meeting with Representatives and patients who met with their Reps yesterday, the three most common reasons Representatives gave for NOT being in support of HB84 were: 1) “Legalizing cannabis, even if limited to well regulated medical use, violates my religious values.”  2) “Legalizing medical cannabis would be a further risk to public safety.”  3) “Approved alternatives to cannabis, like Marinol, already exist.”  Please allow me to address these three rationales one by one.

Raised in a Christian home and having attended a private Christian school, I was familiarized with the Bible at an early age.  With the exception of the “Tree of Knowledge of Good & Evil”, I've yet to find a passage condemning the use of any plant, nor endorsing its state criminalization.  To the contrary, First Timothy 4:4 reads, “For everything created by God is good, and nothing is to be rejected, provided it is received with thanksgiving”.  Honestly, I've never been able to understand how Christian values are exemplified by denying people access to medicine that will ease suffering, improve quality of life and function.

While medical cannabis may seem like a risk to public safety, it is in fact a benefit.  First of all, people already are using cannabis here.  Does throwing them in jail make Carolina a safer place to live?  Certainly not for them!  How many cannabis related car accidents have you ever heard of?  Evidence compiled by the National Highway Transportation Administration demonstrates that cannabis users may actually be safer drivers(www.kushmagazine.com/news/2549-auto-insurance-quote-provider-says-marijuana-users-are-safer-drivers?catid=842) and another study indicates that the incidence of deaths attributed of drunk driving decreases after the enactment of medical cannabis legislation (www.theatlanticcities.com/commute/2011/11/medical-marijuana-laws-may-lead-fewer-traffic-deaths/609/).  Consider how many public safety resources being directed towards cannabis prohibition could be redirected to actual risks to public safety, like violent crimes and thefts.  Judge Jim Gray has been articulate on this issue: (www.youtu.be/b6t1EM4Onao) If public safety truly is a concern of yours, take a look at this data compiled by the Adverse Events Reporting System managed by the FDA (www.drugwarfacts.org/cms/Causes_of_Death).  In 2000, 19,445 deaths were directly attributed to FDA approved drugs. Note how these numbers quadrupled in only 10 years, during which time nearly a half a million deaths were attributed by the FDA to FDA approved medicines!  Compare these numbers to the zero deaths attributed to cannabis  use – throughout recorded history. 
 
Even Marinol (like its synthetic cannabinoid counterparts “Spice”, “K2”, etc.) has been linked to a few deaths.  And Marinol's efficacy doesn't even closely  compare to that of the cannabis, from which over 60 distinct cannabinoids, each with unique medicinal properties, have been isolated.  Cannabis is, in effect many medicines all in one plant.  Our bodies are designed to process substances from the natural world.  Isolating and concentrating substances, particularly synthetic ones risks poisoning, as this chart clearly illustrates. ms of cancer and the horrible effects of chemotherapy and radiation therapies; I've  witnessed my patients effectively cure their cancers with cannabis alone!  I could tell you  success story after success story from the ranks of my Hawaii medical cannabis patients, and will happily do so upon your request.  I know you'd be amazed just how a law like HB84 would literally make Carolina a safer, more healthful, just and prosperous place to live.  Keep in mind – this isn't just a health bill.  It's also a stimulate-the-economy, create-jobs-and-tax-revenue bill.

Please contact me by phone or email if you have any questions.  I'd be happy to meet with you and provide any further documentation you may require.  I plead with you to support HB84 - The North Carolina Medical Cannabis Act, and if you don't personally support it, please at least afford it a hearing, giving it and the countless citizens who would benefit from its enactment the attention it deserves.
 
Sincerely,
Kevin Baiko, M.D.,
Board Certified Diplomat of the American Academy of Cannabinoid Medicine,
Medical Director of the North Carolina Cannabis Patients Network,
North Carolina Resident

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