Caregiver Responsibilities under Hartwick

 

Caregiver Responsibilities under Hartwick

In response to our request, Attorney Randall Collins of Grand Haven addresses the Hartwick CoA Decision

Law Office

of

Attorney Randall L. Collins

_________________________________________________

        P.O. Box 231

Grand Haven, MI  49417

(616) 844-5446

(616) 825-6275 fax

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TO:              Medical Marijuana Community

FROM:         Attorney Randall Collins

DATE: January 17, 2014

RE:              Caregiver Responsibilities

If you are a Caregiver you must read the Appellant Court decision on People of the State of Michigan v. Richard Lee Hartwick.  Richard attempted to do everything by the book but did not understand the meaning of being a caregiver.  He did not know the illnesses of his patients, he did not know what strains or strengths of meds or THC/CBD was working and did not have a paper trail of what he tried for each patient.

If you are growing a strain of high THC, you do not want a patient with pain issues.  Most patients have pain issues and yet there is hardly anyone growing high CBD medicine.  Do you still not get it?  Sativa gets you high, works as an anti-inflammatory in a limited capacity.  Indica helps with pain.  Indica has a high CBD.  Sativa is high THC.  What are you growing?

YOU HAVE TO DECIDE:

A) Do I continue to grow my meds as they stand and find patients who will get the maximum benefits from it, or

B) Do I change my operation, to grow the meds for the current patients I have.

Track what is working for your patients and what is not working.  When did you talk to your patient last, did you sit and have a beer with them or did you actually have a heart-to-heart about their health and what you can do to better the patient?  When push comes to shove if the patients feels no relief from your meds and is just getting a buzz to forget the pain, game over.  You failed.  Medicine is suppose to aid in the relief of the illness.

So what do you need to do to learn more about this?  Test your grow each and every time.  Track how you are performing as a grower and log how the test results show how palliative relief will be maintained for you patient.  The true medical marijuana certification doctors will spot a bad caregiver when asking certain questions of the patient.  The doctor must document their findings every year.  These records of your work will be admissible in court.

I am available for consultation and grow room inspections in an attempt to point you in the right direction.  (616) 844-5446  or on Facebook as Grand Haven Legal

Editor's Note- In addition to knowing your patient's condition and selecting a specific strain for them based on the condition, caregivers are being held responsible for the validity of the doctor/patient relationship between the doctor and their patient.  If the physician is not known to the caregiver, it is wise (and may be legally essential) that the caregiver confirm that the physician will require and retain medical records of the visit, meet personally with the patient, and arrange for follow up with the patient.

 for full article and decision see 'caregiver responsibilities'

I'm a Good Mother- Why is CPS Investigating ME??

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Why is CPS Investigating Me?

By Attorney Jennifer P. Bukovinszky

Bringing a child into this world is hard enough but when the new mother is a marijuana user and has used marijuana during pregnancy, she is faced with so much more.

The Child Protection Law (CPL), requires certain people (mandated reporters), to make a complaint of child abuse to Child Protective Services (CPS) if the mandated reporter suspects that the newborn infant has been exposed to any amount of a controlled substance or if a controlled substance is found to be present in the newborn infant’s body. MCL 722.623a. It is important to note, that the mandated reporter will not be required to make a complaint if it is known that the exposure to a controlled substance was the result of medical treatment administered to the mother or the newborn infant.

But…it is likely that the hospital staff will err on the side of caution when deciding to initiate a complaint to CPS if it is suspected that the mother’s use of a controlled substance has transferred to the newborn infant while in utero.

Once a report has been made, a CPS worker will automatically investigate the complaint to determine if the newborn infant was in fact exposed to a controlled substance and the circumstances surrounding that exposure.

 

Read more...

The Real Truth about Cannabis… and why Marijuana is not a drug!

canny4

Cannabis has been cultivated throughout the world’s history as a source of industrial fiber, seed, oil, food, recreation, religious, spiritual enlightenment, and medicine. Each part of the plant is harvested differently, depending on the purpose of its use.

Cannabis is a flowering plant that includes three known varieties, Cannabis Indica, Cannabis Sativa, and Cannabis Ruderalis. These three grow naturally in Central Asia and South Asia with no human intervention. The flowers (and to a lesser extent the leaves, stems, and seeds) contain psychoactive and normal active chemical compounds known as cannabinoids.

Cannabinoids are a class of diverse chemical compounds that activate receptors on cells that block neurotransmitter release in the brain. These receptors include the cannabinoids found in cannabis and some other plants. Cannabis can be used for pain management by altering transmitter release on nerve cells that carry signals from sensory organs toward the body’s control system to remove the pain.

The most notable cannabinoid is tetrahydrocannabinol (THC), the primary psychoactive compound of cannabis. Cannabidol (CBD) is another major constituent of the plant, representing up to 40% of its substance. Cannabinol (CBN) is the primary product of THC degradation and there is usually little of it in a fresh plant and is only mildly psychoactive. Currently, there are at least 85 cannabinoids in cannabis, with THC, CBD, and CBN consisting of the top three.

As mentioned earlier, THC is the primary psychoactive compound of the cannabis plant. This is what causes you to have the high feeling or the feeling of euphoria. CBD (Cannabidiol) shares a precursor with THC and is also psychoactive, but considered to have a wider scope of medical applications than THC, including treating epilepsy, multiple sclerosis, spasms, anxiety disorders, schizophrenia, nausea, convulsion and inflammation, as well as inhibiting cancer cell growth. Cannabinoids can also be put into cakes, cookies, brownies, or other foods, and can be consumed for recreation or medicinal purposes.

Is Marijuana the same as Cannabis?

Marijuana consists of the dried flowers of Cannabis plants selectively bred to produce high levels of THC and other psychoactive cannabinoids, such as CBD. These cannabinoids are concentrated in a viscous resin produced in structures known as trichomes. Trichomes are the fine outgrowths or the hairs on cannabis flowers. The resin produced from trichomes is a viscous liquid, composed mainly of volatile fluid terpenes, which make resin thick and sticky.

Cannabis plants consisting of dried flowers, i.e., Marijuana can exhibit many variations in the quantity and type of cannabinoids they produce. Selective breeding has been used to control the genetics of plants and modify the cannabinoids. This is the reason why you have such a variety of marijuana strains with distinct taste, smell, and potency. And this is also why certain strains bred from Cannabis plants are better for certain illnesses.

The two main Cannabis plants are Cannabis Sativa and Cannabis Indica. Cannabis Sativa are long lanky plants that can take up to ten weeks to harvest during flowering. They tend to have a more grassy type odor to the buds providing an uplifting, energetic and “cerebral” high that is best suited for daytime smoking.

A sativa high is one filled with energy and can easily entice creativity for new ideas. Sativa plants are dominated by high THC levels and low or no CBD levels. These cannabinoid levels are why cannabis sativa plants are known to be good for alleviating pain.  

Sativa seeds are chiefly used to make hempseed oil which can be used for cooking, lamps, lacquers, or paints. They are also used as caged-bird feed, for it is a moderate source of nutrients for most birds.

Benefits of Sativa:

  • Feelings of well-being and at-ease
  • Up-lifting and cerebral thoughts
  • Stimulates and energizes
  • Increases focus and creativity
  • Fights depression
  • Relieves headaches and migraines
  • Relaxes muscles, relieves pain

Common Sativa Strains:

  • Silver Haze
  • Jack Herer
  • Maui Waui
  • Sour Diesel
  • Skunk #1
  • Trainwreck

Cannabis Indica are short and stocky and can take up to eight weeks to harvest during flowering. . They have a heavy, stony high that is relaxing and can help different medical problems such as treating insomnia. Indica plants have moderate THC levels and higher levels of CBD than Sativa plants.

Indica buds are most commonly smoked by medical marijuana patients in the late evening or even right before bed due to how sleepy and tired you become when high from an indica strain.

Cannabis Indica originally come from the hash producing countries of the world like Afghanistan, Morocco, and Pakistan.

Benefits of Indica:

  • Relieves body pain
  • Relaxes muscles
  • Relieves spasms, reduces seizures
  • Relieves headaches and migraines
  • Relieves anxiety or stress
  • reduces inflammation
  • stimulates appetite

Common Indica Strains:

  • Kush
  • Chemdog
  • God Bud
  • Northern Lights
  • Blueberry

A cancer patient hoping to relieve the pain from chemotherapy would benefit greatly from the effects of an Indica plant, whereas an individual dealing with depression would better benefit from a Sativa plant. Combining different Indica strains, different Sativa strains or a combination thereof creates hybrids. The resulting hybrid strains will grow, mature and smoke in relationship to the Indica/Sativa percentages they end up containing."

Common Hybrid Strains:

  • AK 47
  • Black Jack
  • Blueberry
  • Super Skunk
  • White Widow

Due to the crossbreeding, some strains may have higher THC OR CBD, and the terpenes dictate the smell and flavor.

Terpenes are the primary constituents of the essential oils of cannabis flowers. An “essential oil" carries a distinctive scent, or essence, of the plant. Essential oils are widely used as natural flavor additives for food, as fragrances in perfumery, and in traditional and alternative medicines such as aromatherapy.

THC and the other cannabinoids have no odor, so marijuana’s compelling fragrance depends on which terpenes predominate. It’s the combination of terpenoids and THC that endows each strain with a specific psychoactive flavor. The resinous trichromes of the cannabis plant contain both the cannabinoids as well as the terpenes, which are constantly being replaced as they evaporate from the resin.

There have been over 200 terpenes found in cannabis. However, only a few of these oily substances have large enough amounts to impact the bud. The amount and type of Terpenes can vary with each strain of marijuana, which is the reason for all the different smells and flavors from all the strains. Studies have also shown that the full range of psychoactive and medical effects of Cannabis resin cannot be re-created simply with the use of pure cannabinoid type drugs like THC.

Hmmm...This is an interesting plant, but how is it consumed?

There are a variety of ways to consume Cannabis; however the most prominent way is by some form of smoking or oral consumption. Each way of consumption has benefits and some may have drawbacks to consider. The intensity of your high or the level of the psychoactive effects can differ depending on your method of cannabis consumption. For this discussion, we will focus on smoking with a paper or cigar wrap, pipe or bong, vaporizer, and medibles.

Smoking (paper or cigar wrap):

Smoking is the most expedient method of consumption, with almost immediate effect and dosage controlled by the patient. A rolled paper filled with marijuana is called a joint, while a cigar wrap filled with marijuana is called a blunt. Both methods are definitely reliable for you getting a full blast of THC. A blunt seems to hit harder and get you higher than a conventional joint, but both are very highly effective.

The controversial downside to smoking marijuana is that it can damage the lungs and cause respiratory problems. Although results from clinical trials have been contradictory, many researchers believe herbal marijuana contains toxins and carcinogens that lead to increased risk of respiratory diseases and cancer and therefore recommend other methods of consumption of medical marijuana besides smoking.

However real studies of populations of cannabis users have failed to show the lung damage everyone expected to see and as the NHS report  accepted in 2011 there is "no conclusive evidence that cannabis causes cancer". THC - one of the main chemicals in cannabis seems to have anti-cancer properties which may account for this unexpected finding.

According to reports, if you do choose to smoke, here are some helpful tips to minimize the risk due to toxins and tars contained in the marijuana:

  • Use more potent, higher THC cannabis so less inhalation is necessary to acquire an effective dose.
  • Use a filter and non-chemical rolling paper if smoking a marijuana cigarette (joint) or cigar wrap (blunt).
  • Exhale immediately      after inhaling deeply to avoid the tars in the marijuana from coating your lungs. It is a myth that holding your breath will create a stronger dosage or enable more THC to be absorbed.

Pipe or Bong:

Essentially, a pipe is a bowl to hold the hash or marijuana with a tube to suck on. The smoke goes right from the stem of the bowl into your lungs. The longer the stem the better, as this allows the smoke to cool and the heavy tars to condense out before you breathe them in. The pipe may have a little hole on the side of it, which you cover while you are inhaling the marijuana smoke while holding the whole pipe and smoking. A pipe which has been in use for a few weeks will soon become full of thick sticky tar and will need cleaning out.

A bong can be many different styles but it’s all basically the same thing. The smoke is pulled through some water which gets rid of some carcinogens and makes for a much smoother hit. The chamber is a lot bigger than a bowl so you can clear it which may increase your high. Some studies have reported that bongs are a very safe way to consume marijuana because the water filters out the smoke, thus making them healthier to use.

Bongs get you stoned much quicker than joints particularly if there aren't many people sharing the hits. Bongs also deliver much more smoke in one hit than a pipe or water pipe so inexperienced smokers might find they get too stoned too quickly.

Such as the case with all things, patients must consume their medicine in moderation and always pay attention to how you and your body react to your medicine. If something doesn’t feel quite right with you after medicating, don’t hesitate to seek some help by telling your doctor, family, friends, or be sure to go visit the nearest ER!

Vaporizer

A vaporizer is a small to large size device that heats herbal cannabis to a desired temperature which causes the active ingredients to evaporate into a gas without burning any plant material. You will heat marijuana's active ingredients in the plant to a point where it produces a vapor (a fine mist), then inhale the vapor into the lungs. The correct vaporization temperature is around 320o Fahrenheit.

Hot air vaporization releases about five compounds, with THC being in the highest concentration, whereas smoking marijuana releases about 111 compounds. This is the non-smoked method most often recommended as an alternative to smoking. Patients can utilize it for most of the symptoms/conditions for which marijuana is recommended.

There are many vaporizers on the market, use due diligence when choosing the one for you. Prices can vary, and they are usually in the $200 - $500 range for a good reliable vaporizer. So although vaporizing may be the safest way to consume marijuana, it is also the most expensive. However, there are many new vaporizers on the market, and the open competition seems to be lowering prices. So you should take your time and do some research on the internet or visit your local smoking post or Head Shop.

Medibles (oral consumption):

Medibles are what we call cannabis that is infused in different foods for our consumption. Cannabis flowered tops and leaves are simmered in butter (or vegetable oil) for several hours, transferring the THC and other cannabinoids to the butter. The solid plant material is then discarded. The butter, now a dark shade of green, is then used in baking such items as brownies and cakes, or added to such foods as spaghetti sauce or soup. The oily base of the butter is needed for the cannabinoids to properly adhere.

This method is utilized by many patients suffering from pain and spasticity, and sometimes sleeps disorders. Although not the preferred method for patients suffering from nausea, vomiting or loss of appetite, it is sometimes used to supplement other delivery methods, or used by those unable or unwilling to smoke or use a vaporizer.

By consuming your medicine with medibles, patients have to realize that once the marijuana is consumed, it goes directly into your blood stream, which can get you very stoned and takes effect very quickly.

**Smoking cannabis results in a significant loss of THC and other cannabinoids through exhaled or non-inhaled smoke. In contrast, all of the active constituents enter the body when cannabis is consumed orally.

A warning for those choosing to medicate with edible marijuana – unlike with smoking and vaporizing, it is much easier to over-consume and therefore over-medicate with ingestion. Because it can take longer to feel the effect and/or because the edibles taste good, patients are warned to start with a small amount, wait an hour or two before ingesting more, and be extra careful in consumption so as not to exceed recommended dosage.

No Drugs Involved!

In summary, what we have in cannabis is a wonderful plant that can be used for a variety of things. This one plant can build cities or countries and at the same time feed and heal the people. There is no other plant in the world naturally grown with the capabilities of the cannabis plant. To be considered a drug and illegal, is the greatest folly the world has ever known. Hopefully as time goes on, more studies will show how this plant can help make the world a better place.

Everyone should take some time to read and learn about the cannabis plant and how it has played a major part in our world’s history!

Dell J.

http://www.leafly.com/hybrid

http://en.wikipedia.org/wiki/Cannabis_indica

http://www.thcdigest.com/indica-vs-sativa/

http://en.wikipedia.org/wiki/Cannabis_consumption

http://www.nhs.uk/news/2012/06june/Pages/cannabis-lung-health-risks-underestimated.aspx

http://www.theweedblog.com/smoking-marijuana-vs-vaporizing-marijuana-infographic/

http://www.thestonerscookbook.com/how_to_cook_with_weed.php

http://www.naturalnews.com/cannabis.html

http://www.hightimes.com/read/talking-terpenes

http://www.denalihealthcaremi.com

Prescription Drug Overdose to be Leading Cause of Accidental Death

 

Overmedication and Overdose

Prescription Drug Overdose is the second leading cause of death in 2013, new data suggests it will take the number one slot in 2014 beating car accidents.

According to a recent white paper released by the American College of Physicians, the CDC reports that prescription drug overdose with pain medications are a leading cause of accidental death, second only to motor vehicle accidents.  Current data being evaluated indicate that pain medication overdose will become the leading cause of accidental death in 2014.  As a result ACP has released a ‘Wake Up Call’ summarizing the problem and offering specific proposals to address the problem.

Denali Healthcare takes the over use of pain medications seriously.  There are roughly 116 million patients with chronic pain in the United States according to recent studies.  Approximately one in five patients that sees a primary care physician has a complaint of chronic pain.  To put this in perspective, the average primary care physician sees approximately 20 patients per day; of those, 4 are chronic pain patients.

If each chronic pain patient receives a prescription for 4 doses of Vicodin per day (120 doses per month) the math is straightforward.  Assuming 22 working days per month, the average primary care physician writes for approximately 126,720 doses of Vicodin per year (or the equivalent in other narcotics).  With approximately 30,000 primary care doctors in Michigan, this translates to a staggering 3.8 BILLION doses of narcotic pain medicine annually.

What Denali Healthcare is doing about this

Denali Healthcare Pain Management is dedicated to reducing the number of prescription drugs being dispensed and available in the community.  By only giving enough to control the symptoms of our direct patient, we eliminate the ‘excess’ that can be traded or given away.  We do this in several ways…

  1. Each patient is evaluated with ‘fresh eyes’.  Just because a patient was on a particular prescription pain medication program at another office, once they come to us, we will completely re-evaluate their previous medication, current need and reasonable expectations of treatment results.  We tend to be quite conservative in our approach to narcotic pain medication.
  2. We use combination therapy at Denali Healthcare.  NSAIDS such as motrin, naprosyn, mobic and voltaren work with narcotics to increase the potency of the narcotic without increasing the side effects or sedation.  This tends to reduce the amount of narcotics needed to control the pain to a reasonable level (generally about 50% of the pain level they had when they came to us).  We exclusively use long acting narcotics for baseline pain control with scheduled medication.  We reserve short acting narcotics (Vicodin etc) for ‘breakthrough pain’ and in very limited numbers.
  3. Denali Healthcare uses ALL non-surgical pain control available.  We fully embrace chiropractic, massage, acupuncture, biofeedback, medical marijuana, and counseling and recognize that each in their own way work toward a common goal of pain relief.
  4. The Suboxone Program at Denali Healthcare is here to help those with addiction to narcotics.

For the full discussion and links, go to Prescription Drug Overdose

 

Denali Healthcare of Michigan has New Website!

 

Professionals take over the Denali Healthcare website

Our new Denali Healthcare website is published and in a shakedown cruise stage.  While our www.drbobmmj.com is still up and running, this new website reflects our movement as a practice into pain management and addiction therapy.  We currently run 8 offices from Kalamazoo to Marquette, along with over 20 outreach clinics and have grown to be the premier regional certification practice in N. Michigan.  Now it is time to increase our pain management and narcotic addiction services, increase professional staffing and bring the practice to the next stage of development.

New Features- Check them out!

We’ll be adding content over the next several weeks, including articles, blog entries by myself and other guest authors, each of the offices have their own page with schedules and news and an associated (facebook page).  Rather than try to run all this myself, I’m going to concentrate on patient care and turn the website over to professional webmasters so the presentation is as professional as the medical services we provide.  The Denali Healthcare website will be professional and on the level of a hospital website.  That is what our patients expect and what we want to present to the world.

Please take a few moments to explore the site, then check back every few days to see the updates and new content.  We’d like to get your feedback on features you want to see.  A couple of differences that should be apparent right off the bat is that we’ve gone from joomla to wordpress, the articles now can have reader comments, and visually the site is less cluttered and easier to navigate.  Overall it will evolve into a very useful tool for the pain, addiction, and medical marijuana community in Michigan.  Please explore and suggest ways we can improve it for you.

- Dr. Bob Townsend

 

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