An Interview with Dr. Ed Hoffman on Medical Marijuana Edward M. Bernstein: Well today it's all going to be about medical and about your health first we're going to talk about what is the criteria for a medical marijuana license here in Nevada and then a little bit later in the show we're going to talk about probably the hottest item in the news when it comes to medical issues. Concussions, what that means for your child, what it means for professional sports how you diagnose concussions and where to go if you do suffer a concussion. But first I have with me Dr. Reid Hoffman general physician and I wanted to chat with you because there seems to be a lot of confusion about what type of criteria people need to have to qualify for a medical marijuana card and we have a statute in Nevada that authorized licensing for medical marijuana patients but there are really several very precise criteria that qualify is that correct? Dr. Edward Hoffman: Yes that's correct. When you apply for a medical marijuana card you first have to put it in for an application once they send you the application then you have to fill it out and in the application, there is a physical form and on that form is the specific criteria for the state of Nevada what will qualify you for a medical marijuana card. Edward M. Bernstein: It requires an in-depth medical examination a review of Records right? Dr. Edward Hoffman: That is correct any physician does should document why they are recommending it and that is actually also in the regulations that you should document and also explain the risk and benefit. The conditions that qualify you basically are listed as 'Acquired Immune Deficiency (AIDS] so medical marijuana can help the nauseous and appetite. Cancer which you know covers a wide field of pain, nausea and sleep disturbance. Edward M. Bernstein: chemotherapy a lot of these like the AIDS medications, cancer medications the side effects of a lot of these autoimmune medications is Nausea or loss of appetite when it comes to eating. Dr. Edward Hoffman: In fact, there were two medicines that before the Nevada Legislature okayed medical marijuana the federal government actually had approved for the nauseousness from chemotherapy, one of which is called Cesamet and the other one is Marinol which have been around for a longer period of time but they are the only two that the federal government has approved. Marin is some type of synthetic THC marijuana. There is also glaucoma which is the pressure built up in your eyes. Edward M. Bernstein: It's one of the original medical conditions that I can recall that people who suffer from glaucoma would be able to use marijuana to ease the pressure in the eyes. Dr. Edward Hoffman: That is correct there was a case that a gentleman sued the federal government because this was the only thing that was helping him and preventing him from going blind and from that point on there was a little more liberal attitude about using marijuana for glaucoma. Edward M. Bernstein: Right so what it is, it doesn't cure it lowers the pressure. Dr. Edward Hoffman: That's right, it's one of the main treatments you can do for glaucoma. The other condition post-traumatic stress disorder in which you know most people think of as an example would be 'I was in Vietnam and I suffer night terrors and you know I have anxiety and stress'. But post-traumatic stress can come from a car accident, people have recurrent nightmares of the accident recurring. There are many things that fall under the broadest of the particular criteria of post-traumatic stress there are childhood things, you know child abuse. There's a lot of things that can cause post-traumatic stress. Edward M. Bernstein: That's why so often you hear about veterans coming back either from Iraq or Afghanistan They've been serving the Middle East and there's a lot of PTSD. Dr. Edward Hoffman: That's correct but just not only from those things as I said it can occur with car accidents and childhood issues, but there are also many things that can cause post-traumatic stress. Also one of the things listed is a medical condition that produces cachexia which is a lack of appetite, persistent muscle spasms such as that in people with multiple sclerosis seizure disorder. I think there was that Charlotte's Web CNN Report about it. Once again the conditions that cause severe nausea usually you know cancer chemotherapy for the most part and severe pain which can come through a lot of things like for instance I have a patient that has had multiple back surgeries and even though he's had two back surgeries he still has pain and he's depressed he doesn't sleep and to me instead of giving him pain pills, sleep medicines and anti-anxiety medicines medical marijuana makes sense to me. Edward M. Bernstein: Particularly because it's less strong, it's different than then taking oxycodone or Dilaudid or something like that. Dr. Edward Hoffman: There's always an addictive potential for everything but I would think that at least the medical marijuana is more natural, it can cover all three of those particular things where otherwise I'm getting them from three different medications. You can probably find a hybrid strain of medical marijuana that will deal with all those issues. So you'll be doing one thing instead of three and to me, it's maybe a better answer than giving them pain medications and antidepressants. Edward M. Bernstein: Which in of itself is not a criteria in Nevada like in some states. I believe California may be one of them if you have troubled insomnia and you can't sleep you're eligible for a medical marijuana license. In Nevada that in and of itself is not a criteria. Dr. Edward Hoffman: That is not a criteria, if somebody has post-traumatic stress and has a sleep disorder that would then it would fall within that but as far as just sleep disorder by itself, the answer is no. Edward M. Bernstein: You know it seems to me all those categories I can put into one of three categories either the pain category the glaucoma category or I think that probably the broadest category is how the effect of medical marijuana with gastro issues with being nauseous with appetite issues that type of thing for some reason there's something in the medical marijuana that does help with nausea and it helps almost immediately. Dr. Edward Hoffman: That's true because when you smoke medical marijuana you get your fastest response as opposed to taking something by mouth which can take several hours to take effect. Edward M. Bernstein: Why is that by the way? Dr. Edward Hoffman: Well it's the rate of absorption when you smoke marijuana it gets in your body faster and also is eliminated faster. When you take edible marijuana it takes a little longer to act and stays with you longer but it's just part of your body's metabolism so it's just the way you metabolize things. Edward M. Bernstein: So the digestion of it takes a whole lot longer. Yeah well and there's kind of a catch-all phrase in our statute that if you don't have a condition that's specifically listed where you can apply or petition the state based on one's medical records or your personal condition. Dr. Edward Hoffman: It says that according to any other medical condition it can be classified as a chronic or debilitating medical condition by the regulation of the State Health Division and proved as a chronic debilitating medical condition pursuant to a petition submitted in accordance with Nevada rules and regulations. So you know there's always those rare conditions or something that maybe hasn't been thought about that you can petition the State Department of Health to allow you to be a candidate for medical marijuana. Edward M. Bernstein: Now a lot of the information that we get on other drugs is not really necessarily available yet for medical marijuana because a lot of the drug companies and testing labs are precluded under federal law, I'm studying some of these things. Dr. Edward Hoffman: Right if I can remember correctly the Medical Marijuana Act of 1937, before then it was being used quite often in medicine. In 1937 there was a medical marijuana tax act and they changed it to a schedule to which was considered a dangerous drug, schedule two, highly addictive and having potential for addiction to be greater. Then because of that in order for research to be done in the United States, you have to go through the drug enforcement. you've got to go through the FDA and there's only I think one place where you can get federally licensed medical marijuana for research. This has been a big drawback of why there are no large-scale studies of the benefit of marijuana. There's a lot of studies but there are only small numbers of patients and obviously I think more research is called for to firmly establish the benefit of taking natural medical marijuana. Edward M. Bernstein: It's kind of interesting because most prescription drugs or maybe all are somehow derived out of plant life isn't that the basis and the origins of everything we do? Dr. Edward Hoffman: Well not everything but obviously herbal medicine, actual medicine has existed for thousands of years, for instance, Digitalis know came from a plant in South America and how many people with heart conditions have taken Digitalis. There's a lot of other medications that are plant-based then let's start adding plant-based as treatment. Edward M. Bernstein: Okay well this has been very interesting and thank you for clearing up some of this. We'll be right back with Dr.Scott Pensivy and Dr. Branch Were going to talk about concussions I'm sure you see a lot of that in your practice. Dr. Edward Hoffman: Well you know concussions happen, car accidents as you well know, football injuries, people slip and fall hit their head, concussions are such a common occurrence in everyday life that I think what you're going to hear next is very important. Edward M. Bernstein: Yeah and it's going to really stretch some light on hey how do you know you have one when to go to a doctor when you go to a hospital. We'll be right back and talking about concussions.