I respectfully disagree.  Let me give you some very specific examples that proved otherwise.

1. Vioxx: FDA approved and marketed by Merke.   Was deemed “safe” by the FDA to treat pain associated with arthritis.   Turns out that the drug actually increased the risk of fatal heart attack and stroke in patients taking it.   it was eventually pulled off the market.   Merke had to settle millions of dollars in lawsuits.

2. Oral Estrogen Hormone Replacement: for 20 years we were telling patients that it was not only safe, but also lowered a womnes risk for heart disease and osteoporosis.   Well it turned out that the oral estrogens that they were using and FDA approved were derived from the urine of pregnant horses.  In 2002 The Women Health Initiative Study was stopped because of increased risks of heart disease, osteoporosis, certain cancers and blood clots.

3. Opiates:  Drugs like oxycontin and vicodin are FDA approved and deemed safe.   The use of prescription, FDA approved, opiods results in more deaths than from heroin (schedule 1 drug) and cocaine combined each year.    Yet they are most commonly prescribed medications for chronic pain.    

There are  A LOT more examples of drugs that went through the FDA approval process that have been yanked from the shelves because they were not safe at all.

So this brings us to medical marijuana, a NON FDA APPROVED PLANT.    Research has shown that cannabinoids are affective for treating pain, reducing nausea, stimulating the appetite, protect neurons from oxidative stress, reduce intra-ocular pressure and reduce inflammation.

It is also a fact that no one has ever died from an acute overdose of marijuana (directly from the medicine).   Millions of Americans use it recreationally every week yet we do not see any ill effects to the major organ systems in the body (liver, kidney, heart, lungs)

I am not arguing that cannabis is a completely benign drug.  However I am arguing that just because it has not gone through the FDA approval process that it is somehow unsafe and should not be recommended.   Some of the most respected oncologists in the world at HOAG hospital routinely refer patients to me for medical marijuana recommendations because it works.

So to the Kansas doctor that argued against the use of medical marijuana for the cancer patients in your state, I would rethink your public comments that honestly make you look “bought”.

Patients often question if marijuana is addicting, if they can develop a dependence, tolerance and/or experience withdrawal symptoms.    The DSM-IV manual (main psychiatric diagnosis manual) defines cannabis dependence:  It reads as follows:

“The essential feature of Substance Dependence is a cluster of cognitive, behavioral and physiologic symptoms indicating that the individual continues use of the substance despite significant substance-related problems”. Accordingly, a diagnosis of substance dependence is made if three or more of the following criteria occur at any time in the same 12-month period:

• Tolerance, as defined by either or all of the following:
  • A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
  • A markedly diminished effect on the user with continued use of the same amount of the substance
• Withdrawal, as manifested by either of the following:
  • Characteristic withdrawal symptoms from the substance, such as insomnia, restlessness, loss of appetite, depression, irritability, and anger.^[42]
  • The same or closely related substance is taken to relieve or avoid withdrawal symptoms
• The substance is often taken in larger amounts of over a longer period than was intended
• There is a persistent desire to cut back or control substance use, or unsuccessful attempts to do so
• Considerable time is spent obtaining the substance
• Social, occupational or recreational activities are given up or reduced because of use of the substance
• The substance is used despite knowledge of persistent or recurrent physical or psychological problems caused by the substance.

It has been my experience speaking with patients that when marijuana is used therapeutically to treat a certain conditions (i/e pain, headaches, nausea) there isn’t the amount of dependence that is seen with recreational use.    There has been evidence in the literature of patients requiring more medicine to get the same effect of the drug.    However this usually plateaus at a certain dosage.

I do see a withdrawal syndrom in patients who have used marijuana recreationally for prolonged periods of time (daily for years).  When they stop they experience irritability, insomnia, difficulty focusing and depression.     These effects can be mitigated in the patient who uses medical doses for a specific condition by taking a drug holiday (usually one week every few months).   Scientist are not exactly sure of the mechanism for which dependence develops but feel its most likely due to changes in the CB1 and CB2 receptors.

Studies of long term marijuana users (recreational) have shown over 50% experience dependence issues.    Research points to risk factor for dependence as: regular daily use (or more than 3x/week) and when people start using in their teens.  Adolescents over experience amotivation and fall behind in school and other scholastic achievements.

My primary focus is trying to determine if the benefits of using marijuana outweigh the risks for patients, not recreational users.  The majority of my patients are using medical marijuana as a substitute for another drug.  For example, they use marijuana instead of opiates for pain, benzodiazepines for anxiety and sleep and other drugs with far more potential for dependence, withdrawal and tolerance.     So I guess you have to look at each case individually and make a determination what is best for each patient.

For example today I had a pain patient who has been using a fentanyl patch and also using oxycodone for breakthrough pain.   He has been able to reduce his oxycodone dose from twice daily to maybe one pill a week.  That in my mind is significant and is worth studying.   If you could follow the path of a pain patient on oxycodone and parallel that with someone using medical marijuana I think the results would show significant less morbidity and mortality from using marijuana.   The chronic nausea and constipation alone associated with opiate use is enough justification to use medical marijuana.     This is strictly from thousands of discussions with patients about the overall quality of their life.

In conclusion, I do believe that there are tolerance and dependence issues with marijuana.   However we need to study the right populations to see if this is the case with medical doses vs recreational use.   Secondly, the must also consider the risk/benefit ratio of using medical marijuana in RELATION to the other medications that patients WOULD be using.

More studies need to look at this so that we can give patients more scientific data vs speculation and an educated guess.

Feel free to leave comments about your thoughts on this issue.

Be blessed,

She was happy to report that since she started using medical marijuana she has not had to take one other medication!   Cannabis use in the elderly is rapidly increasing.    Elderly people socialize together and talk.  As soon as she told all her friends at Leisure World about her success they are ready to sign up.  READ ON…

For the first time in my 3 years of practice recommending medical marijuana, my elderly population are the majority of my patients.   This is a trend that been increasing every year.    More and more elderly patients are hearing about the benefits of using medical marijuana.   They are tired of taking pills and are jumping at the opportunity to replace all those pills with one plant.

Here are the stories of just some of the elderly patients I had in the past few weeks:

75 year old male who uses medical marijuana to increase his libido.  He is still sexually active with his wife or 40 years but requires cannabis to get aroused.  He said it works “fantastic”

85 year old women who uses a fentanyl patch to regulate severe back pain as a result of degenerative disc disease.  She is switching to marijuana.

65 year old women with systemic lupus.   She has been on methotrexate and other immune modulators but recently tried medical marijuana and felt great.

71 year old man with advanced colorectal cancer who is undergoing chemotherapy.  He is using medical marijuana to improve his appetite and reduce the nausea associated with chemo.

79 year old man who suffers from sever pain after having 9 back surgeries.  Currently taking Opana which is an opiate based pain killer.   He recently spoke to a friend who suggested he try medical marijuana.

The elderly are my favorite patients.  They appreciate life and just want the day to day/minute to minute moments to be comfortable.   They are at the point where every breath is precious.   They are SO appreciative of the care we provide and thank us the most.

As I just mentioned the area that is inflamed with Tietze’s syndrome is where the ribs attach to the sternum (breast bone).  Typically it occurs on the second rib but it can affect any of the 12 ribs.   There is characteristic inflammation and swelling which causes chest wall pain.   The pain with this syndrome can be severe and many patients go to the ER thinking they are having a heart attack.   In most cases doctors must rule out a heart attack because the symptoms can be so similar.    Fortunately these patients are told they are NOT having a heart attack but unfortunately many doctors do not make the diagnosis of Tietze’s syndrome…. since it is not too commonly seen.

These patients typically have pain that can last from weeks to years and it is chronic in nature.   A similar syndrome called costochondritis is an acute inflammation of the costocartilage but can be differentiated from Tietze’s syndrome by a lack of swelling, an acute onset and course and it also typically affects multiple ribs.

Medical treatment for Teitze’s syndrome is pretty standard.   Patients are prescribed NSAID’s like motrin or naprosyn.    Doctors can also give corticosteroid injections at the site.    Other patients are sent for physical therapy since pain can be worsened by motion.  Unfortunately none of these treatments are curative initially.

In this case my patient stated that the medical marijuana relived his pain by about 90% and it allowed him to get a full nights rest.  He simply vaporized a pure indica strain when he arrived home from work and it almost immediately alleviated his pain.

Cannabis (marijuana) has anti-inflammatory properties.  Studies still need to be done to find the exact mechanism but ultimately it reduces the activity of the blood cells that cause inflammation.  Cannabis also acts as an analgesic (anti-pain) by binding directly to receptors on the nerves in the brain and peripheral nervous system.    So in cases like this it can be a safer alternative than chronically taking NSAID’s (which can cause ulcers and bleeding) or opiates which can be highly addictive.

If you are suffering from Tietze’s syndrome and would like to discuss alternative treatments feel free to contact me or schedule an appointment.

Be blessed,

Darvocet is an opioid narcotic used to treat pain.  It is the same class of drugs as percocet, vicodin, hydrocodone, oxycontin etc.   It was approved by the FDA in 1957 and has been regularly prescribed for pain in around the world.  DOCTORS CONSIDERED IT SAFE BECAUSE THAT IS WHAT THE PHARMACEUTICAL COMPANIES THAT STUDIED IT SAID.

WELL ONCE AGAIN THE MEDICAL COMMUNITY GOT IT WRONG.  And in this case patients died because of it.    IT IS FOR THIS REASON THAT SO MANY OF MY PATIENTS COME IN AND TELL ME “I WANT OFF MY PAIN PILLS AND WANT TO USE SOMETHING MORE NATURAL AND SAFER”… HENSE THE REASON MEDICAL MARIJUANA IS THRIVING RIGHT NOW.

Time and time again in medicine our current practice standards turn out to be detrimental to the overall health of women.   And not often enough do physicians look at the overall nutrient depletion effect of prescribed drugs.  It is shocking to hear how many patients are given prescriptions like they are nothing at the drop of a hat when they tell their doctor they have pain.

Opiate narcotics (“pain pills”) are not safe to take long term.   They are addicting, nauseating, constipating and can cause respiratory depression and death.    More and more patients are developing opiate addictions and more doctors are prescribing them.  I have come to realize that the majority of MD’s have no other arrows in their quiver when it comes to pain management.

To the contrary, osteopathic physicians can also treat using physical manipulation or energetic medicine to reduce pain (i.e cranial-sacral therapy).  Acupuncturist use the bodies energy to treat pain.  Chiropractors use physical manipulation and soft tissue techniques to reduce pain.

Where does cannabis (marijuana) fit in?   Cannabis is used by thousands of patients to get off all the opiates and NSAID’s (i.e. motrin, naprosyn) medications that are riddled with side effects.

Cannabis has been shown, in small doses, to significantly reduce pain in patients.   It does so by binding to CB1 receptors located in the central and peripheral nervous system.    It actually mitigates the pain transmission.  Unlike opiates, it is not addicting, you can not overdose and it is not toxic to any of the major organ systems.   It can be vaporized in very small doses safely.

Time and time again we here about drugs that are commonly prescribed all of a sudden being unsafe!  Vioxx (for arthritis), glyburide (for diabetics), HRT (hormone replacement therapy- NON bio-identical), Darvocet (for pain) and NSAID’s (increased cardiovascular risk).   These are drugs that physicians were told by big pharm that they were tested and safe!

My advice to patients: try every non drug/surgery treatment option prior to starting medication UNLESS withholding drug/surgery poses an immediate risk to your health.

Many patients who suffer from pain experience this same regimen of medications.   All of which may work temporarily but none of which are a good long term treatment plan.  Overuse of ibuprofen leads to stomach and intestinal ulcers and bleeding, heart attack and stroke (potentially).  Overuse of vicodin leads to addiction and dependence, constipation, nausea, itching and mental status changes.  Prednisone, although initially will limit inflammation, will cause many sever side effects (hyperglycemia, osteoporosis, weight gain, psychosis, increased appetite, depression/anxiety, infection due to weakening of the immune system, easy bruising, fatigue).

Amazingly, I expect this patient to get off ALL of these medications and use cannabis daily.   THIS WILL SIGNIFICANTLY IMPROVE THE OVERALL QUALITY OF HIS LIFE.   Eventually, hopefully, he will be able to use cannabis sparingly and be pain free.   BUT, if he has to use cannabis every day the rest of his life… no big deal!   Compared to these other drugs it is much safer.  He can not overdose, it will not cause ulcers and it does not effect any of the major organ systems like these other medications do. If used daily, we just recommend every few months giving your body a break for 5 days or so.

70% of my practice is taking care of pain patients.    Medical marijuana, when used in conjunction with Osteopathy, Chinese Medicine (acupuncture), physical therapy and meditation/prayer, is a highly effective and good long term treatment plan.

For more information about how to make an appointment to see me call my staff at 877-721-0047 and come on in.  We have offices in Irvine and Long Beach California.

Be blessed,

Dr. Breen

http://www.cbsnews.com/8301-504763_162-20015148-10391704.html

Although the study had only 23 patients in its pool I think their findings align with my conversations with over 5000 patients who I have treated for chronic pain.

The reason why cannabis works to control pain is because our body harbors receptors to the medical active ingredients in the plant (cannabinoids) throughout our nervous system.   Specifically the brain, spinal cord and peripheral nerves.   Researches identified these receptors in the mid 1990′s and also identified a cannabinoid called anadaminde that our body produces naturally. This was a significant finding as it gave validity to the stories of patients who state that cannabis is just as effective as any narcotic in treating pain.

One of the advantages that cannabis has over other pain medications is that it does not have the serious side effects that you get with NSAID’s and opiates (Vicodin, Oxycontin, Percocet, Morphine, Fentanyl).   Specifically cannabis is not addictive, does not produce nausea and constipation and also is not going to tear a hole in your digestive tract or shut down your liver.   In fact if NOT smoked cannabis has not been shown to be toxic to any of the major organ systems.   ALL OF THESE ATTRIBUTES AD UP TO AN IMPROVED QUALITY OF LIFE…. IMMEDIATELY.

Today in my Irvine office I had 17 patients, 12 of which requested evaluation for chronic pain from a variety of disorders.   One man had daily headaches with nausea for the past 2 years.  Another women suffered from severe menstrual cramps.    I had one 61 year old mother who was hit by a drunk driver going 90mph in 1985 and shattered her pelvis and lumbar spine.   She has been using cannabis daily for years to help her get to sleep and reduce the pain after work.

Many of you reading this have no idea that you can get relief for chronic pain using medical marijuana (cannabis).   You DO NOT HAVE TO SUFFER LIKE YOU CURRENTLY ARE ANY LONGER!  Simply contact our office to come in and receive a recommendation to use medical marijuana.  You have nothing to lose.  If it doesn’t work than simply do not use it.   If it works then GREAT!

I have offices in Long Beach and Irvine and you can contact us by calling 877-721-0047 or through our website at www.MCSoCal.com

Be blessed,

Dr. Breen

Doctors are very quick to hand out prescriptions for opiates such as vicodin, soma, percocet, fentanyl, morphine etc.  Many MD’s have no idea what else to do to treat patients with pain.   They don’t have the skills to treat the anatomy like an Osteopathic physician, can not adjust like a chiropractor or treat pain with needles like an acupuncturist.  They simply hand patients a script and hope for the best.   I know that sounds very simplistic and condescending but honestly in many cases it’s the truth.

Opiates can cause nausea, constipation, pruritus and can be highly addictive.   Cannabis has none of these side effects and has been proven to have analgesic properties even in small doses.  If vaporized patients expose themselves to NO smoke or carcinogens.

If you are taking opiate medications for pain and would like to see if you can benefit from using cannabis feel free to give us a call and schedule an appointment. 877-721-0047

Be blessed,

Dr. Sean Breen

If you are suffering from pain and want to get off all the pills your doctor has you on please pick up the phone and give us a call.  I can help come up with a pan to ween you off your pain pills so that you can too take back control of your life.

877-721-0047 or go to our website at www.mcsocal.com

I see patients full time in Irvine and Long Beach.

Respectfully,

Dr. Breen

TWO WEEK UPDATE: Sam is down to ONLY 2 PILLS A DAY!!!! She takes one oxycontin in the morning and a norco in the afternoon.  I sat down with her and this is what she said.

“CANNABIS HAS SAVED MY LIFE!”  WOW!  LAST MONTH HER PCP WROTE HER A PRESCRIPTION FOR 600 OXYCONTIN!!!! INSANITY.

I realize that running this practice is NOT going to be a glaring star on my resume.  In fact many of my colleagues will shun me for being a part of this industry and this medicine.

BUT IT IS THE SAM’S OF THE WORLD THAT KEEP ME MOTIVATED AND REMIND ME THAT I AM DOING THE RIGHT THING!  WHAT A SUCCESS STORY.

I AM GOING TO TRY TO GET HER TO DO A VIDEO TESTIMONIAL FOR THE WEBSITE.  SHE IS SUCH AN INSPIRATION TO ME AND WILL BRING HOPE TO ALL THOE PATIENTS WHO HATE THEIR PAIN PILLS!