Archive for July, 2010

Taxing Medical Marijuana;

Posted By Dr. Sean Breen on July 30th, 2010

As medical director for Medical Cannabis of Southern California I evaluate patients for medical marijuana recommendations full time.   I keep reading in the news about California and cities wanting to impose special taxes on the sale of medical marijuana.   Medical Marijuana should be taxed, but not at a higher rate than any other business or industry. This increased tax rate will only be passed on to patients.   Insurance does not cover medical marijuana so the burden is going to fall on patients which is not right.

An increase in the tax imposed on dispensaries will only fuel the black market for medicine where growers are operating under the radar and DO NOT pay sales tax.    I think what cities and the State needs to do is allow current dispensaries to operate FOR PROFIT so that they can show income and revenue.  They need to establish land use ordinances to determine how many they want in the city, allow them to get business licenses and pay taxes like everyone else.   Just treat them fairly!

Imposing a 10% tax rate plus and additional 2.5% like I have been reading about is going to be the nail in the coffin for many dispensaries.   The collective/dispensary business is not the cash cow that people think.   Most do not grow their own medicine and have to pay very high prices to get it from the growers.   Then there is a lot of competition which is keeping prices down.  The people who are going to suffer ultimately are the patients.

I similar example was the California Tax on cigars.   They decided that they were going to increase tax revenue by charging people who smoked cigars extra money.   Do you know what happened??  The local cigar shops got crushed because people now order them online from out of state to save the money.  The local cigar shops and the State of California are making $0.0 dollars on those sales.   Their thinking is counterintuitive and not effective.

Folks, before you get all excited about the increase in revenue your city is going to get you need to figure out what ultimately is going to happen by imposing higher tax rates on medical marijuana.

Posted in medical Marijuana Law
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Long Term Affects of Medical Marijuana on the Brain and Cognitive Function; A discussion

Posted By Dr. Sean Breen on July 29th, 2010

As medical director for Medical Cannabis of Southern California I evaluate patients daily for the use of medical marijuana.   Often patients ask me if cannabis (marijuana) has any long term adverse effects on the body.  It is a great question and one that can not be answered with 100% confidence until more research and studies are completed.   Cannabis research has been limited because of the federal governments currently classification system which states that cannabis is a schedule 1 drug (no medicinal value).  It is difficult to get any funding to study this incredible plant.

Before I discuss what is currently known about marijuana’s affects on the central nervous system short and long term I want to stress that you always have to weigh the benefits and risks of any medication that you take.  And in the case of marijuana you have to consider what medications you WOULD BE TAKING instead of using cannabis and the risks that they pose as well.   Most of the time cannabis is much safer and effective.

Most people have heard someone say at one time or another “that guy is burnt!”… meaning their brain is pretty much fried and they are not solving any calculus equations anytime soon.   The question becomes: does long term use of cannabis adversely affect the brain.   Short term, while acutely medicated, it is pretty clear that cannabis has an affect on short term memory, attention, coordination, balance, reflexes and hinders higher executive functioning (learning and problem solving).   It is for this reason that patients must be very responsible when medicated.   Researches believe that most of these symptoms are a result of THC (tetrahydrocannabinol) which is that main psychoactive ingredient in the plant.   There are over 60 other cannabinoids that we know of in the plant which also exert their effects on the body. An example is cannabinol which is believed to have anti-inflammatory and analgesic properties without the psychoactive affects that THC has.   This is significant as we move forward with therapeutic applications of the plant.

In the long term the research is less clear.   There have been studies that have shown that long term (chronic  daily) heavy users do exhibit some impairment in higher cognitive function (executive functions such as learning and problem solving) but it is difficult to distinguish from the loss of cognitive functioning that occurs naturally with aging.   There have been studies that demonstrated that chronic cannabis users also have a higher incidence of psychiatric comorbidity like anxiety, depression and irritability.    Certainly I have discussed cannabis use with patients who have been medicating for 30 years or more and they do say that if they don’t have access to cannabis they experience increased irritability, mood swings, insomnia and at times depression.   These are considered moderate withdrawal symptoms that some patients can experience.  It is for this reason that we suggest patients take “drug holidays” every few months for about 1-2 weeks to give their bodies a break and chance to “reset” their natural endogenous cannabinoid system.

One of the other questions is if regular heavy use of cannabis affects an individuals drive or motivation.  People describe users having “amotivation syndrome.”   They question whether cannabis affects their ability to reach goals etc.     My personally feeling is that in recreational users this can be the case.    However using cannabis as a medication is completely different.  Patients typically use less psychoactive strains of cannabis and are using much smaller doses.   Most patients just want relief of their symptoms and nothing more.   In these situations I have not found cannabis to affect a patients ability to work or reach goals.   Most get more sleep, are less stressed and have less pain which allows them to be more productive.

Overall I would say that cannabis in therapeutic doses for medicinal purposes poses very few adverse affects to overall patient functioning.  The major organ systems are not affected and the the acute psychiatric affects of the medication are limited.   Long term, patients do much better because 1) they are not dependent on other medications and 2) their day to day quality of life is improved.  I clearly think that the benefits most patients receive outweigh the risks of using cannabis long term.

If you have questions or comments feel free to contact me at any time or come in for an appointment. 877-721-0047 or www.mcsocal.com

We have two full time offices in Irvine and Long Beach California.

Be blessed,

Dr. Breen

Posted in disease treatment
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Medical Marijuana Recommendations by Web Conference? Negligent Doctors stoop to new lows

Posted By Dr. Sean Breen on July 29th, 2010

It is really unfortunate the lengths that doctors are going to make money these days.   Recently medical marijuana recommendation clinics have opened up where the doctor see’s you over skype video conference.   The state medical board is very clear when they say that physicians MUST PERFORM A PHYSICAL EXAM when recommending cannabis to patients.    No doctor in their right mind would ever prescribe a blood pressure medication to a brand new patient that they have never met without meeting them in person and doing a physical exam.   So why would they do it for a medication like cannabis?? The simple answer is GREED.

Many of these doctors were in the medi-spa business (botox, laser skin care etc.) which has taken a nose-dive in this economy so they are looking to make a quick buck by performing medical marijuana recommendations over the internet.    It is amazing to me that they are putting their medical license at risk over the $80 they are charging.

Patients need to understand that these clinics will ultimately by shut down and their recommendations  are not legitimate.   These doctors will eventually be caught and disciplined by the medical board.  Some will lose their license to practice medicine in California.

Make sure when you are calling to find a doctor to discuss the benefits and risks of using cannabis that you ask them “will a doctor physically be there to examine me?”   If the answer is no then I would strongly encourage you to look elsewhere.

If you have questions feel free to contact my office at 877-721-0047

Be blessed,

Dr. Breen

Posted in Medical Ethics
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Medical Marijuana Patients In Irvine, CA July 27, 2010

Posted By Dr. Sean Breen on July 28th, 2010

If you are wondering what types of patients come in to see me for a medical marijuana recommendation, here is a list of all the complaints for the patients I had in Irvine today.  Most patients are coming in because of pain.   They are typically tired of using opiates such as vicodin and oxycontin and want an alternative.   Many of my patients are women in their 50’s and 60’s who are willing to try anything to get relief.

61 year old white female who using cannabis for her restless legs syndrome.

34 year old white male who has a diagnosis of anxiety and depression.

61 year old white female who suffers from arthritis

55 year old white male who had surgery to repair C5-6-7 herniated discs following a motor vehicle accident

51 year old white female who is going through menopause.  She has symptoms of anxiety, hot flashes, insomnia and is easily irritated.

41 year old white make who had reconstructive surgery on his right ankle and suffers from arthritis.

27 year old white female who suffers from anxiety since the age of 17.  She uses cannabis instead of xanax.

25 year old white make who injured his C6-7 vertebra surfing.   He uses cannabis for pain management.

59 year old white female who has sciatica and chronic lower back pain.  She uses cannabis instead of oxycontin.

You would be very surprised by the typical patients that I see using cannabis for their symptoms.   I think the majority of people when they think of medical marijuana envision “teenagers getting stoned.”  That is not the case and quite the opposite.

If you are suffering and would like more information on whether or not cannabis can help you improve the quality of your life feel free to call our office at 877-721-0047 or contact us online at www.mcsocal.com

Be blessed,

Dr. Breen

Posted in disease treatment
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Veterans Administration (VA) to Approve Medical Marijuana Use for Disabled Veterans

Posted By Dr. Sean Breen on July 27th, 2010

It has been a long time coming for United States Veterans who are in need of medical marijuana to treat their symptoms.   It has been VA policy that patients who have admit to using marijuana to treat their ailments would not be approved for benefits of other treatment modalities.    Because of the overwhelming numbers of veterans who suffer from PTSD, difficulty sleeping and chronic pain the government finally approved the medicinal use of marijuana.

This decision is near and dear to my heart.  I am a combat veteran and served with 1st Battalion 4th Marines in Iraq from Jan-Sept 2003.  I have been on the battlefield and know exactly what they are going through.  I have seen both Marines and Navy Corpsman take bullets for their country and am honored to have this opportunity to give back and take care of them.

I currently see patients full time in Long Beach (next to VA hospital) and Irvine  for medical marijuana recommendations. I have had more than a handful of veterans come in despite the VA’s old stance on medical marijuana.   They are my most rewarding patients for personal reasons.

It is time for these veterans to get a good nights sleep, stop their opiate dependency and reduce their dependence on benzodiazepines for their anxiety.

To make an appointment to come in and see me simply call my staff at 877-721-0047 or contact us through my website at www.mcsocal.com

Semper fi,

Dr. Breen

Posted in Medical Ethics, medical Marijuana Law
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Medical Marijuana and Medical Records; The Proper Marijuana Evaluation

Posted By Dr. Sean Breen on July 23rd, 2010

After testifying in court yesterday for a patient of mine arrested for cultivation in San Diego I can not stress enough the importance of working with a medical clinic that demands medical records.    The first thing the court did when they arrested him was to subpoena his medical file.    The judge wanted to make sure that he was a legitimate patient.    The great news for my patient was that we had HIS ENTIRE MEDICAL history intact.  Everything was done according to the letter of the law.

If you a medical marijuana patient or want to obtain a doctors recommendation make sure you make the extra effort to get ahold of your medical records.  The clinic MUST keep them on file for you.   You do not want to be in a situation where your recommendation is not valid because the doctor did not perform a face to face exam and document your illness.

Per the attorney, most doctors are not willing to take the time to show up at court and testify.  Her last case involved a doctor from MMEC (medical marijuana evaluation centers) who has this attorney protection plan…. who refused to show up to court on behalf of her client who was the patient.   She said it really hurt his case.

If you would like to discuss whether or not medical marijuana can improve the quality of your life feel free to call us at 877-721-0047 or contact us through our website at www.mcsocal.com

Be blessed,

Dr. Breen


Posted in medical Marijuana Law
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How to Defend a Medical Marijuana Patient Arrested for Growing Marijuana

Posted By Dr. Sean Breen on July 23rd, 2010

Today I had to appear in court for a patient of mine who was arrested in San Diego for intent to sell marijuana.  He and another patient set up a grow on their property with 180 plants.   They were both legal patients.  Today was a preliminary hearing in front of a judge to determine if their was probable cause that a crime was committed to proceed to trial.   The burden of proof for the prosecution is very minimal.

My role was to testify on behalf of my patient that he was in fact a legal patient, had the right to grow marijuana for consumption and was growing a reasonable amount of medicine.   After stating my credentials my patients attorney attempted to ask me: “In your opinion, what is a reasonable amount for a patient to possess for personal consumption?”

Here was the problem: Prior to asking me that question the district attorney who was prosecuting the case on behalf of the people asked me the following questions: My answers are in bold.

1. Did you receive any specific medical training to prescribe or recommend cannabis? No there is no specific training that physicians are required to go through to be able to recommend cannabis.  Any doctor can recommend marijuana to a patient.

2. Have you taken any additional CME (continuing medical education) courses which makes you an expert in marijuana?  No I have not.  (i actually forgot that i did in fact once take an online CME course about the affects of cannabis on the body)

3. Are there any studies that you know of that specifically recommends how much medicine a patient should use? There are plenty of studies to include ones conducted at the UCSD Medical Cannabis Research Center which describe patients benefiting from the use of cannabis but I can not recall without having them in front of me whether or not specific amounts of cannabis were recommended.    (It is not legal for a doctor to tell a patient how much marijuana to use… per my patients attorney)

4. Do you personally have any experience using marijuana for medicinal purposes? No I do not.

5. Do you tell patients how much marijuana to consume? No as a doctor I tell my patients that can use whatever amount of marijuana that is required to relieve their symptoms. Some patients require more or less than others.

So the problem became when my patients attorney asked me “What I thought would be a reasonable amount for a patient to posses?”  The D.A. quickly argued “Objection, No foundation.”  Meaning I can’t really cant answer the question because it would just be an opinion not based on any expertise or clinical studies or personal use.  He argues I have no personal experience and that  there are no studies that I was aware of saying patients need “X” amount of marijuana to treat chronic pain.  The judge agreed and did not allow my patients attorney to ask me the question.

I personally am not aware if there are any studies that discuss using a set amount of marijuana for any particular illness.  As physicians we really can not discuss a recommended dose because there is no guidance from the medical community.

The truth is there is not any recommended dosing schedule for marijuana.  What I would have answered is that marijuana is unique in that patients can not go the the local drug store and pick up their medicine.   Medicine in dispensaries is often expensive and for many patients the best course of action is to grow as much medicine as possible so they can be assured that they have enough medicine to treat their symptoms.   With many dispensaries being closed it would behoove a patient to have enough marijuana on hand so that they did not have to rely on getting it from an outside source.   This patient would have had enough medicine to last a few years and could have saved a lot of money by not having to go through a collective.

The defense brought in an expert to testify that having 180 plants for two people is reasonable given the yield for new growers (which these patients were).  They could anticipate losing about half their plants because of their inexperience and if they made edibles they could certainly use the rest for personal consumption…. especially if you take into account that there is no real time limit to use all of it.  They could have harvested once and had medicine for 1-3 years.

Here  was another MAJOR PROBLEM for the defense. One of the patients, after the police read them their miranda rights, answered a bunch of questions at the time their residence was raided.   One of which was “what are you intending to do with all of these plants?” To which she allegedly replied “We are going to use some for personal use and also SELL some to our collective.”   She should NEVER have said anything… because she made that one comment made it hard to argue that it was all for personal consumption…. which they very well could have.  The moral of that story is TO NEVER SAY ANYTHING EVER TO LAW ENFORCEMENT UNTIL YOU SPEAK WITH AN ATTORNEY! YOU HAVE THE RIGHT TO REMAIN SILENT.

I do not know what the outcome of this preliminary hearing was as I left after my testimony.   But this issue that came up during my testimony is most likely a hurdle that many attorneys are going to have to jump over if they are trying to defend a specific number of plants that a patient was growing.   Given that the State supreme court ruled that it is unconstitutional for the court to tell a patient what is reasonable… situations like this are doing to be more common moving forward.    If Prop 19 passes it will only make things MORE CONFUSING!

Posted in medical Marijuana Law
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Sjogrens Syndrome, Rheumatoid Arthritis and Medical Marijuana

Posted By Dr. Sean Breen on July 22nd, 2010

Today I took care of a 58 year old women who suffered from Sjogrens Syndrome and Rheumatoid Arthritis who had tried medical marijuana recently and found relief of her symptoms.   Her arthritis mostly affected her hands and shoulders and required multiple drugs for pain management.     She had been on Bextra then Vioxx then Celebrex but had to stop all of them because of kidney disease.    She was at her “wits end” and wanted an alternative to help her get some relief and sleep throughout the night.

Sjogrens syndrome is an autoimmune disease where the bodies white blood cells attack the lacrimal glands which produce tears for the eyes (lubrication) and also the salivary glands.   Most commonly patients complain of dry eyes and dry mouth.  Patients often walk around sipping water all day to keep there mouth moist.   In this patients case her taste buds were affected as well which made it difficult for her to enjoy food.   She found that certain strains of marijuana really improved her appetite and helped her deal with this debilitating disease.

Many patients with Sjogrens syndrome also develop rheumatoid arthritis.   Unfortunately there is no cure or way to reverse the arthritis so patients must learn way through nutrition, physical therapy and medication to improve the quality of their lives.   I have found many patients who use cannabis do REALLY well and don’t require near as much medication as patients who do not use cannabis.  The medically active ingredients in the plant bind to receptors on the white blood cells that cause inflammation and help reduce the pain.

The great thing about marijuana is that is is not toxic to any of the major organs in the body, is not addictive and can be taken over long periods of time.   It can be inhaled without having to smoke it by using a vaporizer and it is almost odorless.

If you would like more information on whether or not medical marijuana can improve the quality of your life feel free to give us a call at 877-721-0047 or contact us though the website at www.mcsocal.com

Be blessed,

Dr. Breen

Posted in disease treatment
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Polymyalgia Rheumatica and Medical Marijuana; Alternative Treatment

Posted By Dr. Sean Breen on July 21st, 2010

Today in my Irvine office I took care of a 71 year old man who suffers from Polymyalgia Rheumatica (PMR) and wanted to see if medical marijuana could reduce his symptoms and decrease the amount of prednisone that he is taking.   Specifically, PMR is characterized by pain in the muscles of the neck, shoulders, lower back and hips/pelvis.   It’s key pathology is inflammation which in turn leads to pain.   The reason why medical marijuana works so well is because the cannabinoids(medically active ingredients in the marijuana plant) have both anti-inflammatory and analgesic (pain reduction) properties.

PMR typically affects patients older than 50.  It is very common that patients also have giant-cell arteritis (temporal arteritis) which is inflammation of the medium and larger arteries.   Commonly patients have headache, jaw claudication (pain) and sometimes visual changes.   The reason for these is that the artery most commonly affected runs across the temple’s bilaterally (temporal artery).

PMR is difficult to treat.  Typically patients get placed on a course of prednisone which is a big gun drug to reduce inflammation in the body.    PMR symptoms will usually improve dramatically when given prednisone.   The duration of initial treatment can be weeks to months.   50% of the patients will have flare-ups when the prednisone is tapered.

The problem with prednisone is that is has A LOT of side effects. Weight gain, psychosis and mood swings, fluid retention, increased appetite,  swelling, easy bruising, headache, insomnia and muscle weakness (there are many more but these are the most common).  My patient was having a lot of edema (swelling) and his mood swings were unbearable (according to his wife)   He had been using medical grade marijuana for the past two weeks and has had good results.    His pain has been reduced dramatically and he is sleeping much longer and throughout the night…. something he hadn’t done in “years”.

The goal for a patient like this is to help him wean off the prednisone, pain killers and sleeping pills and substitute with cannabis.  Certainly it is a very obtainable goal.

If you suffer from arthritis or muscle pain and/or have been diagnosed with Polymyalgia Rheumatica and would like to see if medical marijuana could potentially help you feel free to contact us by calling 877-721-0047 or through our website at www.mcsocal.com

Be blessed,

Dr. Breen

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PTSD (Post Traumatic Stress Disorder) and Medical Marijuana; A supplemental Treatment Approach

Posted By Dr. Sean Breen on July 20th, 2010

Lately I have been seeing more and more patients with PTSD looking to medical marijuana as an alternative to the medications that their psychiatrists have prescribed.   Because I have an office in Long Beach next to the VA and also take care of many Marines from Camp Pendleton I am seeing more and more how cannabis is helping them.

Let me make one point that is very important for PTSD patients to understand.  Medical Marijuana is not going to cure your symptoms. You will still need ongoing therapy and psychiatric counseling to REALLY get past this time in your life.   What medical marijuana can do if help you reduce your dependence on drugs like Trazodone/Xanax/Ambien for sleep and reduce your dependence on mood stabilizers like paxil/prozac/seroquel.  Often these medications have side effects that do not justify the benefit of taking them daily.    Many of my patients tell me that one or two doses using a vaporizer when they come home from work helps them relax and get a good nights rest.

Being a combat veteran myself I understand the stresses that our veterans go though and what they experience when they get home.  I spent 9 months with an infantry unit (1/4 out of Camp Horno, 1MARDIV) in Iraq from Jan-Sept 2003.   I definitely witnessed my share of casualties and had more than one RPG sent my way.   I have lost Navy Corpsman to bullets and covered a KIA marine with a US flag in the heat of battle.   There is nothing more terrifying than the thought of being killed on a regular basis.

I do not take this medication lightly and want to make sure that our military leadership and veterans understand that medical marijuana is an option for them to consider.   It make work and it may not.  But I think it is worth discussing and you should be willing to give it a try if you are frustrated with your current treatment plan.

I have offices in Long Beach and Irvine and see patients 5 days per week.   Our office number is 877-721-0047 or contact us through the web at www.mcsocal.com

Semper fi,

Dr. Breen

Posted in disease treatment
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