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7th Aug, 2015

AIIMS-Bhubaneswar (All India Institute of Medical Sciences-Bhubaneswar) and MCFI (Medicinal Cannabis Foundation of India) today co-hosted a “Seminar on Chronic Pain” in which Indian-American Physician-Scientist Sunil Kumar Aggarwal, M.D., Ph.D. was invited to give a keynote presentation on the use of Cannabis in chronic and cancer pain.

Dr. Aggarwal, an Overseas Citizen of India, who lives in Seattle, Washington, U.S.A., has just completed clinical fellowship training in the National Institutes of Health-Clinical Center, the largest research hospital in the world, in the Pain and Palliative Care Service.  Dr. Aggarwal is a leading Cannabis researcher with major focus on Cannabinoid Integrative Medicine. He is a Palliative Medicine Physician and an Associate Hospice Medical Director at a hospital in Washington State.  He was invited to deliver a keynote speech at the seminar today by Dr. Sukdev Nayak, Professor and Head of the Department of Anaesthesiology at AIIMS-Bhubaneswar.

 Below are a few key points that Dr. Aggarwal emphasized, before concluding with a remarkable series of short videos documenting immediate improvement after patient self-administration of cannabis in movement disorders such as Parkinson’s,Tourette and multiple Sclerosis: 

· Cannabis sativa archeological evidence shows that it was first domesticated in South Asia by 16th century BCE [18 thousand years ago].

· THC, CBD, and other Cannabinoids, the key molecules produced in the resin made by the female flowers of the plant, likely evolved as a protective response to increasing UV radiation from sunlight at higher elevations it was exposed to during the geological uplift that created the Himalayas mountain ranges 50 million years ago

· Cannabis has a long history of use in Ayurveda, a very active traditional medical system in India and beyond, and was documented as utilized by the father of surgery Su?ruta in the 6th-7th century BCE.  The Government of India has entered “Cannabis Sativa” “known for 1,000 years” in their traditional knowledge digital library to protect it and medical knowledge of its many uses, such as pain relief, from international biopiracy, as the Neem plant (Margosa) and Haldi (Turmeric) once faced. Foreign multinational pharmaceutical companies have already attempted to enter India to test their cannabis products on patients.

· Cannabis use as an aide in spiritual development, such as meditation, has been part of Indian religious traditions for thousands of years and remains sacramental and closely associated with Hindu deities such as Lord Shiva and Kali Ma. The Hindu sacred text Atharva Veda (dated between 1400-2000 BCE) mentions plant 'bhang' as being provided for giving relief from distress or anxiety.

· The integrated bioscientific study of how cannabis use affects human physiology and health has led to the discovery over the past few decades of a major molecular signaling system, widespread in the human body and present for 600 million years in living organisms.  The system, known as the endocannabinoid signaling system, plays a critical homeostatic role in normal physiologic function, regulating mood, appetite, memory, inflammation, pain perception, movement, immunity, neuroprotection, bone formation, tumor suppression, and other functions.

· Disorders and deficiencies in endocannabinoids and related components are thought to produce disease, and naturally occurring cannabis compounds (cannabinoids) have been shown to target this system.  

· The WHO has acknowledged the therapeutic effects of cannabinoids including antidepressant, appetite stimulant, anticonvulsant and anti-spasmodic and identified cannabinoids as beneficial in the treatment of asthma, glaucoma, and nausea and vomiting related to illnesses such as cancer and AIDS

· It has been found that an improved therapeutic effect occurs by the synergistic activity of cannabinoids when combined with the other therapeutically active natural chemicals in Cannabis flower resin, such as terpenoids (including myrcene and limonene, also found in mango and lime), flavonoids, and plant sterols, thus supporting a whole plant botanical medicine approach.  

· Cannabis, given in whole plant extract form, has been shown published in randomized controlled clinical trials involving hundreds of patients to significantly reduce untreated pain in advanced cancer patients who were also maximally taking morphine-like pain medications.  Many positive outcome randomized controlled trials have shown benefit of whole plant cannabis preparations in the treatment of chronic pain syndromes, such as those that occur due to damage and disruption of nerves.

· The adverse effects of cannabis use are quite low when compared to other medications.  There has been no recorded case of overdose in its thousands of years of documented use.

· While morphine remains the gold-standard for pain treatment, it remains shocking available to less than 1% of those who need it.  This despite the fact that 99% of global licit opium supply, from which pharmaceutical morphine is extracted, is produced domestically in India (580 tons in 2010).  Use of cannabis has been shown in numerous clinical series to reduce the quantity and dosage of opioids that patients in pain need.

· Sir Dr. W.B. O’Shaughnessy, FRS, an Irish doctor working in India, who co-founded Calcutta Medical College, is credited with first introducing cannabis as medicine to the West in 1838.  He demonstrated with careful experiment the apparent utility of a locally produced cannabis plant extract made in Kolkata which he administered to patients suffering from rabies, cholera, tetanus, infantile convulsions, and painful rheumatological conditions.

· In Jan-March 1961, at UN meeting in NYC, the Indian Delegate stated on record that: “India would not be able…to enforce prohibitions on the use of those substances [ganja and bhang], particularly in remote localities where, as inexpensive sedatives, they were used for medical and quasi-medical purposes”.  They opposed placement of cannabis in the same category as heroin and were supported in this position by Ghana, Pakistan, France, United Kingdom, Germany, Uruguay, and Burma, who lobbied that cannabis be at least as available as opium.

· Now 40 American states, the District of Columbia, and the U.S. territories of Guam and Puerto Rico allow patients to legally access medical cannabis in some form.  National medical cannabis treatment and research programs are active in Israel, Canada, Uruguay, the Netherlands, and are being set-up in many other countries.  A UN General Assembly Special Session on revising the international drug control treaty system is occurring in 2016 in New York with significant input for the first time from health and human rights NGOs.

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