Medical marijuana laws regarding transplant

[Juniah]

Good evening everyone!

I am just curious whether anyone has successfully been added to the transplant list while using marijuana to treat the side effects of dialysis and kidney failure. I know you cannot be actively using marijuana while on the list because of the possible drug interactions with immunosupressants, however I know that both Washington state and California have passed laws in regard to transplants and marijuana users. Supposedly you are not allowed to be disqualified for an organ transplant if you use medical marijuana. Did they use to immidiately disqualify you for organ transplant if you've ever tested positive for or admitted using marijuana, or has it always been like in my case, where they just wait to further evaluate you until you test negative? I am trying to understand why they are doing this, because I've had to stop for about 2 months prior to even start the rest of the testing process, and it has resulted in a severely diminished quality of life, and I've heard others in my clinic talk with the nurses about using marijuana to treat their symptoms, but were advised not to because of the current state of the law when it comes to transplants. My main question is, why don't they allow you to use until you are listed, especially those using deceased donors, since the wait time is usually much longer then the time needed to clear THC from your system? Maybe this is something we should bring up to legislators, that say you can have one positive test, then 2-3 months after your first test if you test positive again you get put back at the end of the line, or something along those lines? I've found a specific type of medical marijuana that has helped me with nausea, insomnia, and fatigue, but was forced to stop using after my first visit with the transplant team before they would even consider further testing. This seems to go against the law that was recently passed regarding organ transplants and marijuana use. I'm by no means going to say I'd rather smoke weed then get a kidney and pancreas transplant, but I know so many people could benefit from the use of medical marijuana but will never be able to because of the way these laws work. Is it because the registry is national/federal? I just don't understand why they would knowingly decrease so many individual's quality of life for, from what I can see, is no apparent reason. So many people suffer from nausea, insomnia, fatigue, restlessness, and a number of other problems associated with kidney disease and dialysis, you would think a little more consideration would have been put into the laws regarding the subject. I am curious if anyone has any insight on the thought processes behind the decision to outright bar you from transplantation if you happen to use marijuana.






sp mod Cas

[Charlie B53]

I grew up in Yakima.  After the Army we lived in the Lynwod/ Everett area for some 20 odd years before the phone Company closed the operations center and Wife transferred here to Missouri.

For a few years I grew some of the finest in our huge closet.  After a brush with what I figured to be a DEA Agent attempting to set me up, I quit growing, quit using altogether.  That was in Sept 81, I still misis it.  So I was tickled when WA legalized pot.

Now there are a number of issues yet to be resolved.  Employers are still dismissing employees, and now this medical issue, denying treatment over the use of medical pot.

Prime issues for the right A-Hole Attorney.   Laws need change.  Management attitudes need change.  Far too many times the only way to get big changes to start is to hit them in the wallet, HARD.

I wish I would have gone on to Law School.  Still ain't too late, I don't think I could afford it on SSD.

Talk to a couple of Atty's, see if they can recommend someone willing to take it on to set the needed president.






sp mod Cas

[kickingandscreaming]

I think it's fear of the unknown combined with knee-jerk puritanicallness.  It is a shame as MMJ can be very useful.  I use it to sleep and to help gloss over some of the uncomfortable aspects of PD for me.  I hav had several recent brushes with medical people and I didn't hesitate to tell tjhem that I used MMJ.  They didn't bat an eyelash.  But it wasn't a transplant--which is much more complicated.

[cassandra]

When I had dad's kidney and I moved from the Netherlands ( pot 'legal') to the UK (pot classified as a hard drug) most nephs here (UK) had no problem with it. They had more problems with the tobacco. However, I don't see medical M ever okayed in the UK. Too much money being made from the chemical tablets by people with too much power over Parliament.

[kickingandscreaming]

Too much money being made from the chemical tablets by people with too much power over Parliament.

Of course the very same story is true in the US and it is now legal in many states (altho Attorney General Sessions might see to that).

[Charlie B53]

I've long said that EVERY plant exists for our use.  Over the history of the planet we have forgotten what each plant is to be used for.  That's a problem that needs serious attention.

[Simon Dog]

I've long said that EVERY plant exists for our use.  Over the history of the planet we have forgotten what each plant is to be used for.  That's a problem that needs serious attention.

What are the uses for hogweed?

[smartcookie]

I think this probably is a federal issue more than state in regards to transplant.  Marijuana, medical or not, is still illegal federally.  So if you have someone in a non-legalized state wanting to list for a transplant in a legalized state or vice versa, there can be a potential problem or even a lawsuit.  Also, there is probably not enough testing done on marijuana in regards to transplant.  There needs to be more studies done.  I live in the rural south and I am not sure marijuana will be legalized anytime soon, so this problem is probably years away from being settled.  I don't have that much of a problem with medical marijuana, but recreational marijuana I do personally have a problem with after reading studies stating that adolescents or even young adults whose brains are still developing (up to age 25) can experience detrimental affects from heavy marijuana use.  Now it has been a couple years since I researched the subject, so I do need to brush up. 

[MooseMom]

John Oliver addressed this issue (well, not regarding tx specifically) in his show last night.  It was very interesting and showed just how legally complicated this is.

https://www.youtube.com/watch?v=BcR_Wg42dv8

[Charlie B53]

My 'other' laptop that I take with me to treatments I left a page open to an article about this same issue, in Maine.  A transplant patient was dropped from consideration for using MMJ.

The article went on to explain the possibilities of fungal infections from MaryJ and actually has been claimed to be the cause of a couple of deaths from that infection.

I willl have to go open that 'puter, log in here and post that link.

[Charlie B53]

I'm back!   Went and got my 'other' laptop that I take everywhere.  In treatment this morning I found this article just as treatment was ending so I didn't have time to link it here.

http://www.cnn.com/2017/03/31/health/medical-marijuana-organ-transplants-explainer/

I don't doubt there will be some 'extracts' than can be safely used once sterilized in a manner to ensure no fungal contamination.  As usual, not today.  Lots of study will be needed. processes developed, etc., before MMJ can be proven safe.

[Juniah]

Sorry it took so long for me to get back to this thread, was out of town for a few days, thanks for all the replies, and the youtube vid! I knew about the fungal issues being a complication with immunosupressants, that was the first thing the transplant surgeon mentioned when I brought up the subject at our first transplant clinical meeting. Anyone on these types of drugs should avoid smoking because of it, it's definitely not worth the risk. This brings up the subject of edible marijuana products though. One of these days when I have some spare time I may shoot an e-mail off to one of the NORML attourneys or something, if I do I will make sure to post an update on what he says. I'm going to go watch that youtube vid right now!

I do understand the concern you stated smartcookie, anyone under the age of 25 should stay away from any for of marijuana. It is the responsability of those who sell, and use marijuana to keep it out of the hands of people who shouldn't have it.

Another interesting resource for the growing industry of marijuana is a television show called weediquette, on the viceland channel. There is a smorgasbord of interesting investigations and interviews among leading people in the field, and even a handful of politicians regarding the uses, legalization, and problems that marijuana use may cause, if you are into that kind of thing.

[Charlie B53]

I've a wide and varied education, plus an equally varied working life so I tend to interrelate many things far differently than most people.

Bear with me.

Newer dry cleaning machines are very neat.  They use solvents in the tubler to rinse clean items.  The solvent is drained off into a 'still'', evoporated and condensed back into the 'clean' tank.  Sludge is left in the still which needs to be scraped out.  Got it?

Pot has both oil solubles and water soluble elements.  Check

So take a brand new dry cleaning machine, only instead of a solvent, use high grade alcohol, like vodka which is about 50/50 water and alcohol.

Stuff the drum with pot. You may have to put it in a mesh bag to keep all the leaf pieces contained.  Run the machine repeatedly 'washing' the plant with the alcohol dissolving the elements/oils from the plant.  Evaporate the alcohol off and condense it back into the clean tank for the next load.  Scrape out the 'sterilized' and concentrated active elements from the still.

Enjoy.

The end produce should be safe from fungal and bacterial contamination as the alcohol would have killed anything and everything.

I need to move back to Washington.

[kickingandscreaming]

Without using a washing machine, this is essentially how MMJ edibles are made.  They don't simply dump weed into  brownie batter.  They refine out the oil and use that in making baked goods, candies, tinctures etc,  I would stongly doubt that a fungus could survive that process. 

And, BTW, the same fear of fungus should exist for ANY herb that one might use, e.g. thyme, rosemary and down the line.  Are they forbidding tx patients from using herbs?  If not, then there's something else going o n.

[smartcookie]

Kickingandscreaming, I think it is just the smoke inhalation that doctors are worried about in regards to fungus.  The lungs are more susceptible to fungal infections then the digestive track.  Plain old stomach acid probably takes care of a lot of fungal infections in the stomach.  I know you get fungal infections in your mouth, lungs and skin, though. 

[Charlie B53]

60's', 70's, and into the 80's I just added pot to my brownies, and/or spaghetti sauce.  There were no 'oils' back then.  And I had a selection of what was currently 'on the market' or growing in my closet.

[nursey66]

Smartcookie is correct. . It has to do with the risk of fungel lung infections . The plant carries a lot of fungi that isn't harmful to most people but very dangerous to those on anti rejection medications . My husband got a fungal lung infection from cleaning up the area around the bird feeders in the spring and nearly died from it. He was in the hospital for 4 weeks. Had fevers at 104 degrees . 

[Charlie B53]

I've argued with Dr's for years over the issue of lung/fungal infections.  That 'creeping crud' many get, coughing up crud seeming for months. Chest X-ray looks clear, but near constant wheezing.  Anti-biotics have no effect.  The warm dark damp conditions within the lungs are PRIME breeding grounds for fungii of many many types.

Dr's KNOW but are not willing to admit it.  Anti-fungal medications can be hazardous to the liver, or so I am told, so Dr's may be reluctant to prescribe until within a hospital setting where they can  keep close observation on daily labs.  While the rest of us 'Walking Dead' suffer through it until our bodies finally overcome the invasion.

I have a fully loaded DEAD refrigerator in the garage that I am reluctant to clean out.  It's green and black inside.  When I began to spray it with an anti-fungal, 'dust' began rising.  Those spores so light they can drift gret distances on even the slightest air currents.  Masked, I respray it every couple of days until I get the courage to begin bagging and tossing the contents. I have replaced the faulty plug on the cord. I have yet to replace the wall socket.  All must be done after I disassemble the freezer so to sterilize the entire enclosure.  I'm such a cheap SOB I won't just toss it and replace it if I can repair it.

[nursey66]

My husband was finally given the anti fungal drugs after many tries with regular antibiotics when in the hospital. He had to take them for 1 month after discharge Very expensive . He was in the donut hole. , the copay was 2,450 dollars for a one months supply.  It was over a 5000 dollar per month drug !! Luckily he only needed to be on it for a month after spending a month in the hospital .  Those fungal lung infections are not something to take chances with, they can be deadly for transplant patients. He was diagnosed with aspergillosis.

[kickingandscreaming]

Hot off the presses:

Recreational use of marijuana: Current experience and information for nephrologists
Madhusudan Vijayan, MBBS and Ajay K Singh, MBBS, FRCP, MBA — April 5, 2017

Abstract

Support for legalizing the recreational use of marijuana has been steadily climbing. While there has been a decline in marijuana-related convictions and increase in state revenues, the impact on public health and safety is not clear. The nephrology community must be aware of the complications of chronic marijuana use, such as recurrent acute kidney injury secondary to hyperemesis.
Background

Marijuana is the most widely used illicit drug in the United States and in the world. About 44% of the US population aged 12 years and above have admitted to lifetime use of marijuana.1 The pro-marijuana legalization arguments include decriminalization of young people, higher arrest rate of ethnic minorities, difficulty in enforcing marijuana laws, apparent safety profile, and less addictive potential compared to alcohol and tobacco. State revenue generation is appealing, and tight regulation has been created to ensure that minors don’t get access to marijuana. The anti-marijuana legalization arguments include an increase in marijuana use among young adults, high potential for abuse, the potential rise in marijuana-related road traffic accidents, and use of marijuana as a “gateway drug” for more dangerous substances.

Recently, four additional states (California, Massachusetts, Maine, and Nevada) have voted to legalize the recreational use of marijuana, bringing the total to eight states and the District of Columbia. Oregon, Washington, Alaska, and Colorado have previously legalized recreational use of marijuana. Three of these states have given their first report on the impact of marijuana legalization. 2-4
Intoxication

The impact of marijuana legalization on road safety is not clear. In Oregon, 36% of frequent users reported driving within three hours of using marijuana.4 In Washington, 49% of young adults admitted to driving within three hours after using marijuana.2 Among people charged with driving under the influence of marijuana, 62% perceived no risk related to road safety under such conditions. There was a 122.2 % increase in the number of people with active THC in their blood in fatal driving accidents.

In Colorado, the number of drivers positive for tetrahydrocannabinol (THC) increased from 57% to 65% from 2012 to 2014. Of those positive for THC, detection of psychoactive component delta-9 THC at 2 ng/mL rose from 52% to 67%. 3 The fatalities in drivers positive for THC or THC-in-combination increased 44% from 2013 to 2014. However, the number of reported cases of driving under the influence of drugs (DUID) reduced by 18% from 2014 to 2015.

The number of marijuana-related calls to Washington State Poison Center increased by 79.27 % between 2010 and 2014, and almost half of these calls were from youngsters. The number of marijuana-related calls to the Poison Control Center in Oregon also increased substantially among all age groups in the second half of 2015. The number of marijuana-related calls to the Colorado state poison control centers tripled in two years.
Impact on kidney health

It is important that physicians are aware of the various complications of chronic marijuana use. Of note to nephrologists, chronic use can lead to recurrent acute kidney injury (AKI) from cannabinoid hyperemesis syndrome (CHS), which is often under-recognized. 5 CHS is frequently reported in the medical literature with several case reports published, but the number of emergency room visits for diagnosis remains high.

Chronic users of marijuana can initially have a prodrome, which is characterized by early morning nausea, aversion towards food, and weight loss. This is followed by the hyperemetic phase, which is paradoxical, considering the fact that medical marijuana is used as an anti-emetic.

A peculiar feature of this hyperemesis is the relief of nausea by taking hot showers. There have been reports of patients staying in the hot shower for days to relieve nausea. This becomes a learned and compulsive behavior. The recovery phase begins with marijuana cessation and is associated with recovery of appetite and eventual resolution of nausea. The syndrome recurs on later use of marijuana.

The hyperemetic phase can be complicated by recurrent AKI due to dehydration, mixed metabolic alkalosis, and elevated anion gap metabolic acidosis. Dehydration occurs because of vomiting and is greatly accentuated by taking scorching hot showers. One of our patients also had rhabdomyolysis as part of the clinical picture, which has previously been reported with the use of synthetic cannabinoids. Due to recurrent AKI, his serum creatinine levels remained elevated and returned to baseline only months after the cessation of marijuana smoking.

Treatment mainly consists of intravenous hydration, antiemetics, and marijuana cessation. Capsaicin cream, lorazepam, and haloperidol have been recently reported to relieve the hyperemesis and are areas of ongoing research. 6-8
Marijuana use and kidney transplantation

Marijuana use is not considered to be a contraindication for organ donation or transplantation, but it is regarded as a risk factor for medical complications, due to physical and behavioral components, albeit there is little evidence for this. 9 Areas of concern include susceptibility to fungal infections, possible interaction with the metabolism of immunosuppressants and co-existing behavioral disturbances. Previously, marijuana users were commonly denied kidney transplants, but physician attitudes towards this have been changing. Now experts have begun emphasizing behavioral assessment of these patients to rule out any negative influence of smoking marijuana on their socio-economic conditions. Seven states have disallowed physicians from rejecting potential transplant recipients solely on the basis of the use of medical marijuana. Transplant centers usually ask kidney donors to stop smoking tobacco and marijuana for 6-12 weeks prior to organ donation.
Summary

It is too early to make a social judgment on the impact of legalization of recreational use of marijuana. But with increased activity to the state poison call centers, the nephrology community must be aware of the potential complications of smoking marijuana, such as the risk of recurrent kidney injury from CHS. Behavioral issues must be taken into account while considering marijuana smokers as potential organ transplant recipients.
References

    National Survey on Drug Use and Health 2015. Substance Abuse and Mental Health Services Administration. US Department of Health and Human Services. Available from: https://nsduhweb.rti.org/respweb/homepage.cfm. Accessed on 22 Feb 2017.
    Washington State Marijuana Impact Report. Northwest High Intensity Drug Trafficking Area. March 2016.
    Marijuana Legalization in Colorado: Early Findings. A report pursuant to Senate Bill 13-283. March 2016
    Marijuana Report: Marijuana use, attitudes and health effects in Oregon. January 2016.
    Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004; 53:1566-70
    Roman F, Llorens P, Burillo-Putze G. Topical capsaicin cream in the treatment for cannabinoid hyperemesis syndrome. Medicina Clinica (Barc). 2016 Dec 2; 147(11):517-518.
    Witsil JC, Mycyk MB. Haloperidol, a novel treatment for cannabinoid hyperemesis syndrome. Am J Ther. 2017 Jan / Feb; 24 (1):e64-e67
    Cox B, Chhabra A, Adler M, Simmons J, Randlett D. Cannabinoid hyperemesis syndrome: case report of a paradoxical reaction with heavy marijuana use. Case reports in Medicine. 2012 (:757696
    Pondrom S. Transplantaion and marijuana use. American Journal of Transplant. 2016 Jan; 16 (1):1

http://www.nephrologynews.com/recreational-use-marijuana-current-experience-information-nephrologists/?utm_source=newsletter_040617&utm_medium=email&utm_campaign=newsletter&mkt_tok=eyJpIjoiWkRKaE1UZ3hPRGMxWTJNeiIsInQiOiJROEFUVjhMXC9hbldMZERtMXRhOUdBWURiNjFRSEdXUVBUNWtwdGZ6dFwvNnJmVnhSOFI3K3pMZkY2WDFrWVFtelZhU0ZHbndiTzJWRms4eGNxMzFJdHVMRlwvOEVNaUxJcnl1UzZkUUp3N0YxQXNHbnFqR3NRd3JsUjNyVks3RXdzRCJ9

[Charlie B53]

What I got out of this report is..... we need a lot more study before better decisions can be made.

I can testify from my experience as a grower and heavy user throughout the 70's that I have no permanent ill effects from my 'exposure'.

I should classify that.  My plants were grown in very well controlled environment.

Still, that old 'All things in moderation' still applies.  Pot, as with any medication, including alcohol, can used, and abused. 

It is up to every individual to learn the difference and to use good judgement.

[nursey66]

I just read this article . Thank you for putting up the research . I don't see any reference to the fungal threat to the lung of kidney transplant patients. We were told that by our clinic, my husband wasn't using, l just happened to ask "why " when the question about using came up .

[Whamo]

   I was using edibles to sleep, but my phosphorus test went sky high so I stopped. 

[kickingandscreaming]

What kind of edibles raised your phosph?  I use a small piece of chocolate at nights to sleep and it hasn't affected my phosph. levels.