cannabis: a gateway off opioid addictionohio patient network medical marijuana: a gateway drug?...

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Chapter 8 © 2012 Goslin and Hooker, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Surgical Management of the Aortic Root B. Goslin and R. Hooker Additional information is available at the end of the chapter http://dx.doi.org/10.5772/51831 1. Introduction The surgical management of aortic root pathology is complicated and challenging. The dynamic structure of the root serves the purpose of being the outflow tract of the left ventricle, a conduit to coronary perfusion, and path for blood flow to the end-organs. The anatomy of the aortic root is the basis of what leads to complex problems needing surgical correction including aortic valve repair, aneurismal disease of the sinuses and root, dissection of the ascending aorta, in addition to other surgically correctable disorders. The anatomy, pathology, pathophysiology, and imaging, as well as the surgical management of the aortic root will be discussed. 2. Anatomy The aortic root is proximally defined as the left ventricular outflow tract and distally defined as the ascending aorta at the sinotubular junction. (Figure 1) Critical structures of the root include; the aortic valve, sinuses of Valsalva, coronary ostia, and transition at the sinotubular junction into the ascending aorta.[1] The leaflets of the aortic valve form a transient barrier between the left ventricular outflow tract and the lumen of the proximal aorta. Leaflets are individually suspended around the aortic annulus. [2] There is debate between surgeons and anatomists regarding the anatomy of the fibrous annulus. [1,2] Surgeons grossly perceive the annulus to be a circumferential fibrous structure while anatomists have identified individual histologic hinge points for each of the leaflets. All three leaflets have a rigid border (lunules) which lie adjacent to one another when the aortic valve is in the closed position.[1,3] The lunules of each triangular shaped leaflet convalesce at the apex of the leaflet to form the nodule of Arantius. While the leaflets are able to form a uniform barrier in the closed position along the commissures, they have separate dimensions which affect the flow dynamics and coronary perfusion during systole.[3] The superior side of each leaflet is basket-shaped (open to the aortic lumen) and

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Page 1: Cannabis: A Gateway off Opioid AddictionOhio Patient Network Medical Marijuana: A Gateway Drug? Cannabis: A Gateway off Opioid Addiction FOR IMMEDIATE RELEASE: 3/6/2017 The rediscovery

Ohio Patient Network

www.OhioPatientsNetwork.org

Medical Marijuana: A Gateway Drug?

Cannabis: A Gateway off Opioid Addiction

FOR IMMEDIATE RELEASE: 3/6/2017

The rediscovery of cannabis’s medical use (aka pot or marijuana) is a very interesting recent development with the growing

acceptance of the medical use of marijuana. Cannabis utility in treating opioid addiction is being rediscovered and

documented by numerous medical journal articles.

Acceptance of a positive drug test for marijuana coupled with traditional patient counselling is more likely to achieve long

term positive result versus substituting one addictive opioid drug for another addictive opioid drug. This is compatible with

the Center for Disease Control Guidelines for Prescribing Opioids for Chronic Pain 1 recommendations.

"Clinicians should not test for substances for which results would not affect patient management or for which implications for

patient management are unclear. For example, experts noted that there might be uncertainty about the clinical implications

of a positive urine drug test for tetrahyrdocannabinol (THC).”

Additionally in the CDC report

“Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient

abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids

from alternative sources and the clinician missing opportunities to facilitate treatment for substance use disorder."

Several years ago this subject came up during a debate between Ohio Patient Network’s Executive Director Rob Ryan and

Ohio Attorney General Mike Dewine. The Attorney General’s whole argument of marijuana being a Gateway drug was

flipped to Marijuana being a Gateway off the hard drugs. More recently Ohio Patient Network was part of panel discussion

with the local judicial, health & drug treatment professionals in Portsmouth Ohio. (Note: Portsmouth was the epicenter of

the Ohio’s opioid epidemic.) Marijuana, as either a substitute or part of adjunct therapy, was accepted by the members of

audience and the panel.

Even the DEA had to recently capitulate to a legal challenge based on the United States Information Quality Act. The DEA

was charged with promoting numerous false statement (such as marijuana being a gateway to harder drugs). Their

document “The Dangers and Consequences of Marijuana Abuse” has been recently removed.2

Now is the time to bury the false classification of marijuana as a dangerous, addictive drug with no medical use; and use it to

mitigate the effects of the truly addictive and dangerous drugs. See OPN’s brochure Addiction and Cannabis for more

information.3

OPN is currently working on assembling the necessary supporting data and will petition the Ohio Medical Board to add

addiction to Ohio Medical Marijuana Control Program as a Qualifying condition.

1-Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No.

RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.

2-News report on DEA document removal - http://www.alternet.org/drugs/dea-quietly-removed-document-marijuana-health-risks-website

3-Addiction and Cannabis information Brochure http://www.ohiopatientsnetwork.org/index.php/pamphlets/64-addiction

Ohio Patient Network, a 501C3 Non Profit Patient focused organization

Media Contact information: 513-442-4495 or [email protected]