Please Welcome, Dr.Cannabinergy!

Sunil Aggarwal

[Editor’s Note from Jahan Marcu] – This guest post was written by Sunil Aggarwal, M.D., PhD. Sunil Kumar Aggarwal is a graduate of the University of Washington’s NIH-supported Medical Scientist Training Program. He received his M.D. in 2010 and his Ph.D. in Medical Geography in 2008. He completed his internship in Preliminary Internal Medicine at Virginia Mason Medical Center in Seattle, Washington and is currently continuing his Residency in Physical Medicine and Rehabilitation at New York University’s Rusk Institute of Rehabilitation Medicine.

As an NSF Graduate Research Fellow, Dr. Aggarwal conducted and published human studies of medical cannabis use under the first-ever granted federal Certificates of Confidentiality which protected 176 enrolled study subjects recruited both from sites of both cannabis delivery and medical consultation.  He has authored or co-authored papers on cannabinoid medical science, dosing, and human rights published in journals of Pain medicine, Hospice and Palliative Medicine, General Medicine, and Law, in addition to a book chapter for the general public.[Read More about Dr. Aggarwal]

Dear Readers of Freedomisgreen.com,

My friend and colleague, cannabinoid researcher and doctoral student Jahan Marcu of Temple Univeristy, has graciously invited me to write a blog post here introducing the launch of my new website, cannabinergy.com.

At its core, cannabinergy.com is a vehicle for public education to inspire, alight, and broadly educate internet users about basic and social scientific understandings regarding the endogenous cannabinoid signaling system and the cannabingeric properties of cannabis hempflowers.  It seeks to be relevant to current policy debates and therefore aims to present the ecological politics, or political ecology, of cannabis, thereby giving visitors a broader understanding of the complex web of powerful actors and grassroots movements that are variously attempting to enclose, monopolize, ignore, or democratize this increasingly valued botanical resource.  In this current scenario, a website such as cannabinergy.com is needed to help to stimulate and facilitate the public conversation regarding the status of this plant as a commons resource and its responsible use guided by science and green ethics.

The website accomplishes much of this by showcasing my own academic and personal journey as a bicultural physician-scientist and medical geographer who has, over time, come to understand the social and medicinal significance of the cannabis plant.  This is illustrated through a online digital library of papers, public presentations, interviews, personal reflections, and photographs.  The ultimate goal is to link this website up to another one called cannabisconversation.com which will allow a much greater degree of user participation and dialogue.  I invite you to explore, learn, be inspired, and share at cannabinergy.com!

Thank you,

Sunil Kumar Aggarwal, M.D., PhD

aka “Dr. Cannabinergy”

Jahan Marcu is currently investigating the pharmacology of cannabinoid receptors. He was working at the California Pacific Medical Center Research Institute when exciting discoveries were made showing enhanced anti-cancer effects with THC and CBD from the Cannabis plant. The findings were published in the Journal of Molecular Cancer Therapeutics. In 2009 he received the Billy Martin Award from the International Cannabinoid Research Society (ICRS). Jahan is currently the vice-chair the Medical and Scientific Advisory Board at Americans for Safe Access (ASA). Questions?   Contact    [email protected]

DISCLAIMER: The views and opinions expressed are those of the author and do not necessarily represent any University, business or affiliates. While the information provided in this blog is from published scientific studies it is not intended to diagnose or treat any disease.

Rep. Merrick, NH Advocates Keep Up Fight for Medical Marijuana

5/17/2011 – Representative Evalyn Merrick of New Hampshire is keeping up the fight for medical marijuana. She is a cancer survivor who is sponsoring the compassionate use bill. Backed by a strong grassroots network and many of her peers in the NH General Court, they have seen the effort get close to victory.  But a major hurdle was thrown up last week.

Under threat of veto by Governor John Lynch, the Senate stopped the bill from going out to a floor vote. The legislation had already passed the House; the Senate vote would have sent the bill to the governor’s desk. Two years ago a similar bill cleared committees and floor votes in both houses with bi-partisan support, only to be vetoed by Lynch.

“I was hoping with all hope that it would pass,” said Merrick in a phone call to Freedomisgreen on Friday.

But her reaction was that of a pragmatic and seasoned legislator, “I knew that they were against the bill passing the Senate,” said Merrick. “Especially since the Governor discussed the bill with the majority caucus. In light of that knowledge a tabling vote was probably the best thing, because the bill isn’t dead and will come back in the session next year. “

However, the reaction from local activists was more biting. They feel that Senators should not have kowtowed to Lynch.

Sarah Levesque is a vocal advocate in New Hampshire who attended the Senate session on May 11, 2011. She emailed this report and her reaction:

HB 442 was voted on in the House and passed with an overwhelming majority and was introduced to the senate on March 23, 2011. The Senate Health and Human Services committee held their public hearing on April 14th; it was well attended, with standing room only. There was again, extensive testimony in support of the bill. Veterans, doctors, legislators, patients, all gave honest first hand testimony of the benefits of medicinal cannabis, while the Attorney General’s office portrayed the bill using presumptions and gross over exaggerations.

The Senate was then set to vote on HB 442. Sponsors, advocates, supporters and patients took the time to come to watch the proceedings on May 10th to show their support. Clayton Holton, a Muscular Dystrophy patient, took the time and energy to travel from Somersworth to attend the proceedings.

Clayton previously testified that he weighed 79 pounds at six feet tall prior to using cannabis. He explained that within two months he had gained eight pounds. He credits his life to cannabis.

Clayton is confined to a wheelchair and was denied access to the voting session. The Gallery to view the Senate Chambers is accessible only by stairs. The Senate Chambers themselves would have been accessible, but he was not allowed the exception.

Just before the bill was introduced, a recess was called. The Republican Senators congregated in one area, while the Democrats in another.

The Senate reconvened, and the bill was introduced. Sen. Molly Kelly spoke in favor of the bill. Senator Raymond White stood and spoke about Clayton and urged support.

Levesque continued:

A motion to table the bill was introduced and the Senate jumped on it. They displayed an appalling level of cowardice by avoiding and ignoring the patients affected by this bill. To not have the decency to face this man while determining his fate is despicable.

Rep. Merrick was still hopeful that they might be able to reach some compromise on the bill’s language that would move Gov. Lynch to support it.

“As disappointed as it was, I know that we’ve brought in so many different stakeholders in this process in order to have something that the Governor will sign. I’ve been working on this bill for 6 years I think that’s why it has become a model for other states.  And we can make it better. I’m not giving up on this.”

Then she added, “Who knows, maybe the federal government will figure this out too?”

I could not resist asking a follow-up to that final point.

So do you think it would be a good idea for state elected officials like yourself to travel to Washington DC in order to ask Congress to re-schedule marijuana at the federal level?

Merrick responded quickly, “Absolutely, without any hesitation of doubt. It has been proven with all of the science. We need the federal government to change the schedule [of marijuana in the Controlled Substances Act] in order for people, to have access safely … and for the right reasons.”

So, as advocates stride to clear this new obstacle for medical marijuana in New Hampshire they may also have some positive influence on the national debate. State legislators like Merrick, the well-educated champions for local patients, could have a significant impact in DC.

More info at http://nhcompassion.org/

Questions?  [email protected]

Chris Goldstein is a respected marijuana reform advocate. As a writer and radio broadcaster he has been covering cannabis news for over a decade. He volunteers with local groups to change prohibition laws including PhillyNORML and The Coalition for Medical Marijuana New Jersey.

Poll Shows NJ Voters Continue Strong Medical Marijuana Support

Photo: Chris Goldstein

New Jersey residents continued to resoundingly support legal access to medical marijuana according to data released by The Quinnipiac University Polling Institute yesterday. The extensive poll largely concerned opinions held about Governor Chris Christie, the Legislature and other politicians. But some issues were also put to 1, 276 registered NJ voters, including medical marijuana.Regardless of age, ethnicity, gender or political affiliation the people of New Jersey support the rights of seriously ill individuals having legal access to cannabis. However, the poll did not ask about the current debate over the regulations for the medical marijuana program.Here’s the full data on the question:

From Quinnipiac University Polling Institute 12/21/2010 release LINK31. Do you support or oppose allowing adults in New Jersey to legally use marijuana for medical purposes if their doctor prescribes it?——- Tot Rep Dem Ind Men Wom Wht BlkSupport 76% 66% 82% 77% 77% 75% 77% 78%Oppose 21 32 16 20 20 22 20 20DK/NA 2 2 2 3 2 3 2 2—- AGE IN YRS……. POL PHIL………——- 18-34 35-54 55+ Lib Mod ConSupport 87% 78% 72% 88% 81% 60%Oppose 12 19 26 10 17 37DK/NA 1 3 3 2 2 2FULL Quinnipiac POLL DATA

Of note: The same poll found that the issue of legal medical cannabis is more strongly supported by voters than any New Jersey politician or governing body. For example: Governor Christie found overall support among 48% of voters polled.Among his base of Republican voters medical marijuana is just about as popular as Mr. Christie himself: 74% approve of the governor’s job so far and 66% support medical cannabis.Overall, medical marijuana remains one of the most widely supported public policy issues in the Garden State.

Review on clinical studies with cannabis and cannabinoids

Cannabidiol

In 2006 an excellent review on cannabis and cannabinoid clinical trials was published by Ben Amar. However, there have been at least 37 new clinical trials evaluating medical applications of cannabis and cannabinoids since 2005. The new review of clinical trials was published by Dr. Arno Hazekamp and Dr.Franjo Grotenhermen.

Abstract
To date, a large number of controlled clinical trials have been done evaluating the therapeutic applications of cannabis and cannabis-based preparations. In 2006, an excellent review was published, discussing the clinical trials performed in the period 1975 to June 2005 [Ben Amar 2006].

The current review reports on the more recent clinical data available. A systematic search was performed in the scientific database of PubMed, focused on clinical studies that were randomized, (double) blinded, and placebo-controlled. The period screened was from July 1, 2005 up to August 1, 2009.

The key words used were: cannabis, marijuana, marihuana, hashish, cannabinoid(s), tetrahydrocannabinol, THC, CBD, dronabinol, Marinol, nabilone, Cannador and Sativex. For the final selection, only properly controlled clinical trials were retained. Open-label studies were excluded, except if they were a direct continuation of a study discussed here.

Thirty-seven controlled studies evaluating the therapeutic effects of cannabinoids were identified. For each clinical trial, the country where the project was held, the number of patients assessed, the type of study and comparisons done, the products and the dosages used, their efficacy and their adverse effects are described. Based on the clinical results, cannabinoids present an interesting therapeutic potential mainly as analgesics in chronic neuropathic pain, appetite stimulants in debilitating diseases (cancer and AIDS), as well as in the treatment of multiple sclerosis.

Keywords: cannabinoids, cannabis, therapeutic potential, controlled clinical trial, efficacy, safety

This article can be downloaded, printed and distributed freely for any non-commercial purposes, provided the original work is properlycited (see copyright info below). Available online at www.cannabis-med.org
Author’s address: Arno Hazekamp, [email protected]

Their research paper can be accessed here.

Science Editor Jahan Marcu is currently investigating the pharmacology of cannabinoid receptors. Contact science { at } freedomisgreen.com

Poor Diet Impairs Cannabinoid Receptors

New data suggests that our diet can effect our response to cannabinoids. The authors demonstrate that an Omega-3 deficient diet in rats leads to a less functional endocannabinoid system, specifically by reducing the functionality of the Cannabinoid type 1 receptor (CB1R). The reduction of CB1Rs was associated by the authors with impaired emotional behavior. The endocannabinoid system may require a diet rich in Omega-3 fatty acids (i.e. Fish, nuts,etc).

Additionally, this article discusses the lack of essential nutrients in western diets. In the United States high-calorie, inexpensive, high-fat and nutritionally deficient diets are common. These bad diets are correlated to obesity and brain disease. For example, an imbalance in Omega-3 fatty acids has been linked to nueropsychiatric diseases, like depression. However the mechanism of neuroprotection from Omega-3 fatty acids remains unknown.

We already know that our diet can influence our response to cannabinoids and Cannabis. Could the negative effects of cannabinoids be related to nutritionally-deficient diets, which are also associated with mental diseases, such as depression? Could eating a better diet make for a better cannabinoid experience? This study raises a number of radical ideas that warrant further studies.

Jahan Marcu is currently investigating the pharmacology of cannabinoid receptors. He was working at the California Pacific Medical Center Research Institute when exciting discoveries were made showing enhanced anti-cancer effects with THC and CBD from the Cannabis plant. Jahan is currently the vice-chair the Medical and Scientific Advisory Board at Americans for Safe Access (ASA).   Contact:  science { at } freedomisgreen.com

DISCLAIMER: The views and opinions expressed are those of the author and do not necessarily represent any University, business or affiliates. While the information provided in this blog is from published scientific studies it is not intended to diagnose or treat any disease.

Pot and Pumpkin Pie: Endocannabinoid System Enhanced by Vitamin E

Could eating a better diet make for a better cannabinoid experience? The journal of Free Radical Biology and Medicine published a report, which identifies vitamin E as a “modulator of the cannabinoid system.”

Alpha-Tocopheral is considered the main ingredient of vitamin E, and is well known for its anti-oxidant properties and mood elevating abilities. Low levels of alpha-tocopheral in the brain are associated with health issues such as depression and neuronal degradation.

The authors demonstrated that the actions of vitamin E can be blocked, if the cannabinoid type 1 receptor is blocked by a drug AM251. AM251 can block cannabinoid receptors and prevent them from being activated.

The authors report that the vitamin E and cannabinoid receptor interactions are occurring in a region of the brain known as the hippocampus, which may help explain the benefits of vitamin E other than its anti-oxidant properties.

Vitamin E can have profound effects on brain function, and it is widely used as a food additive. Without vitamin E in the diet a number a symptoms can start to appear, such as anxiety or ataxia.

However, vitamin E does not directly activate cannabinoid receptors, like for example THC, instead alpha-tocopheral modulates the receptor. The receptor modulation from alpha-tocopheral may be an important part of normal cannabinoid receptor function. More research is need to fully understand exactly how alpha-tocopheral obtained from the diet can influence the cannabinoid system.

High-calorie, inexpensive, high-fat and nutritionally deficient diets are common in the United States. These bad diets are correlated to obesity and brain disease. A balance of omega-3 fatty acids or vitamin E can help us live longer and healthier. The mechanism of this wonderful benefit is due to an integrated response between these lipids such as from alpha-tocopheral and cannabinoid receptors.

We ask ourselves the same questions as before; Can our diet can influence our response to cannabinoids and Cannabis? Could the negative effects of cannabinoids be related to nutritionally-deficient diets, which are also associated with mental diseases, such as depression?

This study raises a number of radical ideas that warrant further studies.

By the way…pumpkins have a good amount of vitamin E for some (possible) seasonal cannabinoid receptor system adjustments!

Jahan Marcu is currently investigating the pharmacology of cannabinoid receptors. He was working at the California Pacific Medical Center Research Institute when exciting discoveries were made showing enhanced anti-cancer effects with THC and CBD from the Cannabis plant. The findings were published in the Journal of Molecular Cancer Therapeutics. In 2009 he received the Billy Martin Award from the International Cannabinoid Research Society (ICRS). Jahan is currently the vice-chair the Medical and Scientific Advisory Board at Americans for Safe Access (ASA). Questions?   Contact    [email protected]

DISCLAIMER: The views and opinions expressed are those of the author and do not necessarily represent any University, business or affiliates. While the information provided in this blog is from published scientific studies it is not intended to diagnose or treat any disease.

Pot Queen “Natty Baby” Kenly and Charlie Sheen – Winning

What’s there to say about Charlie Sheen that hasn’t already been said….by him? Who can forget such inimitable quotes as these?

“I’m bi-winning … If I’m bipolar, aren’t there moments where a guy, like, crashes and is lying in the corner, like, ‘Oh my God, it’s all my mom’s fault’? Shut up.”

“I have cleansed myself. I closed my eyes and in a nanosecond, I cured myself. It’s the work of sissies.”

“Clearly I have defeated this earthworm with my words. Imagine what I would have done with my fire-breathing fists.”

“I’ve spent, I think, close to the last decade effortlessly and magically converting your tin cans into pure gold.”

“I have a disease? Bullshit! I cured it with my brain, with my mind…this bootleg cult arrogantly referred to as Alcoholics Anonymous supports a 5% success rate. My success is 100%.”

“I have real fame. They have nothing. They have zero. They have that night and I will forget about them as the last image of them exits my beautiful home.”

The Goddesses? Let me just say this about The Goddesses…I don’t believe the term is good enough, but when you’re bound by terrestrial descriptions, you must use the best choice available.”

Ah yes, the Goddesses, who include the very terrestrial Rachel Oberlin and Natalie Kenly. Kenly is the premiere model” for Cali Chronic X magazine and named the magazine’s “Official Chronic Girl 2010.” In addition, she is a graphic  designer and was a cheerleader in high school. Good to know.

Pot Smoke Management 101

Do you know where I'm going?

4/2/2011 – My friend lives in a co-op building in Brooklyn, where the tenants dictate how the place is run. During a recent board meeting, they discussed a scent-related issue: pot smoke. A couple that lives in one of the downstairs apartments lights up frequently. Tenants and guests are often greeted, when they enter the lobby, with a strong scent of weed. The collective wasn’t sure how to approach this couple.

My friend, a green-friendly gal who knows the couple, volunteered.

“What am I supposed to say to them? I mean, I smoke weed in my apartment,” she asked me.

“And what do you do?”

“I turn on the overhead fan, burn a little incense, open the window. Plus, I smoke weed from a little one hitter…it’s not like giant bong hits or something.”

“Well, that’s what you may want to convey to them. If they plan on smoking weed in a close quarter building, they may want to consider how to manage their smoke better.”

So here’s some “smoke management” pointers for people living in close quarters (that don’t include blowing smoke into toilet paper rolls and dryer sheets because that’s just weird). If you have any other suggestions, please leave a comment:

  • Smoke with awareness. If you want to remain off of the radar, reconsider that bong the size of a small child in the middle of your studio apartment. Unfortunately, it’s still an illegal substance and needs to be treated in that manner. In short, don’t be too casual.
  • Revisit how you smoke weed – your smoking accoutrement, in other words. Vaporizers obviously generate less scent. One hitters are less smoky. Bongs might be better left in locations where others are not likely to be affected the smoke it creates.
  • Circulation and ventilation is key. Blowing out windows isn’t always such a smart idea (you never know who is downwind). Running a fan and opening windows disperses the smoke in a gradual manner.
  • Burn a little sage instead of incense. Most incense is cheaply made crap (other than companies like Fred Soll, who produce amazing, truly all-natural sticks.) Sage dissipates into the air quickly, while removing overpowering scents (and bad mojo, according to Native American tradition). Incense can be noxious and perfumey.
  • Create a safe space. Out here in the suburbs, many weed-friendly folk have something akin to a clubhouse for weed. It’s usually in the form of a shed or a garage. Neighbors are none the wiser. (And it fosters a secret kid’s club feeling that many of us appreciate at this juncture of our adult lives.)
  • Be considerate. Remember, smoke is smoke. Some people don’t like it. Cigarette smoke is highly offensive to many pot smokers. But for others, any kind of smoke or strong scent can be an annoyance.

My friend spoke with the couple downstairs who now use their overhead fan and place a rolled-up towel under their door when partaking (there’s a substantial amount of space between their front door and the floor). These small changes seem to have made the difference. (Though several people, including myself, have complained that they don’t smell pot smoke in the lobby anymore.)

 

 

Sage Stick – Pot Smoke Dissipator and Bad Mojo Lifter

Smoke Rising Photo Source: Guiri R. Reyes

Beth Mann is a popular blogger and writer for Open Salon and Salon. She is also an accomplished actor and director with over 15 years of experience, as well as the president of Hot Buttered Media. She currently resides at the Jersey shore where she can often be seen surfing or singing karaoke at the local dive bar.

Contact: maryjane {at } freedomisgreen.com

Grassroots Editor Interviews Cannabis Reform Pioneer Debby Goldsberry

Debby Goldsberry is a formidable presence in the arena of cannabis reform and has been for the past 25 years. She received the NORML Pauline Sabin award in 2005 and co-founded Berkeley Patients Group. In honor of Women’s History Month, our very own Diane Fornbacher interviews this long-standing pioneer.

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Story and photo by Diane Fornbacher/Source: HighTimes.com

You helped found the successful Berkeley Patients Group in 2000, what other projects have you got cooking?

Right now, I am largely focused on helping to implement the medical cannabis ordinances passed in Oakland and Berkeley in the fall of 2011. Each city is planning to issue more dispensary permits, and they are trying to issue manufacturing permits for medical cannabis cultivation. The federal government is pushing back hard, even threatening to arrest the Oakland City Council. So, there is work to be done in each of these cities to get permits issued. Medical cannabis needs to be produced in a safe manner, and these two cities plan to set a standard for others to follow nationwide.

I’ve also been working closely with the NORML Women’s Alliance (NWA) on the Steering Committee to amplify the voices of women in the drug policy reform movement, specifically regarding parents and families.

Cannabis Action Network (CAN), where we are setting the stage for further development and evolution are developing the CAN History Project, which will record counterculture history from the 1980’s until 1996 when Prop 215 passed. A lot of history needs to be preserved and shared. Also, knowledge gained through tough times and the fun times over the last 20 years in fighting against the drug war will be documented.

Since Proposition 215 or the (Compassionate Use Act of 1996) passed, 15 states and Washington D.C. have had varying degrees of success and failure with their medical marijuana programs. Which states do you believe have the most compassionately crafted laws?

Well, I don’t think anyone’s done it perfectly yet. None of them are effectively dealing with the supply problem. Many patients still can’t get their medicine, there is an over proliferation of dispensaries which creates a backlash – in Michigan, Colorado and in Los Angeles specifically (there are pockets of perfection in the Bay Area). In Maine, each dispensary must supply all of their own medicine from only one facility. Recently, large greenhouses in Maine suffered roof collapses from snow. Imagine that one problem like this wiping out the entire supply of medicine for the patients there. It would take months to get back up and running. Locally is where most of the hope is found. When a city works with stakeholders, good regulations develop. Sometimes the states don’t do a great job, but locally, good plans can come to pass. We want to work on regulations more here in California and hope other state governments will follow our successes. Until then, we’re sort of in a holding pattern until things get more precise and functioning properly at our local level.

Read more.

PA: Medical marijuana bill warming up for 2011

A supporter protests for medical marijuana in Philadelphia

Because of the two-year cycle of the Pennsylvania General Assembly the medical marijuana bills are expected to be re-introduced soon. Advocates and legislators are also talking about some interesting changes.PA saw medical marijuana legislation introduced for the first time in 2009 by Rep. Mark B. Cohen of Philadelphia. In 2010 Senator Daylin Leach introduced the concurrent bill in upper chamber.The PA House Health and Human Services Committee held two important public hearings in Harrisburg and in Pittsburgh. Patients, physicians, advocates, religious leaders and even former law enforcement officers testified in favor of medical marijuana.This week the Board of Directors at the non-profit advocacy group Pennsylvanians for Medical Marijuana (PA4MMJ) held a conference call with Rep. Cohen to look at the effort for 2011.During the call Rep. Cohen emphasized his commitment to re-introducing the bill this year and the group also discussed some alterations to the language.Cohen continues to be a strong champion for the issue in PA, commenting on his Facebook page today:

“Changes in the bill will include naming the act after former Pennsylvania Governor Raymond P. Shafer, a leading critic of federal drug policies…”

Shafer, a Republican, was appointed by President Nixon to oversee a blue-ribbon commission to study marijuana. In 1972 the panel of experts concluded that personal marijuana use and possession should not be criminal. They also found that marijuana did not belong in Schedule I of the federal Controlled Substances Act. *President Nixon ignored his own commission’s recommendation. Marijuana has remained in Schedule I since 1970. Each state has a drug scheduling system to match the federal code. Two states, Iowa and Oregon, have moved marijuana to Schedule II.There are also suggestions that provisions to re-schedule marijuana, at the state level, be included into the Pennsylvania medical cannabis legislation.A major shift for the issue in PA is the change in Governor. Ed Rendell would have likely signed a medical marijuana bill if it passed. But the newly elected Tom Corbett (the former state Attorney General) has voiced opposition to the issue.When Frankin&Marshall University conducted the most recent polling on the topic last year that showed a whopping 80% of state residents support the medical marijuana bill.It took over five years to pass legislation in New Jersey. Patients and advocates are striving for a less protracted fight in the Keystone State.Further updates on the status of medical marijuana in PA are expected soon – more info at www.pa4mmj.orgRep. Cohen’s medical marijuana page – http://www.pahouse.com/Cohen/med_marijuana_info.asp*Schedule I drugs under the Controlled Substances Act for the United States. Required findings for drugs to be placed in this schedule:– The drug or other substance has a high potential for abuse.– The drug or other substance has no currently accepted medical use in treatment in the United States.– There is a lack of accepted safety for use of the drug or other substance under medical supervision.