Add Qualifying Condition – Irritable Bowel Syndrome (IBS)

This page is for tracking the ACIA’s progress towards applying with the Arkansas Department of Health (ADH) to add Irritable Bowel Syndrome (IBS) as a qualifying condition.

We have chosen IBS because of the condition’s similarity to Crohn’s Disease, which is already one of the qualifying conditions. In other words, it should be an easy one to add, and it will be a good test of the ADH’s willingness to add additional qualifying conditions.

Below is the petition form from the ADH and our information and notes gathered in preparation for submitting the petition.

Petition to Add a Debilitating Medical Condition

A – Name the medical condition, medical treatment or disease. Provide the ICD-10 code(s).

  • K58.0 – Irritable bowel syndrome with diarrhea
  • K58.1 – Irritable bowel syndrome with constipation
  • K58.2 – Mixed irritable bowel syndrome
  • K58.8 – Other irritable bowel syndrome
  • K58.9 – Irritable bowel syndrome without diarrhea

B – Describe the extent to which the debilitating medical condition or disease itself and/or the treatments, cause severe suffering and impair a person’s daily life.

IBS is classified according to the primary symptoms displayed by each patient. Thus diarrhea, constipation, and alternating diarrhea with constipation and infection become the basis for diagnosing the disease as IBS-D, IBS-C, IBS-A, or post-infectious IBS-PI, respectively. Ulcerative colitis is a form of IBD that can affect other body parts as well. Crohn’s disease, another form of IBD, is an autoimmune disorder affecting the gastrointestinal tract.

Other frequently observed symptoms may include abdominal discomfort (gas, bloating, cramps), the sensation of incomplete void of stool, gastroesophageal reflux disease (GERD), anxiety, depression, pain (abdominal, back, head, muscle), increased generalized weakness, and lack of energy.

Case reports from cannabis-using IBS patients suggest that cannabis may be effective in managing some symptoms, especially nausea, diarrhea, stress, cramps, and lack of appetite.

C – Describe conventional medical therapies, to alleviate suffering caused by the condition or the treatment thereof.

Doctors may recommend patients try some of the following medicines to relieve IBS symptoms:

  • Laxatives to help with constipation.
  • Fiber supplements for constipation relief.
  • Antibiotics to reduce bloating.
  • Peppermint oil capsules to reduce symptoms.
  • Anti-diarrheal tablets to slow stool movement through the colon.
  • Antispasmodics to reduce painful muscle spasms in the abdomen.
  • Antidepressants to relieve the general symptoms.

When taken over a protracted period, many of these drugs cause side effects. For example, abruptly stopping antidepressants can cause withdrawal symptoms. Side effects of antidepressants include:

  • Sexual problems
  • Vomiting
  • Nausea
  • Sleepiness
  • Weight gain
  • Diarrhea

Antidepressants can even make patients feel suicidal in the worst-case scenario. Both antidepressants and antispasmodics can worsen constipation. Muscle relaxants are prescribed in these cases. Unfortunately, muscle relaxants contain a mild sedative that can be habit forming. Even fiber supplements and laxatives can have adverse effects. Some people report worsened gas and bloating from supplements. Laxatives can be habit forming when used too often. Some people report nausea as a side effect of taking peppermint capsules.

Other conventional IBS treatments include:

  • Stress-relieving therapies
  • Gut-directed hypnotherapy
  • Mindfulness training
  • Probiotics

D – Describe proposed benefits from the medical use of cannabis, for the named medical condition or disease.

  • Could use patient count for Arkansas
    • APCD – All-Payer Claims Database
    • Trang Riley
    • 501-526-2319
    • may have to pay to pull numbers from database
    • Storm will call
  • ‘Approximately 20 percent of Arkansans will have IBS symptoms at some point in their lives.’ T. Glenn Pait, M.D.

Approximately 35 million Americans are impacted by IBS.

Research is being carried out in the field of medical marijuana for irritable bowel syndrome. Some evidence suggests that your body’s endocannabinoids, the molecules in your body that resemble compounds found in pot, could help limit intestinal inflammation. People with IBD have higher levels of cannabinoid receptors in their colon. There have been some small studies that show many patients take medical cannabis for irritable bowel syndrome symptoms.

Even though cannabis and irritable bowel syndrome research and treatment recommendations are still in their infancy, there are ways pot can improve your quality of life. Marijuana can ease three main symptoms of IBS — depression, diarrhea and abdominal pain.

Using Cannabis to Treat IBS-Related Depression

IBS affects patients’ mental well-being. Cannabis is a well-known mood lifter. Just a little can make a patient feel far more positive. A study published in April 2016 in the journal Neuropharmacology discovered a non-psychoactive substance in cannabis, cannabidiol (CBD), eases anxiety and antisocial behaviors in rodents in minutes. The effects continued to work over time. Conventional antidepressants can take weeks to work. Cannabis could work wonders for you if you feel depressed as a result of your illness.

Using Cannabis to Treat IBS-Related Diarrhea

Diarrhea is a debilitating, painful and embarrassing symptom of IBS. Cannabis has been shown to help with diarrhea by reducing the rate food moves through your gastrointestinal tract while minimizing abdominal cramping.

Using Cannabis to Treat IBS-Related Abdominal Pain

A study published in the British Journal of Pharmacology suggests cannabinoid treatments can help manage diseases like IBS. Pot is both anti-inflammatory and works well at alleviating nerve pain. Another study points to cannabinoid treatments calming intestinal lining inflammation and sensitivity in people with GI problems.

E – Provide evidence generally accepted by the medical community and other experts, that the use of medical cannabis alleviates suffering caused by the named condition or disease. Supporting evidence includes full text peer reviewed journal articles and/or complete medical studies.

F – Attach letters of support for the use of medical cannabis from physicians and or other licensed health care providers knowledgeable about the named condition or disease. This may include a letter from the physician with whom the petitioner has a bona-fide physician patient relationship. And any additional medical testimonial or scientific documentation.

  • Robert DeBin knows Dr. Alonza Williams, an Arkansas gastroenterologist, is willing to write a support letter – he does support medical cannabis
  • Melissa Fults has an IBS patient with a history of cannabis keeping his IBS in permanent remission – Melissa’s step-father-in-law – he will be willing to write a testimonial letter – he was practically disabled from IBS with conventional therapies and had a complete turnaround after treating his IBS with cannabis

Internal Notes

2018-02-22

Robert deBin: Can’t make today’s call but my dr Williams update is: I’ve been in touch with his assistant. Gave her all the info. Dr. Williams is out of town until next week. Hope to hear something then.

2018-02-16

Conference call notes:

  • Attendees
    • Eric
    • Storm
    • Bradley
    • Baron
    • Erin H.
    • Steve Johnson
    • Adam H.
    • Loretta
    • Corey
  • Loretta – New Jersey added IBS in July of 2017 via petition
    • She spoke with supervisor, recommended we speak with the director
    • Scott is the director of the NJ cannabis association
      • scott@newjerseycannabusiness.com
    • We should be able to get help with our petition
  • Eric
    • Will reach out to Minnesota, New York, and Pennsylvania about IBS
  • Steve
    • We should be clear that methods of administration such as sublingual and ingestion (edibles) are alternatives to smoking for IBS patients
2018-02-09

Conference Call notes:

  • Attendees:
    • Steve
    • Adam G.
    • Eric R.
    • Jason
    • Adam H.
    • Robbin
    • Robert
    • Brandon
    • Corey
    • Dr. Melissa
    • Baron
    • Loretta
  • Robert spoke with Dr. Williams
    • has agreed to write letter of support
    • ask for letter by end of next week, if possible
  • Corey
    • Jerry Puryear – has agreed to write letter
    • Josh Winningham – has agreed to write letter
    • Dr. David Bearman – has agreed to write letter – California doctor
    • reaching out to Dr. Jeffrey Hergenrather for a letter of support
    • Sara Payan is looking for patients to provide letters
  • Brandon
    • not much luck with UAMS
    • has one physician, a gastroenterologist, who is willing to work with us
  • IBS patient count in Arkansas
    • all-payer database
    • Arkansas All-Payer Claims Database (APCD)
    • Storm will call to ask for patient counts
      • From Jason Martin:
        Mary-Lee Smith
        Director of Communications
        Arkansas Center for Health Improvement
        1401 West Capitol Avenue | Suite 300 – Victory Building | Little Rock, AR  72201
        501.526.2248 direct | 501.526.2244 office | 501.526.2252 fax
        MWSmith@uams.edu
  • Baron
    • Dr. Sulak wants to be paid for his help
  • Submission format to ADH
    • Joy Gray confirmed that a paper copy is required
    • We may opt to provide an electronic copy, as well
2018-02-06

Letter from Dr. Joe Goldstrich:

The use of cannabinoids in the management of Irritable Bowel Syndrome

2018-02-05
Update from Eric Ryan:

Good afternoon to everyone!

To be respectful of those who get inundated with emails, I have copied only those that I know to have volunteered or been tasked with the sourcing of information, or should otherwise be included.  If you feel anyone was left out please feel free to forward.
I know everyone has a lot on their plates so I’m sending this email as a friendly reminder.  If you find time in your busy schedules to work on a little information for our petition, this is the direction we are looking for from specific individuals:
  • Robert deBin to reach out to Dr. Alonzo Williams
  • Corey and Baron are already communicating with Dr. Sulak, thank you guys!
  • Corey is also working with Dr. Goldstrich, Dr. Puryear, Sara Payan for real patient experience, and potentially Dr. Bolen and Dr. Fogoros
  • Steve Johnson sent us the relevant pages from Cannabis Health Index, and Storm transcribed much of the relevant information where it belongs. Thank you gentlemen!
  • Bradley and Dr. Taliaferro I believe are also reaching out to a network of experts and advocates who might also offer support here in Arkansas.
  • Eric to add content to Section B this week.
We will have another call to see where we are on this Friday from 1p,-1:35pm if I’m not mistaken or there are not any scheduling conflicts here.  I believe Erin will send out an invite via Facebook and Calendar invite through email.
I know everyone is very busy, the Association appreciates whatever amount of time you have to devote to this important patient building project! I hope everyone has a great week!!!
-Eric Ryan
From Corey Hunt:
Please see below for Dr. Joe & Dr. Sulak’s bio’s

Joe Goldstrich, MD, FACC
Dr. Joe is Board-Certified in Internal Medicine, Cardiology, and Clinical Lipidology, with a distinguished career in traditional medicine, nutrition, lipid management and preventive cardiology. He is a Fellow of the American College of Cardiology and the former National Director of Education and Community Programs for the American Heart Association. Since 2012, he has specialized in medical cannabis, helping patients utilize cannabis as part of their traditional medical treatment. He currently serves as a member of the Board of Directors for the Society of Cannabis Clinicians and holds an active California medical license.

Dustin Sulak, D.O.
Dr. Dustin Sulak is a renowned integrative medicine physician based in Maine. He has helped 18,000+ patients and is nationally regarded as an expert on medical cannabis. Dr. Sulak holds the distinction of being a Diplomat of the American Academy of Cannabinoid Medicine. He lectures on medical cannabis and the endocannabinoid system nationally. Dr. Sulak currently serves as a member of the Board of Directors for the Society of Cannabis Clinicians.

Email from Corey to Dr. Russo:

Dr. Russo,

I hope this finds you well. My name is Corey Hunt, we have met at a few medical cannabis conferences over the past few years. I am the co-founder of Illegally Healed. I am friends with Justin Kander and the former creative director for Patients Out of Time.
I live in Arkansas and have helped advocate for cannabis education here in my s state. I sit on the board of directors of the Arkansas Cannabis Industry Association. As an association, we are in the process of petitioning the state to add Irritable Bowel Syndrome as a qualifying condition to the state’s medical cannabis program.
I have heard you speak at many conferences, most recently at the 2017 Terpestival in Seattle – FANTASTIC PRESENTATION! I figured since you were the first researcher to make a connection between cannabis and IBS over 15 years ago, you could be of expert assistance on this matter.
Any recent research you could point us to would be very helpful to our petition.
If you are able to provide a letter of support addressed to the Arkansas Department of Health, that would help fulfill requirements of our petition. You can send this directly to me and I will include in the submission to the DoH.
Joe Goldstrich, MD and Dustin Sulak, D.O. are both providing letters of support as well.
Specifically, these are the 3 areas of the petition that we are hoping your letter will assist with:
  • A description of the proposed benefits from the medical use of marijuana specific to the proposed debilitating medical condition or disease.
  • Evidence generally accepted by the medical community and other experts that the use of medical marijuana alleviates suffering caused by the debilitating medical disease and/or treatment.
  • Letters of support for the use of medical marijuana from physicians and/or other licensed health care professionals knowledgeable about the condition or disease.
Thank you,
Corey Hunt
Email from Corey to Dr. Joe Goldstrich:
Dr. Joe,
To add a qualifying condition to the Arkansas program, we must petition the director of the Department of Health. Part of the petition process set forth by the state requires us to have letters of support from physicians with experience in cannabis and the condition we are petitioning for.
As a favor to me and Arkansas patients, would you please provide a written testimony on what you have seen cannabinoid therapies be able to do in patients with IBS.
Here are the 3 areas of the petition that we are hoping your testimony will assist with:
  • A description of the proposed benefits from the medical use of marijuana specific to the proposed debilitating medical condition or disease.
  • Evidence generally accepted by the medical community and other experts that the use of medical marijuana alleviates suffering caused by the debilitating medical disease and/or treatment.
  • Letters of support for the use of medical marijuana from physicians and/or other licensed health care professionals knowledgeable about the condition or disease.
We are attempting to add IBS specifically because Chron’s and Colitis are already an approved condition.
Thank you, my friend! Dr. Dustin Sulak is also providing a written testimony and helping on this petition as well. I think by having TWO board members of the SCC providing testimony, this will drastically help our chances of getting this petition approved.
Always a pleasure hearing from you,
Corey
Email from Corey to Dr. Sulak:

Dr. Sulak,

RE: Baron Crane. Baron is part of the team at the ACIA that is working toward completing a petition to the state to add a qualifying condition to the Arkansas program. Baron may have more to add… this is the specific ask:
To add a qualifying condition to the Arkansas program, we must petition the director of the Department of Health. Part of the petition process set forth by the state requires us to have letters of support from physicians with experience in cannabis and the condition we are petitioning for.
As a favor to me and Arkansas patients, would you please provide a written testimony on what you have seen cannabinoid therapies be able to do in patients with IBS.
Here are the 3 areas of the petition that we are hoping your testimony will assist with:
  • A description of the proposed benefits from the medical use of marijuana specific to the proposed debilitating medical condition or disease.
  • Evidence generally accepted by the medical community and other experts that the use of medical marijuana alleviates suffering caused by the debilitating medical disease and/or treatment.
  • Letters of support for the use of medical marijuana from physicians and/or other licensed health care professionals knowledgeable about the condition or disease.
We are attempting to add IBS specifically because Chron’s and Colitis are already an approved condition.
Thank you, my friend. I owe you a big favor for this one!!! Dr. Joe Goldstrich is also providing a written testimony and helping on this petition as well. I think by having TWO board members of the SCC providing testimony, this will drastically help our chances of getting this petition approved.
Always a pleasure hearing from you,
Corey
2018-02-02

Conference Call Notes:

  • Attendees
    • Eric
    • Dr. Melissa
    • Adam G.
    • Jason
    • Kyle
    • Robert
    • Steve
    • Adam H.
    • Erin
    • Storm
    • Robbin
    • Loretta
    • Brandon
    • Corey
  • For future calls, meeting invites need to be sent via Facebook and traditional calendar invite
  • IBS will be our one and only focus for adding qualifying conditions at this time
  • Dr. Alonzo Williams
    • past member of Arkansas State Medical Board
    • gastroenterologist
    • doctor at UAMS
    • Robert deBin will reach out to him
  • Dr. Sulak – known to Corey and Baron
    • he’s willing to write a letter of support
    • has real world experience treating IBS
    • Baron will reach out to him
  • Dr. Joe Goldstrich
    • known to Corey
    • agreed to write letter or can provide support in some other way
    • will write opinion letter
    • have anecdotes from current IBS patients
    • site on board of Society of Cannabis Clinicians
    • will provide monograph for IBS
  • IBS research provided by Loretta Level
  • Jerry Puryear
    • pharmacist on Corey’s board
    • willing to write letter
    • pharmacist at UAMS
  • States IBS is approved in for medical cannabis:
    • Maine
    • Minnesota – inflammatory bowel disease
    • New Jersey
    • New York
    • Ohio
    • Pennsylvania
  • Narrative for B, C, and D
    • please email to Eric Ryan
  • Overall goal of completion by March 2nd
  • Steve Johnson will send relevant pages from Cannabis Health Index
  • Sara Payan
    • nurse at San Francisco dispensary
    • can provide letter about patient anecdotes about treatment for IBS
    • contact of Corey’s
2018-01-31

From Baron Crane: I have reached out to Dr Dustin Sulak and am waiting for a reply. He is a medical cannabis doctor in Maine who has experience treating IBS patients. Maine is one of the few states that recognize IBS as a qualifying condition and Dr Sulak is the only doctor I have been able to find so far that discusses treating IBS. If we can find a doctor that has patient experience treating IBS with cannabis that is willing to write a testimony that could be the key to getting it approved.

2018-01-29

From Bradley Phillips – Network of experts and advocates:

Experts and Advocates

2018-01-26

From Storm Nolan – I spoke with Joy Gray today, the head of the MMJ division at the ADH. She confirmed that they haven’t received an application yet to add a qualifying condition. Let’s be the first!

2018-01-24

From Robbin Rahman – Here is our statutorily established evidentiary burden:

Section 4(c)(2) of the AMMA: “In considering a petition, the department shall add medical conditions or treatments to the list of qualifying conditions set forth in section 2 of this amendment if patients suffering medical conditions or undergoing the treatments in question would derive therapeutic benefit from the use of marijuana, taking into account the positive and negative health effects of such use.”

The DOH form requires us to make additional, different showings, but I think if they deny it and we decide to seek an appeal through a lawsuit, this is the burden that we have to make absolutely sure we carry.

So the first step in my mind is making sure we have gathered as much evidence as possible of a “therapeutic benefit.” I presume this has a clinical meaning – perhaps one of the doctors or Brandon could chime in on this.

The Arkansas Supreme Court just ruled that the legislature cannot waive sovereign immunity (the concept that you can’t sue the state). Very controversial and could mean that you can’t sue under AFOIA now, which is crazy.

Luckily, the appeal right for adding conditions is set forth in a Constitutional amendment, so we should still be able to appeal the decision of the DOH.

2017-12-14

From Brandon Thornton: I think this Russo article is a good place to start. He makes a compelling case for using cannabis to treat IBS and includes strong references to back his points. Most of his references are paid-access articles, but I think I can access these from the UAMS Pharmacy School drug info center (I’m going to try anyway). We can follow his lead and build a case based on his references and any other peer-reviewed articles that have been published since. Let’s make it impossible for the BOH to say no!

Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Benefits of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?