Sunil Kumar Aggarwal’s Doctoral Dissertation

Dr.Sunil Kumar Aggarwal Doctoral Dissertation

Dr.Sunil Kumar Aggarwal Doctoral Dissertation

“The Medical Geography of Cannabinoid Botanicals in Washington State:Access, Delivery, and Distress”

 

Doctoral Dissertation.  Accepted August 22, 2008.

©Copyright 2008
Sunil Kumar Aggarwal

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington, 2008 Program Authorized to Offer Degree: Geography,University of Washington

Abstract: The Medical Geography of Cannabinoid Botanicals in Washington State: Access, Delivery, and Distress

Sunil Kumar Aggarwal, Chair of the Supervisory Committee: Professor Jonathan Mayer, Geography

Though rendered dormant by a post-1937 Cannabis sativa L. prohibition, the emerging field of cannabinoid medicine is growing in the United States as ever greater numbers of physicians become educated about the physiologic importance of the endogenous cannabinoid system and about the wide safety margins and broad clinical efficacies of cannabinoid drugs, available in both purely botanical and purely chemical varieties and useful for managing pain and other conditions in the growing chronically and critically ill patient population.

Research presented here is focused on medical access and delivery of cannabinoid botanicals in Washington State and seeks to map the geography of this developing cannabinoid medical care system by taking medical geographic “snapshots” of two purposefully chosen locations: a rural clinic site in Washington State where patients currently access cannabinoid botanicals for medical use in the treatment of chronic pain syndromes with acceptable safety under medical supervision and another site where qualifying patients are delivered environmentally culled cannabinoid botanicals. At the former site, retrospective chart reviews were conducted with 139 patients with chronic pain, and at the latter site, a convenience sample of 37 qualifying patients delivered a monoclonal lot of  cannabinoid botanical medicine were prospectively studied using standard and tailored survey instruments.

A political ecology of disease approach was employed to rationalize and depathologize patients’ mental distress at potentially facing possession-related legal problems due to their consumption of the still-contraband biota. Results provide quantitative and qualitative insight into the frail health status in both samples of qualifying patients and give a grounded understanding of the lengths that patients and care providers go, despite multiple hurdles, to access and deliver treatment with cannabinoid botanicals that relieves patients’ diverse symptoms and improves their health-related quality-of- life.

The complete Doctoral Dissertation of Dr.Cannabinergy, Sunil Kumar Aggarwal may be viewed here.

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Dr,Cannabinergy, Sunil Kumar Aggarwal MD, PhD, Physician-Scientist and Medical GeographerAsk Your Questions and  Talk to Dr.Cannabinergy

TABLE OF CONTENTS
Page
List of Figures……………………………. iii
List of Tables ……………………………    iv

Introduction: Medical Geography and the Phenomenon of Hempen Cannabinergy……..1
References for Introduction ………………..20

The Medical Geography of Cannabinoid Botanicals in Washington State I:
Characteristics of Patients with Chronic Pain Accessing Treatment at a
Rural Clinic……………………………………….25
Introduction to Cannabinoid Medicine in the US…………25
Contesting Cannabinoid Botanical Medicines……….31
Authorizing the Medical Use of Cannabinoid Botanicals in
Washington State ………………………………………….36
Study Design and Procedures ………………….40
Results……………………………………………………..44
Conclusion …………………………………….49
References for I…………………………..56

The Medical Geography of Cannabinoid Botanicals in Washington State II:
Subjective Health Status of Qualifying Patients Delivered a Clonal Lot of
Maturated Germplasm………………………………..67
Introduction…………………………………………….67

Contesting Cannabinoid Botanical Medicines and the Human-Environment
Relationship ………………………………………………………69
Study Background …………………………………………………76
Study Design………………………………………………………..81
Study Procedures ………………………………………….83

Complementary and Alternative Cannabinoid Botanical Medicines
Community Clinic Characteristics………………………………85
Subjective Health Status in a Convenience Sample of Qualifying Patients……88
Prospective Health Data from Returned Take-Home Materials……………………95
Cost of Keeping a Lot of Cannabinoid Botanical Medicine Stocked and
Deliverable…………………………………………………………………96
Discussion……………………………………………………………97
Conclusion ……………………………………………………….100
References for II …………………………………………130

The Medical Geography of Cannabinoid Botanicals in Washington State III:
Contraband Psychoactive Biota Consumption and the Political Ecology of
Mental Distress at Facing Possession-Related Legal Problems ………….141
Tracing the Roots of a Critical Political Ecology of Disease ……….141
Psychoactive Biotic Substances and the Political Ecology of
Mental Distress ……………………………………………………………..145
Substance-Related Disorders Diagnostics and Possession-Related Legal
Problems …………………………….152
Banning Biota and Sowing the Seeds of Distress…….159
Asserting the Human Right to Health…………………….166
Therapeutic Cannabis Users’ Mental Distress at Facing Possession-Related
Legal Problems: a Local Case Study…………………………168
Discussion………………………………………………….180
Conclusion …………………………………………………185
References for III ……………………………………195
Conclusion: Pain Relief on Pain of Death—When Worldviews Collide …….205
References for Conclusion………………………………209

Bibliography ……………………………………………211
Appendix A: Chart Review Data…………………………273
Appendix B: Interview Script and Survey Instruments….302
Appendix C: Consent Form………………………………357
Appendix D: Available Health Statistics from State Agencies Administering
Cannabinoid Botanical Medical Access Programs: OR, NV, CO, RI………..360

 

 

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