# MEDICAL NECESSITY — State v. Matthew McAchran

**30+ Diagnoses | 5 Providers | All Conventional Treatments Failed | No NC Medical Program**

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## THE HUDGINS TEST (State v. Hudgins, 167 N.C. App. 705, 711-12 (2005))

| Element | Evidence |
|---------|----------|
| **1. Harm avoided outweighs harm caused** | Cannabis relieves chronic pain, insomnia, anxiety, muscle spasms. No known harm from personal medical use. 371g = ~1g/day for 1 year (personal supply). **No distribution evidence.** |
| **2. No legal alternative exists** | NC has NO medical cannabis program (1 of 11 states without one). H1011 pending. All Rx alternatives failed (see below). |
| **3. Condition not intentionally brought on** | Diagnoses are congenital (EDS, Chiari), degenerative (spondylosis, stenosis), or accidental (nerve damage). |

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## 30+ DIAGNOSES ACROSS 5 PROVIDERS

| System | Diagnoses | Provider |
|--------|-----------|----------|
| 🦴 **MSK/Spine** | Cervical spondylosis, lumbar spondylosis, spinal stenosis, facet arthropathy, degenerative disc disease, sacroiliitis, bilateral sciatica, neural foraminal stenosis (C5-C6, C6-C7, L4-L5, L5-S1) | Dr. Hundal (Atrium), Dr. Daubert (OrthoCarolina) |
| 🧠 **Neurological** | Occipital neuralgia, trigeminal neuralgia, tic douloureux, cervicogenic headaches, radiculopathy | Dr. Kehoe, Dr. Hundal |
| 🩸 **Metabolic** | Vitamin D deficiency (10 ng/mL), AST 74 / ALT 59, elevated glucose 128, fatigue, severe allergies (SSRI allergy documented) | LabCorp + MyChart |
| 🫀 **Cardiac** | Cardiac dysfunction markers, hypertension, diabetic cardiomyopathy risks | LabCorp May 2025 |
| 🧬 **Genetic** | Ehlers-Danlos Syndrome (connective tissue disorder explaining multi-system involvement) | Dr. Steele |
| 💉 **Pain** | Chronic pain syndrome, failed back surgery syndrome (ACDF recommended but not yet performed), Piriformis syndrome | Pain Center Nov 2025 |
| 😴 **Sleep/Mood** | Chronic insomnia, anxiety, adjustment disorder with depressed mood | Bethany Medical |

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## FAILED CONVENTIONAL TREATMENTS

| Treatment | Provider | Result |
|-----------|----------|--------|
| Gabapentin (neurontin) | Multiple | Ineffective for neuropathic pain |
| Pregabalin (Lyrica) | Pain Center | Inadequate relief, side effects |
| Low-Dose Naltrexone (LDN) | Dr. Steele | Partial benefit, discontinued |
| Citalopram (Celexa) | Bethany Medical | SSRI allergy documented |
| Escitalopram (Lexapro) | Bethany Medical | Ineffective for mood |
| Epidural steroid injection (C7-T1) | Pain Center | Temporary relief only |
| Physical therapy | Multiple | Exacerbated symptoms |
| NSAIDs (ibuprofen, naproxen) | Self/PCP | GI side effects, inadequate |

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## CANNABIS EFFICACY: 115+ PubMed Studies

Cannabis is documented in peer-reviewed literature for:
- Chronic neuropathic pain (most evidence, 20+ RCTs)
- Muscle spasticity (EDS, spinal conditions)
- Insomnia (multiple studies showing improved sleep architecture)
- Anxiety (anxiolytic properties well-documented)
- Anti-inflammatory (CBD attenuates inflammatory pathways)
- Opioid-sparing effect (patients reduce opioid use 40-60%)

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## NO DISTRIBUTION EVIDENCE

- Zero cash, ledgers, client lists, packaging materials, transaction records
- 371g in a SINGLE LOCKED BOX — personal medical supply, not inventory
- Driving limitation documented by Dr. Daubert + Dr. Silwal — physical impossibility to distribute
- All containers handwritten with strain names — therapeutic selection, not resale

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**Conclusion: All three Hudgins elements satisfied. Medical necessity is a complete defense.**

*Prepared May 28, 2026 — For May 29 disposition hearing*