Cannabis in PTSD – Part II

“In spite of his family’s pampering, Bobby felt strange in civilian life. Preceded by the slap on his face of a freezing wind —stinking of diesel fuel, spent gunpowder and suffocating sand—a recurring image haunted his sleep.

The troubling, taciturn hitchhiker—smelling of mirth and holding a sharp scythe—hops into their patrolling Humvee at the camp’s gate. Clad with a paltry poncho, he silently squats in a corner. Waiting.

-“WATCH OUT FOR IDES,” Bobby yelled. “One hit—you’re toast.”

-“Easy,” William Senior said coming to his bedside. “I’ll bring a snack—“ He came back shortly holding a tray with two glasses of milk and cookies.

-“We booked a predator-hunting trip out West. Want to saddle up, Cochise?”

In my novel, Bobby, the main character’s high school sweetheart, suffers from PTSD after spending several tours of combat in Iraq and Afghanistan. Many active duty American servicemen and veterans have this disease, which has been properly recognized as such and is being studied at present.

The web page of the “Veterans for Medical Cannabis Access” says, “despite the anecdotal evidence to the contrary, most of the experimental studies that have been conducted so far indicate that by and large the administration of exogenous cannabinoids such as vaporizing therapeutic cannabis may not be the most reliable nor effective means of utilizing the eCB system to treat anxiety and aversive memories such as those formed in PTSD.” They advocate the investigation of other mechanisms to limit the eCB breakdown, which coupled with the extinction/habituation therapy might alleviate PTSD.

Considering the humongous amount of human and material resources that the U.S. military has been deploying worldwide, it is certainly not too much asking that they assign a fraction to PTSD’s scientific and clinical research.

One of the most pressing issues for the veterans with grave symptoms of PTSD is the unrelenting persecution of some authorities in a few states when one of them is caught consuming or, worse, planting some marijuana in their backyard for their consumption. In the “First Southeast Cannabis Conference and Expo of South Florida” held at the Fort Lauderdale Convention Center on June 10, 11 2017, Attorney Michael Minardi gave a good presentation about the legal challenges and remedies in these prosecutions. He said that the dismissal of these cases must be based on proving “the medical necessity’ of this act. However he gave several examples of harrowing ordeals veterans had to go through.

The soldiers that carry the defense of the realm deserve an equitable redress.

What do you think? Please tell us.

Don’t leave me alone.

 

Cannabis in PTSD – Part I

We can still remember that great scene in Oliver Stone’s “Platoon” movie where the stressed-out grunts dance in their tent while passing around a bamboo pipe. The association of marijuana with the U.S. military dates back to the Vietnam War where it was a good, ready solace for the terrified and tired soldiers in the field.

The diagnostic term “Post-Traumatic Stress Disorder” (PTSD) refers to a series of psychiatric symptoms secondary to an unusually stressful/traumatic emotional event, a common occurrence in the military. The fifth edition of the “Diagnostic and Statistical Manual” (DSM) has these criteria categories:

  • Criteria A: the person was exposed to death, threatened death of threatened serious injury or sexual violence by direct or indirect ways.
  • Criteria B: the traumatic event is consistently experienced.
  • Criteria C: avoidance of trauma-related stimulation after the trauma.
  • Criteria D: frequent thoughts or feelings that began or worsened after the trauma.
  • Criteria E: trauma related arousal and activity that began or worsened after the trauma.
  • Criteria F: symptoms last greater than one month.
  • Criteria G: creates distress or functional impairment.
  • Criteria H: symptoms are not due to medications, drug abuse or medical illness.

The PTSD complex can include the syndromes of Depersonalization (observers consider that the individual is dreaming) and Derealization (the individual feels things that do not have an external stimuli) Exposure to high explosive blasts account for a considerable number of PTSD cases, for which physicians must always suspect and rule out structural brain changes before using the PTSD label as a primary psychiatric – not physical disorder.

In PTSD there is an endocannabinoid deficiency, as the body does not produce enough to fill all the brain receptor sites; by replenishing them, the CB-1 signals deactivate the traumatic memories, avoiding the impaired fear extinction, aversive memory consolidation and chronic anxiety of PTSD. Cannabis can produce acute anxiety reactions and panic attacks, especially in individuals not used to THC. Is it an adjuvant cause or a needed relief?

A paper by the “National Center for PTSD” said that the effects of cannabis use vary according to the concentration and potency of the cannabinoids. “The concentration of THC in the marijuana plant can range in strength from less than 1% to 30% based upon strain  and cultivation methods…Cannabis extract products, such as waxes and oils, have been produced and sold in which the concentration of THC can be as high as 90%.” Even though the prolonged use of Cannabis may reduce the worst symptoms of PTSD, it can produce a steady physiological tolerance and eventually drug addiction.

We will continue this discussion in an upcoming second part of this article.

What do you think? Please tell us.

Don’t leave me alone.

Cannabis in Epilepsy

There is an increasing interest in the use of marijuana products to treat grave neurological disorders like Parkinson’s disease and Multiple Sclerosis. However the American Academy of Neurology (AAN) has said in a position statement that anecdotal evidence is not enough to support this use because:

  1. Its efficacy is not supported by properly conducted clinical trials
  2. Its clinical safety is still being questioned for long-term use
  3. Its interaction with prescription medications is still unknown

The AAN has requested the reclassification of marijuana-based products from their current Schedule 1 status according the DEA guidelines in order to allow its use under International Review Board (IRB) clinical protocols. This administrative step is especially needed to protect the investigators who study patients with grave diseases and/or children with vulnerable brains. Most of the standardized preparations used in clinical trials are not available in the USA and the results cannot be extrapolated to non-standardized weed. Moreover most marijuana products sold in the USA are not controlled by any federal agency, for which they may not contain the labelled ingredients.

Epidiolex is a purified, 99% oil-based Cannabidiol (CBD) product that delivers known and consistent amounts of drug in each dosage; the FDA has given selected Epilepsy centers the permission for its “compassionate use” in some the 30% of patients who do respond to the traditional therapies. An open-label study—without a placebo control—of this drug that included 214 patients aged 2 to 26 years old with epilepsy refractory to currently available treatments showed that seizures decreased an average of 54% in the 12 weeks. Patients taking Onfi had a better response than those who did not. Two studies of the use of Epidiolex in the Lennox-Gastaut syndrome and the Dravet syndrome have recently been completed with encouraging results.

The most common side effects observed in the 214 people were: sleepiness (21%), diarrhea (17%), fatigue (17%) and decreased appetite (16%). The safety data from the trials with epileptic children had similar side effects.

What do you think? Please tell us.

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Cannabis in Multiple Sclerosis

As Marijuana is being considered as an adjuvant in the treatment of several neurological diseases to relieve the spasticity, tremors and insomnia, there is still disagreement as to whether it is indeed helpful in Multiple Sclerosis. In contrast to the advanced age of most patients with Parkinson’s disease, MS usually starts in earlier stages of life with crippling personal consequences. Some scientific studies have attempted to solve the clinical controversies.

In one study participants with a stable stage of their MS were divided into two groups of 144 people that received a Cannabis extract and another one of 135 people who received a placebo before and after three months of treatment, their perception of changes in their muscle tone was recorded. The muscular hypertonicity improved two fold in the group taking cannabis; the most frequent adverse events were urinary tract infections and dizziness.

In a 2011 European clinical study Naxibimols—an oral spray derived from Cannabis—were used to improve the spasticity of MS patients with good results that heralded its approval for use in many countries, except the USA.

In 2005 630 patients with stable stage of MS from 33 specialized centres in the United Kingdom were randomly assigned to receive THC or a placebo for fifteen weeks. Patients receiving marijuana reported improvements in pain and spasticity, which could not be confirmed by standardized testing.

Oral dosage of Dronabidol—a synthetic Cannabis derivative—was used to treat a particularly aggressive type of MS: the progressive-relapsing form; the drug did not have a significant clinical effect on progression of the MS.

In 2014 the American Academy of Neurology released a report on Cannabis use in neurological disorders, which stated that the use of oral cannabis extract and synthetic THC might be effective in the treatment of spasticity. The use of the oral spray Sativex might be helpful in the treatment of spasticity, pain and urinary frequency, with dizziness as a collateral effect.

As many more states approve the use of marijuana for medical purposes in the USA, other properly designed clinical studies will be implemented.

What do you think? Please tell us.

Don’t leave me alone.

Cannabis in Parkinson’s disease

After several people with Parkinson’s disease posted commentaries online that the use of marijuana improved their tremors, researchers designed clinical studies to find out if cannaboids (the drug molecules in marijuana) have a protective effect on the dopaminergic cells of the human brain.

Marijuana has approximately 100 neuroactive chemicals that interact with:

  1. Type 1 (CB1) receptors located in the Central Nervous system.
  2. Type 2 (CB2) receptors located in the Peripheral Nervous system.

People with Parkinson’s disease have less CB1 receptors than those without. Cannabis has agonists of the receptors that stimulate the same function as the natural compound (dopamine) but also has antagonists that block it. As medical marijuana preparations may contain both agonists and antagonists, the design and implementation of clinical research trials is cumbersome.

Delta-9-tetrahydrocannibinol (THC) is the primary component of marijuana but it has a long latency period, for which it cannot be easily measured for dosage; clinical studies give it in the form of capsule, nasal spray or liquid. Most studies had a low number of patients and did not implement a double blind set-up, which limited their scientific certitude.

Cannabidiol (CBD), its primary non-psychoactive element, has been studied in the control of non-motor symptoms in PD like psychotic episodes. After taking 400 mg/day of oral cannabidiol for a month, the participants had fewer psychotic symptoms without cognitive or motor side effects. In another study involving patients with disturbances of REM sleep—crying, laughing, cursing and yelling in the middle of the night—the daily dosage of 75 to 300 mgrs of Cannabidiol for at least six weeks reduced the symptoms.CBD can be consumed as cannabis oils like they do for pediatric patients; a dollop of oil is placed in a capsule under the tongue or mixed with foodstuff.

The research on marijuana use in neurological diseases is in its early stages but, as many more U.S.A. state legislatures approve its medical use, there will be a new civic impetus for their completion.

What do you think? Please tell us.

Don’t leave me alone.

Acupuncture in Migraine

According to a recently published paper that used data stored in the  Cochrane Database and originating from 22 clinical research trials with 4,985 people that had migraine headaches, the use of Acupuncture reduces the frequency of episodes compared to both pharmacological therapy and sham Acupuncture.

Acupuncture studies are difficult because the “blinding” (participation of individuals that do not receive the actual treatment but ignore it) is not perfect as the use of needles alters the flow of energy in the body meridians.

In 15 trials where Acupuncture was compared with sham Acupuncture, the frequency of headaches was cut in half in 50% of the patients receiving true Acupuncture compared to 41% of the ones receiving sham Acupuncture. In 3 trials where Acupuncture was compared to drug treatments, the frequency of headaches was halved in 59% of patients treated with Acupuncture compared to 54% of people taking drugs. Moreover the people receiving Acupuncture reported fewer side effects and were less likely to drop out of the studies.

The benefit of Acupuncture may also be explained by the following factors:

  1. Expectations and beliefs of the patients.
  2. Knowledge and openness to new experiences.
  3. Patient-provider relationship.

Patients that have a higher commitment to a healthy lifestyle and engage themselves in all aspects of treatment, tend to have much better outcomes in complementary medicine.The literature suggests that combining pharmacotherapy and behavioral approaches is much more effective and longer lasting than either one alone.

The non-pharmacological treatment of chronic Migraine headaches includes patients’ education, identification of triggers, vitamins and herbal therapy, biofeedback, etc., which have a bonafide place in the holistic approach of practitioners. Acupuncture is useful in the treatment of chronic conditions but only well-trained, experienced and reputable practitioners should do it.

What do you think? Please tell us.

Don’t leave me alone.

Understanding the Kamasutra

When I was a little boy, my uncle José Luis, a teenager at the time, gave me surreptitiously a copy of the Kamasutra to peek at the drawings of racy variants of coitus.

But that universally known repertory of acrobatic positions to make love was much more than an erotic compendium to laugh at. It was serious business. And still is.

Wendy Doniger, an authority on Indian literature, has placed this book in the larger context of Indian treatises, an ancient and comprehensive library. She gives special attention to the Arthashastra, the treaty in Sanskrit on the use and abuse of political power, supposedly written by the scholar Kautilya.

She proposes that the erotic manoeuvres of the Kamasutra are a variant of the stratagems and deceptions of the Arthashastra, as conquering a woman and a city might need similar tactics based on deception and skulduggery. It is also related to the more archaic Dharmashastra or the book of Manu.

These texts illustrate the three “purusharthas” (lifetime’s goals) of the Hindu religious tradition, which are “dharma” (law), “artha” (self-interest) and “kama” ( pleasure). The Kamasutra is a compendium of the multiple erotic situations that a generic Indian character, wealthy and carefree, called “the nagaraka” (man-about-town) discovers in his hedonistic vagabondage.

This profane text harks back to the nebulous times of the Vedic antiquities. Nandin, the bull that guarded the door of the chamber where Shiva and Uma had an intercourse lasting for a thousand years, jotted down notes of the feat. That erotic knowledge was passed down through the centuries to humans, albeit in a much more reduced form, as they could not hope to apply it all.

In classical India, the body of knowledge, large and thorough at the outset, gets shrunk until it reaches the Kali Yuga, the wasteland we are living in. In Vedic India, everything is inter-related, including eroticism and philosophy. In our all too rational societies where emotional frustration due to unsatisfactory relationships is widespread across all ages and societal strata, we have a hard time to grasp that ancient wholeness.

What do you think? Please tell us.

Don’t leave me alone.