First Pharmaceutical Treatment for PTSD Within Reach

[RainDog]

http://www.sciencedaily.com/releases/2013/05/130514085016.htm

May 14, 2013 — In a first-of-its-kind effort to illuminate the biochemical impact of trauma, researchers at NYU Langone Medical Center have discovered a connection between the quantity of cannabinoid receptors in the human brain, known as CB1 receptors, and post-traumatic stress disorder, the chronic, disabling condition that can plague trauma victims with flashbacks, nightmares and emotional instability.

Their findings, which appear online today in the journal Molecular Psychiatry, will also be presented this week at the annual meeting of the Society of Biological Psychiatry in San Francisco.

CB1 receptors are part of the endocannabinoid system, a diffuse network of chemicals and signaling pathways in the body that plays a role in memory formation, appetite, pain tolerance and mood. Animal studies have shown that psychoactive chemicals such as cannabis, along with certain neurotransmitters produced naturally in the body, can impair memory and reduce anxiety when they activate CB1 receptors in the brain. Lead author Alexander Neumeister, MD, director of the molecular imaging program in the Departments of Psychiatry and Radiology at NYU School of Medicine, and colleagues are the first to demonstrate through brain imaging that people with PTSD have markedly lower concentrations of at least one of these neurotransmitters -- an endocannabinoid known as anandamide -- than people without PTSD. Their study, which was supported by three grants from the National Institutes of Health, illuminates an important biological fingerprint of PTSD that could help improve the accuracy of PTSD diagnoses, and points the way to medications designed specifically to treat trauma.

"There's not a single pharmacological treatment out there that has been developed specifically for PTSD," says Dr. Neumeister. "That's a problem. There's a consensus among clinicians that existing pharmaceutical treatments such as antidepressant simple do not work. In fact, we know very well that people with PTSD who use marijuana -- a potent cannabinoid -- often experience more relief from their symptoms than they do from antidepressants and other psychiatric medications. Clearly, there's a very urgent need to develop novel evidence-based treatments for PTSD."

This research is hard to do. Not because the research itself is difficult, but because the National Institute on Drug Abuse controls who gets cannabis for research. They have consistently denied the FDA access in order to fund studies that may ameliorate one of the most debilitating forms of psychological trauma.

http://www.popsci.com/science/article/2013-04/why-its-so-hard-scientists-study-pot

Why It's So Hard For Scientists To Study Medical Marijuana

Both the American Medical Association and the American College of Physicians have called for more research into the therapeutic uses of marijuana and for the U.S. government to reconsider its classification as a Schedule I substance.
The University of Mississippi grows and harvests cannabis for studies funded by the National Institute on Drug Abuse, yet because NIDA's congressionally mandated mission is to research the harmful effects of controlled substances and stop drug abuse, the institute isn't interested in helping establish marijuana as a medicine.

"If you’re going to run a trial to show this is going to have positive effects, they’re essentially not going to allow it," Lyle Craker, a professor and horticulturist at the University of Massachusetts Amherst, says.

The federal government's position on marijuana, according to a January 2011 document featured prominently on the DEA's homepage, is that:

The clear weight of the currently available evidence supports [Schedule I] classification, including evidence that smoked marijuana has a high potential for abuse, has no accepted medicinal value in treatment in the United States, and evidence that there is a general lack of accepted safety for its use even under medical supervision… Specifically, smoked marijuana has not withstood the rigors of science–it is not medicine, and it is not safe.

Burge tells a different story. "The United States government has gone to great lengths to prevent [medical] research on whole-plant marijuana," he says, though research into isolated components of the plant has gone on.

[Victor_c3]

1. I'll volunteer myself to a study looking into the impact of smoking pot on PTSD

I've never smoked anything in my life, but I'd do it to further science.

[RainDog]

5. Israel allows medical marijuana for PTSD - for rape victims, too

they started doing this in 2011 - but it was controversial at the time.

http://www.haaretz.com/weekend/magazine/should-we-be-treating-ptsd-with-thc-1.372173

Of approximately 6,000 Israelis currently being treated with medical cannabis (aka medical marijuana ), most suffer from chronic pain and terminal illnesses. The therapeutic potential of cannabis has been known for many years and is recognized by the Health Ministry. But many patients - for example, victims of sexual assault who suffer from post-traumatic stress disorder (PTSD ) and have a psychiatric recommendation for treatment with medical cannabis - encounter bureaucratic obstacles.

A year and a half ago, Dr. Yehuda Baruch - the chair of the Health Ministry's advisory board for medical cannabis - recognized the effectiveness of the substance for PTSD sufferers. Within a year, 142 requests by such patients for treatment were approved. Dozens of soldiers who suffer from PTSD as a result of their army service were, and continue to be, treated with medical cannabis, with the authorization and support of the Health Ministry and the Ministry of Defense. However, victims of sexual assault have been left out in the cold.

For D., marijuana is not a drug but a medicine. "When I smoked, I didn't need medicines," she says. "It didn't make my life good and beautiful, but it did make it bearable." She now shuns the array of medicines and sleeping pills she took because of the side effects. "If you take sleeping pills, you will bring yourself into sleep mode, you will succeed in getting yourself into bed and shutting off the light, but in the morning you are not the same person. You don't function. The quantity of pills I need in order to fall asleep will turn me into a zombie the next day. My brain is erased; people speak to me but I don't function. How can you live like that? How can you work like that, study, go out of the house, communicate with people?

The cannabis is effective, but fear of the police leaves her in a constant state of anxiety. "These days, most of my nightmares have to do with the police arriving and entering my home," D. says. "It's like rape, as though this is the only safe place I still have but it's not actually safe."

[madokie]

2. After 15 months of constant shelling I came home bugnuts

Smoking pot helped me even though I didn't realize what was happening for years. I know now though.

[madokie]

10. the last visit to the VA for blood work

my doctor told that from now on he was going to have to report anyone who tested positive for pot.
Its been my savior for 43 years now but no longer can I partake. I have a panic attacks and they deny that I need anything so I'm left in limbo now. I used to use alcohol and pot to help me cope but I quit drinking a few years back when I became a grand dad cause I didn't want my grand daughter to know me as a drinker and now the pot has been taken from me. I'm stressing but I'm trying to maintain.
I wish I knew what to say to you for what you've been though but I don't. All I know to do is offer a and a tear, sorry
PTSD for whatever reason sucks

[RainDog]

12. A veteran waited 9 years for the DEA to respond to a request

Americans for Safe Access (ASA) had petitioned the DEA to hold rescheduling hearings regarding cannabis and they simply ignored the request for 9 years. They finally responded after the threat of a lawsuit and denied the hearing on Jan. 22, 2013.

One of the plaintiffs was a veteran who wanted to reduce his use of opiod medications prescribed for pain relating to war injuries. His doctor also told him that he would be refused medication if he tested positive for cannabinoids, even tho cannabis is not physiologically addictive and offers better results than morphine, etc.

The state prefers morphine because, you know, cannabis is so dangerous in comparison....

http://americansforsafeaccess.org/article.php?id=7474

I'm sorry for your situation, but happy to hear that you stopped using alcohol - that stuff can be debilitating if someone uses it to self-medicate.

[dionysus]

17. better than morphine, really? I've had cannabis help with headaches and nausea, and some aches,

but when I ruptured a disc in my back and my sciatic nerve was enveloped with bits of disc, chronic couldn't touch the pain. I was just high off my ass and still in agony... in that case, only vicodin would work. Do you think it works differently with different types or levels of pain?

[RainDog]

19. In terms of addictive properties and side effects

When prescribed for long-term use.

If marijuana can help someone to lessen the amount of an opiod used, that's better for the person, imo.

I'm no doctor. I can only talk about the experiences others have related and the veteran said that cannabis helped him to reduce the quantity of opiods that was part of his medication schedule.

And different people have different pain thresholds, etc. so, as with everything else in this world, people respond differently and what works for one person doesn't work for another.

When talking about "better," that was in the context of better than having to use more opiods rather than fewer opiods.

[dionysus]

22. ok. i wasn't trying to be contradictory.

I was just talking about my own personal experience


PS luckily, after time my back got better, but it took 3 months to be able to stand up straight... sciatic pain is the worst pain I have ever experienced in my life...

[RainDog]

23. oh, didn't take it that way

the wording was confusing and you have a good point about the relative strength of various substances.

I think that one way that cannabis is going through some more changes these days is that, since Reagan, people were incentivized to grow hybrids with maximum THC.

since a little more research has been done, some people are going back to strains with more CBD, which doesn't produce the euphoria of mj but is great for inflammation, etc...

so, talking about this stuff, imo, is good all around.

[Chuuku Davis]

24. As a VA doc now

And ex MIL and ER doc there is something wrong here.
There is no requirement to report any patient for smoking pot.
Shit, I wouldn't know who to report it to.
If the patient has a controlled substance contract it will cause problems though.

[madokie]

25. Would that be

since I'm taking hydrocodone?
Thanks for the info
I had quit smoking for a while but during my 65th birthday celebration I smoked some weed and it showed up. Since then I've gone back to being a non-toker.

[Chuuku Davis]

29. Yes

But even then I don't report it to anybody
I tell the patients they can either smoke pot or have the narcotics,their choice.

[Politicalboi]

3. Follow the money

They make money from busts, and big pharma is probably paying to keep MJ in limbo forever. Can't have people growing their own medicine, how will we get our big bonuses? In 20 years MJ is not going to have any side effects that will kill you. But pills on the other hand from pharmaceutical companies found to cause illness or early death, get the stamp of approval.

[RainDog]

7. Hopefully Polis' legislation will remove cannabis from the CSA

That's the best hope for some sanity regarding this issue at this time.

[mainer]

4. Pot and alzheimer's -- could this change our stupid policy against studying it?

because it has enormous financial implications for the country.

http://healthland.time.com/2012/10/29/how-cannabinoids-may-slow-brain-aging/

[RainDog]

6. thanks for the link/info! n/t

[hunter]

8. It'd be nice if there was a whole lot less trauma to begin with.

It won't be a good thing if there's no effort to reduce wars and abuse and terrible accidents, but instead someone simply hands you a pill so they can write off the problem as solved.

Sorry about that land mine, mister. Here's a prosthetic leg and some PTSD pills... NEXT!

[RainDog]

11. Well, war isn't the only reason for PTSD

Last edited Tue May 14, 2013, 09:00 PM - Edit history (1)

and, yes, while I wish we lived in a world with less war, we don't.

I wish we lived in a world with no rape victims. But we don't. I wish we lived in a world with no trauma from abuse. But we don't.

So, I don't see any reason to victimize people twice because the war on drugs is profitable for military contractors.

Antidepressants are largely ineffective for PTSD, but they're what gets thrown at people now. Along with powerful opiods that cause addiction.

But these are okay, while an herb is not.

That's insanity.

[hunter]

28. The "War on Drug" causes a good deal of trauma too.

Pot growers should probably be treated the same as people who brew their own beer. Commercial growers should probably be as tightly regulated as tobacco, perhaps with a ban on any sort of advertising or distinctive packaging.

All sorts of addictions should be entirely decriminalized and treated as a public health problem.

[RainDog]

31. You know what's funny, politically, about this issue?

Not funny-ha-ha but funny ironic...

Jimmy Carter, who wanted to decriminalize marijuana when he was in office, was also the president who made it possible for the craft beer brewing market to exist.

Since that time, Americans have created brews to rival those in Europe produced over hundreds of years. What a great way to open up the American market to better products and small businesses!

(My ex is from Belgium, where they have 100 different "craft" beers from those monks back in the day with a lot of time and hops on their hands, so I really appreciate the use of beer, like wine, to accompany foods - and just like the variety. My former s-i-l went to cooking school, so she taught me lots about this, at least from the taster's pov. lol. oh, and interesting aside, too - cannabis is related to hops used to brew beer.)

Anyway, Teddy Kennedy undermined Carter's re-election campaign and, of course, his family's vested interest was in distilled spirits. And now one of the biggest voices from the Democratic Party to maintain marijuana prohibition is Patrick Kennedy. The alcoholic beverage industry doesn't want the competition from boutique marijuana, in the same way they didn't want the competition from craft beer breweries. I wonder if that has anything to do with Patrick's "principled stance" on this issue. lol.

I agree with you that a better approach to addiction is to treat it as a health issue rather than a criminal issue, all around. I also think that all drugs should be decriminalized and those hard drugs that really disrupt people's lives should be available cheaply, clean needles should be free, and the same place where addicts get drugs could be the same place where they can sign on to an addiction treatment program - and these should be readily available. We would save lives and would save millions of dollars by dealing with secondary illnesses related to addictions by making it possible to acquire them without resorting to an illegal market. Take the mystique of being an outlaw out of the life surrounding such drugs and view the people who use them as someone with a sickness whose illness can be treated or, at the least, ameliorated without as many problems from criminal activity, etc. Get it off the streets and make the streets safe.

[siligut]

27. Do you remember the video of a goat slaughter that was leaked?

It was a video of the military basically torturing goats. Goats scream like people. PTSD results from the mind being exposed to situations that are unconscionable/unbearable and then not being allowed to process the information, so the trauma stays hidden.

In an attempt to harden the minds of soldiers, they were exposed to these goats being slaughtered, under controlled conditions, as it has been shown that people who grew up on farms or in situations where they saw repeated trauma and death, experienced less post-war PTSD.

This is an extreme example, but as you may know PTSD has been just plain ignored in the past, and the point I am trying to make is that war isn't going away any time soon, so if there is something to help with PTSD, which can be quite debilitating, then I am supportive of it.

[RainDog]

13. Treating PTSD with Medical Marijuana Could Curb Veteran Suicides

http://reason.com/blog/2013/03/22/treating-ptsd-with-medical-marijuana

...U.S. military veterans are committing suicide at increasing rates—averaging 22 per day. That’s 20 percent higher than in 2007. Prescribing powerful psychotropic (mood altering) drugs like Lorazepam for post-traumatic stress disorder (PTSD) and anxiety is common practice among military doctors, but thankfully that's starting to change in response to the many negative side-effects and an almost total lack of observable positive effects.

Part of the problem with treating PTSD with high-intensity (and generally highly-addictive) pills is the tendency for veterans to self-medicate, according to Alec Dixon, a U.S. Navy veteran and the Director of Client Relations for SC Laboratories.

Veterans—whether Iraq, Afghanistan, Gulf, Korean, or Vietnam War vets—have largely self-medicated as a form of personal coping and treatment with PTSD. Often it is excessive binge consumption of alcohol alone or combined with a cocktail of other prescribed medications. Most vets and active duty military turn to alcohol from an inebriate standpoint due to the "zero-tolerance" policy on cannabis within the UCMJ and, historically, within the Veterans Administration.

...Vets are learning (that cannabis is effective to deal with PTSD) --but are forced to live in constant fear of arrest because marijuana is still illegal at the federal level, even in cannabis-friendly states like Colorado. Former U.S. Navy Corpsman Jeremy Usher is one such example. He had to obtain an expensive prescription for Marinol, a synthetic version of marijuana’s active ingredient, THC, to manage his PTSD symptoms while on probation for three DUIs—all of which he accrued after returning from Iraq and Afghanistan in 2003. He is a poster-boy for the self-medication that is all too common among the shell-shocked vets who don’t receive effective treatment.

[librechik]

14. so--just keep smoking vast quantities of cannabis--it's my best chance for recovery

and allows me to laugh at trauma.

Who needs research? works for me...

[RainDog]

15. One way that cannabis can be used therapeutically

Last edited Wed May 15, 2013, 01:38 PM - Edit history (1)

is the same way that beta blockers have been used.

Of course, everyone responds to substances differently (whether legal or illegal), but for some people, cannabis helps to relieve anxiety. This is also a function of beta blockers (and has been prescribed off-label for a long time for professional musicians, for instance, for performance anxiety/stage fright.)

For use in processing trauma, however, beta blockers and cannabis allow someone to reframe memories in a context that doesn't set off all their adrenaline reactions - "memory" for someone with PTSD is sort of a misnomer, since the body, etc. responds as though the event is actually happening (not in a psychosis way, but in a "flight or fight" physiological way.) So if someone is able to work with a therapist to get beyond the terrors and horrors without having that reaction, the idea is that people can "retrain" their brains to not have that panic reaction.

I've tried some of this with beta blockers but not cannabis.

Something that Raphael Mechoulam, the scientist who first identified the first cannabinoid talks about, too, is the use of cannabis to help people forget.

http://veteransformedicalmarijuana.org/content/general-use-cannabis-ptsd-symptoms

Dr. Mechoulam is the Israeli scientist who identified THC as the psychoactive compound in marijuana, and decades later he discovered the brain's endocannabinoid system and the endogenous neurotransmitter anandamide. He is one of the most respected Israeli neuroscientists and has been a senior advisor to the Israeli government on marijuana policy and the ethics of research with human subjects. He discussed his experiments demonstrating the neuroprotective effects of the endocannabinoid system in mice that have had traumatic injuries to the brain. He believes the neuroprotective effects of marijuana may eventually have applications for other neurological and psychiatric conditions, including Alzheimer's and Parkinson's disease.

Another fascinating discovery, one with implications for PTSD, is that the cannabinoid system is integrally related to memory, specifically to memory extinction. Memory extinction is the normal, healthy process of removing associations from stimuli. Dr. Mechoulam explained that an animal which has been administered an electric shock after a certain noise will eventually forget about the shock after the noise appears alone for a few days. Mice without cannabinoid systems simply never forget - they continue to cringe at the noise indefinitely.

This has implications for patients with PTSD, who respond to stimuli that remind them of their initial trauma even when it is no longer appropriate. By aiding in memory extinction, marijuana could help patients reduce their association between stimuli (perhaps loud noises or stress) and the traumatic situations in their past. Working with Army psychiatrists, Dr. Mechoulam has obtained the necessary approvals for a study on PTSD in Israeli veterans, and hopes to begin the study soon.

(the article spends some talk about pharmacological uses of cannabinoids and notes that the typical use may not offer the best route to actual extinction of PTSD, but serves more to treat symptoms.)

...If an individual were to want to get the most out of using therapeutic cannabis to improve a PTSD condition they should try to use low to moderate doses with as stable a blood level as possible for general anxiety and depression symptoms. Oral cannabis produces more stable blood levels. Since peak levels will produce the most soporific effect, administration of oral cannabis right before bed should produce the most benefits for improving sleep patterns. If the goal is to use cannabis to facilitate extinction of the response to PTSD triggers than small to moderate doses of cannabis vapors should be administered shortly before planned exposure to the trigger. A series of regular extinction sessions will produce better results than a single session. If cannabis appears to make aversion, fear, or aversive memories worse then the dosage should be lowered. If feelings of fear do not improve with lower dose then discontinue use of cannabis as fear-extinction aide.

[librechik]

34. thx!

[RainDog]

35. ...

[JaneyVee]

16. I've read that MDMA works wonders for PTSD.

[RainDog]

18. CNN reported on this

http://www.cnn.com/2012/12/01/health/ecstasy-ptsd-1

I've seen a lot of reports about the use of psychedelics, and the study of them, for use in treatment of addictions, too. And, of course, the guy who started AA took LSD and said it helped him to gain some insight to keep it simple, one day at a time.

Of course, those substances are entirely prohibited, Schedule 1 in the CSA, so research is hard to do for the same reason it's hard to do research on medical uses of cannabis.

We really need to rethink our approaches to healthcare issues.

I don't advocate anyone do anything illegal - but this nation should not make potentially life-saving substances illegal simply because someone used something at a rave once upon a time.

[Megalo_Man]

26. And DMT, and Psilocybin, and Ayahuasca.

[RainDog]

32. The Drug Policy forum, here

has some links to the uses of various psychotropics for different issues.

Nat'l Geo had a program about people who use different substances. Ibogaine detox is part of an underground system of addicts helping addicts to kick the habit.

One middle-class guy in Texas who uses mushrooms once every two months or so to treat his cluster headaches. He's about as far from the stereotypical shroomer as they come. That he is doing something illegal really bothers him - but the relief from cluster headaches makes him break the law. Cluster headaches are also called "suicide headaches" because the pain is supposed to be some of the most intense going that doesn't actually kill you - tho some people are driven to suicide to stop the pain.

How much more humane to, instead, allow someone to spend a day at their house, every two months, treating themselves.

Pharma research in the past, don't know about now, was looking into ways to isolate the components that would provide this relief without the hallucinogenic effects.

Why are we, as a culture, so averse to medicine that alters consciousness, briefly, if the outcomes are so positive?

You have to wonder what it says about our culture that we fear medicine that defies proscribed states of being, even temporarily. It's Puritanism, imo, that makes our culture so punitive.

I'm sure indigenous cultures could weigh in on that issue...

[mick063]

20. It only will cost government funded insurance

about 1500 bucks per dose.


The single greatest problem with calling marijuana a medicinal treatment.

Call it a recreational drug, like alcohol, and let people realize the side benefits of mental relaxation. I fully expect a "Monsanto like" patent with all other forms of marijuana declared illegal.

Just guessing, but it is rather predictable.

No, my problem isn't with the insurance. It is with the racketeering known as the pharmaceutical industry. This is the industry that purposely creates cancer drug treatment shortages to keep prices artificially high. Like about 1000% too high.


They don't do anything unless there is big money involved. Just wait until they get their hands on pot.

Stop declaring it a medicinal aid. You will regret it one day.

[RainDog]

21. Dr. Lester Grinspoon wrote about this issue in the past

posted here - http://www.democraticunderground.com/1170125

Abstract: Given the very limited toxicity of marijuana and the growing appreciation of its therapeutic value, it will undoubtedly find increasing application as a medicine in the coming years. But there is uncertainty about the forms in which it will be made available. Governments are hesitant to approve it because of concern about its use for nonmedical purposes and the difficulties of distributing as a medicine a substance that is already easily available. An alternative is the development of commercial cannabis pharmaceuticals that can be regulated and controlled. But pharmaceutical firms will be reluctant to invest the necessary money if they believe they cannot compete successfully with marijuana. Some of these products may have advantages over whole smoked or ingested marijuana, but most will not, and they will all be quite expensive. Ultimately, we can anticipate two medical distribution networks, a legal one for cannabinoid pharmaceuticals and an illegal one for street or homegrown marijuana

Marijuana will never be classified as a drug in its natural state... because it's not. And I don't think it should be.

What pharma cos are trying to do, however, is to pretend that their whole-plant cannabis meds are not cannabis and that synthetics that isolate molecules are just as good - and, for some people at least, they're not.

The only way we're going to have sensible cannabis policy is to remove it from the Controlled Substances Act, which is what Polis' legislation intends to do.

Just as people may use valerian root instead of valium or St. John's Wort instead of an SSRI, some people may prefer to use an inexpensive but less potent form of what will become a synthetic medicine for other applications.

[Brickbat]

30. Anecdotes don't make good science, but I know several vets who self-medicate with pot to deal with

PTSD and have good results.

[RainDog]

33. All science starts with observation

As Dr. Grinspoon sort of noted in the link, above, the reason we have medicines we do is because someone observed a benefit from one thing or another.

Willow bark tea is the basis of aspirin - it didn't just appear out of nowhere. Salic acid had been used by native americans for centuries before someone created a synthetic version.

We have 5000 years of medical use of cannabis in human history and no one has ever died from the substance.

...so, of course it's a horrible and dangerous product that has no medical value and should never be legal.