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US Army recruits with history of cannabis use perform no worse than others – study

The study focused on waivers for new recruits with a history of cannabis consumption, ADHD and mental health conditions such as depression or anxiety

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A US government-funded report examining army recruits has found that past cannabis use may not have an impact on overall performance.

The US Army report showed that recruits were more likely to leave the army over their cannabis use rather than over health or performance issues. It also found that recruits with a history of cannabis were just as likely to make sergeant.

The report, by the RAND’s Arroyo Center, a US army research and development centre, focuses on waivers that allow the army to reconsider applicants who have been initially rejected for various reasons including cannabis consumption. Applicants who test positive, hold court records or self-disclose their use require a waiver to enlist.

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The researchers collected records of recruits who entered the US Army from 2001 to 2012 then tracked them through until 2018.

In some cases, those recruits with attention deficit (hyperactive) disorder (ADD/ADHD), anxiety disorders or a history of depression may not qualify for a waiver. The researchers were interested in determining if there needs to be improved screening of those with mental health conditions or ADHD. They also wanted to examine if the legalisation of cannabis in certain US states should lead to screening policy changes.  ADHD diagnoses are increasing in the US and affect 10 per cent of the population according to the report.

US Army report

In a blog post, RAND wrote: “Without waivers, a failed drug test for cannabis would block the one-third of American 18-year-olds who say they have used marijuana at least once in the past year. Recruits who make it into the US Army despite low-level histories of cannabis use perform no worse, overall than other soldiers. That should be welcome news in recruiting offices nationwide.”

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Micheal Hansen, associate director of RAND Arroyo Centre said: “When people hear ‘waivers,’ they sometimes think the US Army is letting people in who really shouldn’t be there. The strongest message of our report is that using waivers has nothing to do with changing quality standards.”

US Army waivers

The RAND researchers reported that groups of recruits would change relatively little if waivers were to be increased. They noted that in some cases this would be an improvement in performance. They also found no strong evidence that legalisation had had an impact on recruits either.

The authors suggest that the US Army ‘continue to carefully screen recruits with a documented history of cannabis but should be less concerned with these recruits if they have no misconduct offences.”

Mental health

Long Covid: Experts explore the role of cannabinoids in treatment

Experts have explored the idea of cannabinoid therapy in the treatment of long Covid.

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Experts explored the idea of cannabinoid therapy in the treatment of long Covid, in a one-off webinar hosted by the Medical Cannabis Clinicians Society.

Professor Mike Barnes, neurologist and director of the Medical Cannabis Clinicians Society (MCCS), was joined by Dr Anjali Didi, a general practitioner based in Australia and Dr Hosseini, chief scientific officer at BOD pharmaceuticals, to explore the role that cannabinoids could play in treating long Covid.

The webinar, which took place on Tuesday 30 November, was aimed at clinicians who may be treating patients experiencing long Covid patients and are keen to learn about alternative therapies or treatments.

It could not have been more timely, following the emergence of a new concerning variant in the UK, Omicron.

Dr Anjali Didi explained the importance that the endocannabinoid system (ECS) has in the body and how this interacts with different cannabinoids, focusing on CBD, THC, CBG, CBC and CBDV. She highlighted the important role of the CB1 and CB2 receptors throughout the body.

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Different cannabinoids may have different benefits associated with them. Studies have shown that CBG may produce a response in skin tumours, while CBC and CBDVA may potentially reduce seizures by up to 40 per cent.

Dr Didi said that although doctors can often feel nervous about prescribing cannabinoids such as THC, they needn’t be worried.

Dr Didi: “THC interacts with the CB1 receptor as an agonist. It’s responsible for intoxicating effects in high doses and that’s important to know when you prescribe. CBD is known to counteract that intoxicating effect, so even though that is something people worry about when they first start to prescribe in low or 50:50 doses, it’s unlikely. The rule is always start low, go slow.”

Dr Didi, who was originally based in the UK before relocating to Australia, has treated both British and Australian patients.

When she began to see long Covid patients at her clinic, she noted a particular set of symptoms occurring in patients around two months post-infection.

“Long Covid was something I was labelling a set of symptoms as, that I had seen in people typically around two months post the acute infection,” she explained.

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“The World Health Organisation is now calling it post Covid-19 syndrome or post-acute sequelae Covid (PASC). Some of the symptoms that have appeared in reports and my practice include insomnia, depression, anxiety, fatigue both mental and physical, shortness of breath and cough.”

Her patients also report pain in different places, including the joints, headaches, chest pain, myalgia, neurocognitive dysfunction, involuntary movement and anosmia that persists. Case reports also show repeated pyrexia, fever and dizziness.

It was original research on CBD and sleep that convinced Dr Didi to try prescribing cannabinoids for the treatment of long Covid. She explained her experience with prescribing cannabis for one of her patients.

Long Covid case study

The patient that Dr Didi chose to present was a 42-year-old British male patient who contacted Covid in March. He was diagnosed after losing his sense of smell.

“His initial infection was in another country in March, with an acute loss of smell when he couldn’t smell his coffee. He was quite well for three or four days with just that. He [then] started to present with a lot of diarrhoea and his acute infection with myalgia changed from day 10 to headaches, night sweats and breathlessness with a cough,” she said.

“The biggest thing was that it got worse when he was lying down, so he was sleeping on two or three pillows. He worked quite hard in the finance industry but he has never been well since the infection.”

Dr Didi explained that her patient experienced a lot of disturbance with muscle fasciculations [twitching] in the body which caused a lot of anxiety, resulting in an insomnia pattern that stopped him from being able to sleep.

While her patient was healthy with no chronic conditions, he had mentioned he had asthma and allergies as a child. He came to see the doctor after struggling for nine months after his initial infection. He had also been off work for some months as a result of the illness.

“He had some pill rolling tremors that were worrying him and he had learned to sit holding his right hand to prevent the fasciculations taking over from his thought process. He felt he couldn’t think as well as he used to be able to, but I had no way to measure that and neither did he. He was fatigued enough to not be able to walk his daughter to school which was around a 10 – 15-minute walk.”

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As well as brain fog and tiredness, Dr Didi’s patient also reported feeling pain in his muscles and stabbing chest pains which were quite debilitating. However, his biggest issue was lack of sleep and he had tried using prescription medication or alcohol to help.

Dr Didi said: “Since the PASC had started, he hadn’t been able to sleep, sometimes all night. He felt, looking back, that it was the fasciculations but also the speed of thoughts in his head, whether that was caused by lockdown or his worry about his symptoms. It could have been an amalgamation of things.”

Long COVID crash

In April, her patient experienced what he described as a ‘Covid crash.’

Dr Didi outlined the different medications that he had tried but it was after this that she suggested they discuss medical cannabis.

She explained: “He was able to walk a little bit but was very fatigued. In September, he had a two week period where he was unable to get out of bed, enough that his wife was bringing him makeshift bedpans. When he wakes up, he finds that his joints ache and he doesn’t have any balance.”

The doctor started him on a small dose of Seroquel to help improve his sleep, before starting him on a tiny dose of a BOD medical cannabis product with a ratio of 20mg of CBD and less than two per cent THC.

He began to feel less anxious but felt he wanted to reduce the SSRI due to experiencing issues with his libido. Dr Didi increased the medical cannabis but he began to feel increasingly sleepy. He found success with 20mg of Medcabilis [the BOD product] but felt the 40mg was too strong for him.

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“I wanted to try to support him in his decision to go back to work,” she added.

“I asked him to try a new SSRI but continue with the CBD which is something he never stopped. He felt that the one or two days he stopped it, he didn’t feel well in terms of fatigue. He was also able to complete 10-minute walks where he could take his daughter to school.”

Dr Didi also presented another case study of a woman with long Covid who struggled to sleep. She was prescribed a 50:50 ratio of THC and CBD. She reported that it helped her daytime anxiety so has been kept on her dose.

Dr Hosseini from BOD Medical Cannabis explained more about the two products used in both case studies.

“The two case studies mentioned included the Medicabilis five per cent, which is a pharmaceutical-grade product available in the UK by prescription,” she said.

“It has 50mg per ml of CBD but in addition, it does have other minor cannabinoids as well. It has less than 2mg per ml of THC which makes it relatively safe for prescribing to manage symptoms related to neurological or psychological effects such as anxiety.”

So can cannabinoids treat Covid-19?

Prof Barnes concluded the panel by touching on the recent research which suggests cannabinoids may help with lung inflammation experienced by Covid patients.

study from early 2021 revealed that some cannabis strains could potentially help to reduce a type of inflammatory distress referred to as a ‘cytokine storm’.

He suggested that as long Covid is sometimes caused by the cytokine storm, an overreaction of the immune system, through cannabinoids we may be able to reduce the numbers of patients suffering from symptoms.

“Cannabinoids – generally CBD – being anti-inflammatory may reduce the incidence of long Covid,” commented Prof Barnes.

“There are some early indicators from Israel and Canada, so people are looking around that more definitively.”

He added: “It’s a really important question for global health but we still can’t answer it yet.”

 

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Mental health

Could medical cannabis help with HIV/AIDS?

To mark World AIDS Day, we examine if medical cannabis could help with symptoms such as nausea, pain and anxiety.

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On World AIDS Day, we examine the science behind taking medical cannabis to help manage some of the symptoms.

Wednesday 1 December marks World AIDS Day, dedicated to raising awareness of HIV/ AIDS and also mourning those who passed away.

The UN AIDS estimates that 37.7 million people globally were living with HIV in 2020. They also estimate that since the start of the epidemic, 36.3 million people have died from AIDS-related illnesses.

What is HIV?

The first cases of HIV/AIDS were recorded in the late 70s and early 80s. As the first cases began to originate in the gay community, the disease was originally referred to as ‘GRIDS’ which stood for Gay-Related Immunodeficiency Disease.

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Human Immunodeficiency Disease (HIV) is a virus that affects the immune system. It damages and weakens the cells making it easy for opportunistic diseases or infections to get in. The body is unable to defend itself. HIV is found in the semen, vaginal and anal fluids, blood and breast milk of those with the virus. It can be passed from person to person but AIDS cannot. Most people with HIV, thanks to advances in science may go on to develop AIDS but live with the disease for longer periods of time.

How do HIV and AIDS differ?

Acquired Immunodeficiency Deficiency Syndrome (AIDS)  is the name given to a collective group of opportunistic illnesses that occur after the immune system has been damaged by HIV.

The most common ways to transfer HIV is through unprotected anal or vaginal sex or sharing unclean needles. The NHS estimate that 80 per cent of those who contract HIV will experience a flu-like illness for one to two weeks after infection. The most common symptoms are sore throat, raised temperature, rashes, tiredness, joint pain or swollen glands.

Could Medical Cannabis help with HIV symptoms?

HIV and Appetite loss

One of the first reasons why patients began to turn to medical cannabis in the 80s to help with symptoms was to counteract AIDS wasting syndrome and associated pain.

The lack of appetite means patients may seldom feel hungry enough to eat or feel well enough to prepare a meal. Cannabis helped patients experiencing this to regain their appetite. It is estimated that the prevalence of wasting syndrome can be between 14 and 38 per cent.

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In the late 80s, doctors started to prescribe Marinol which contains synthetic tetrahydrocannabinol.

Joint Pain

Peripheral neuropathy, or nerve pain, happens when some of the nerves get damaged. It can cause stabbing pains, burning, or tingling sensations in the hands and feet. HIV and antiretroviral medications may trigger the pain. HIV When the immune system is weakened this makes it easier to get other infections that can cause peripheral neuropathy.

Marinol was often prescribed for neuropathic pain as well as appetite stimulation. Cannabis was thought to help with some of the nerve pain caused by early AIDS medication such as AZT. Neuropathic pain, which is where the exterior sheath covering nerve cells is stripped away exposing nerve endings resulting in chronic pain.

A review from 2018 suggested that medical cannabis may be a tolerable and effective neuropathic agent. The researchers analysed over 16 different studies with 1750 participants.

The authors wrote: “The evidence appears to support the safety and efficacy of short-term, low-dose cannabis vaporization and oral mucosal delivery for the treatment of neuropathic pain. The results suggest medical cannabis may be as tolerable and effective as current neuropathic agents; however, more studies are needed to determine the long-term effects of medical cannabis use.”

HIV: A red ribbon for World Aids Day resting in a pair of hands
Better sleep

THC may help with improving the quality of sleep experienced by HIV+ patients. One of the symptoms of HIV can be night sweats which make it difficult to stay asleep or cause poor quality rest. This results in increased fatigue which can leave a patient feeling more run down and stressed as a result.

Night sweats occur when the body is attempting to fight a disease such as HIV. This often accompanies joint pain, unexplained weight loss, fever and chills.

A study suggested that consuming cannabis with higher THC levels can reduce the amount of REM sleep patients experience. This means a deeper, more restful sleep which can lead to better, restorative rest.

Leaning into terpenes can also help. Some terpenes are thought to be really helpful for better sleep including Linalool which is found in lavender, geraniums and jasmine.

Better cognitive function

A study from New York in the journal, AIDS Care, reported that HIV+ patients who consumed cannabis showed the same or greater cognitive performance than non-users.

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Researchers took 138 HIV+ patients of which 47 had a history of cannabis use while 91 did not. Those with a history of cannabis use were found to have ‘better processing speed, visual learning, memory and dominant hand motor ability.’

Reduced neuroinflammation due to HIV

A study from San Diego examined if daily cannabis use might reduce central nervous system inflammation in a cohort of patients with and without HIV.

The researchers noted that those who consumed cannabis had lower levels of chronic inflammation compared to those who did not. Furthermore, the users’ results were similar to the HIV subjects with no history of cannabis use.

This may make it useful for preventing or delaying the development of HIV Associated Dementia which is where the virus spreads to the brain. It can cause memory loss, difficulty thinking, concentrating and speaking clearly. It is a progressive disease that sadly gets worse with time.

It may also help with HIV Associated Neurocognitive Disorder which is often found in the later stages of the disease. It causes progressive loss of memory, behaviour and motor function problems.

Different forms of dementia and some cognitive issues are thought to be caused by inflammation. It has been linked to a number of different conditions such as Alzheimer’s Disease, depression and anxiety. Although more research is needed to understand how cannabinoids interact with our endocannabinoid system and the receptors in our bodies, a study from 2016 shows THC may be neuroprotective.

Authors wrote: “Cannabinoids such as tetrahydrocannabinol stimulate the removal of intraneuronal Aβ, block the inflammatory response, and are protective.”

Mental Health

As with any long term health condition, there can often be a lot of anxiety and depression around diagnosis.

Some cannabinoids such as THC and CBD are thought to potentially help with anxiety. It may induce feelings of calm, improve relaxation and also help with better quality sleep.

There is some debate over the balance of THC and CBD when it comes to anxiety. Some believe that lower doses of THC while higher CBD hybrids may help reduce the risk of worsening symptoms. Alternatively, some patients choose to balance their own ratios depending on their particular symptoms on the day by combining CBD and THC in different ways.

HIV: A variety of different ways to take CBD including capsules, skincare, oil, sprays and pwoders

HIV and T-cell count

When HIV enters genetic information into our T cells, it makes copies of itself causing the helper T cells to die. This disrupts our immune response allowing opportunistic infections to get in without detection or fight.

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CD4 are referred to as ‘helper cells’ that help the body to recognise pathogens with a protein called CD4. However, CD8 T cells are referred to as ‘killer cells’

Killer T cells seek out pathogens and help to destroy them preventing infection. If T Cells fall below a certain number, a person may go on to receive an AIDS diagnosis. Certain medications, such as chemotherapy, can affect a T cell amount so it is important to note if a new prescription may be safe to take or not with HIV.

One study from 2008 offered a longitudinal analysis of both HIV+ and HIV- men who reported that their cannabis did not have an impact on the CD4 and CD8 T cell counts.

How to get a medical cannabis prescription for HIV/AIDS

This requires self-referring or asking your GP to refer you to a clinic in the UK for assessment. The clinics will not be able to diagnose HIV or AIDS but will be able to discuss the options with you.

Medical cannabis is usually assumed to be the last option if prescription medication has not worked to control the symptoms. After an initial assessment, your doctor at the clinic can discuss if cannabis is the best possible option, what you can expect to experience and how the costs work.

A prescription may be offered in a number of different formulas such as oils, flowers or topicals.

What is the best way to take medical cannabis for HIV/AIDS?

There is no right or wrong way to take medical cannabis or CBD for HIV/AIDS. The best way is to talk to your doctor about what will suit your current condition and lifestyle. If a patient is experiencing problems with a sore throat which is common with the flu symptoms or fungal infection such as oral thrush, then swallowing edibles may be difficult. Alternatively, vaping may aggravate lung pain.

Edibles or vaping may be a better option if the taste of oils creates a problem. Keeping a journal of your medical cannabis intake can be helpful when it comes time to have your first follow up appointment or in assessing how a particular product is working for you.

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Mental health

Men’s mental health: “It’s something you have to deal with every day”

Ian McLauren and Sam Williamson, co-founders of CBDiablo speak about mental health support and what needs to change for men.

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Men: a blue background with the outline of a head against it

In the final part of our Men’s Mental Health series, Ian McLauren and Sam Williamson, co-founders of CBDiablo speak about how their own experiences and why they choose to give back to a mental health charity.

Read the first, second and third parts of our men and mental health series here.

Ian McLauren and Sam Williamson, co-founded CBDiablo together in 2019, an online, Edinburgh-based CBD store that has a particular focus on mental health.

Both men have experienced mental health difficulties in their lives, which made them feel passionate about offering help to others. So much so that they donate a portion of their profits to mental health charities.

Ian explained how his experience of bullying while at school, started his struggle with mental health.

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“My mental health journey started when I was a teenager. I struggled a lot with bullying and I experienced anxiety. When I got a little bit older, this led to suicidal thoughts and I needed to go to counselling,” he said.

A report from 2018, revealed that bullying can have a massive effect on pupils’ mental health. In a survey of 2,000 students, one fifth said they had experienced bullying while three quarters felt this directly impacted their mental health. A further 33 per cent reported having suicidal thoughts as a result.

“When I got to university, I got sick with a reoccurring chest infection which led to [me experiencing] depression and struggling to function,” Ian continued.

“My life is quite heavily impacted with my mental health and even today it’s a struggle. It’s something you have to deal with every day but I’ve gotten to a place where I’m on top of it.”

It can be difficult to open up about mental health, especially for men. They are less likely to access psychological therapies than women, according to The Mental Health Foundation. Only 36 per cent of referrals to the NHS talking therapies are men. As a result, men may resort to other more dangerous ways of coping with mental health strain, such as drinking, drugs or violence.

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Mental health and staying CALM

The charity, Campaign Against Living Miserably (CALM) estimates that 125 people die by suicide every week in the UK, with 75 per cent of those deaths being men.

Ian said: “I spoke to my mum and she pushed me in the direction of help. I was very nervous and unsure what to do. When I was at university, it got to a point where I didn’t want to lay around in bed anymore, so I knew I needed to go and get a job and complete my studies. I went to the doctors and got help that way. I don’t remember it being difficult, but it wasn’t my choice either, I was either forced by situation, or by a parent.”

Ian and Sam met in their first year of university. After they completed their studies, they moved into marketing and SEO, but it wasn’t until they worked with a CBD company that they came across its benefits for mental health. They decided to go into business together but were determined to have a charitable focus.

Sam said: “We tried CBD when we started working with the client and we felt a benefit from it fairly early on, especially for things like sleep. Sleep is obviously a big part of your mental health.”

A lack of sleep creates a vicious circle when it comes to health. Poor sleep can impact mental health leaving a person feeling sluggish, stressed or increasingly anxious. Increased stress or anxiety can then affect the quality of sleep contributing to poor mental health.

Ian added: “We really enjoyed CBD, so we thought we would do something by ourselves. But [we wanted to] do something that means something. The obvious choice was mental health because of my own experiences. We made a beeline for CALM as well because it represents who we are.

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“I’ve got two brothers and Sam has three brothers. We both have dads or uncles and it’s not always easy to open up, especially for men. That’s why we chose a mental health charity and one with a predominately male focus.”

Men: A photo of Ian from CBDiablo

Mental Health charities

CALM is a charity that takes a stand against suicide in the UK, by raising awareness of the stereotypes, offering help and running life-saving services.

It offers a free and confidential web chat for anyone in need of help and also hosts support services for anyone who has lost someone due to suicide. While the charity is not solely focused on men, it has launched campaigns such as  #BestManProject which aims to challenge male stereotypes, encourage positive behavioural changes and address help-seeking behaviour using art, music or sport.

Both Ian and Sam decided to donate 20 per cent of their profits to CALM. They are incredibly transparent about the donation process often posting their donations to the charity on Instagram. In September, they posted that they donated £665. CALM highlighted that just £8 can answer one life-saving call and that they managed to answer over 83 of these over the month of August.

The brand also highlights mental health and wellness across their social media, choosing to focus on Movember for men’s health. Movember is the mental health campaign that sees men grow their facial hair to raise awareness.

The response has been positive. Sam explained it is one of the reasons that people stay with the brand, while they often email to say it has been the start of their own mental health journey.

“It’s a bit part of the reason why people continue to buy from us,” Sam said.

Ian added: “We get a lot of people emailing to say it’s changed their life, which is great, or that it has been a building block towards feeling better. It might have been part of their journey towards therapy or improving their lifestyle. CBD does seem to be quite a fundamental part of it for some people.”

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Men: A photo of Sam from CBDiablo

Introducing change

When it comes to changing the way men speak about their mental health, Ian highlighted that it can be a generational thing.

“I think a lot of the time, older generations of men don’t want to seem weak or vulnerable and that’s transcended down to younger generations,” he said.

“Even though things are a little better, there is partly a pride or bravado. If you are struggling with mental health or feeling bad then you’re not really meant to bring it up, so it’s awkward to talk to somebody.”

He continued: “A lot of guys don’t feel equipped to deal with that conversation either. If a friend comes to you who is struggling, then I don’t think a lot of men know how to deal with that. Girls seem to deal with it really well, it seems to be discourse between friends but for men, not so much.”

In speaking with other charities that deal with male mental health or creating communities where men can go to feel less isolated, they have also learned that sometimes it can be down to body language.

Ian added: “Apparently men like to sit next to each other, side by side, but women prefer to be face to face, which is how they like to open up. There are those key differences but it’s not clear if it’s biology that causes that. These are differences that might stop health services from being equipped to deal with different people because there are slight differences in the way people open up.”

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