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Medical cannabis shows ‘real promise’ in the treatment of PTSD

Psychiatrist and cannabis prescriber, Dr Niraj Singh, explains why medical cannabis could help patients with PTSD.

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PTSD: sychologist sitting and touch hand young depressed asian man for encouragement

Research is still ongoing, but medical cannabis has shown real promise in the treatment of PTSD, writes psychiatrist and cannabis prescriber, Dr Niraj Singh.

Post traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD does not just happen to combat veterans. 

PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. It is estimated that six per cent of the world’s population will have PTSD at some point in their lives.

PTSD: Banner for the Medical Cannabis Clinics

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear, or anger; and they may feel detached or estranged from other people. 

People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, the exposure could be indirect rather than first-hand. For example, PTSD could occur in an individual learning about the violent death of a close family or friend. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases.

What are the symptoms?

Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.

Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of traumatic events. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.

Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.

Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to on going and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; on going fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction).

Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.

Many people who are exposed to a traumatic event experience symptoms similar to those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms must last for more than a month and must cause significant distress or problems in the individual’s daily functioning. 

Many individuals develop symptoms within three months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, anxiety as well as alcohol and substance misuse.

Treatment of PTSD

Any of the following treatment options may be recommended:

  1. Watchful waiting – monitoring your symptoms to see whether they improve or get worse without treatment
  2. antidepressants – such as SSRIs
  3. psychological therapies – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR)
  4. Treatment of other concomitant mental illness as well as alcohol/substance misuse.

How does medical cannabis help?

People with PTSD

  • Have lower levels of the neurotransmitter anandamide, an endocannabinoid that binds to CB1. (1)
  • More CB1 receptors in brain regions associated with fear and anxiety than volunteers without PTSD
  • “If anandamide levels are too low the brain compensates by increasing the number of CB1 receptors” (2)

CBD prevents the breakdown of anandamide, which binds to the CB1 receptors potentiating endocannabinoid signaling.

CBD can reduce anxiety through its actions on several receptors, which are known to regulate fear and anxiety-related behaviours. 1

THC binds to the CB1 receptor directly helps reduce sleep latency and REM sleep which results in less nightmares.

THC also modulates threat related processing in trauma-exposed individuals with PTSD (3).

Therefore medical cannabis can be effective in treating symptoms of PTSD and complex PTSD. 

As patients suffering from PTSD experience intrusive thoughts, flashbacks, sleep disruptions, and demonstrate avoidance behavior, these symptoms not only contribute to the persistence of PTSD, but also render treatment difficult. 

The prolonged stressors and symptom persistence cause derangement in the central neurobiological process, particularly in the prefrontal cortex, hippocampus, amygdala, and cingulate gyrus, which can lead to nightmares, sleep disruptions, and anxiety. 

Research is ongoing and medical cannabis has shown real promise in the treatment of PTSD. I have certainly observed this in my clinical practice. Where conventional treatment is unsuccessful, those who access medical cannabis may experience better quality of life, psychosocial functioning, and working ability with medical cannabis treatment alongside psychological therapies.

 

References

  1. Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study. Molecular Psychiatry, 2013; DOI: 10.1038/mp.2013.61
  2. (ScienceDaily. 2020. Brain-Imaging Study Links Cannabinoid Receptors To Post-Traumatic Stress Disorder: First Pharmaceutical Treatment For PTSD Within Reach. [online] Available at: <https://www.sciencedaily.com/releases/2013/05/130514085016.htm#:~:text=If%20anandamide%20levels%20are%20too,been%20shown%20to%20impair%20memory
  3. Cannabinoid modulation of corticolimbic activation to threat in trauma-exposed adults: a preliminary study. Psychopharmacology (Berl)

. 2020 Jun;237(6):1813-1826. doi: 10.1007/s00213-020-05499-8. Epub 2020 Mar 11. 

 

Mental health

Mental health, addiction and medical cannabis – an expert’s insight

We sit down with the recently-appointed medical director of The Medical Cannabis Clinics, Dr Luisa Searle.

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Mental health, addiction and medical cannabis - an expert's insight

The recently-appointed medical director of The Medical Cannabis Clinics, Dr Luisa Searle, shares how her background in psychiatry and addiction is feeding into her new role. 

Dr Luisa Searle has been treating patients with addiction disorders for the last six years, seeing patients struggling with substance misuse and establishing outreach services for young people and the homeless across London. 

Now, she is helping people legally access cannabis, a substance that has historically been demonised as a ‘gateway drug’. 

Feeling burnt out and craving a fresh new challenge, Dr Searle was looking for a change in her career when she crossed paths with The Medical Cannabis Clinics, joining the team as medical director in April this year. 

anxiety: A banner advert for the medical cannabis clinics

“It frustrates me, this division that there seems to be in mental health, whereby if you’ve got a substance misuse issue, you’re not worthy of mental health treatment,” Dr Searle told Cannabis Health. 

“But actually, your mental health is often being self-medicated by substances and whether you agree with that or not, that’s how some people cope.”

Prior to joining TMCC, Dr Searle was unaware that medical cannabis was beginning to be prescribed more widely.

She was coming into the industry with a fresh perspective, and despite her background in addiction medicine, she said she had very little prejudice against cannabis. 

“It didn’t make sense to me to not explore it,” Dr Searle said.

Dr Luisa Searle, medical director at The Medical Cannabis Clinics

A balanced approach

“I’m not here to say it’s a wonder drug. I’m not here to say it doesn’t have its risks or side effects. It’s by no means suitable for everybody, but this idea that it’s a substance of abuse and not even [worth] researching as a potential medicine I think is, unfortunately, based in historical racism and hysteria, which has no place in science as far as I’m concerned.”

But while she was intrigued by this new and emerging field of medicine, due to her past experience, she was determined to take a “balanced approach” to prescribing. 

For Dr Searle, it is imperative that cannabis is seen for what it is. While it has immense potential for managing hard-to-treat conditions and a possible alternative to physically addictive opioids, it is still a substance that can cause dependence. 

“Any substance, legal or illegal, with some psychoactive effect has the potential for abuse, but that’s where I come in as the doctor,” Dr Searle said. 

“If I felt that you needed diazepam, that prescription is entirely under my control. It is down to me to work with patients  to try to prevent [dependency] from happening and to advise and educate them, so that they can make informed decisions about their care.”

Dr Searle is only three months into her role at TMCC but she is already seeing the positive impact that medical cannabis is having on patients. 

People with difficult-to-treat conditions like insomnia and anxiety are seeing improvements in their lives after trying numerous conventional treatments that failed to help. 

Meanwhile, patients who have previously relied on pharmaceuticals like antidepressants and SSRIs  – which can come with severe side effects – were able to “feel themselves” again after reducing their dose of traditional medication in favour of medical cannabis. 

“What’s really been nice is seeing success with people who have tried lots of different conventional treatments and haven’t really gotten anywhere,” Dr Searle said.

“I was talking to a gentleman who had a traumatic brain injury and was getting migraines on a regular basis. He had really struggled with his work and his life. With a small amount of medicinal cannabis flower, he feels much more himself.

“That’s the really nice thing [about] working in this clinic; just seeing that turnaround in people who’ve been quite stuck.”

NHS access

Having worked for the NHS for 15 years, Dr Searle is a firm believer in everyone having access to the healthcare they need. 

Right now, this does not apply to the medical cannabis space. Very few people have been able to access an NHS prescription while private prescriptions can cost hundreds per month. 

“It is a little bit challenging for me that I have to be in a private clinic in order to provide medical cannabis treatment,” Dr Searle said.

“While TMCC has extremely reasonable prices in comparison to other types of private health care, it is still a cost and if you’re on a low income it might as well be a million pounds.”

Dr Searle wants to see medical cannabis being more widely prescribed, but it has to be “sensible” with regulations around who can prescribe and how. 

She continued: “Why shouldn’t it be available on the NHS in the right circumstances? What I don’t want to see is what can potentially happen with opioids – with people becoming dependent on them.

“It’s not a medication for all. There are concerns, particularly among younger people. We’re still not 100 per cent clear as to the risks around potentially life-changing mental health issues and specifically psychosis.”

Importance of eduction

Dr Searle has not encountered huge numbers of cases where recreational users have later developed psychosis, but she has seen enough for it to be a concern. 

“It’s not something that I could just dismiss,” she said.

“When we have young people coming to us, it’s all about education. It’s just like any medication, if you start on antidepressants, you don’t start with a high dose, you start on a low dose and build it up. You check the tolerance and you review the patient regularly to see if there have been any improvements or side effects.”

Dr Searle also points out that studies into psychosis and cannabis use have examined street cannabis rather than medical-grade products prescribed by clinics like TMCC. 

“Street cannabis potentially has incredibly high levels of THC and very low levels of CBD,” she said

The benefits for some patients speak for themselves, but Dr Searle stresses the fact that a medical cannabis prescription is not right for everyone. 

“Whilst I think [medical cannabis] is great and we get lots of positive feedback, we do have some adverse reactions to it where it’s not suitable,” she said.

“People shouldn’t be lulled into a false sense of security that just because your doctor prescribed it and it’s legal for medicinal use it’s not without its risks.”

Dr Searle sees a lot of potential in cannabis as an alternative drug for chronic mental health disorders and pain, even as a possible method for weaning patients off opioids. But she warns that people who are prone to addiction may end up transferring their dependency from one substance to another. 

“If you break your leg, opioids are fantastic for that, but what they’re not so good for is chronic pain,” she said. 

“The withdrawal process from them can be horrendous and there could be a place for cannabis to alleviate some of those withdrawal symptoms.”

But, she added: “I think I would be much more cautious about that, simply because until you’ve dealt with and understood your addiction and those behaviours and those are resolved and you’ve engaged with other ways to cope with your emotional stresses, you may just be switching one addiction for another.”

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Cantourage Clinic now offers discounts to Armed Forces community

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Cantourage Clinic, is hoping to improve access to cannabinoid therapies for members of the Armed Forces community, after committing to the Armed Forces Covenant. 

The CQC-registered clinic, which launched in the UK this year, is now offering a permanent 10 per cent discount on consultations for veterans and their direct family members.

This is in addition to making donations to the veteran’s mental health charity, Combat Stress, following its recent commitment to the Armed Forces Covenant. 

The Armed Forces Covenant is a government-run obligation pledging support to those who have served in the UK Armed Forces.

In honour of Armed Forces Day on the 25 June, Cantourage Clinic has also now reduced the cost of initial consultations for all patients from £99 to £49 for the month of June. Members of the Armed Forces community will receive a further 10 per cent discount off this price.

A donation of £1 from each consultation will be made to COMBAT STRESS – a UK charity dedicated to helping servicemen and women in dealing with post-traumatic stress disorder, and other mental health conditions.

Shortage of mental health staff within the NHS and military is an ongoing issue.

Reports from a study conducted by the Royal College of Psychiatry and published in the BMJ last year, highlighted that England has just one consultant psychiatrist for every 12,600 people.

With at least 1.5 million people waiting for mental health treatment, sufferers are being forced to contact emergency services or crisis services whilst they await treatment, with one in 10 ending up at an emergency department.

According to data presented by the British Journal of Psychiatry (2018), the prevalence of post-traumatic stress disorder (PTSD) among veterans (7.4 per cent) is almost double that of the UK public (4 per cent) – and even higher among veterans who served in Afghanistan or Iraq.

Effective mental health services and treatment options is, therefore, an important consideration in the support of veterans and those close to them.

PTSD often has a long-lasting and debilitating effect on the affected individual and a wider impact on those close to them.

It often co-occurs with other mental health concerns, including anxiety, depression and insomnia. A growing body of evidence supports the potential of medical cannabis in the treatment of PTSD and co-occurring conditions.

Recent data shows that cannabis use is on the rise among veterans diagnosed or experiencing symptoms of PTSD.

A recent study found that participants with a diagnosis of PTSD who used cannabis were 2.57 times less likely to no longer meet the criteria for PTSD at the end of the one-year study period.

In another study, participants with PTSD reported improvements in sleep quality among other therapeutic effects of cannabis use.

Cantourage hopes its 10 per cent discount on initial and follow-up consultations to all veterans and their direct families will help to improve the accessibility of treatment to those affected by PTSD and related conditions.

Cantourage’s new offer was launched ahead of Armed Forces Day on 25 June.

Lead psychiatrist Dr Anup Mathew said: “I’m extremely proud be part of an organisation such as Cantourage Clinic which acknowledges and understands that those who serve or who have served in the Armed Forces, along with their families, should be treated with fairness and respect in the society they serve with their lives.

“Especially in view of recent and on-going conflicts, we should never forget the sacrifices the Armed Forces community have made and continue to make for all of us.”

Gabriel Newman, CEO at Cantourage Clinic

Gabriel Newman, CEO at Cantourage Clinic, said: “We are delighted to show our support to the brave community of veterans. All over North America, there are programmes in place to equip military servicemen and women with improved access to cannabis.

“The benefits of substituting Opioids or Benzodiazepines for medical cannabis have been widely reported, studies have shown that patients experienced ‘fewer adverse side effects’ and ‘better symptom management’ in comparison to opiate-based drugs.

“Cantourage Clinic is the UK’s first medical cannabis clinic to directly support the Armed Forces Covenant. We are proud to be leading the way in providing education and support to help improve the quality-of-life for military veterans in the UK.”

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US study to explore best CBD/THC ratio for anxiety

To date not much is known about the specific ratio of cannabinoids that works best to alleviate symptoms. 

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A new study aims to shed light on the best ratio of CBD and THC to treat anxiety symptoms.

While multiple studies have established the efficacy of medical cannabis in treating anxiety, far less is known about the specific ratio of cannabinoids that works best to alleviate anxiety symptoms. 

A new study – led by Florida Gulf Coast University (FGCU), the Releaf App, which allows patients to track their symptoms and usage and CannaMD, a network of medical cannabis prescribers – aims to explore the subject.

Researchers plan to recruit up to 1,000 medical cannabis patients to track patient-reported experiences while consuming medical cannabis purchased at dispensary locations across the state of Florida.

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Eligible study participants will use MoreBetter technologies to answer standardised anxiety-related questions via a smartphone for a 45-day period to track details of their cannabis use and associated outcomes related to symptom relief and side effects. 

MoreBetter technologies are widely used by researchers, healthcare professionals, and cannabis product manufacturers to collect data on the performance of cannabis and CBD products, as reported by cannabis patients and consumers.

“Given the increased anxiety and stress that has been reported over the past few years, this is a timely study,” says Tyler Dautrich, COO of MoreBetter Ltd, the company behind Releaf App. 

“Working with groups like FGCU and CannaMD enables us to collect localised real-world data outcomes, which will ultimately help improve the experience for registered cannabis patients in Florida.” 

Representing one of Florida’s largest networks of medical cannabis physicians, CannaMD’s chief medical researcher, Jessica Walters, agrees: “Identifying specific CBD/THC ratios that work best for anxiety is a critical area of study with immediate real-world applications for a large percentage of the patients we see every day.”

As Dr Martha Rosenthal explains: “Approximately one-third of Americans will suffer from a significant anxiety disorder at some point in their lives, and many turn to medical cannabis to alleviate their symptoms.

“This study will expand our knowledge on the effects of medical cannabis on symptoms of anxiety, patient patterns of use, and the correlation of medical cannabis with other anxiolytic drugs and practices.”

This study marks the first in an ongoing collaboration between FGCU, MoreBetter, and CannaMD to advance medical cannabis research in the state of Florida and contribute to evidence-based literature regarding the use and efficacy of cannabis products statewide. 

 

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