I once heard the definition of trauma as “any experience that is larger than your ability to process.” Trauma can land hard and ripple through the human experience, surfacing at the most unwelcome times, leaving devastating and life threatening symptoms in its wake.

Here in Israel, a country where army service and reserve duty is mandatory, PTSD is prevalent. Many of us have an intimate, even personal perspective on PTSD. It is our belief that the more we share knowledge about PTSD and the more awareness we create around this debilitating condition, the more we can help usher in better health options and better care for those suffering…worldwide.

PTSD is a priority for us at CannaTech and we have woven it as an agenda item in our programming. From Sue Sisley, an internationally recognized doctor specializing in Post Trauma in US veterans, to Israeli IDF veterans who created the non-profit “Lochamim Lchaim – Fighting for Life,” we do our best to give this issue the space and attention it deserves.

We are hopeful about the new research and growing awareness surrounding medical cannabis as a treatment for the symptoms of PTSD. For many of those suffering, this brings more than a little hope. For countries like the United States, where the amendment that would have allowed veterans access to medical cannabis through federal doctors (in states where medicinal use is legal)  was once again blocked, we believe this awareness and discussion is critical.

For some perspective; upwards of 8%  of the US population suffers from PTSD, 26% of whom are men and women of military service. In Israel, approximately 9% of citizens have been diagnosed with PTSD. That’s 720,000 people in Israel with  PTSD or 1 out of every 10!

This is an issue that demands attention.

chilling statistics about veteran suicide rates in the United States.

 

WHAT IS PTSD EXACTLY?

PTSD stands for Post Traumatic Stress Disorder. The causes of PTSD are varied, and anyone, regardless of age or circumstance, who has experienced a traumatic event can be susceptible to PTSD. There is a range of criteria used to arrive at a diagnosis of PTSD:  

According to Diagnostic and Statistical Manual of Mental Health (DSM-V), there are three main “clusters” of symptoms. These clusters cover symptoms of avoidance, re-experiencing and hyperarousal. Following a traumatic event, PTSD patients are likely to feel trauma related feelings and thoughts, experience nightmares, flashbacks, emotional distress and hypervigilance among a host of other symptoms. This overactive fear system makes it difficult to modulate feelings and reactions, especially in regard to situations that trigger the memory or experience of the trauma.

molecular structure of hormone and neurotransmitter norepinephrineOne of the main ways PTSD  manifests physiologically is an increase in the hormone and neurotransmitter norepinephrine. The release of norepinephrine (as well as epinephrine) is what makes your blood pump and heart pound, giving you the shakes when you’re put in a stressful situation…real or imagined. It triggers the release of glucose into the bloodstream and increases blood pressure, heart rate, mental alertness, and respiratory rate.

Simply put, it is the body’s fight-or-flight response and it forces a lot of energy output from multi systems in the mind and body. 

Current pharmacological treatments for PTSD include SSRI (selective serotonin reuptake inhibitors), anti-depressants, anti-anxiety medications, counselling, cognitive behavioural therapy and in extreme cases antipsychotics. Though many patients show positive outcomes with these treatments, the large majority of these treatments have not been designed specifically to treat PTSD.

Second line treatments are often opioid based, which can cause a range of side effects (restlessness, anxiety) and long term issues (tachycardia, addiction and suicidal tendencies). Addiction to opioid based substances is a key long term issue.

PTSD and Israel

The effects of regional conflict, military service and the aftershocks of the holocaust on the society as a whole is palpable. Approximately 9% of citizens have been diagnosed with PTSD. Fortunately, medical cannabis is legal in Israel. Although the process to obtain a licence is still more involved and cumbersome that we believe it needs to be, [eventually], patients have non-pharmaceutical options.

Israel is the heartland of innovation in the medical industry so it is not surprising they are one of, if not the country with the most research and development in the industry of medical cannabis.

Dr. Irit Akirav of Haifa University, Israel, has conducted extensive research into the effects of cannabis as a treatment for PTSD in animal models. Along with her colleagues, Dr. Akirav has shown that administering cannabinoids within a defined window of time after a traumatic event decreases likelihood of development of PTSD.

This indicates that the marijuana did not erase the experience of the trauma, but that it specifically prevented the

development of post-trauma symptoms in the rat model”

– Dr. Irit Akirav

Cannabis as a Treatment

There is no shortage of anecdotal evidence when it comes to treating PTSD with cannabis, however we are gaining solid, clinical evidence that demonstrates the anti-anxiety and antidepressant properties of cannabis. These discoveries give a backbone for future research and development into the effects of cannabis on the brain and how it can relieve symptoms of PTSD.

“It has been suggested that pharmacologic treatments in psychiatry have been overly reliant on neurotransmitter
systems and their agonists. In the last several decades, advances in psychopharmacology have reduced adverse
reactions but have failed to lead to major disease improvement. The endocannabinoid system may shed new light
on the physiologic basis of psychiatric diseases, leading to new and more effective treatments.”

-Prof. Raphael Mechoulam

Professor Raphael Mechoulam keynote CananTech 2016 Tel Aviv

Medical cannabis’ capacity to aid with memory extinction is one of the key aspects that is currently being researched. Memory extinction occurs naturally, organically in the average population. Those who have experienced trauma however, often have impairment to their natural memory extinction ability. Medical cannabis has shown to support the body’s endogenous memory extinction abilities, reducing the ability of traumatic memories to trigger the sympathetic response of fight or flight.

As we mentioned previously, the current, standard treatment for pain related to injury or psycho-biological pain related to PTSD include opioid-based pharmaceuticals. Side effects of these opioids can be devastating, with addiction chief among them.

Recently, cannabis has been touted not only as a treatment for PTSD but also as a withdrawal aid for those addicted to opioids. Dr Yasmin Hurd, who presented at CannaTech 2017, has conducted research with cannabidiol (CBD, a major therapeutic compound of the cannabis plant) and its actions regarding inhibiting drug seeking behaviour and decreasing stress vulnerability. These aspects are key when it comes to helping patients overcome addiction. In addition, it has been shown that medical cannabis can aid in reducing likelihood of relapse within a defined period of time.

cannabis is not a gateway drug it is an exit strategy

 

Dr Mike Hart has also raised the possibility that due to the calming actions of CBD, it may also be beneficial as a pre-treatment for therapy sessions. With carefully dosed medical cannabis, patients can be brought to a calmer state, and counselling and/or cognitive therapies may have greater impact.

“If you’re in such a disease state and all of those thoughts are not clear… you’re not going to be able to accept the
information, you’re not going to be able to do a true analysis on yourself, and you’re not going to be able to apply
the new information that you’re learning.”
Dr Mike Hart

Both anecdotal and research based evidence demonstrate that cannabis has positive effects for symptoms such as, night sweats, sleep disturbances, cognition and anxiety. There is strong hope around using cannabis as an adjunct treatment to cognitive therapy and other varieties of counselling.

Researchers however do warn of potential side effects from medical cannabis. In some, cannabis can instigate feelings of paranoia and impact short term memory, though scientists are delving deeper into which specific cannabinoids trigger these specific actions, the hope is to refine and formulate medicines that do not provoke these side effects.

Each human metabolises drugs differently, so despite widespread legislation in support of medical cannabis, it is clear that personalised medicine, specific strains and deeper research is the pathway of the future.

“Just like any other substance, it’s not for everybody. For some people it works well, for some people it doesn’t.”
Prof. Marcel Bonne-Miller

 

The Research

This review of 11 studies of military veterans with PTSD concludes that veterans of the military have shown substantial signs of decrease in anxiety, insomnia as well as increase in general coping ability when using cannabis.

Additionally, PTSD patients suffer a comorbidity rate, meaning that they experience more than one condition at a time. 79% of females and 88% of males diagnosed with PTSD also suffer from depression, substance abuse and anxiety disorders. Given the growing evidence of cannabis as a treatment for depression, anxiety and substance abuse, the potential benefit of cannabis therapy for comorbidity is very promising. This combined with a growing body of  evidence that the endocannabinoid system  has involvement in reduction of fear and anxiety suggests that cannabinoids may have positive effects on reducing suicidal ideations and behaviour as well.

“I went from being an anxious mess to numbing myself with the pills they were giving me…
Cannabis helped me get out of the hole I was in. I started to talk to people and get over my social anxiety.”
-Mike Whiter, 39-year-old former Marine 

The future

The future of safer treatment for patients suffering with PTSD is hopeful. We most certainly need more clinical studies to assess the effect of cannabis on the brain and on long term psychological impact. The importance of awareness, education and increasing the efficacy of detection and treatment for PTSD is critical in advancing this field of study.

Of equal importance, health care providers need to increase their ability to provide accurate, timely and precise care to those that need it most.

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