Control and comfort of mental illness with marijuana

Editor’s note: The following testimonial was written in the ‘discussion’ section of the Wikipedia “Medical Cannabis” page. It had been removed, deemed inappropriate. This is the reality for many people who need and illegally use this herb:

I was diagnosed ten years ago with mental illness due to physical ABUSE suffered as a child and emotional and sexual abuse suffered in my 14 year marriage. My diagnosis was panic attacks with associated psychosis, social anxiety disorder, agoraphobia, claustrophobia, post traumatic stress syndrome and GAD (general anxiety disorder). GAD doesn’t sound so bad, I thought, yet I was told it was every anxiety order that there is, all rolled into one. WOW! My psychologist also told me in her 35 years of practice I had suffered more trauma than ANY patient she had treated. WOW AGAIN! I knew I felt completely broken and could no longer work. I actually could not leave the house (my parents) or even get in the shower due to paralyzing fear. I sat in a bedroom in my parents house, staring at the TV or out the window without being there in my mind. I just went away to nowhere. When I did come back to the world to eat or go out of the room, I was in a panic and cried with the grief of someone that had just experienced the death of a loved one.
I have never written about this and I know it is hard to understand unless you have experienced a similar disorder yourself.
My point is this: Marijuana saved my life!!! I was given every antidepressant and anti psychotic that there is and had terrible adverse reactions to all of them. Of course my doctors did not believe me at first, but as time went on they could see that it was true. Thank God for blessing me with the best doctors in the world, because they did really listen to me. They saw my behavior and finally treated me with an anti anxiety drug. This helped somewhat, but I had to be given such large doses to be able to function out in society, the government would not allow this. Finally I smoked a joint of marijuana and the world looked and felt different. It felt right. It wasn’t my first time. I had smoked pot in high school, just as I had drank alcohol.
It was different now, mixed with my anti anxiety drug Ativan the world didn’t seem quite so frightening. Soon I was able to get into the shower without having a panic attack. I could go outside and walk around the yard (for short periods). Slowly, day by day, with marijuana and one pharmaceutical I am able to feel again. Sometimes good, still mostly bad, BUT I AM ALIVE AGAIN, without being terrified. And I was getting better every day. Then one day I was busted for a quarter of an ounce of marijuana. I am now looking at jail time. I cannot do this! I am back in my previous state of mind, only worse. Needless to say I do not live in California. But if I live through this (which seems doubtful now, I have had one suicide attempt). Living without marijuana, and being locked up are not options for me, that leaves only one other option, depending on my court outcome (which I am afraid to wait for, because then it will be too late). What do I do? How can I live through this. I am scared to death, literally. And over such a stupid, petty little thing!!!!!! I have never hurt anyone, I was only helping myself to live. How can the government be so ignorant? Sorry, stupid question. I have nothing left to say, except that marijuana SHOULD BE LEGALIZED!

 

Editor’s footnote: Because it was so daunting, I choose to remove the very last part of this testimony, dated 14 October 2010. I later realized it is not fair to this person, so…

“GOODBYE. SEE YOU ON THE OTHER SIDE!” was the last thing written.

How I use Medical Cannabis (a testimonial)

A friend of this blog recently submitted a raw food-inspired fudge recipe from our “tests kitchen” near Santa Fe (which we’ll be posting soon). There were some notes included with the recipe regarding the healing effects of all the different ingredients, and we asked her to elaborate.  Although her testimony is pretty unbelievable, it’s quite easy for me to believe as I have experienced these same profound healing effects from Cannabis ~

“i have fibromyalgia symptoms, supposedly comes from my muscles never turning off – cannabis gets right into the very cells and calms them down – the spasms stop and the knotting of the muscles (you can see and feel it) stops.

i have ptsd symptoms, meaning nightmares, hyper arousal, cant sleep, fear all the time, eating is sporadic cause i cant digest food – cannabis gives me an appetite and i can actually eat without a stomach ache, helps me sleep, calms my mind so not on hyper arousal and no fear, and lessens the nightmares.

i have had to take an overabundance of vitamin c because of a toxic liver situation, which affected my intestines – Cannabis stopped the symptoms in my intestines.

I have a migraine today and cannabis took a lot of the pain off.

Now all this happens when i am not high – as i am taking only an amount to calm my symptoms, digesting it [via edibles].”

The POT Conference: Patients Out of Time

Mary Lynn Mathre and Al Byrne, co-founders of Patients Out of Time – they’re the ones in motion, constantly.

(Source)  Patients Out of Time is a pro-cannabis reform group led by Al Byrne, a retired Naval officer, and MaryLynn Mathre, a Vietnam era nurse.  Al survived two catastrophic events in which others died and over the years he’s had to deal with post-traumatic stress. He calls it PTS not PTSD. He says, “It’s not a disorder, it’s a rational response to what you’ve seen.”

Al’s a big tall man who played outfield for Notre Dame before he went off to war. He has spent years counseling vets in Appalachia for the Department of Veterans’ Affairs Agent Orange Class Assistance Program. MaryLynn, who goes by ML, is an addictions consultant. Her publications include “Cannabis and Harm Reduction: A Nursing Perspective,” in the Journal of Cannabis Therapeutics. They are married and based in Virginia.

Al and ML had been active in NORML but split off in 1994.(Everyone’s faction fights seem oh so avoidable but one’s own.) In 1995 they formed their own group, with participation from Irvin Rosenfeld, Elvy Musikka, George McMahon, and several other surviving patients from the federal Investigation New Drug program. They could have called it Patients Out of Patience but the abbreviation wouldn’t have worked.

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Marijuana could alleviate symptoms of PTSD

An Israeli study finds that the cannabinoids in cannabis provide anxiety relief, could affect emotional memory and may enhance PTSD treatments.

Cannabis

Photo courtesy of Yossi Zamir/Flash90
In pill or drug form, cannabis could be used alongside exposure therapy to stymie the effect of trauma.

(Source)  Back in the early Sixties when the Flower Children were getting high, parents in the US government were consulting Prof. Raphael Mechoulam from Israel about the effects of pot smoking on their teens. Mechoulam, an organic chemist from the Hebrew University of Jerusalem, was the first to isolate the psychotropic element THC in the cannabis plant. He dubbed its active chemical components ‘cannabinoids.’

Ever since his discovery, the medical community has recognized and lauded the importance of cannabinoids in alleviating chronic pain and nausea in cancer patients and modulating the symptoms of HIV/AIDS. A new study, this time at Israel’s University of Haifa, has found a reason to legalize the use of cannabinoids, assuming that its benefits outweigh the potential risks.

According to the study by Dr. Irit Akirav from the Department of Psychology at Haifa University, cannabinoids may relieve the symptoms of Post Traumatic Stress Disorder (PTSD), a debilitating disorder that strikes 10 to 30 percent of people who suffer from a traumatic event such as war, a car accident, rape or a terrorist attack.

In her study published in the Journal of Neuroscience, Akirav used an animal model and a synthetic form of marijuana that didn’t induce psychotropic effects, to measure the compound’s efficacy at reducing the effects of PTSD.

Relieves stress in rats

In the first part of the study, Akirav and her students examined how long it took rats to recover from the trauma of electric shock without the drug. Some of the traumatized rats were exposed to a series of procedures intended to stress them even further, while another group of rats was exposed to both stress and trauma but also received a dose of cannabinoids directly to the brain – into the amygdala region. The amygdala is known to be connected to emotional memory, which is linked to PTSD.

Researchers concluded that rats that received the drug experienced hormonal changes and consequently their brains didn’t release an increase of the stress hormone that the body normally produces as a reaction to stress. People with PTSD are found to have abnormal levels of this stress hormone.

“The results of our research should encourage psychiatric investigation into the use of cannabinoids in post-traumatic stress patients,” Akirav, who hopes that if enough animal studies are conducted in this area, sufficient evidence will be provided to convince clinicians to initiate trials on humans, tells ISRAEL21c.

There is already talk in Israel about conducting clinical trials on soldiers in the Israel Defense Forces to investigate the effects of cannabinoids on PTSD, but Akirav says she will continue to work at present with animals. She believes that in the case of PTSD, the cannabinoids, which seem to be a perfect fit to cure many disorders and diseases in our bodies, have an effect on emotional memory.

Weighing risks and benefits

“In the case of people with PTSD, it could be a good solution to take marijuana, but we still don’t know the possible negative effects of the drug,” she cautions. “For PTSD sufferers, where their situation is terrible, something like marijuana has other effects – an effect on anxiety, and we are trying to pinpoint brain areas that are involved.”

But more than providing anxiety relief, cannabinoids could affect emotional memory and enhance PTSD treatments by modulating the emotional memory component, she argues. Akirav believes that in pill or drug form they could be used in combination with exposure therapy to stymie the effect of a trauma. And since cannabinoids are already widely used and in some cases prescribed as cancer therapies, they could potentially pass through regulatory hurdles quickly as a drug to treat PTSD.

“As opposed to other drugs, one wouldn’t need to adjust it, because people use it already as a chronic therapy for HIV and it helps them,” she says. However, she concludes, in the case of PTSD, more extensive studies are still needed to ensure that the benefits of taking cannabinoids would outweigh the risks.

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10 Reasons the U.S. Military Should (Officially) Use Pot

Medical marijuana may have a host of advantages over other treatments for traumatized vets, but the VA won’t even study its efficacy.

By Penny Coleman, AlterNet.

On top of a 100 percent disability rating with PTSD, “Charlie” — who asked that his real name not be used — came home from Afghanistan with a traumatic brain injury, a back injury and gastrointestinal problems. The VA pulled every magic trick out of its bag to treat him. But nothing worked.

What did work was marijuana.

Shirak-e-Mazar, the milk of Mazar, is what got Charlie through his deployment in Afghanistan. Shirak-e-Mazar is what Afghanis call the paper-thin sheets of hashish that sell for about $1.50 an ounce. It’s a 5000-year-old recipe, perfected in the Mazar-e-Sharif region, for preparing the compressed resin glands of the marijuana plant, and unless things have changed since Charlie left Afghanistan in 2004, it’s available, well, just about everywhere.

So was alcohol, but according to Charlie, it didn’t provide the same kind of relief: “You get some drinks in you, you get nice and loose; you drop your inhibitions and think you’re invincible. But you haven’t dealt with the stress; you’ve just kind of blocked it; you don’t really understand the possible outcomes of what you’re about to do—or you don’t care.

“Smoking though … you can appreciate the stresses and understand everything that’s going on, but you’re still relaxed enough to do what you have to do, and do it well.”

Since he got home, he says he is “smoking about one and a half grams a day, depending on how I’m doing. I go through an ounce in three to four weeks. I’m medicating for PTSD, but also a back injury and gastrointestinal problems, so if I had to do things like shovel the walk … I would have to smoke a little more.”

Unfortunately, Charlie does not live in one of the 13 states that have authorized the use of medical marijuana. In the rest of the states, federal law still applies, and according to the United States Department of Agriculture (USDA) marijuana is still classified as a Schedule I drug. Schedule I drugs are those deemed most dangerous, more so than cocaine, oxycodone and methamphetamines, all of which are Schedule II.

“Me and the rest of my veterans’ group talk about it all the time,” he says. “Most of them also medicate with marijuana. If you asked any of us what, out of everything, was most effective in PTSD treatment, we would tell you marijuana.” But the VA is a federal agency, so even in the 13 states where doctors are at liberty to suggest that patients try marijuana, they are prohibited from dispensing it.

The first two years after he got home, Charlie and his wife were still active duty. Marijuana was too risky, so he drank. A lot. So much that he almost killed himself and his wife.

“Alcohol seemed to exaggerate all the negative feelings, the anger, the rage, the depression, the desperation.”

Since Charlie was discharged in 2006, the VA has pulled an astonishing variety of medications out of its magic bag. Charlie’s list is an impressive one that many, perhaps most, vets who have gone to the VA for help with post-combat stress and pain issues will recognize.

“I’ve been on six different antidepressants, lorazepam for anxiety; two sleep aids, Ambien and something else; three medications for my stomach problems, including omeprazole; and Topomax and amyltriptomine for migraines.

Even if the sleeping pills got me to sleep, I’d still wake up in the middle of the night from nightmares. The only difference is that WITH the pills I’d wake up dizzy and disoriented. The disorientation made for a smooth transition into flashbacks, and if you want to see a vet have a bad episode, make sure he/she is completely disoriented and wake them suddenly in the dark. (Don’t try this at home — danger, danger!)

“The lorazepam was prescribed for the anxiety caused by the antidepressants, but it turned me into some kind of shuffling Ozzie Osborne zombie. I didn’t have the physical energy to do anything but lay on the couch. Topomax and amyltriptomine turned me into a sloppy, silly bedlamite, groggy like I’d had too much to drink and babbling like a face-painted Anna Nicole Smith. Oh, and the Topomax had me hurling up last year’s Christmas dinner.

“I’ve gone through pain management more times than I can count on my hands, and I’ve had over twelve series of epidermal steroid injections done to my lower back. None of them ever did anything for me. Except of course make my stomach problems much worse. I started smoking [marijuana] again three years ago, and it’s been the best pain management I’ve found. I can pick up my thirty-pound daughter for a while now, which might not seem like a big deal, but it is. Oh, as for helping with hypervigilance, it does, but given the current legal status of my medication of choice in this state, I am hypervigilant for the police.”

And not without cause.

Even in states where medical marijuana has been approved, conflicting state and federal laws have provided law enforcement agencies with an excuse to prosecute according to personal prejudice.

Recently, the Obama Department of Justice instructed prosecutors to leave legitimate growers of medical marijuana alone. That is a step in the right direction, but there are at least 10 reasons why they should be encouraged to continue moving toward saner and clearer policies.

1) Until proven otherwise, marijuana is the safest thing they’ve got in their pharmacopoeia.

Marijuana has been used worldwide to treat pain, stress and any number of other ailments since the third millennium BCE.

It has been outlawed in the United States since 1937, but since 1970, with passage of the Controlled Substances Act, marijuana has been classified as a Schedule I drug, with a “high potential for abuse,” “no currently accepted medical use” and a “lack of accepted safety” for use of any kind.

The Schedule I classification has meant that for the better part of 40 years, claims could be made that marijuana would turn you into a serial psycho-killer, a spotted owl or a socialist, and nobody could prove them wrong.

Daunting layers of federal permits discouraged serious study of the substance’s efficacy, and strictly controlled access to the only legally grown supply have meant that grants were awarded only to those folks who weren’t looking for anything nice to say about pot.

Schedule I drugs can’t even be the subject of research or study.

But this November, the young guard at the American Medical Association (AMA) gleefully hip-checked the doomy, gloomy straight-laced old guard out of the way and voted to revisit marijuana’s Schedule I classification.

After reviewing all the reliable information available, their conclusion was this (PDF):

“Adverse reactions observed in short-term randomized, placebo controlled trials of smoked cannabis to date are mostly mild without substantial impairment. Physicians who comply with their ethical obligations to ‘first do no harm’ and to ‘relieve pain and suffering’ should be protected in their endeavors, including advising and counseling their patients on the use of cannabis for therapeutic purposes.”

In taking that position, the AMA joined the American College of Physicians, the country’s second largest physician group, which in February 2008, had adopted a similar resolution.

As former Surgeon General Dr. Jocelyn Elders wrote in AlterNet in 2008, it’s time “to put science ahead of politics.”

2) Reduce our dependence on foreign opioids.

Chronic pain is the leading indication for medical marijuana use, accounting for 90 percent of the patients in Oregon’s medical marijuana program.

Recently, research done both in Canada and the United States has demonstrated a synergistic interaction between cannabis and opioids. Patients who smoked a little weed along with their meds found they could decrease their opioid dose by between 60-100 percent.

So consider that if the entrenched drug warriors were finally outflanked, VA doctors would be allowed to prescribe marijuana and our vets could reduce their consumption of opioids.

3) Restore the reputation of the VA among veterans.

After all the criticism of the VA for limiting access, shredding claims, misdiagnosing illnesses as a cost-saving trick and using soldiers as uninformed guinea pigs to test pharmaceutical drugs linked to suicide and other violent side effects, veterans invited by the VA to knowingly participate in a marijuana study might be inclined to allow the euphorogenic qualities associated with cannabis to blur their outrage, even to the point of forgiveness.

4) Israeli rats have less stress than American soldiers.

In an article published in the September issue of the Journal of Neuroscience, Israeli scientists revealed that injecting synthetic marijuana into the brains of rats allowed them to recover faster from trauma. In fact, it “cancelled out the symptoms of stress.”

The researchers predicted that marijuana may help patients overcome life stresses that worsen reawakened trauma and other symptoms of post-traumatic stress disorder.

5) And then there is Sativex.

Savitex is an oromucosal spray, developed by the British firm GW Pharmaceuticals, that has been called “liquid marijuana” because it is derived from the entire botanical cannabis plant. In 2005, the Canadian government approved its use for relief of neuropathic pain and the FDA has agreed to trials in the U.S. prior to an approval application.

It will be challenging to persuade patients that Sativex, which will surely cost more than what can be grown in your backyard, is the better choice. No pharmaceutical preparation, synthetic or natural, has yet proven as effective as the smoked plant. In fact, the only proven advantage of such medications is that they are legal.

Those FDA trials, by the way, were supposed to be completed by the end of 2009.

6) We gave Big Pharma 40 years of government handouts and they came up with zilch.

Instead of paying extortionist rates, imagine if the VA could say, “Sorry, Bayer, but you’re going to have to make it cheap and make it good, or they’ll just grow their own.”

It’s a piece of cake to go around Big Pharma on this one. All you need is a little sun, soil and TLC, or a grow-lamp in your basement. And the good fortune to get to your crop before the cops, the local kids or the deer.

How easy? Since 2006, entrepreneurial Americans have grown enough marijuana to displace corn as the leading cash crop in America.

7) The growing process is itself demonstrably therapeutic.

A recent study out of the Naval Postgraduate School and Stanford University predicts that as many as 35 percent of returning soldiers could have PTSD. The number of veterans who have already served in Iraq and Afghanistan has reached 1.8 million.

Another study, courtesy of the Pentagon, estimates that as many as 360,000, or 20 percent of the veterans of these current wars have suffered traumatic brain injuries.

That’s a lot of new fists that will be banging on the doors of an already overwhelmed VA asking for help. How serendipitous then, that a promising treatment option being offered to traumatized veterans across the country is gardening.

8. We could fill some budget gaps.

Imagine the savings for states like Washington that are currently facing huge financial deficits. Washington announced this month that a bill to legalize marijuana altogether will be on the ballot in 2010.

The circularity is sweet; the logic hopefully irresistible. Traumatized veterans could be hired by the state to garden, which relieves their post-combat stress symptoms and also affords them an income and the self-respect that comes with employment. The crop they grow will medicate their own psychic distress and that of other veterans, while at the same time replenish the state coffers when sold in state-run liquor stores.

Rep. Mary Lou Dickerson, a Seattle Democrat who is sponsoring the legalization bill, said she expected legal sale of marijuana could bring in as much money as alcohol; more than $300 million a year.

It will also challenge legislators in other cash-strapped municipalities to consider the billions of dollars worth of marijuana that is currently going untaxed, and whether they want to stand on principle or on solvency.

9) Suicide prevention.

The National Center for Posttraumatic Stress Disorder acknowledges that there is “disagreement whether pharmacotherapy should be considered a first-line treatment for PTSD.”

As illustration, their manual, “Treatment of the Returning Iraq War Veteran,” states: “We recommend SSRIs as first-line medications for PTSD pharmacotherapy in men and women with military-related PTSD.”

The Journal of Clinical Psychiatry reports that 89 percent of veterans with PTSD are prescribed antidepressants and 34 percent antipsychotics by the VA.

Of the specific medications identified as potentially useful, all but two come with black box warnings of suicide or increased risk of death.

In October, VA Secretary Eric K. Shinseki announced that, “(m)ore Veterans have committed suicide since 2001 than we have lost on the battlefields of Iraq and Afghanistan—each one a tragedy.”

Soldier suicides are at an all-time high and so are prescriptions for all kinds of new and dangerous drugs. Nobody can say for sure if there is a connection between those two facts, and I would never suggest that marijuana could or should take the place of SSRIs or any other drugs proven to be effective in managing PTSD. Or that marijuana could prevent soldier suicides. But the vast majority of drugs the VA prescribes for PTSD are known to worsen depression, increase suicidal thinking or increase risk of death in enough people to warrant the warning.

The same is not true of marijuana.

10) It would bring some coherence to our nation’s drug policies.

It is just possible that Tim Leary was right when he said that “(p)sychedelic drugs cause paranoia, confusion, and total loss of reality in politicians that have never taken them.”

Daniel Robelo of the Drug Policy Alliance says, “The federal government has a duty to help veterans receive the most effective treatment available for their combat-related conditions, and for PTSD and chronic pain, marijuana is often that treatment. All veterans (and non-veterans) who might benefit should have unfettered access to this effective medicine, which is well within the margin of safety for any drug, and in fact, much less dangerous than most drugs commonly used to treat PTSD and pain.”

PTSD and Cannabis: A Clinician Ponders Mechanism of Action

See Also:

*Rat Study: Marijuana May Ease PTSD
*Marijuana Vs. Anti-Depressants for PTSD Marijuana Wins Hands Down
*Could Medical Marijuana Benefit Fort Hood Trauma Victims?

https://i1.wp.com/www.salem-news.com/stimg/february132009/ptsd_orange_340.jpg

By David Bearman, MD

One often intractable problem for which cannabis provides relief is post-traumatic stress disorder (PTSD). I have more than 100 patients with PTSD.
Among those reporting that cannabis alleviates their PTSD symptoms are veterans of the war in Vietnam, the first Gulf War, and the current occupation of Iraq. Similar benefit is reported by victims of family violence, rape and other traumatic events, and children raised in dysfunctional families.

Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder —once referred to as “shell shock” or “battle fatigue” — is a debilitating condition that follows exposure to ongoing emotional trauma or in some instances a single terrifying event. Many of those exposed to such experiences suffer from PTSD. The symptoms of PTSD include persistent frightening thoughts with memories of the ordeal. PTSD patients have frightening nightmares and often feel anger and an emotional isolation.
Sadly, PTSD is a common problem. Each year millions of people around the world are affected by serious emotional trauma. In more than 100 countries there is recurring violence based on ethnicity, culture, religion or political orientation.
Men, women and children suffer from hidden sexual and physical abuse. The trauma of molestation can cause PTSD. So can rape, kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as mugging, torture, or being held captive.
The event that triggers PTSD may be something that threatened the person’s life or jeopardized someone close to him or her. Or it could simply be witnessing acts of violence, such as a mass destruction or massacre. PTSD can affect survivors, witnesses and relief workers.

Symptoms
Whatever the source of the problem, PTSD patients continually relive the traumatic experience in the form of nightmares and disturbing recollections. They are hyper-alert. They may experience sleep problems, depression, feelings of emotional detachment or numbness, and may be be easily aroused or startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, be violent, or be more aggressive than before the traumatic exposure.

Triggers
Seeing things that remind them of the incident(s) may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of a traumatic event are often difficult.
Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. Movies about war or TV footage of the Iraqi war can be triggers. People with PTSD may respond disproportionately to more or less normal stimuli —a car backfiring, a person walking behind them. A flashback may make the person lose touch with reality and re-enact the event for a period of seconds, hours or, very rarely, days. A person having a flashback in the form of images, sounds, smells, or feelings experiences the emotions of the traumatic event. They relive it, in a sense.
Symptoms may be mild or severe — people may become easily irritated or have violent outbursts. In severe cases victims may have trouble working or socializing.

Symptoms can include:
• Problems in affect regulation —for instance persistent depressive symptoms, explosion of suppressed anger and aggression alternating with blockade and loss of sexual potency;
• Disturbance of conscious experience, such as amnesia, dissociation of experience, emotions, and feelings;
• Depersonalization (feeling strange about oneself), rumination;
• Distorted self-perception —for instance, feeling of helplessness, shame, guilt, blaming oneself, self-punishment, stigmatization, and loneliness;
• Alterations in perception of the perpetrator —for instance, adopting distorted beliefs, paradoxical thankfulness, idealization of perpetrator and adoption of his system of values and beliefs;
• Distorted relationship to others, for instance, isolation, retreat, inability to trust, destruction of relations with family members, inability to protect oneself against becoming a victim again;
• Alterations in systems of meaning, for instance, loss of hope, trust and previously sustaining beliefs, feelings of hopelessness;
• Despair, suicidal thoughts and preoccupation;
• Somatization —for instance persistent problems in the digestive system, chronic pain, cardiopulmonary symptoms (shortness of breath, chest pain, dizziness, palpitations).

Cannabis
Ample anecdotal evidence suggests that cannabis enhances ability to cope with PTSD. Many combat veterans suffering from PTSD rely on cannabis to control their anger, nightmares and even violent rage. Recent research sheds light on how cannabis may work in this regard.
Neuronal and molecular mechanisms underlying fearful memories are often studied in animals by using “fear conditioning.” A neutral or conditioned stimulus, which is typically a tone or a light, is paired with an aversive (unconditioned) stimulus, typically a small electric shock to the foot. After the two stimuli are paired a few times, the conditioned stimulus alone evokes the stereotypical features of the fearful response to the unconditioned stimulus, including changes in heart rate and blood pressure and freezing of ongoing movements. Repeated presentation of the conditioned stimulus alone leads to extinction of the fearful response as the animal learns that it need no longer fear a shock from the tone or light.

Fear Extinction
Emotions and memory formation are regulated by the limbic system, which includes the hypothalamus, the hippocampus, the amygdala, and several other structures in the brain that are particularly rich in CB1 receptors.
The amygdala, a small, almond-shaped region lying below the cerebrum, is crucial in acquiring and, possibly, storing the memory of conditioned fear. It is thought that at the cellular and molecular level, learned behavior —including fear— involves neurons in the baso-lateral part of the amygdala, and changes in the strength of their connection with other neurons (“synaptic plasticity”).
CB1 receptors are among the most abundant neuroreceptors in the central nervous system. They are found in high levels in the cerebellum and basal ganglia, as well as the limbic system. The classical behavioral effects of exogenous cannabinoids such as sedation and memory changes have been correlated with the presence of CB1 receptors in the limbic system and striatum.
In 2003 Giovanni Marsicano of the Max Planck Institute of Psychiatry in Munich and his co-workers showed that mice lacking normal CB1 readily learn to fear the shock-related sound, but in contrast to animals with intact CB1, they fail to lose their fear of the sound when it stops being coupled with the shock.
The results indicate that endocan-nabinoids are important in extinguishing the bad feelings and pain triggered by reminders of past experiences. The discoveries raise the possibility that abnormally low levels of cannabinoid receptors or the faulty release of endogenous cannabinoids are involved in post-traumatic stress syndrome, phobias, and certain forms of chronic pain.
This suggestion is supported by our observation that many people smoke marijuana to decrease their anxiety and many veterans use marijuana to decrease their PTSD symptoms. It is also conceivable, though far from proved, that chemical mimics of these natural substances could allow us to put the past behind us when signals that we have learned to associate with certain dangers no longer have meaning in the real world.

What is the Mechanism of Action?
Many medical marijuana users are aware of a signaling system within the body that their doctors learned nothing about in medical school: the endocan-nabinoid system. As Nicoll and Alger wrote in “The Brain’s Own Marijuana” (Scientific American, December 2004):
“ Researchers have exposed an entirely new signaling system in the brain: a way that nerve cells communicate that no one anticipated even 15 years ago. Fully understanding this signaling system could have far-reaching implications. The details appear to hold a key to devising treatments for anxiety, pain, nausea, obesity, brain injury and many other medical problems.”
As a clinician, I find the concept of retrograde signaling extremely useful. It helps me explain to myself and my patients why so many people with PTSD get relief from cannabis.
We are taught in medical school that 70% of the brain is there to turn off the other 30%. Basically our brain is designed to modulate and limit both internal and external sensory input.
The neurotransmitter dopamine is one of the brain’s off switches.The endocannabinoid system is known to play a role in increasing the availability of dopamine. I hypothesize that it does this by freeing up dopamine that has been bound to a transporter, thus leaving dopamine free to act by retrograde inhibition.
By release of dopamine from dopamine transporter, cannabis can decrease the sensory input stimulation to the limbic system and it can decrease the impact of over-stimulation of the amygdala.
I postulate that exposure to the PTSD-inducing trauma causes an increase in production of dopamine transporter. The dopamine transporter ties up much of the free dopamine. With the brain having lower-than-normal free dopamine levels, there are too many neural channels open, the mid-brain is overwhelmed with stimuli and so too is the cerebral cortex. Hard-pressed to react to this stimuli overload in a rational manner, a person responds with anger, rage, sadness and/or fear.
With the use of cannabis or an increase in the natural cannabinoids (anandamide and 2-AG), there is competition with dopamine for binding with the dopamine transporter and the cannabinoids win, making a more normal level of free dopamine available to act as a retrograde inhibitor.
This leads to increased inhibition of neural input and decreased negative stimuli to the midbrain and the cerebral cortex. Since the cerebral cortex is no longer overrun with stimuli from the midbrain, the cerebral cortex can assign a more rational meaning and context to the fearful memories.
I have numerous patients with PTSD who say “marijuana saved my life,” or “marijuana allows me to interact with people,” or “it controls my anger,” or “when I smoke cannabis I almost never have nightmares.” Some say that without marijuana they would kill or maim themselves or others. I have no doubt that cannabis is a uniquely useful treatment. What remains is for the chemists to determine the precise mechanism of action.

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