Post-Traumatic Stress Disorder - by David Bearman, MD
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. PTSD is caused by exposure to an emotionally traumatic experience – rape, kidnap, war, being raised in a dysfunctional family. 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, are hyperalert, easily startled by everyday noises and rapid movement, and often feel anger and an emotional isolation.
In June of 2007 the Pentagon issued a report stating that 30-40% of troops fighting in Iraq will return with PTSD. They lamented the fact that the Army culture discourages admitting PTSD. They pointed out that there were insufficient funds for the Army and/or VA to be adequately staffed to meet the demand for treatment of PTSD. Recently the VA recognized that many veterans gain relief from the symptoms of PTSD by using cannabis. They dropped a rule that patients who tested positive for cannabinoids would be dismissed from VA pain management programs. Clearly the evidence of PTSD is even higher in soldiers injured in the war. This policy change is therefore helpful to supporting our fighting men and women.
Causes of PTSD
- War
- Earthquake
- Kidnapped
- Dysfunctional Family
- Being Molested or Raped
- Accidents
Sadly, PTSD is a common problem. It is not confined just to war. 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. Growing up in a dysfunctional family can cause PTSD. The trauma of molestation can cause PTSD. So, too, 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 mass destruction or massacre. PTSD can affect survivors, witnesses and relief workers.
We have learned that the impact of the endocannabinoid system on dopamine plays an important role in PTSD. The Max Planck Institute in Germany showed that cannabinoids helped decrease fearful memories. Science's increased understanding of the impact of traumatic events on the mind is having a profound effect on our ideas about effective drug abuse treatment and prevention. It further calls into question the logic or wisdom in criminalizing a mental health problem.
In the case of PTSD when flashbacks are triggered, the PTSD afflicted person may respond with anger, rage, sadness and/or fear. But cannabis helps to mitigate these symptoms.
Why do we see this? With the use of cannabis or an increase in the naturally occurring cannabinoid, anandamide (e.g., by using metabolic blocking agents), there is competition with dopamine for binding with the binding sites on the dopamine transporter. Cannabis wins, kicking dopamine out of being bound, thus raising dopamine levels and making a more normal level of free dopamine in the brain available to act as a retrograde inhibitor. This leads to increased inhibition of neural input, (via retrograde inhibition), decreases stimuli to the midbrain and the cerebral cortex. The neural impulses are fewer and traveling slower. In this way the PTSD afflicted individual can more rationally deal with their response to PTSD triggers. There is more opportunity for the cerebral cortex to address these concerns rationally. With a lot of dopamine bound up in retrograde inhibition and the midbrain, the reptilian brain takes charge. It sees things as black and white, life and death. The PTSD sufferer is then left with raw emotions emanating from the memory of the traumatic event.
In 2006, Dr. George Lundberg, an editor of MedGenMed, editorially argued for the reclassification of cannabis in the USA. That would legally allow its medical use and, as the AMA argued in a 2009 resolution, allow for research to be done without being hamstrung by cannabis’ schedule I status.
Lundberg wrote, “…marijuana is much less dangerous than many other substances in less restrictive schedules, like morphine and cocaine, not to mention the unscheduled legal mass killers tobacco and alcohol. Of course, marijuana does have proven medical usefulness for some conditions. People obey laws they believe to be just; they do not obey the marijuana laws because they know they are unjust, even absurd.”
former JAMA editor, Dr. George Lundberg, Adjunct Professor of Health Policy, Harvard School of Public Health, Boston
It is reassuring to see that the VA recognizes that there is a sound enough scientific basis to accommodate veterans who find relief for PTSD and pain that they are no longer to be ostracized by the VA. So now they join the DEA 1988 Decision by DEA ALJ Francis Young. The FDA approved a phase III clinical trial for tincture of cannabis and Health and Human Services Department has a patent on CBD in recognizing the medicinal value of cannabis and cannabinoids. When is the federal government going to recognize states' rights and science and allow the appropriate use of cannabis medicine?
Who's Who in Medical Cannabis - Dale Gieringer, Ph.D - by c.a. riley
About his time at Harvard in the late 60s, Dale Gieringer declares, “I was not one of the ’60s radicals. I was pretty libertarian and sort of Republican-leaning. [I was] definitely in the political minority.”
Gieringer continues, “I arrived at an interesting time at Harvard. I didn’t even know what marijuana was as a freshman. It was dangerous, something that disreputable people used. There was no discussion of drugs at Harvard back then.” Since those times, much about Dr Dale Gieringer has changed with the times.
Dr Gieringer concentrated his studies on math and eventually moved to California, where at Stanford in 1984 he earned a PhD in economics and public policy, writing his doctorate on the topic of DEA drug regulation. Gieringer, however, considers his year as a congressional intern in Washington in the mid-70s to be his “real education.” He says that his decades of medical cannabis advocacy would never have happened had it not been for that year on Capitol Hill.
Today, as state coordinator of California NORML (since 1987), Vice-Chairman of the national NORML board of directors, a co-founder of the California Drug Policy Reform Coalition and of Californians for Compassionate Use, he is one of this nation’s leading advocates for relegalizing marijuana—certainly not usually considered an issue with which a conservative such as Gieringer would align himself.
Under Gieringer’s direction, California NORML has become a model for the medical cannabis campaign across the nation, and for its crusade to re-legalize the plant for recreational purposes as well.
Dr Gieringer has distinguished himself in innumerable ways as a courageous leader in the quest for safe medicine and sensible drug policy. A full list of his accomplishments in the decades since his early days in Washington is far too lengthy to post in its entirety here, but a few more highlights from his long career in drug policy activism are given below, in no particular order:
- Published research on drug screening; marijuana smoke harm reduction; marijuana and safe driving; medical cannabis use; cannabis potency testing
- Presented testimony before the California legislature and in court actions on issues related to personal use of marijuana
- Published book on the economic benefits of legalizing cannabis (1994)
- Helped organize and co-write Proposition 215, which voters passed, legalizing medical cannabis in California (1996)
- Advocated for Oakland’s “Measure Z,” an Oakland local tax and regulation initiative which led to discussion on general legalization of marijuana and prompted Assemblyman Tom Ammiano to introduce the first legalization bill, Assembly Bill 390. Gieringer was gratified to see language from his 1994 book on the economic benefits of legalization in the legislation. (2004)
- Gieringer was involved in California NORML’s groundbreaking study on alternative methods of delivering medical cannabis to patients. Gieringer concluded that “Water pipes and vaporizers are now the gold standard for medical marijuana.”
Dr Dale Gieringer has definitely “put his money where his mouth is” (played a huge role) in drug policy reform and we cannot thank him enough for his brilliant work.
High Times magazine has tried to, with its award of “Freedom Fighter of the Year” title to Dr Gieringer in November, 2010 at its annual Cannabis Cup celebration. Of the honor Gieringer says, “It was a big year for marijuana. I usually spend Thanksgiving with my family. But I made an exception for this.”
Gieringer goes on to predict a further uphill battle for cannabis legalization, “Prop. 19 most likely won’t pass quite yet. Federal law has tried to pre-empt states on this, so it really has to be done on a national basis. I said I’d be happy to retire when marijuana is legal in California. But I’m going to be 65 in April, so I’ll have to take a late retirement.”
What's New
Alabama: Considering a medical marijuana law.
HB642 - The Michael Phillips Compassionate Care Act of Alabama
Arkansas: Considering a medical marijuana law.
Connecticut: Considering a medical marijuana law.
Florida: Medical marijuana petition drive underway.
Idaho: Considering a medical marijuana law.
Illinois: Considering a medical marijuana law.
Bill Status of SB1381
Indiana: Considering a medical marijuana law.
Iowa: Considering a medical marijuana law.
Kansas: Medical marijuana petition drive underway.
Marijuana Bill Reaches House
Cannabis Compassion and Care Act
Maryland: Considering a medical marijuana law.
Bill Status of SB 627
Massachusetts: Considering a medical marijuana law.
Minnesota: Considering a medical marijuana law.
Missouri: Considering a medical marijuana law.
HOUSE BILL NO. 1670 - An Act relating to the use of marijuana for medicinal purposes
Cottleville Mayor Don Yarber hopes Missouri legislature passes medical marijuana law
New Hampshire: Considering a medical marijuana law.
New York: Considering a medical marijuana law.
North Carolina: Considering a medical marijuana law.
North Carolina Medical Cannabis Act
Ohio: Considering a medical marijuana law.
HB 214
Pennsylvania: Considering a medical marijuana law.
HB 1393
South Carolina: Considering a medical marijuana law.
South Dakota: Medical marijuana petition drive underway.
Tennessee: Considering a medical marijuana law.
Texas: Considering a medical marijuana law.
Wisconsin: Considering a medical marijuana law.
The Jacki Rickert Medical Marijuana Act
Featured Recipe - Mac Attack: A Canny Bus Treat by Jay R. Cavanaugh, Ph.D.
Everyone loves macaroni and cheese. Nancy Wife and I sure do. Before we even start you better know that this recipe is a heart attack on a plate. I tried to measure the grams of saturated fat and just lost track. What's really different about our Canny version is that using Better Bud Butter actually lowers the saturated fat quite a bit but not nearly enough to call this healthy.
Please don't even try to follow this recipe too closely. Improvise. If you don't like white cheddar use yellow. If you don't like sharp cheese use Longhorn or mild. Heck you can even use a good Swiss cheese like Jarlsberg. It's OK. You won't go to jail for substitutions. Of course the cannabutter does make this overall recipe a Federal felony. Can you imagine getting 10 years in Leavenworth Prison for felony Mac? Yikes.
Once you've made your own home baked Mac you'll never do store bought again. The key to this recipe is using the freshest ingredients you have that meet your particular taste. If you're a vegetarian you'll love this recipe even without the ham (some vegetarians can consume dairy). If you'd prefer to use bacon or even ground beef instead of ham, go for it! You want it spicier? Kick it up with diced fresh chilies. This recipe comes with three guarantees:
- You'll love it
- You'll gain weight (lots of us patients need that J)
- You'll probably require anti-cholesterol meds if you eat this too often
Ingredients:
8 tablespoons of Better Bud Butter
4 tablespoons of flour
2 cups of regular milk
1 cup of heavy cream
8 ounces of aged cheddar cheese grated (white or yellow)
12 oz of good macaroni noodles (you can use penne if you're snobby)
1 teaspoon salt
1 tablespoon cracked black pepper - to taste
1 tablespoon Jay's Essence or cayenne pepper - to taste
8 oz of fined diced smoked ham (real Black Forest if you can find it)
Optional: 2 medium sized Jalapeno chilies finely diced
Optional: ½ cup finely diced Maui onions
Optional: 1/3 cup of fresh bread crumbs
Directions:
Cook the pasta of your choice in lightly salted boiling water. We use fresh pasta so 4 minutes is more than enough. If you use dry try 8 minutes. The key is Al Dente (that means "to the teeth"). Actually, I went to school with Al and have never forgotten him. A handy trick is to add a cap full of olive oil to the water to prevent sticking. Cook the pasta then drain and set aside.
Slowly melt the Better Bud Butter over a low heat. Gradually work in the flour with LOTS of stirring (yes you're making a rue). Whisk in the milk and bring to a slow boil then turn off the heat. Add the spices and mix in the finely grated cheese (yes, you're now making a Béchamel sauce). As the cheese melts (it will be very thick) slowly add just enough cream for the texture you like. Mix in the diced smoked ham and chilies and/or onions if you like.
Pour all of the ingredients into a large greased (we use Pam) baking dish and sprinkle with bread crumbs if you like (we leave them out for reasons explained below).
Bake in a preheated 350 degree oven for about 20-35 minutes or until brown and bubbly.
Hint Number One: Let the dish sit out for at least ten minutes before you try to plate it. This stuff is hot, hot, and hot.
Hint Number Two: Mac Attack Two (otherwise known as Maximum Mac)
Assuming you and your friends don't finish the entire casserole on the first evening, cover the leftovers and place in the refrigerator for 24 hours. The next night cut out rectangles of Mac Attack and dust with flour, roll in an egg wash, roll in fresh crumbs, and yes, oh my God, deep fry at 350 degrees. Yum! This dish is not for cardiac amateurs. Keep your nitro handy.
Recommended beverage: Any good Oregon Pinot Noir lightly chilled
Caution: Do not operate heavy machinery or attempt surgery after eating. Don't drive after two helpings.
