Many people who suffer with ADD and/or ADHD find that medical cannabis improves their ability to focus and their level of performance with certain tasks.  Unfortunately clinical studies in humans are lacking, but there is a case report from Heidelberg University Medical Center in Germany that concluded, "There was evidence that the consumption of cannabis had a positive impact on performance, behavior and mental state of the subject".  Also, there are some preliminary studies in laboratory animals that point to less hyperactivity and impulsivity with the use of cannabinoids (the active medicines in cannabis).  
Currently the thought is that there is a deficiency of dopamine in the brains of ADD and ADHD sufferers. Stimulants, often a treatment for ADD and ADHD, block the reuptake of dopamine and can also facilitate their release, compensating for the deficiency seen in ADHD.  Cannabis also increases the availability of dopamine in the brain, although it is thought that this is through a different type of reaction than that of stimulants. 
Some ADD and ADHD patients who find good results with prescribed stimulant medications choose to stay on these medications as they cannot use cannabis during the day, however they often find that the common side effects of poor appetite and insomnia from the stimulants are counteracted by cannabis use in the evening.  These patients report that the combination of stimulant medication during the day and cannabis use at night allows for better daytime function with minimal adverse side effects. Other patients with ADD and ADHD find that they are unable to take stimulant medications due to ineffectiveness or unacceptable side effects and they find much better focus, concentration, relaxation and improved function with cannabis medicine. 
Adriani et al.  The Spontaneously Hypertensive-rat as an Animal Model of ADHD: Evidence for Impulsive and Non-impulsive Subpopulations.  Neuroscience Biobehavioral Review 2003; 27:639-51

Strohbeck-Kuehner et al. Cannabis improves symptoms of ADHD.  Cannabinoids 2008; 3(1):1-3

Viggiano et al. Prenatal Elevation of Endocannabinoids Corrects the Unbalance between Dopamine Systems and Reduces Activity in Naples High Excitability Rats.  Neuroscience and Behavioral Review 2003; 27:129-39
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Cannabis has been used to treat anxiety and depression for thousands of years.  A recent survey of patients seeking care in medical marijuana doctors' offices in California reported that 38% (51% female and 33% male) of the patients found relief of anxiety and 26% (35% female and 23% male) found relief of depression. 

The cannabinoids, a group of compounds in marijuana that are known to be medicinal, have been found to have anxiolytic and antidepressant properties.   Oddly, these compounds can also cause paranoia, anxiety and depressive episodes.  Although there are many variables that can account for this paradox, three things stand out.  The first variable that may affect what type of response an individual patient may have to marijuana depends on the levels of THC and cannabidiol (CBD) in the cannabis plant that is used – this is called the potency and cannabinoid profile of the plant.  The second variable is the dose that the patient takes – how much marijuana was inhaled or ingested; and the third, the patient’s genetic makeup – something that is difficult to assess,  but may affect a patient’s anxiety response.  THC, the most prominent medicinal compound in marijuana, is known to cause an anxiety reaction in high doses in some patients.  CBD, the second most common compound in marijuana, appears to ease anxiety even if taken in high doses.
Some studies have been done, both in animals and in humans, to look at how marijuana might affect anxiety and depression.  One study reported that mice that are missing the receptor for the cannabinoids in marijuana had depression-like responses to stress.    Another similar study reported that mice with damaged receptors for marijuana had abnormal responses to stress and altered sensitivity to antidepressant medication.   Another study looked at the natural chemical similar to the compounds in marijuana, called anandamide, which animals and humans make in response to stress.  When anandamide was not allowed to break down (meaning it stayed in the system longer), it acted like an anxiety reliever and antidepressant.  

In human studies, the marijuana compound CBD was compared to a placebo and two anti-anxiety medicines for treatment of social anxiety.  CBD was found to be as effective as the two known anti-anxiety medicines and was significantly more effective than the placebo.   In a similar study, patients with social anxiety who received CBD had less body symptoms of anxiety and less negativity about public speaking than those who received a placebo.  Also a synthetic cannabinoid (a marijuana-like compound made in a laboratory) was found to reduce anxiety in patients suffering from anxiety disorders after a month of treatment.

In human studies of the brain, it was found that CBD increased blood flow to the areas of the brain that are known to control anxiety. 
Nunberg, H., et al. An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California.  Journal of Drug Policy Analysis (2011) 4 

Zuardi, A., et al. Action of cannabidiol on the anxiety and other effects produced by Δ9-THC in normal subjects. Psychopharmacology (1982) 76: 245-50

Martin, M., et al.  Involvement of CB1 cannabinoid receptors in emotional behaviour.  Psychopharmacology (2002) 159: 379-87 

Steiner, M., et al.  Impaired cannabinoid receptor type 1 signaling interferes with stress-coping behavior in mice.  Pharmacogenomics Journal (2008) 8: 196-208 

Fride, E., et al. Differential response to acute and repeated stress in cannabinoid CB1 receptor knockout newborn and adult mice.  Behavioral Pharmacology (2005) 16: 431-40

Gobbi, G., et al.  Antidepressant-like activity and modulation of brain monoaminergic transmission by blockade of anandamide hydrolysis.  Proceedings of the National Academy of Science of the United States of America (2005) 102: 18620-18625

Zuardi, A., et al. Effects of ipsapirone and cannabidiol on human experimental anxiety.  Journal of Psychopharmacology (1993) 7: 82-8

Bergamaschi, M., et al. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients. Neuropsychopharmacology (2011) 36: 1219-26 

Crippa, J., et al. Effects of cannabidiol (CBD) on regional blood flow. Neuropsychopharmacology (2004) 29: 417-26

Fusar-Poli, P., et al. Distinct effects of delta-9-tetrahydrocannabinol and cannabidiol on neural activation during emotional processing.  Archives of General Psychiatry (2009) 66: 95-105 

Fusar-Poli, P., et al. Modulation of effective connectivity during emotional processing by delta-9-tetrahydrocannabinol and cannabidiol.  International Journal of Neuropsychopharmacology (2009) 24: 1-12
Crippa, J., et al.  The effect of cannabidiol (CBD), a cannabis sativa constituent, on neural correlates of anxiety: a regional cerebral blood flow study.  Schizophrenia Bulletin; 12th International Congress on Schizophrenia Research; San Diego, (2009) 35: 197-198

Fabre, L., et al. The efficacy and safety of nabilone (a synthetic cannabinoid) in the treatment of anxiety.  British Journal of Psychiatry (2001) 178: 107-115

Ilaria, R., et al. Nabilone, a cannabinol derivative, in the treatment of anxiety neurosis. Current Therapeutic Research (1981) 29: 943-9
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Arthritis is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. There are over 100 different types of arthritis, the two most common being osteoarthritis and rheumatoid arthritis. Over 46 million Americans suffer with arthritis.
Osteoarthritis is arthritis that develops from wear and tear. Rheumatoid arthritis is the result of inflammation that happens when the body's immune system does not work properly.
Osteoarthritis is also called degenerative joint disease or degenerative arthritis. It results from overuse of joints and can come from sports injuries, obesity, or aging. It can strike early in life, especially in athletes or persons with significant trauma to a joint. Osteoarthritis is most common in joints that bear weight, such as the knees, hips, feet, and spine.
With osteoarthritis, the cartilage in the joint gradually breaks down. Cartilage acts as a shock absorber and as it disappears, the bones in the joint begin to rub together, causing pain. The joint lining can become inflamed adding to the pain.
Rheumatoid Arthritis is the most common form of inflammatory arthritis. About 1.5 million Americans have RA and 75% of those are women. This disease is due to a problem with the immune system. A normal immune system only attacks foreign invaders into our bodies, such as bacteria or viruses. In RA, the immune system attacks the bodies' own joints and destroys them. This is a very painful and debilitating illness.

Other causes of arthritis include gout, lupus, and psoriasis.
There are a number of different conventional treatments for arthritis and of course, the treatment depends on the type of arthritis that you may have. Some of these treatments, despite being helpful, have serious and potentially dangerous side effects that make long-term treatment difficult.

The documented use of marijuana to treat arthritis dates back to the 1700s, as cannabis was known at that time to be a very effective painkiller.

Scientific research supports the claims that marijuana is helpful for different forms of arthritis. There are a number of studies that show that cannabis has a beneficial effect on inflammation and also on the immune system. For many years researchers have been prohibited from studying cannabis due to its illegality and classification as a Schedule I controlled substance. But in the past 15 – 20 years, much research has been done and the results are promising.

The cannabis plant has over 400 hundred natural chemical compounds and of those, about 70 are called "cannabinoids". THC is the most prominent cannabinoid and it has been found to be anti-inflammatory and pain relieving. Another prominent compound, called cannabidiol (CBD), gets metabolized by the body and changes into a potent anti-inflammatory similar to the drug indomethacin, but without the significant stomach upset associated with that drug.

One study from 2006 reports that administration of cannabis extracts to patients with rheumatoid arthritis produced statistically significant improvements with reduction of pain on movement, pain at rest, better quality of sleep, and less inflammation when compared to placebo. No serious adverse side effects were observed with the use of the marijuana.

Other research in humans has also showed that many patients are able to reduce their usage of non-steroidal anti-inflammatory drugs (NSAIDS) when using cannabis. NSAIDS, such as ibuprofen and naproxen, have significant side effects, such as stomach upset, heartburn, ulcers, and increased risk of stroke, heart attack and cardiovascular death.

Lab and animal studies indicate that the natural medicines in cannabis (the cannabinoids) can block the progression of rheumatoid arthritis. In one study, a synthetic cannabinoid (one that is created in a lab) was shown to protect joints from damage and improve arthritis. Also research from Japan and in Romania both report that cannabinoids modulate the immune system, that is, cannabis actually calms the attacking immune system and can be beneficial for treatment of inflammatory disease.

The anecdotal evidence from arthritis patients is overwhelmingly positive in that medical marijuana improves symptoms and quality of life with little to no adverse side effects. Patients report less pain, better mobility and improved sleep with cannabis. Many medical cannabis patients are choosing alternative methods of using cannabis so as not to smoke it, as the by-products of the burning plant are unhealthy for your lungs. Vaporizers - medical devices that turn the medicinal compounds in cannabis to a vapor with heat, thus avoiding the smoke – are a healthier way to take cannabis, as are edibles and liquid tinctures. Some arthritis sufferers also find that topical preparations of cannabis, made into a balm, salve, or alcohol-based liquid that is massaged into the area of arthritis, alleviates the pain and allows a patient to avoid the psychoactive "high” effects of the cannabis.

If you are interested in learning more, call 1-855-411-4420 for an appointment and we will be happy to help you decide if cannabis may be helpful in your situation.

Blake et al. 2006. Preliminary assessment of the efficacy, tolerability and safety of a cannabis medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology 45: 50-52

Malfait et al. 2000. The non-psychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induces arthritis. Journal of the Proceedings of the National Academy of Sciences  97: 9561-9566

Sumariwalla et al. 2004. A novel synthetic non-psychoactive cannabinoid (HU-320) with anti-inflammatory properties in murine collagen-induced arthritis. Arthritis & Rheumatism 50: 985-998

Tanasescu et al. 2010. Cannabinoids and the immune system: an overview. Immunobiology Epub (8):588-97

Croxford et al. 2005. Cannabinoids and the immune system: potential for the treatment of inflammatory diseases? Journal of Neuroimmunology (166) 3-18
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By far the two most common symptoms experienced by cancer patients undergoing chemotherapy and radiation treatment are profound nausea and vomiting.  The next most common difficulty for these patients is pain. These symptoms can lead to dramatic weight loss, fatigue, insomnia and for many patients, anxiety and depression.  Patients with these symptoms have poor quality of life and are looking for some relief without adding more negative side effects. 

There are a number of conventional medications available for the treatment of nausea and vomiting. There are problems with these medications, such as the inability to swallow the pill due to nausea or inability to keep down a pill down due to vomiting. Also the high costs of these medications make using them difficult. And, for some patients, these medications just don’t work.  

In the 1970s and 1980s, several states, including California, New York, New Mexico and Michigan to name a few, researched the use of natural cannabis to combat nausea and vomiting in cancer patients.  In these studies, natural cannabis was found to be effective for both symptoms and was equal to or better than the conventional medications available at that time.  In 1988, a study found that out of 56 cancer patients who did not get relief from standard anti-vomiting medications, 78% were symptom-free after use of cannabis.  Currently there are a number of new medications that are very effective for nausea and vomiting but there are still some patients who do not respond to them or who cannot tolerate or afford them.  For these patients, medical cannabis is a viable alternative. 

Many studies have been done using Marinol (dronabinol), which is a synthetic THC pill that is approved by the FDA to treat nausea and vomiting from chemotherapy.  Marinol is well known to be inferior to inhaled natural cannabis for a number of reasons.  First, Marinol contains only THC; it lacks all of the other therapeutic natural medicines, called cannabinoids, which exist in the cannabis plant.  There are about 70 cannabinoids and a number of them have been shown to bolster the effects of THC, meaning one gets a better response when taken together.   Also Marinol has more psychoactivity than natural cannabis, making some patients feel too "high”.  This is because the cannabinoids help balance out the high in the natural form but this balance is missing in the synthetic form.  Another reason that Marinol is inferior is because it must be taken orally and this can be quite difficult if nausea and vomiting are present.   Also oral administration has a delayed onset and the question of how much actually is absorbed comes into question. Only 5-20% of Marinol is absorbed and because it is metabolized slowly, its therapeutic and psychoactive effects can be very unpredictable.  When one inhales natural cannabis, the effects are felt almost immediately and the nausea stops quickly. One can easily regulate the dose and re-dose if needed.   Lastly, Marinol is expensive – it costs about $200-$800 per month depending on the dose. 

It appears from years of research that cannabis works well as a painkiller without the unwanted side effects of conventional painkillers. For those with severe pain in advanced cancer, cannabis works synergistically in combination with the opioid painkillers to decrease pain without the dangerous side effects of using higher doses of opioids that can cause more nausea, lessen appetite, and can potentially be lethal if too much is used.   It is reported that 25% - 40% of cancer patients suffer with neuropathic pain, which is pain that comes from damaged nerves. This type of pain is notoriously resistant to treatment with conventional medications including opioids.  There are numerous studies that show that cannabis is particularly effective for this type of pain, with minimal side effects. 

Cannabis has also been found to have some anti-tumor effects. The first mention of the anti-tumor properties of cannabis were documented in 1975 when a study showed that three compounds found in the cannabis plant, including THC, retarded the growth of lung cancer cells.  Since then, a number of studies have looked at the anti-cancer effects of the cannabinoids. One particular type of aggressive brain tumor, called a glioma, appears to stop growing and even regress in the presence of cannabinoids. This finding was reproduced in multiple studies in the lab and in animals.  It has also been noted that THC selectively targeted malignant cells and ignored the healthy cells.  In 2006, researchers did the first ever pilot study in humans looking at using THC to shrink recurrent brain tumors.  It showed some decrease in tumor growth in some of the patients.   In March of 2011, investigators at the British Columbia Children’s Hospital in Vancouver reported the regression (shrinking) of brain tumors in two teenagers who were regularly inhaling cannabis and were not receiving any other conventional treatment.  

Additionally there is active research looking into cannabidiol, a prominent cannabinoid in the natural plant, as a potential treatment for aggressive breast cancer.  Researchers at California Pacific Medical Center Research Institute in San Francisco found that cannabidiol (CBD) inhibits a gene that is believed to be responsible for the metastatic process that spreads cells from the original cancer tumor throughout the body.  Additionally, separate research studies have shown that the cannabinoids inhibit the growth and spread of various cancer cell lines including breast carcinoma, prostate carcinoma, colorectal carcinoma, gastric adenocarcinoma, skin carcinoma, leukemia cells, neuroblastoma, lung carcinoma and others. 

The National Cancer Institute recently posted research on cannabinoids and cannabis on its website. This is progress as the National Cancer Institute is a federal agency and cannabis is still considered by the federal government to be a substance with no medicinal value.  The fact that they are posting study results on their website is a sign that the research is sound and the results undeniable.  They report, "The potential benefits of medicinal cannabis for people living with cancer include antiemetic effects, appetite stimulation, pain relief, and improved sleep. In the practice of integrative oncology, the health care provider may recommend medicinal cannabis not only for symptom management but also for its possible direct anti-tumor effect".  The website also states: "Cannabinoids have a favorable drug safety profile. Unlike opioid receptors, cannabinoid receptors are not located in the brainstem areas controlling respiration; therefore, lethal overdoses due to respiratory suppression do not occur. Although cannabinoids are considered by some to be addictive drugs, their addictive potential is considerably lower than that of other prescribed agents or substances of abuse."  

Of course more research is needed, however, considering the safety profile of cannabis and the promising studies that already have shown remarkable results, most physicians agree that cannabis use by cancer patients is helpful and certainly improves quality of life.
If you or a loved one is suffering with the symptoms caused by cancer and its treatment, medical marijuana may be able to help improve quality of life.  Medical marijuana can be taken by vaporizer, tinctures, and edibles so as to avoid smoking. Many patients find tremendous benefit with better sleep, better appetite, relief of anxiety and stress, elimination of nausea and vomiting and less pain. 
Vinciguerra et al. Inhalation marihuana as an antiemetic for cancer chemotherapy. New York State Journal of Medicine 1988;88:525-527  

Abrams DI, Jay CA, Shade SB, et al.: Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68 (7): 515-21, 2007

British Medical Association (1997). Therapeutic Uses of Cannabis. Harwood Academic Pub.
Munson et al. 1975. Antineoplastic activity of cannabinoids. Journal of the National Cancer Institute Sept 55 (3): 597-602

Sarafaraz et al. 2008. Cannabinoids for cancer treatment: progress and promise. Cancer Research 68: 339-342

Guzman, 2003. Cannabinoids: potential anticancer agents. Nature Reviews Cancer. 3(10): 745-55

Massi et al. 2004. Antitumor effects of cannabindiol, a non-psychotropic cannabinoid, on human glioma cell lines. Journal of Pharmacology and Experimental Therapeutics Fast Forward 308: 838-845

Cafferal et al. 2006. Delta-9-Tetrahydrocannabinol inhibits cell cycle progression in human breast cancer cells through Cdc2 regulation. Cancer Research 66: 6615-6621

Di Marzo et al. 2006. Anti-tumor activity of plant cannabinoids with emphasis on the effect of cannabidiol on human breast carcinoma. Journal of Pharmacology and Experimental Therapeutics Fast Forward 318: 1375-1387

De Petrocellis et al. 1998. The endogenous cannabinoid anandamide inhibits human breast cancer cell proliferation. Proceedings of the National Academy of Sciences of the United States of America 95: 8375-8380

McAllister et al. 2007. Cannabidiol as a novel inhibitor of Id-1 gene expression in aggressive breast cancer cells. Molecular Cancer Therapeutics 6: 2921-2927

Cafferal et al. 2010. Cannabinoids reduce ErbB2-driven breast cancer progression through Akt inhibition. Molecular Cancer 9: 196

Sarfaraz et al. 2005. Cannabinoids receptors as a novel target for the treatment of prostate cancer. Cancer Research 65: 1635-1641

Mimeault et al. 2003. Anti-proliferative and apoptotic effects of anandamide in human prostatic cancer cell lines.  Prostate 56: 1-12

Ruiz et al. 1999. Delta-9-tetrahydrocannabinol induces apoptosis in human prostate PC-3 cells via a receptor-independent mechanism. FEBS Letters 458: 400-404

Pastos et al. 2005. The endogenous cannabinoid, anandamide, induces cell death in coloretal carcinoma cells: a possible role for cyclooxygenase-2. Gut 54: 1741-1750

Casanova et al 2003. Inhibition of skin tumor growth and angiogenesis in vivo by activation of cannabinoid receptors.  Journal of Clinical Investigation 111: 43-50

Powles et al. 2005. Cannabis-induced cytotoxicity in leukemic cell lines. Blood 105: 1214-1221

Jia et al 2006.  Delta-9-tetrahydrocannabinol-induced apoptosis in Jurkat leukemic T-cells in regulated by translocation of Bad to mitochondria. Molecular Cancer Research 4: 549-562

Manuel Guzman. 2003. Cannabinoids: potential anticancer agents. Nature Reviews Cancer 3: 745-755

Preet et al. 2008. Delta-9-tetrahydrocannabinol inhibits epithelial growth factor-induced lung cancer cell migration in vitro as well as its growth and metastasis in vivo. Oncogene 10: 339-346

Baek et al. 1998. Antitumor activity of cannabigerol against human oral epitheloid carcinoma cells. Archives of Pharmacal Research: 21: 353-356

Carracedo et al. 2006. Cannabinoids induce apoptosis of pancreatic tumor cells via endoplasmic reticulum stress-related genes. Cancer Research 66: 6748-6755

Michalski et al. 2008. Cannabinoids in pancreatic cancer: correlation with survival and pain. International Journal of Cancer 122 (4): 742-750 

Ramer and Hinz. 2008. Inhibition of cancer cell invasion by cannabinoids via increased cell expression of tissue inhibitor of matrix metaloproteinases-1.  Journal of the National Cancer Institute 100: 59-69

Whyte et al. 2010. Cannabinoids inhibit cellular respiration of human oral cancer cells. Pharmacology 85: 328-335

Leelawat et al. 2010. The dual effects of delta (9)-tetrahydrocannabinol on cholangiocarcinoma cells: anti-invasion activity at low concentration and apoptosis inductin at high concentration. Cancer Investigation 28: 357-363

Gustafsson et al. 2006. Cannabinoid receptor-mediated apoptosis induced by R(+)-methanandamide and Win55,212 is associated with ceramide accumulation and p38 activation in mantle cell lymphoma. Molecular Pharmacology 70: 1612-1620

Gustafsson et al. 2008. Expression of cannabinoid receptors type 1 and type 2 in non-Hodgkins lymphoma: Growth inhibition by receptor activation.  International Journal of Cancer 123: 1025-1033
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Chronic Pain

A recent report published by the Institute of Medicine stated that over 116 million Americans are currently living with chronic pain and that most patients are undertreated.  What is chronic pain? The term "chronic" usually refers to pain that has lasted three to six months.  Some doctors define chronic pain as "pain that extends beyond the expected period of healing".   

Chronic pain is divided into 2 categories: 

(1) Nociceptive pain - pain coming from superficial areas like skin,  deep areas like ligaments, muscles, tendons, bones and blood vessels, and injury or damage to organs; this pain is often described as dull and achy; and 
(2) Neuropathic pain - pain coming from nerve damage in the brain, spinal cord, or nerves going out the extremities; this type of pain is often described as burning, tingling, or stabbing; it is well known that this type of pain is difficult to treat 

Chronic pain is associated with higher rates of depression, anxiety, sleep disturbance and decreased physical activity.  Many chronic pain sufferers are treated with conventional pain medications that have significant side effects, such as stomach upset, bleeding in the gut, nausea, constipation, decreased appetite, drowsiness, and addiction.  And so many people report that they do not get adequate relief with these medications.  Some find that the treatment with all of its negative side effects is almost as bad as the pain and they become more anxious and depressed from their poor quality of life.

Marijuana (also known as cannabis) has been used to treat pain since the first century AD.  After it was made illegal in 1941, many new synthetic drugs were developed to treat pain but they all have problematic side effects.  In the 1960's, the use of recreational cannabis was popular and those with pain conditions found that although their intent was recreational, the effects were medicinal.  The "medical marijuana" movement began.

There are FDA-approved scientific studies that show that inhaled cannabis can significantly alleviate neuropathic pain.  One study showed that smoking cannabis reduced nerve pain in HIV patients by more than 30% when compared to placebo.  Another study looked at healthy volunteers who were given injections that caused pain. The volunteers that were given medium dosages of cannabis had significantly reduced pain.  A third study reported that inhaled cannabis reduced neuropathic pain from different diseases in patients who were unresponsive to standard pain therapies.  Most recently, a study from McGill University found that smoked cannabis significantly reduced pain, improved quality of sleep and lessened anxiety in patients who had pain that failed to respond to conventional therapies.  

There are over 400 compounds in the cannabis plant and 70 of these fall into the category of "cannabinoids".  Researchers had isolated some of these compounds and tested them for their pain-killing properties.  These studies showed that giving someone just one cannabinoid compound gave only limited relief of pain compared to the administration of all the cannabinoids together, just as they occur in nature.  There are some available prescription synthetic cannabinoids (like Marinol) but they rarely work as well as nature's plant. 

We see chronic pain patients who are suffering every day between the pain and the side effects of their medicines.  Many patients report that they can stop or reduce their use of opiates, NSAIDS, and muscle relaxers, and they consistently report that they get significant relief of pain and much better sleep.  And they also report that they have better relationships at home and at work because they are not irritable from the pain.  

If you are suffering with chronic pain and all of the symptoms that it causes, make an appointment to see if medical cannabis might be helpful in improving your quality of life.  Using healthy delivery methods (such as vaporizers, sublingual preparations and edibles) in medicinal doses allows for little to no side effects. Don't lose another day to pain when the medicinal use of cannabis in many cases works well for those who suffer with chronic pain.
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Fibromyalgia is a syndrome in which people suffer with chronic pain, usually widespread body pain with multiple tender points in joints, muscles, tendons and other areas of the body.  Fibromyalgia sufferers also have fatigue, sleep problems, depression, anxiety, and headaches.  It is unknown why fibromyalgia occurs, although some causes or triggers are thought to be physical or emotional trauma, abnormal pain response, sleep disturbances, or viral infections.  Fibromyalgia is more common in women aged 20 – 50 years of age, but can occur in either sex at any age. It appears that there are 4-6 million Americans diagnosed with fibromyalgia. 

Conventional treatment of fibromyalgia includes pain relief and therapy to learn to cope with the symptoms.  There are three medications specifically approved for the treatment of fibromyalgia but many patients are unhappy with the adverse side effects (which can include weight gain, nausea, insomnia, sweating, difficulty weaning off the medication, dizziness, headaches, and constipation). 

Many fibromyalgia patients report that they are self-medicating with cannabis. Cannabis has been used for thousands of years to treat pain conditions and recent research has shown that cannabis is an effective painkiller.  In one study in 2006, fibromyalgia patients received daily doses of THC as the only pain reliever over a period of three months; all reported significant reduction in daily-recorded pain and electronically induced pain.  Another study reported that the administration of a synthetic cannabinoid significantly decrease pain in 40 fibromyalgia patients in a randomized, double-blind, placebo-controlled trial.  A recent study (2011) from Spain reported that fibromyalgia patients who used cannabis had a statistically significant reduction in pain and stiffness, enhancement of relaxation, and improved sleep with an increased feeling of well being.  

Dr. Ethan Russo, a neurologist who has studied the cannabinoids (the natural medicines in marijuana) for many years, reported that cannabinoids have demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, IBS and related disorders.  He suggested that patients suffering with these conditions may have an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines.  This concept is currently being investigated in laboratories all over the world. 

If you are suffering with the debilitating symptoms of fibromyalgia, we are here to help you!  Call 1-855-411-4420 and discover what other patients have found.  Medical marijuana is a real option with sound scientific evidence that quality of life can be improved with its use.   
Fiz J, Durán M, Capellà D, Carbonell J, Farré M. Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life. PLoS One 2011;6(4):e18440

Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2-18

Ware et al. 2005. The medicinal use of cannabis in the UK: results of a nationwide survey. International Journal of Clinical Practice 59: 291-295

Schley et al. 2006. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induces pain, axon reflex flare, and pain relief. Current Medical Research and Opinion 22: 1269-1276

Skrabek et al. 2008. Nabilone for the treatment of pain in fibromyalgia. The Journal of Pain 9: 164-173

Ware et al. 2010. The effects of a nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesthesia and Analgesia 110: 604-610

Ethan Russo. 2004. Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in mograin, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinology Letters 25: 31-39
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Despite tremendous achievements in the development of medications to treat HIV and AIDS, these patients still suffer with nausea, poor appetite and pain.  Studies have shown that about 23%-44% of HIV/AIDs patients worldwide use marijuana to treat their symptoms, namely nausea, vomiting, poor appetite, nerve pain, anxiety and depression. T

The most common pain conditions for these patients are peripheral neuropathy, herpes sumplex, herpes zoster, back pain, arthritis and headaches.  It is reported that 30%-50% of people with HIV/AIDs suffer with nerve pain, which is often resistant to conventional pain medications. 

There have been a number of scientific studies that have shown that marijuana is an effective treatment for reducing nerve pain with limited side effects and no change in immune status.  There are also scientific studies that show that THC, one of the active ingredients in marijuana, increased appetite, improved mood, decreases nausea and promoted weight stabilization, with tolerable side effects.  

Two studies reported that patients using marijuana were more likely to take their HIV medications because the nausea and other side-effects were decreased by the marijuana use. 

Marijuana has been thought in the past to lower immunity however studies show that THC and smoked cannabis had no effect on viral loads, CD4/CD8 T-cell levels or even on the plasma concentration of anti-retroviral medications.  

Many patients suffering with HIV/AIDs symptoms or who are having difficult side effects from the required medications find relief with medical marijuana use.  Better appetite, weight gain or stabilization, better mood, reduced anxiety and reduced depression have all been reported by our patients.  

Please feel free to call us at 855-411-4420 if you have any questions about using medical marijuana as an alternative treatment.  We are here to help you!
Dansak, D., Medical Use of Recreational Drugs by AIDS Patients. Journal of Addictive Disease (1997) 16: 25-30

Braitstein, P., et al. Mary-Jane and Her Patients:  Sociodemographic and Clinical Characteristics of HIV-positive Individuals Using Medical Marijuana and Antiretroviral Agents. AIDS (2001) 15: 532-533

Furler, M., et al. Medicinal and Recreational Marijuana Use by Patients Infected with HIV. AIDS Patient Care and STDS  (2004) 18: 215-28
Prentiss, D., et al. Patterns of Marijuana Use Among Patients With HIV/AIDS Followed in a Public Health Care Setting. Journal of Acquired Immune Deficiency Syndromes (2004) 35: 38-45

Woolridge, E., et al. Cannabis Use in HIV for Pain and Other Medical Symptoms. Journal of Pain and Symptom Management (2005) 29: 358-67

Fogarty, A., et al. Marijuana as Therapy for People Living with HIV/AIDS: Social and Health Aspects. AIDS Care (2007) 19: 295-301

Hewitt, D., et al. Pain Syndromes and Etiologies in Ambulatory AIDS Patients.  Pain (1997) 70: 117-23

Singer, E., et al. Painful Symptoms Reported by Ambulatory HIV-infected Men in a Longitudinal Study.  Pain (1993) 54: 15-19

Husstedt, I., et al.  Screening for HIV-associated Distal-symmetric Polyneuropathy in CDC-classification Stages 1, 2, and 3.  Acta Neurologica Scandinavia (2000) 101: 183-187

Abrams, D., et al.  Cannabis in Painful HIV-associated Sensory Neuropathy:  A Randomized Placebo-controlled Trial.  Neurology (2007) 68: 515-21

Ellis, R., et al. Smoked Medicinal Cannabis for Neuropathic Pain in HIV: A Randomized, Crossover Clinical Trial.  Neuropsychopharmacology (2009) 34: 672-80 

Beal, J., et al.  Dronabinol as a Treatment of Anorexia Associated with Weight Loss in Patients with AIDS.  Journal of Pain and Symptom Management (1995) 10: 89-97

Beal, J., et al.  Long-term Efficacy and Safety of Dronabinol for Acquired Inmunodeficiency Syndrome-associated Anorexia. Journal of Pain and Symptom Management (1997) 14: 7-14

Dejesus, E., et al. Use of Dronabinol Improves Appetite and Reverses Weight Loss in HIV/AIDS-infected Patients. Journal of the International Association of Physician in AIDS Care (2007) 6: 95-100

Haney, M., et al.  Dronabinol and Marijuana in HIV-positive Marijuana Smokers:  Cloric Intake, Mood, and Sleep. Journal of Acquired Immune Deficiency Syndromes (2007) 45: 545-54

de Jong, B., et al.  Marijuana Use and Its Association with Adherence to Antiretroviral Therapy among HIV-infected Persons with Moderate to Sever Nausea. Journal of Acquired Immune Deficiency Syndrome (2005) 38: 43-46

Wilson, K., et al.  Predictors for  Non-adherence to Antiretroviral Therapy.  Sex Health (2004) 1: 251-57

Garcia de Ollalla, P. et al.  Impact of Adherence and Highly Active Antiretroviral Therapy on Survival in HIV-infected Patients. Journal of Acquired Immune Deficiency Syndrome (2002) 30: 105-10

Abrams, D., et al.  Short-term Effects of Cannabinoids in Patients with HIV-1 Infection: A Randomized, Placebo-controlled Clinical Trial.  Annals of Internal Medicine  (2003) 139: 258-66

Kosel, B., et al.  The Effects of Cannabinoids on the Pharmacokinetics of Indinavir and Nelfinavir.  AIDS (2002)  16: 543-50
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Intestinal Illnesses

Many patients suffering from bowel diseases such as Crohn’s Colitis, Ulcerative Colitis and Irritable Bowel Syndrome are turning to medical cannabis for treatment.

Crohn’s Colitis  is a form of inflammatory bowel disease that can occur anywhere along the gastrointestinal tract.  Although the exact cause is unknown, the condition is linked to a problem with the body’s immune system. In Crohn’s patients, the immune system, which normally attacks foreign invaders like viruses and bacteria, is overactive and attacks the normal parts of the intestinal tract.  This inflammation causes many different symptoms: crampy abdominal pain, fatigue, loss of appetite, pain when using the restroom, persistent diarrhea or constipation, unintentional weight loss, bloody stools, joint pain, and fistula formation.
Ulcerative Colitis is another form of inflammatory bowel disease that affects the large intestine and rectum.  Just like Crohn’s, the cause of ulcerative colitis is unknown but symptoms of stress, smoking cigarettes and certain foods can trigger symptoms.  The symptoms are similar to Crohn’s – abdominal pain, cramping, bloody stools, diarrhea, nausea, vomiting, fever, weight loss, joint pain and mouth sores. 

IBS, Irritable Bowel Syndrome, is not a form of inflammatory bowel disease in that there is nothing structurally wrong with the bowels.  But there may be a problem with the way the muscles in the intestines work or increased sensitivity to stretching or movement in those with IBS.  Stress can worsen IBS.  IBS occurs in 1 in 6 people in the United States. 

Currently there is no definitive treatment for either form of colitis or IBS.  Patients are advised to pay attention to their diet to see if they associate certain foods with worsening symptoms.  Patients are also advised to lower their stress as this can worsen their condition. Medications that suppress inflammation and the immune system are sometimes prescribed but can have difficult side effects.

There is REAL scientific evidence that the natural compounds in the marijuana plant can help patients with inflammatory bowel disease: 
  • The cannabis plant contains a number of natural medicinal chemicals, called cannabinoids, which play a role in suppressing inflammation and calming the immune system.  One compound in cannabis, called cannabidiol or CBD, has been shown to have significant anti-inflammatory and immunosuppressive effects. Studies in animals have demonstrated that the activation of cannabinoid receptors in the gastrointestinal tract protects the body from inflammation and regulates gastric secretions and intestinal motility, among other functions.  CBD-rich strains are available and have the added benefit of minimal psychoactivity (meaning they do not cause the "high" that THC-rich strains cause).

  • In one study, CBD normalized motility in an experimental model of intestinal inflammation – this means that CBD normalized the flow of food and nutrients through the intestines by decreasing the inflammation, and normal flow of food means less diarrhea and less constipation.
  • In 2009, a study reported in the Journal of Molecular Medicine demonstrated that CBD actually prevented experimental colitis in mice.  
  • In a human study from the Mayo Clinic in Minnesota, it was shown that one dose of synthetic THC relaxed the colon and eased post-eating cramping when compared to a placebo.

  • In the United Kingdom, researchers found that the cannabinoids promoted healing in the gastrointestinal membrane, which help may explain the improvement that many colitis patients report with use of cannabis. A number of other studies have resulted in the same conclusions. 

  • Dr. J. Hergenrather, a California physician, surveyed patients with Crohn’s disease who were using medical cannabis in 2005.  All thirty patients surveyed reported significant improvement in the following symptoms: less pain in the gut, improved appetite, less nausea and vomiting, less fatigue, less depressed mood, and better activity levels.  

  • A recent published report in the Israel Medical Journal reported that Crohn's patients using medical marijuana had reduced disease (as measured by a specific disease activity index) and had less need for prescription drugs and less surgical interventions. 
In my experience, many Crohn’s and ulcerative colitis patients, as well as those with Irritable Bowel Syndrome, report tremendous improvement of symptoms with the use of medical cannabis. Many patients state that cannabis has multiple benefits for their symptoms, such as less cramping, more normal bowel movements, better appetite, less weight loss, and less stress.  Patients report less flare-ups of severe pain, and some patients even report that the use of cannabis has reduced the number of hospitalizations for severe episodes of inflammation. Patients also report that they are able to reduce or eliminate the prescribed pharmaceutical medications with the use of cannabis, especially steroids. 

It appears that cannabis, when used medically, helps those with significant bowel disease such as colitis and IBS.  Both scientific studies and patient anecdotal reports support this.   As the science of cannabis continues to be studied, we will be able to understand the exact ways in which cannabis helps those with colitis and IBS. If you are suffering with any type of gastro-intestinal disorder and are looking for relief, call us at 1-855-411-4420 to get more information. 

Wright et al Differential Expression of Cannabinoid Receptors in the Human Colon: Cannabinoids Promote Epithelial Wound Healing, Gastroenterology (2005) Volume 129 (2): 437-453

Cannabinoids and gastrointestinal motility: animal and human studies.  Department of Experimental Pharmacology and Endocannabinoid Research Group, University of Naples Federico II, Naples, Italy, European Review for Medical and Pharmacological Sciences (2008) Aug: 81-93

Borelli et al, Cannabidiol, a safe and non-psychotropic ingredient of the cannabis plant Cannabis sativa, is protective in a murine model of colitis.  Journal of Molecular Medicine (2009) 87:1111-1121 

Esfandyari et al, Effects of a cannabinoid receptor agonist on colonic motor and sensory functions in humans: a randomized, placebo-controlled study.  American Journal of Physiology/Gastrointestinal and Liver Physiology (2007) 293: 137-145

Izzo and Coutts, Cannabinoids and the digestive tract. Handbook of Experimental Pharmacology (2005) 168: 573-598.

Baron et al. Ulcerative colitis and marijuana.  Annals of Internal Medicine (1990) 112: 471

Hergenrather  2005. Cannabis Alleviates Symptoms of Crohn’s Disease. O’Shaughnessy’s 2

Naftali et al. Treatment of Crohn's disease with cannabis: an observational study. Israel Medical Association Journal 2011;13(8):455-8
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Migraine Headaches

A migraine headache is a common type of headache that may occur with other symptoms, such as nausea, vomiting, and/or light or sound sensitivity. There are 45 million Americans that suffer with chronic migraine headaches. These headaches tend to start between the ages of 10 and 45. The headache is throbbing and sometimes is only felt on one side of the head. Some patients get warning symptoms, called an aura, before the actual headache begins. Some patients see spots or have blurry or tunnel vision as their aura, then the severe headache begins.

Migraine headaches occur more often in women than in men, can run in families and can be triggered by many different things, such as certain foods, odors, hormonal changes, lack of sleep, loud noises, and stress.

The symptoms of migraine headaches can be debilitating. Patients describe pain behind their eyes or in the back of the head and neck. The headache usually is throbbing and severe and can last hours to days. As mentioned, patients can have nausea, vomiting, numbness or weakness, light or sound sensitivity, loss of appetite and sweating. For many patients, symptoms of fatigue, neck pain and inability to concentrate can persist after the migraine has gone away. It is clear that migraine headaches interfere with quality of life for those that suffer from them.

There is no cure for migraines but there are many medications available for treatment and prevention. Many doctors will have their patients keep a diary to see if specific triggers can be identified and avoided. About 30% of migraine patients do not get relief from the standard migraine medications.

Many patients who suffer with migraine headaches are currently using medical cannabis with good results. There are even reports of people using cannabis for migraine treatment that date back to the 6th and 7th centuries. Unfortunately, since cannabis has been illegal in the US for the past 70 years, doctors and researchers have been prevented from studying any beneficial effects.

There are only a few studies that have looked at how cannabis may help with migraines. Lab studies report that a specific area of the brain that is involved in migraine, called the periaqueductal gray matter, contains many cannabinoid receptors. This is the area where the medications in cannabis, called cannabinoids, bind to brain cells and have their effects. There also has been lab research into how cannabis may alter the neurotransmitters involved in migraine attacks. Although there aren’t any human clinical trials investigating the efficacy of cannabis on the treatment of migraines, numerous patient reports abound. Many patients report that if cannabis is taken at the onset of the headache, the headache will not occur. Other patients report that the severity of the headache is lessened significantly so that they can still function without having to lie down in a dark, quiet room. And some patients report that their migraines occur with less frequency as they state they have less stress and better sleep with cannabis use. Stress and sleep deprivation are two common triggers of migraines; if these causes are reduced, the frequency of migraines are also reduced. For many patients, the nausea and vomiting associated with migraine headaches are eliminated with the use of cannabis.

The Institute of Medicine reported in 1999 that cannabis should be studied for the treatment of migraines as it has been shown to eliminate, alleviate or lessen the pain. Currently physicians and researchers in the US are not permitted to study the beneficial effects of cannabis, only detrimental ones as it is still classified as a Schedule I drug.

Every day we see migraine sufferers who very clearly find beneficial results of cannabis treatment for migraines - and often these are patients who never thought that they would ever try cannabis. Many patients get somewhat desperate for relief as the debilitating symptoms are so difficult to live with. Finding that medical cannabis actually improves the quality of life without any significant adverse side effects is enough to make a believer out of many who used to doubt the medical effectiveness of this plant.

Please call us at 1-855-411-4420 if you want to learn more about medical cannabis for the treatment of migraine headaches.
Lichtman et al. Investigation of brain sites mediating cannabinoid action: Evidence supporting periaqueductal gray involvement. Journal of Pharmacology and Experimental Therapeutics (1996) 276: 585-593

Joy et al, eds.  Marijuana and Medicine:  Assessing the Science Base.  Washington, DC: National Academies Press, 1999
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Multiple Sclerosis

Multiple sclerosis is an autoimmune disease that affects the central nervous system which is made up of the brain and spinal cord. Autoimmune diseases occur when the immune system, which normally attacks foreign substances in the body (such as viruses and bacteria), turns against the body and attacks healthy cells. In MS, the covering of the nerves called the myelin sheath is the target of this attack, and it becomes inflamed, and cannot function normally. It is not clear yet what triggers MS. Some researchers suspect that it is related to a virus or may be due to genetics; some think it is a combination of both. MS is more common in women and usually is diagnosed before the age of 40. There are a few different types of MS depending on the severity, rates of relapse, and rate of progression of symptoms.

Symptoms of MS vary since the location and severity of each attack vary. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms. Fever, hot baths, sun exposure, and stress can trigger or worsen attacks. It is common for the disease to have a waxing and waning course. Sometimes MS may continue to get worse without periods of improvement. MS patients typically become disabled and for some, this disease is fatal.

There is no known cure for MS at this time but in recent years, there have been many advances in the medications used to slow the progression of the disease. These medications are called immuno-modulators and they target the immune system. Studies show that they decrease the rate of relapses by an average of 32%. There are significant side effects and very high costs to these medications but all patients with MS should discuss the use of these agents with their specialists.

Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body. The list of symptoms for MS is extremely long, and includes muscle spasticity, pain, visual problems, fatigue, tremor, depression, vertigo, and many others. It is clear that many MS patients benefit from using medical cannabis as this natural medication can reduce or eliminate some of the terrible symptoms associated with this disease. A recent survey demonstrated that almost 50% of patients with MS use cannabis to help reduce symptoms.

The symptoms that MS patients repeatedly report as responding to treatment with medical cannabis are the following: Muscle spasms, neuropathic pain (nerve pain), tremors, incontinence, loss of balance, depression, anxiety, insomnia, loss of libido, and fatigue.

Numerous studies documenting the benefits of medical cannabis for MS patients have been published. One study used a pharmaceutical product called Sativex, which contains two of the major cannabinoid medicines in the cannabis plant, to see if MS patients had any improvement. Both neuropathic pain and sleep disturbance were improved significantly. Sativex is currently still in clinical trials and not available as a treatment in the United States, although it is available in a number of European countries.

In 2008, researchers at the University of California at San Diego reported that inhaled cannabis significantly reduced objective measures of pain intensity and spasticity in patients with MS in a placebo-controlled, randomized clinical trial. Investigators concluded that "smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis and provided some benefit beyond currently prescribed treatment”.

Researchers are also looking at the possibility that cannabis may inhibit the progression of MS disease. In one study, a man-made cannabis extract medication given to mice with MS type disease found that the progression of MS was delayed, leading the researchers to surmise that cannabis may be what is called "neuro-protective”, that is, it may actually protect the nerves from becoming inflamed or getting worse. The effects of the natural medicines in cannabis to suppress inflammation and the immune response with possible protection of the nerves is an active area of research and hopefully will be further elucidated with continued study.
Many MS patients that come to our offices report reduced pain, better sleep, reduced anxiety and depression and overall an improved quality of life. They report that they have little to no side effects with the responsible use of cannabis. If you would like to learn more about the use of medical marijuana to treat the symptoms of MS, please call us toll free at 855-411-4420.
Jody Corey-Bloom. 2010. Short-term effects of cannabis therapy on spasticity in multiple sclerosis. In: University of San Diego Health Sciences, Center for Medicinal Cannabis Research. Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding. op. cit.

Clark et al. 2004. Patterns of cannabis use among patients with multiple sclerosis.  Neurology 62: 2098-2010

Pryce et al. 2003. Cannabinoids inhibit neurodegeneration in models of multiple sclerosis. Brain 126: 2191-2202
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Muscle Spasms

Many people suffering with chronic muscle spasms have turned to medical cannabis for relief of their pain. The muscle relaxing properties of cannabis have been noted in the literature dating back hundreds of years. In the 19th century, Dr. William O'Shaughnessy used a hemp extract to treat a patient suffering with severe muscle spasms from tetanus and rabies. In 1890, Dr. J.R. Reynolds published a report in one of the earliest medical journals, Lancet, describing cannabis as treatment for muscle spasm, epilepsy, migraine and other medical conditions.

Most studies on cannabis and the cannabinoids in treatment of muscle spasms have focused on multiple sclerosis (MS). These studies have shown that many MS patients have found significant relief of muscle spasms and pain. In a survey of patients who presented to medical cannabis specialty clinics in California, 13% stated that they were using cannabis to alleviate pain associated with muscle spasms. In a 1990 study, THC was compared to codeine and placebo in a paraplegic patient who suffered with severe painful muscle spasms; THC was found to be significantly better than codeine or placebo in reducing the muscle spasms with both codeine and THC significantly improving sleep and pain.
O’Shaughnessy, W. On the preparation of the Indian hemp or gunjah (cannabis indica):  The effects on the animal system in health, and their utility in the treatment of tetanus and other convulsive diseases. Transactions of the Medical and Physical Society of Bombay (1842) 8: 421-461

Reynolds, J. On the therapeutic uses and toxic effects of cannabis indica.  Lancet (1890) 1: 637-638

Maurer, M., et al.  Delta-9-tetrahydrocannabinol shows antispastic and analgesic effects in a single case double-blind trial.  European Archives of Psychiatry and Clinical Neuroscience (1990) 240: 104
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Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that is triggered by a traumatic event that involved the threat of injury or death. Post-traumatic stress disorder can develop after someone experiences or witnesses an event that causes intense fear, helplessness or horror.

Many people who are involved in traumatic events have a brief period of difficulty adjusting and coping, after which they improve and get better. In some cases, though, the symptoms can get worse or last for months or years. Symptoms can sometimes interfere with normal functioning, sleeping, and interpersonal relationships.  This is often when the diagnosis of PTSD is made.
Three groups of symptoms are required in order to make the diagnosis of PTSD:  

(1) recurring re-experiencing of the traumatic event (troublesome memories, flashbacks, nightmares)

(2) avoidance to the point of having phobias of places, people, and experiences that are reminders of the traumatic event, and 

(3) chronic physical signs of hyperarousal, such as insomnia, trouble concentrating, irritability, anger, blackouts, and difficulty remembering things.  

PTSD sufferers often have emotional numbing that manifests as difficulty enjoying activities that they previously enjoyed, inability to look forward to future plans, and emotional distancing from loved ones.

Conventional treatment for PTSD includes psychotherapy, learning coping skills, and family counseling.  Medications such as anti-depressants, mood stabilizers, sleep aids, and anti-anxiety medicines are often prescribed.  Some patients find relief with these treatments but it is well known in the medical community that PTSD is difficult to treat.

Many PTSD sufferers have found good results with medical cannabis use, especially for relief of insomnia and anxiety.  Cannabis can give PTSD patients a sense of well being and serenity, and it allows them to continue to function with little to no adverse side effects.  PTSD patients often prefer medical cannabis over conventional medications, as it is a single medication that helps with a number of symptoms (as opposed to taking multiple medications for each separate symptom) , and the risk of medication interactions is removed.  There are a number of researchers currently exploring the science behind the use of cannabis for treatment of PTSD and the results are promising.  
A study from Israel in 2009 found that the cannabinoids (the medicinal compounds in the cannabis plant) prevented a stress response in previously traumatized rats. 

Another report from Israel in 2011 that PTSD patients using medical cannabis had "significant improvement in quality of life and pain, with some positive changes in severity of PTSD".  These researchers, as part of their routine consulting work at MaReNA Diagnostic and Consulting Center in Bat-Yam, Israel, assessed the mental condition of 79 adult PTSD patients who had applied to the Ministry of Health in order to obtain a medical cannabis license.  About half of the patients got their licenses and were studied for about two years. 

The majority of these patients also used conventional medications.  The daily dosage of cannabis was about 2-3 grams per day.  The patients reported a discontinuation of or lowering of dosages of pain killers and sedatives.  The group of patients that showed improvement were those that also suffered from pain and/or depression. 

Researchers concluded that "results show good tolerability and other benefits, particularly in the patients with either pain and/or depression comorbidity".  (Comorbity is the term used when a patient suffers from more than one condition).  These results were presented at the 2011 Cannabinoid Conference in Bonn, Germany.  

Many of our patients who suffer from PTSD report that medical marijuana has helped them by lessening anxiety, improving mood, improving sleep, eliminating nightmares and producing an overall improved sense of well-being.  Many of these patients had tried and failed other medication treatments. 

For now, PTSD patients that live in states where medical use of cannabis is approved are using it to help decrease the debilitating symptoms of their illness and improve their quality of life.  If you or a loved one is suffering from PTSD, you may find relief from the use of medical marijuana.  Call us and we will be happy to answer any questions you have about this natural treatment. 
Ganon-Elazar, E., Cannabinoid Receptor Activation in the Basolateral Amygdala Bocks the Effects of Stress on the Conditioning and Extinction of Inhibitory Avoidance. Journal of Neuroscience (2009) 29 (36): 11078-11088
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Sleep Disorders

Medical cannabis patients routinely report that the use of this medication improves sleep.  In a survey of patients who presented to medical cannabis evaluation clinics in California, 71% stated that they were using cannabis to improve sleep, with 14% reporting that it was the main symptom for which they were seeking care at the clinic.  Many of these patients were given recommendations to use over-the counter sleep aids or had been given prescription for "sleeping pills".  Many people report that sleeping pills don't work very well or leave long-lasting effects that cause a "hangover" the next day. Many people are also concerned about the side effects of synthetic medications or potential habit-forming properties of sleeping pills. .

Since cannabis has been illegal for the past 70 years, physician and researchers have not been able to study it as a potential sleep aid.  However, in studies of other medical conditions, researchers have reported that patients often found improved sleep with cannabis use.  In a 2007 study by Dr. E. Russo, a cannabis plant based extract was assessed for effects on pain; the results of the study showed that 40 – 50% of subjects attained "good or very good” sleep quality when asked to rate their sleep.  A number of other studies have shown that cannabis and specifically cannabidiol, one of the medicinal compounds in cannabis, was shown to extend sleep time, reduce early awakening, and have no hangover side effects the next day. 

At our offices, approximately 70% of patients report improvement of sleep.  Patients report that they fall asleep faster and have more hours of sleep with medical cannabis use.  They also report that they feel well-rested the following day without any "hangover" effects.  It appears that with responsible use, medical marijuana can improve sleep for many people who suffer with insomnia.
Nunberg, H., et al. An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California.  Journal of Drug Policy Analysis (2011) 4 

Russo, E., et al. Cannabis, Pain, and Sleep: Lessons form Therapeutic Clinical Trials of Sativex, a Cannabis-Based Medicine. Chemistry & Biodiverisity (2007) 4: 1729-1743 

Bisogno, T., et al. Molecular targets for cannabidiol and its synthetic analogues: effect on vanilloid VR1 receptors and on the cellular uptake and enzymatic hydrolysis of anandamide. Journal of Pharmacology (2001) 134: 845-852

Carley, D., et al. Functional role for cannabinoids in respiratory stability during sleep. Sleep (2002) 25: 391-398
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Tourette's Syndrome

Approximately 100,000 Americans suffer with Tourette’s syndrome (TS).  Tourette’s syndrome is a neurological disorder with symptoms of repetitive involuntary movements and vocalizations called tics.  The syndrome is named afer a French neurologist, Dr. Georges Gilles de la Tourette, who first described the condition in 1885. 

There is no known cure and the symptoms are often a source of social and psychological difficulty for the patient.  Many people with TS also have ADHD, learning disabilities, OCD, depression and/or anxiety. 

The most common group of medications used to treat the symptoms of Tourette’s syndrome is called neuroleptics.  These medications are helpful only to some TS patients and often have many adverse side effects, including sedation, weight gain, and cloudy thinking.  They can also have serious side effects of tremor, twisting movements, and other involuntary movements.   If a patient has both TS and ADHD, the stimulants that are often used to treat ADHD cannot be used as these drugs are contraindicated in TS patients.  

Some TS patients have reported improvement of symptoms with cannabis use.  A number of studies validate these claims and support the use of cannabis for TS patients.  

In 1988, an article published in the Journal of Clinical Psychopharmacology reported three males (aged 15, 17 and 39) who had incomplete responses to conventional medications for Tourette’s syndrome who all noted that their symptoms were eliminated with the use of smoked cannabis.  

In 1999, a researcher reported that a 25 year old male who used cannabis had significant reduction of tics that lasted over seven hours from the time of the dose of cannabis.

In 2002, researchers reported on a group of TS patients were given either THC or a placebo.  They found a significant improvement in tics and in OCD behavior for those patients that received THC.

In 2003, a randomized double-blind placebo-controlled study looked at 24 TS patients who received THC over a six week period.  No detrimental effect was seen on learning curve, interference, recall and recognition of word lists, immediate visual memory span, and divided attention. Authors concluded that neither acute nor long-term cognitive deficits were caused by treatment of TS with THC.
In the medical journal Expert Opinions in Pharmacotherapy, investigators reported that, "Therapy with delta-9-THC should be tried… if well-established drugs either fail to improve tics or cause significant adverse effects.”

For many people suffering with Tourette’s syndrome, conventional medications may not be effective or may cause too many adverse side effects.  For these patients, cannabis is a very viable alternative and may result in an improved quality of life.
Sandyk et al. Marijuana and Tourette’s Syndrome.  Journal of Clinical Psychopharmacology (1988) 8: 333-335

Muller-Vahl et al.  Treatment of Tourette Syndrome with Delta-9-tetrahydrocannabinol: No influence on neuropsychological Performance.  Neuropsychopharmacology (2003) 28: 384-388

Muller-Vahl et al. Treatment of Tourette Syndrome with Delta-9-tetrahydrocannabinol.  American Journal of Psychiatry (1999) 156:495

Muller-Vahl et al. Treatment of Tourette’s Syndrome with Delta-9-THC:  A randomized crossover trial. Pharmacopsychiatry  (2002) 35: 57-61

Muller-Vahl et al. Cannabinoids reduce symptoms of Tourette’s Syndrome. Expert Opinions in Pharmacotherapy (2003) 4: 1717-25
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