The Examiner
Wednesday 01 Jul 2009
My post traumatic stress is horrible. I've had a horrible life. The saving factor was that I found pot. It saved me, saved my life. My nightmares were gone...
I spent the afternoon making a chart that lists the states that have passed medical marijuana exemptions and the conditions they allow. I did this after reading Suffering veterans are caught between science and lack of political courage published 19 Jun 2009 in the Kalamazoo Gazette.
I've been meaning to review the various state medical marijuana laws and make this chart for some time now, as one after another state has omitted psychiatric conditions from their short list.
When it comes to the conditions allowed, marijuana law in the United States consists of a short-list of conditions explicitly written into the law, and "other conditions" which require approval by a committee or board under the state Health Department. The short-list is fairly standard and includes AIDS/HIV, wasting syndrome, cancer, pain, nausea, seizures (epilepsy), and spasms (multiple sclerosis, Chron's disease). Psychiatric conditions never make the short list.
California is the only state that does not require approval by a state board to allow the medicinal use of cannabis for conditions not on its short list. Two states, Vermont and Maine, have no provision for adding anything.
Michigan, New Mexico, Oregon, and Rhode Island allow the use of medical marijuana for Alzheimer's rage.
New Mexico is the only state that has PTSD listed as an approved condition.
Washington has explicitly prohibited the use of cannabis for anxiety and depression.
Colorado, Oregon, and Rhode Island provide some figures regarding how many patients are using cannabis for what conditions. Glaucoma, which is on every short list, is 1% in Colorado and 2% in Oregon and Rhode Island. Cancer is 3% in Colorado, 4% in Oregon, and 12% in Rhode Island. Cachexia, which is on every short list, is 2% in Colorado, 3% in Oregon, and 0% in Rhode Island. HIV is 2% in Colorado, 3% in Oregon, and 13% in Rhode Island.
Fred Gardner reported last year that California doctors who recommend marijuana state 3-5% of their patients use it for PTSD and that Dr. Tod Mikuriya, who made his own diagnoses, reported 8% of his patients using cannabis for PTSD. This is in line with the lifetime prevalence of PTSD in the United States, which is 7.8%.
Approximately eight percent of the >9,000 Californians whose cannabis use I have monitored presented with PTSD (309.81) as a primary diagnosis. Many of them are Vietnam veterans whose chronic depression, insomnia, and accompanying irritability cannot be relieved by conventional psychotherapeutics and is worsened by alcohol. For many of these veterans, chronic pain from old physical injury compounds problems with narcotic dependence and side effects of opioids.
Survivors of childhood abuse and other traumatic experiences form a second group manifesting the same symptoms —loss of control and recurrent episodes of anxiety, depression, panic attacks and mood swings, chronic sleep deficit and nightmares.
One of the worst problems with PTSD are nightmares and the ensuing sleep deprivation. Sleep deprivation alone can result in hallucinations and psychosis. And what I hear over and over from medical marijuana patients with PTSD is that cannabis stops the nightmares and they can sleep. And the fact that it allows them to sleep, that it stops the nightmares, is almost always the first thing they mention when they talk about how cannabis helps.
PTSD often involves irritability and inability to concentrate, which is aggravated by sleep deficit. Cannabis use enhances the quality of sleep through modulation of emotional reactivity. It eases the triggered flashbacks and accompanying emotional reactions, including nightmares.
The importance of restoring circadian rhythm of sleep cannot be overestimated in the management of PTSD. Avoidance of alcohol is important in large part because of the adverse effects on sleep. The short-lived relaxation and relief provided by alcohol are replaced by withdrawal symptoms at night, causing anxiety and the worsening of musculoskeletal pain.
Psychiatric Times reported 1 Nov 2008 that a study of 116 Viet Nam veterans found that disturbed sleep was the most frequently reported symptom at 90%, and that "recurrent nightmares are a signature feature of PTSD". It states that sleep phobia is common, partly due to dread of nightmares: "Recurrent nightmares, sleep phobia, and chronic insomnia provide a strong conditioning context for associating the bedroom with anxious arousal. This becomes even stronger for sexual assault victims who may have experienced the traumatic event in the bedroom. Thus, patients with PTSD have difficulty in relinquishing a defensive posture that is critical for inducing normal healthy sleep."
It's interesting to note that Dr. Mikuriya compares the psychiatric impairments of PTSD to physical spasms, and infers that both are similarly relieved by cannabis.
Cannabis is a unique psychotropic immunomodulator which can best be categorized as an “easement.” Modulating the overwhelming flood of negative affect in PTSD is analogous to the release of specific tension, a process of “unclenching” or release. As when a physical spasm is relieved, there is a perception of “wholeness” or integration of the afflicted system with the self. For some, this perceptual perspective is changed in other ways such as distancing (separating the reaction from the stimulus, which can involve either lessening the reaction, as with modulation, or repressing/suppressing the memory; walling it off; forgetting).
The modulation of emotional response relieves the flooding of negative affect. The skeletal and smooth muscle relaxation decreases the sympathetic nervous reactivity and kindling component of agitation. Fight/flight responses and anger symptoms are significantly ameliorated. The fear of loss of control diminishes as episodes of agitation and feeling overwhelmed are lessened. Experiences of control then come to prevail. Thinking is freed from attachment to the past and permitted to fix on the present and future. Instead of being transfixed by nightmares, the sufferer is freed to realize dreams.
Based on both safety and efficacy, cannabis should be considered first in the treatment of post-traumatic stress disorder. As part of a restorative program with exercise, diet, and psychotherapy, it should be substituted for “mainstream” anti-depressants, sedatives, muscle relaxants, tricyclics, etc.
And this brings in the issue of the pharmaceuticals now commonly used to treat this disorder. The ones I know most about are the SSRIs. According to Fox News, 5% of people prescribed the SSRIs (Selective Serotonin Reuptake Inhibitors - Prozac, Zoloft, Paxil...) will develop manic-psychosis as a result. Other effects (they're not side-effects, they're EFFECTS) include sleep-walking and homocidal/suicidal ideation. And they're addictive, with some studies showing "discontinuation syndrome" as high as 60%.
I've taken the SSRIs, and survived. My experience of sleep-walking was that I believed myself to be having a momentary fatasy, a passing thought, when I was actually doing it. It was the most frightening thing I've ever experienced. Combine that with homocidal/suicidal ideation and you get Columbine. Fox News also reports that 7 of the past 12 school shooters were either on or withdrawing from SSRIs.
In an article published in the Salem-News 8 May 2007, Dr. Phillip Leveque stated , "The Vietnam Administration Clinics have tried every anti-psychotic and anti-depressant in the book as well as highly potent pain killers like Oxycontin and M.S. contin (morphine) with minimal success for PTSD. They did end up with thousands of drug addicts and alcoholics."
But even in California and New Mexico PTSD patients who are veterans are being forced to choose between medical care from the Veterans Administration or medical marijuana.
Even though pain patients can cut their opiod use in half by using cannabis, and even though 89% of medical marijuana patients in Colorado use if for pain and 93% in Oregon and 62% in California, the VA is insisting some patients sign a "pain contract" which subjects them to urine test for illegal drugs in order to receive pain medications from the VA, and refusing to provides services to those who "test dirty".
# Veterans for Medical Marijuana Access
http://www.veteransformedicalmarijuana.org/
http://www.examiner.com/
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