Vol. 6, Number 12
December 2014
cheryl riley, James Freire,
Dr. David Bearman,
Gradi Jordan, Ed Glick,
Paul Armentano,
Sunil K Aggarwal,
Al Byrne, Amanda Reiman,
Jim Greig, Joan Bello,
Arthur Livermore
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PTSD and Cannabis: A Clinician Ponders Mechanism of Action - David Bearman, MD

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

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder —once referred to as “shell shock” or “battle fatigue” — is a debilitating condition that follows exposure to ongoing emotional trauma or in some instances a single terrifying event. Many of those exposed to such experiences suffer from PTSD. The symptoms of PTSD include persistent frightening thoughts with memories of the ordeal. PTSD patients have frightening nightmares and often feel anger and an emotional isolation.

Sadly, PTSD is a common problem. Each year millions of people around the world are affected by serious emotional trauma. In more than 100 countries there is recurring violence based on ethnicity, culture, religion or political orientation.

Men, women and children suffer from hidden sexual and physical abuse. The trauma of molestation can cause PTSD. So can rape, kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as mugging, torture, or being held captive. The event that triggers PTSD may be something that threatened the person’s life or jeopardized someone close to him or her. Or it could simply be witnessing acts of violence, such as a mass destruction or massacre. PTSD can affect survivors, witnesses and relief workers.


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


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

Symptoms may be mild or severe — people may become easily irritated or have violent outbursts. In severe cases victims may have trouble working or socializing. Symptoms can include:

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

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

Fear Extinction

Emotions and memory formation are regulated by the limbic system, which includes the hypothalamus, the hippocampus, the amygdala, and several other structures in the brain that are particularly rich in CB1 receptors. The amygdala, a small, almond-shaped region lying below the cerebrum, is crucial in acquiring and, possibly, storing the memory of conditioned fear. It is thought that at the cellular and molecular level, learned behavior —including fear— involves neurons in the baso-lateral part of the amygdala, and changes in the strength of their connection with other neurons (“synaptic plasticity”). CB1 receptors are among the most abundant neuroreceptors in the central nervous system. They are found in high levels in the cerebellum and basal ganglia, as well as the limbic system. The classical behavioral effects of exogenous cannabinoids such as sedation and memory changes have been correlated with the presence of CB1 receptors in the limbic system and striatum.

In 2003 Giovanni Marsicano of the Max Planck Institute of Psychiatry in Munich and his co-workers showed that mice lacking normal CB1 readily learn to fear the shock-related sound, but in contrast to animals with intact CB1, they fail to lose their fear of the sound when it stops being coupled with the shock.

The results indicate that endocan-nabinoids are important in extinguishing the bad feelings and pain triggered by reminders of past experiences. The discoveries raise the possibility that abnormally low levels of cannabinoid receptors or the faulty release of endogenous cannabinoids are involved in post-traumatic stress syndrome, phobias, and certain forms of chronic pain.

This suggestion is supported by our observation that many people smoke marijuana to decrease their anxiety and many veterans use marijuana to decrease their PTSD symptoms. It is also conceivable, though far from proved, that chemical mimics of these natural substances could allow us to put the past behind us when signals that we have learned to associate with certain dangers no longer have meaning in the real world.

What is the Mechanism of Action?

Many medical marijuana users are aware of a signaling system within the body that their doctors learned nothing about in medical school: the endocan-nabinoid system. As Nicoll and Alger wrote in “The Brain’s Own Marijuana” (Scientific American, December 2004):
    “ Researchers have exposed an entirely new signaling system in the brain: a way that nerve cells communicate that no one anticipated even 15 years ago. Fully understanding this signaling system could have far-reaching implications. The details appear to hold a key to devising treatments for anxiety, pain, nausea, obesity, brain injury and many other medical problems.”
As a clinician, I find the concept of retrograde signaling extremely useful. It helps me explain to myself and my patients why so many people with PTSD get relief from cannabis.

We are taught in medical school that 70% of the brain is there to turn off the other 30%. Basically our brain is designed to modulate and limit both internal and external sensory input.

The neurotransmitter dopamine is one of the brain’s off switches.The endocannabinoid system is known to play a role in increasing the availability of dopamine. I hypothesize that it does this by freeing up dopamine that has been bound to a transporter, thus leaving dopamine free to act by retrograde inhibition.

By release of dopamine from dopamine transporter, cannabis can decrease the sensory input stimulation to the limbic system and it can decrease the impact of over-stimulation of the amygdala.

I postulate that exposure to the PTSD-inducing trauma causes an increase in production of dopamine transporter. The dopamine transporter ties up much of the free dopamine. With the brain having lower-than-normal free dopamine levels, there are too many neural channels open, the mid-brain is overwhelmed with stimuli and so too is the cerebral cortex. Hard-pressed to react to this stimuli overload in a rational manner, a person responds with anger, rage, sadness and/or fear.

With the use of cannabis or an increase in the natural cannabinoids (anandamide and 2-AG), there is competition with dopamine for binding with the dopamine transporter and the cannabinoids win, making a more normal level of free dopamine available to act as a retrograde inhibitor.

This leads to increased inhibition of neural input and decreased negative stimuli to the midbrain and the cerebral cortex. Since the cerebral cortex is no longer overrun with stimuli from the midbrain, the cerebral cortex can assign a more rational meaning and context to the fearful memories.

I have numerous patients with PTSD who say “marijuana saved my life,” or “marijuana allows me to interact with people,” or “it controls my anger,” or “when I smoke cannabis I almost never have nightmares.” Some say that without marijuana they would kill or maim themselves or others. I have no doubt that cannabis is a uniquely useful treatment. What remains is for the chemists to determine the precise mechanism of action.

Poll: 60 Percent Of Americans Say States, Not Feds, Ought To Decide Marijuana Question - Paul Armentano

Six out of ten voters believe that states, not the federal government, should authorize and enforce marijuana policy, according to national polling data reported this week by the Washington, DC think-tank Third Way.

When presented with the option, 60 percent of respondents said that state officials ought to possess the authority to “control and decide whether to legalize marijuana.” Only 34 percent of those polled said that the federal government ought to enforce marijuana laws.

Similarly, a super-majority of voters (67 percent) agreed, “Congress should pass a bill giving states that have legalized marijuana a safe haven from federal marijuana laws, so long as they have a strong regulatory system.”

Overall, 50 percent of voters said that they support legalizing marijuana for recreational purposes while 47 percent opposed the notion. However, among those opposed to legalization, 21 percent endorsed the idea of Congress providing a “safe haven” from federal prohibition in those states that have chosen to legalize the plant’s use and sale.

“The fact that state legalization of marijuana violates federal law and creates an untenable policy situation was clear – and the voters we polled responded not with ideological proclamations but by supporting a middle-ground, pragmatic policy which would ease that conflict as the legal landscape continues to quickly shift,” representatives for the think-tank stated in a media release. “This means marijuana is not an issue of absolutes for many Americans – rather, it requires a nuanced balancing of values and interests.”

Nationwide, voter support for cannabis legalization was highest among Democrats (64 percent), Millennials (61 percent), and non-white/Hispanic voters (61 percent). A majority of women voters and self-identified Republicans opposed legalizing marijuana for recreational purposes. By contrast, majority support (78 percent) for the legalization of cannabis for medicinal purposes extended throughout all demographics.

Among respondents, 54 percent expressed a favorable view of those who used cannabis therapeutically, while only 36 percent said that they possessed a favorable view of social consumers.

When it came to the issue of how to most effectively influence voters’ opinions on marijuana law reform, authors reported that neither negative nor positive messaging “moved voters substantially in either direction.” Specifically, authors’ reported that many respondents failed to sympathize with the idea that the drug war was overly punitive or that the federal government might once again begin cracking down on state-compliant cannabis consumers and providers.

Authors concluded, “As opponents lean heavily into values-based arguments regarding teenage marijuana use and highway safety, more research still needs to be done to identify a compelling value for legalizing recreational marijuana – the way that compassion underlies support for medical marijuana.”

Researchers collected opinion data over the course of several months in two separate waves – first with a late summer focus group and then with an October poll of 856 registered voters, conducted online.

Full text of the Third Way report is online here.

Original article is here.

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What's New

Alabama: Considering a medical marijuana law.
   HB642 - The Michael Phillips Compassionate Care Act of Alabama

Arkansas: Considering a medical marijuana law.

Florida: Medical marijuana did not pass with 58% support

Idaho: Considering a medical marijuana law.

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

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

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 - Cajun Bud Stuffing by Jay R. Cavanaugh, PhD

We love the holiday season. What a wonderful excuse to just go cook your brains out. There are tons of recipes out there in the newspapers, magazines, books, and television. Help yourself!

Here’s a recipe that you won’t find in Emeril’s cookbook or anyone else for that matter with the exception of The Canny Bus Trip Kit. What’s Thanksgiving without turkey and what’s turkey without stuffing? It’s Mutt and Jeff, Yin and Yang, Martin and Lewis, you get the picture.

Our stuffing is made outside of the bird. You’ll say but how then do you get all of those great turkey juices into the stuffing? Don’t worry, there is a way. The trick is that all you want from your turkey in your stuffing is flavor and not nasty old E. Coli. That turkey cavern that some folks use to cook their stuffing is a fertile breeding ground for bacteria that are somewhat common in poultry. So, hey, we won’t go there but we will save some turkey juice to add to our “stove top” Cajun stuffing at the end.

You can get very creative with this simple recipe. We use Andouille sausage but you can substitute bacon, Italian sausage, or even chorizo or linguica so long as it is precooked. We’re going to brown the vegetables in Black Out Bud Butter so we don’t want to expose it too long to too high a heat and we don’t want raw sausage J

If you don’t like celery leave it out and try chopped bell pepper instead (Nancy Wife doesn’t like either and I like both). The apple in this recipe is really optional as is the diced Serrano chilies.

For those patients who rarely sleep well a couple of helpings of this stuffing along with all of that tryptophan from the turkey and all the calories will send them to dreamland by midnight.

1 pound Andouille sausage- diced
½ cup Black Out Butter (or Better Bud Butter)
1 large Texas Yellow sweet onion (Maui is even better)
½ to 1 cup of chopped celery
2 apples (Granny’s are good so are McIntosh) cored and diced
1 tablespoon chopped fresh sage
1 table spoon chopped fresh thyme
3-4 cups crumbled corn bread (we cheated and made a box of Marie Callender brand kicked up with a tablespoon of Dr. Jay’s Essence)
3-4 cups whole grain bread croutons (we make our own-hey it’s just dry bread)
1 teaspoon salt
1 tablespoon cracked black pepper
2 ½ cups of chicken broth (we use “Better than Bullion” and it is the bomb)
½ cups of turkey drippings

½ cup of diced fresh Serrano or Jalapeno chili


Bake the corn bread mix following package directions and set aside to cool. We buttered our bake pan with Plugra butter. You could also use Black Out Butter.

Sautee the sausage, drain the fat off and set aside to cool. In the same pan melt the Black Out Butter and gently sauté the onion, celery, salt, and pepper until soft then add the apple and continue to gently cook until the apples pieces are slightly soft.

Bring 3 cups of water to a low boil and add 1 tablespoon of Chicken Better Than Bullion. Add the sage and thyme and cook until dissolved.

Place the corn bread crumbles and whole grain croutons into a large mixing bowl. Add the onions, celery, etc. from the sauté pan. Fold in the browned diced Andouille. Add enough seasoned broth to moisten the stuffing but not too much or it will be mushy.

Bake in an oven preheated to 375 degrees for 30 minutes. Remove from the oven and fold in the turkey juice. Voila!

Recommended accompaniment:

A full course sage roasted turkey dinner. This could include Serenity Garlic Roasted Mashed Potatoes with Bud Butter or even Purple Passion Mashed Potatoes. Yikes! Don’t forget the baked sweet potatoes, steamed green beans with French fried onions, and heck, we even roasted a smoked Virginia ham.

Recommended Beverage: Nevada City Winery 1999 Vintage Zinfandel. This is one delicious wine that will stand up with all of the flavors of your stuffing, other side dishes, and both roast turkey and ham. For those white wine lovers I’d recommend a Sterling Vineyards Chardonnay.

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