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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.

References
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

Cannabis has been used to treat anxiety and depression for thousands of years.  A recent survey of patients seeking care in California medical cannabis doctors' offices 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 phytocannabinoids, a group of medicinal compounds in cannabis, have been found to have anxiolytic and antidepressant properties.   Both THC and CBD, the two most prominent phytocannabinoids in the cannabis plant, decrease anxiety and depression. Patients should be careful with THC dosing as it can have the opposite effect (increased anxiety) if too much is taken.  CBD, in both low and high doses, helps to alleviate anxiety and depression.  Many patients use cannabis products, such as under the tongue tinctures, that contain both CBD and THC to get the best results.

Although research into the benefits of cannabis is still prohibited in the US, some studies have been done to look at the effectiveness of cannabis for the treatment of anxiety and depression. In one study, 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 (racing heart-rate, sweating)and less negativity about public speaking than those who received a placebo.  Also a synthetic cannabinoid (a cannabis-like compound made in a laboratory) was found to reduce anxiety in patients suffering from anxiety disorders after a month of treatment. In another human study, CBD was found to increase the blood flow to areas of the brain that control anxiety.

References
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

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

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

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 cannabis to treat arthritis dates back to the 1700s, as it was known at that time to be a very effective pain reliever.

Scientific research supports the claims that cannabis 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, some 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 "phytocannabinoids". THC, the most prominent cannabinoid, is anti-inflammatory and pain relieving. CBD (cannabidiol) is a potent anti-inflammatory as well and is being used quite successfully by many patients who wish to avoid the intoxicating effects of THC.

A 2006 study reports that administration of cannabis extracts to patients with rheumatoid arthritis produced statistically significant improvements with reduction of pain with movement, pain at rest, better quality of sleep, and less inflammation when compared to placebo, all without any serious side effects.

Other human research 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, gastric bleeding, 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 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 cannabis 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, thus avoiding the smoke – are a healthier way to take cannabis, as are edibles and tinctures. Some arthritis sufferers  find that topical preparations of cannabis that are massaged into the area of arthritis alleviates the pain so well that they don't need to take cannabis internally.  Patients can use cannabis products that are THC-rich, CBD-rich or combination of both CBD and THC depending on their response.  Recently, products containing raw cannabis (not heated) are also being used as they act as very potent antiinflammatories.

References
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

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 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.

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.

Cannabis is proving to be an excellent solution to the opioid epidemic that is killing many Americans.  Cannabis is safe to combine with opiates and when combined, enhances pain relief without adding to the danger of respiratory depression (stopping breathing).  Cannabis also helps to lessen the side effects of opioid withdrawal and also will help opioids work better if they stop working.  Both THC and CBD can help reduce pain and now with so many different cannabis products on the market, patients can customize their treatment to get maximal results.

We see chronic pain patients every day in our office and we are able to help them lessen or eliminate the use of toxic pain medications.  Many patients also report that anxiety is reduced and sleep is improved.  And they also report that they have better relationships at home and at work because they are not irritable from the pain.  Using healthy delivery methods (such as vaporizers, sublingual preparations, topical balms and edibles) in medicinal doses allows for little to no side effects.

References

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education.Washington (DC): National Academies Press (US); 2011

Abrams, Donald I., et al. "Cannabis in painful HIV-associated sensory neuropathy A randomized placebo-controlled trial." Neurology 68.7 (2007): 515-521.

Rukwied, Roman, et al. "Cannabinoid agonists attenuate capsaicin-induced responses in human skin." Pain 102.3 (2003): 283-288.

Ware, Mark A., et al. "Smoked cannabis for chronic neuropathic pain: a randomized controlled trial." Canadian Medical Association Journal 182.14 (2010): E694-E701.

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 medications 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 pain reliever.  In a 2006 study, 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.  Another recent study 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.

We have many patients with fibromyalgia finding relief with cannabis.  Bothe THC and CBD can be helpful and treatment can be customized so that the intoxicating effects of THC can be avoided.

References
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

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 scientific evidence that the natural compounds in the cannabis plant can help patients with inflammatory bowel disease:

• The cannabis plant contains phytocannabinoids, which play a role in suppressing inflammation and calming the immune system.  Cannabidiol (CBD), the non-intoxicating compound in cannabis, 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.
• 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 our 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.

References
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

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.  Both THC and CBD can help with migraine headaches and treatment can be customized to give the best effects.

References
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

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 not available as a treatment in the United States, although it is available in a number of European countries, however patients in medical cannabis states can use natural cannabis to achieve the same benefits of Sativex, and in many cases, without any negative side effects.

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.

References
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.

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

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

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.

References
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

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. 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 cannabis 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 cannabis.  Both THC and CBD can be used to achieve maximal benefits with minimal side effects.

References
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

http://www.maps.org/media/view/fda_approves_new

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 80 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 90% 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.

References
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