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PTSD & Cannabis

PTSD & Cannabis. Dr. Nick Salamie PharmD, RPh. Post Traumatic Stress Disorder (PTSD). Mental Health Condition 10% of US population Symptoms Intrusive Memories Avoidance Negative changes in thinking and mood Changes in physical and emotional reactions Complications

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PTSD & Cannabis

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  1. PTSD & Cannabis Dr. Nick Salamie PharmD, RPh

  2. Post Traumatic Stress Disorder (PTSD) • Mental Health Condition • 10% of US population • Symptoms • Intrusive Memories • Avoidance • Negative changes in thinking and mood • Changes in physical and emotional reactions • Complications • Quality of Life Destroyed • Depression/anxiety • Substance abuse • Suicidal thoughts/attempts

  3. PTSD • Causes • Not completely understood • Complex Mix of Factors • Stressful Experiences • Genetics • Temperament • Biochemical Regulation • Diagnosis • Physical Exam • Psychological Evaluation • DSM-5 Criteria

  4. Mainstream Treatments • Psychotherapy • Cognitive Therapy • Exposure therapy • EMDR • Medications • Antidepressants • sertraline (Zoloft) • paroxetine (Paxil) • Anti-anxiety medications • prazosin (Minipress)

  5. Mainstream Treatments: Side Effects • sertraline (Zoloft) • Nausea (13-24%) • Headache (20-25%) • Insomina (12-28%) • Ejaculation Disorder (7-19%) • paroxetine (Paxil) • Nausea (15-24%) • Insomnia (11-24%) • Asthenia (10-15%) • Ejaculation Disorder (10-15%) • alprazolam (Xanax) • Memory Impairment • Addiction • Withdrawal

  6. Endocannabinoid System • Found in all complex animals • Homeostasis • CB1 and CB2 receptors • Located all over body • Anandamide and 2-AG • Regulation of memories

  7. Endocannabinoid System: PTSD • The amygdala • Memory and Fear conditioning • Structural change • MRI Scans • Uncontrolled amygdala activation • Changes in ECS signaling • Lower anandamide • Abnormal CB1 receptor densities • Phytocannabinoids as treatment • In conjunction with psychotherapy

  8. PTSD: THC • Direct on action CB1 and CB2 receptors • Anxiety Reduction • Typically at “lower” doses • 2.5mg or lower in new patients • Mood/Depression • Sleeping/Waking Nightmares

  9. PTSD: CBD • Indirect CB1/CB2 activator • Studies with Rats • Anxiety • THC buffer • 2017 Review • Treatment for traumatic memories • Fear memory disruption • Adjunct to Psychotherapy • Has to be given after memory retrieval • Dose around Psychotherapy

  10. Terpenes/Chemovar (Strain) Selection • Aromas and Physiological Effects • Stay away from pinene rich cannabis! • Memory enhancing • Limonene • Uplifting • Linalool and/or myrcene • Anxiolytic and analgesic

  11. First PDI Visit • Goals • Improve Quality of Life • Drug Interactions • Assess Patients Cannabis Experience • No or little cannabis experience • Intermediate cannabis experience • Advanced Cannabis Experience • Product selection and initial strategy • Minimum Effective Dose • “Sweet Spot” • Follow Up

  12. Dosage Forms • Inhalation • Combustion • Vaporization • Ingestible • Edibles • Oils (RSO) • Tablets/Capsules • Sublingual/Buccal/Oromucosal • Topical • Transdermal

  13. Getting Your Cannabis Card • Formal Diagnosis of 1 of the 41 qualifying conditions • Completion of Physician Written Certification Form by Licensed Physician • Fingerprint/Background Check • Completion of Online Forms and Payment • Provisional Registration • Dispensary Transfer

  14. Resources • Backes, Michael, et al. Cannabis Pharmacy: the Practical Guide to Medical Marijuana. Black Dog & Leventhal Publishers, 2017. • J. L. C. Lee, L.J. Bertoglio, F.S.Guimaraes, and C.W. Stevenson (2017), “Cannabidiol Regulation of and Emotional Memory Processing: Relavance For Treating Anxiety-Related and Substance Abuse Disorders,” British Journal of Pharmacology, doi: 10.1111/bph.13724 • Paroxetine. Adverse Effects. Medscape Mobile App. WebMD, LLC. • “Post-Traumatic Stress Disorder (PTSD).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 July 2018, www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/diagnosis-treatment/drc-20355973. • “Post-Traumatic Stress Disorder (PTSD).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 July 2018, www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967. • Russo, Ethan B., and Jahan Marcu. “Cannabis Pharmacology: The Usual Suspects and a Few Promising Leads.” Cannabinoid Pharmacology Advances in Pharmacology, 2017, pp. 67–134., doi:10.1016/bs.apha.2017.03.004. • Salamie, Nicholas PharmD, RPh. “Alzheimer’s Disease and the Alternative to Opioids Act.” Powerpoint File. • Sertraline. Adverse Effects. Medscape Mobile App. WebMD, LLC.

  15. Questions

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