LIFESTYLES
OPPORTUNITY
EDUCATION July/August 2016
EDITION Post traumatic Stress Disorder A NEUROBIOLOGICAL APPROCH TO TREATMENT
Bipolar Disorder and Manic Episodes
Oath, Duties and the Pursuit of Harmony GROWING THROUGH TRAUMA
Editor’s Letter Welcome to the sixth issue of Cannabis Nurses Magazine. This Issue focuses on Mental Health and how Medical Cannabis may aid as a treatment option. For most qualifying conditions, approval has relied on low-quality scientific evidence, anecdotal reports, individual testimonials, legislative initiatives, and public opinion however, there is much research relating to this topic nationally and from around the world. Within this issue our featured cover story is Nurse Bryan Krumm MSN, CNP, RN, BC, defending the use of Medical Cannabis as a treatment option for Mental Health issues and the barriers that still exist at a Federal level. Included in this issue are two of his works, the first from the Nurse Practitioner Journal titled Posttraumatic Stress Disorder: A Neurobiological Approach to Treatment and a personal piece written specifically for Cannabis Nurses Magazine titled Oath, Duties and the Pursuit of Harmony. We are honored to have this great National Cannabis Nurse leader share his writings for other Nurses to learn from and apply into their daily practice. He is a visionary light and a continued example to model in the future development of Cannabis Nursing. Medical Cannabis for the Treatment of Mental Illness has caused considerable debate within the medical community and have very much polarized opinion. Bryan Krumm CNP provides a solid, reasoned case for why – despite all the prohibition and social stigmas you might read and or live by – these health recommendations should be welcomed as a healthier alternative to incorporate into current Western medicine practices. We also have a special edition piece written by a Biomedical researcher and medical writer from India, Prakash Janakiraman, who discusses How CBD’s Can Effectively Treat Bipolar Disorder Symptoms and Manic Episodes with his extensive experience in pharmacology, molecular oncology, stem cells science, clinical trials and has written several research publications in peer-reviewed medical journals. Many are interested in learning how mental health issues can benefit from the use of medical cannabis and how incorporating it into their daily treatment benefits the patient as a whole. We also are pleased to welcome a positive piece on Growing Through Trauma written by Nature Nurse President, Heather Manus RN, who speaks about Trauma which does not have to mean defeat. It can be a perfect opportunity for growth, and can be used as a catalyst to move lives forward in unexpected ways. This concept actually has a name, Posttraumatic Growth (PTG) and its positive impact on healing through the use of medical cannabis is gaining strides in the recovery and maintenance of patients with mental health issues across the board. And with Independence Day on July 4th, we focus on our Veterans and the many struggles they face with mental health issues and how Medical Cannabis is making positive strides within their recovery. Roger Martin, of Grow for Vets, discusses the upcoming national campaign: The American Hero Cannabis Tour this year in 2016 where they will be campaigning across the country with Veterans and National Football Players to bring awareness to the front ranks on getting Medical Cannabis approved at the Federal level for Veterans. We then join, Dannion Brinkley, Co-Founder of The Twilight Brigade, who states, “We must now, as a nation, take a united stand for cannabis as an alternative choice in the medical protocol available to our Veterans”. We owe it to our Veterans to fight to the death for the ability of Medical Cannabis to be allowed at the federal level. As Nurses, we must continue to advocate for the needs of our patients, as we are consistently rated as the most trusted medical professionals in the United States. We are trained to identify problems and to find ways to fix them. We learn the importance of listening and collaborating, rather presuming we have all the answers. We are taught to practice critical thinking skills, instead of believing everything we are told. We advocate for the rights of patients even if that means going against the establishment. We are inspired by the empathy and compassion that is at the heart of Nursing. We inspire others through our actions. We are the voice for patients and it is solely our duty to Be the Change.
We must Grow.
Julie Monteiro RN, BSK “Ask Nurse Juhlzie” Editor@Cannabis Nurses Magazine
Contributors July/ August 2016
Publisher
Robert Herman/ND1Media
Managing Editor
Julie Monteiro RN, BSK
Creative Director
Heather Manus, RN
Contributors Heather Manus, RN Leslie Reyes, RN Marcie Cooper, RN, MSN, AHN-BC Lisa Buchanan, RN ,OCN Carey S. Clark, PhD, RN, AHN-BC, RYT Chef Herb Cooking withherb.com Roger Martin- Founder Grow for Vets Jennie Stormes, RN, BSN
Cannabis Nurses Magazine publishes the most recent and compelling health care information on cannabis health, studies, research and professional nursing issues with medical cannabis. As a refereed, clinical practice bimonthly journal, it provides professionals involved in providing optimum nursing care with the most up to date information on health care trends and everyday issues in a concise, practical, and easy-to-read format. Readers can view the magazine digitally for free online at: CannabisNursesMagazine.com or subscribe to a printed copy to be delivered to your door.
We are currently accepting articles to be considered for publication. For more information on writing for Cannabis Nurses Magazine, check out our writer’s guidelines at: cannabisnursesmagazine.com/writers-guidelines or submit your article to: editor@cannabisnursesmagazine.com 4780 W. Ann Rd., Suite 5 #420 N. Las Vegas, NV 89031 Editor@cannabisnursesmagazine.com Online 24/7 at: cannabisnursesmagazine.com
Heather Manus, RN Heather Manus is a native New Mexican and Registered Nurse specializing in all aspects of medical cannabis care. She is currently a board member of the American Cannabis Nurses Association, serving as Chairwoman for the ACNA conference committee. She also holds a certificate of completion for The Core Curriculum for Cannabis Nursing and has taught the ACNA advanced care curriculum.
Leslie Reyes, RN Leslie Reyes, RN is a Board Member and the previous Secretary for the American Cannabis Nurses Association (ACNA). Leslie has worked as a Registered Nurse in Urgent Care, Psychiatric and Behavioral Health, and has been involved in cannabis patient advocacy for over ten years. She is a co-creator and co-author of the Core Curriculum in Cannabis Nursing owned by the ACNA, and is also on the committees for Communications and Media, Conference Planning, Certification, Events, Membership, Nominations, and the Executive Committee.
Marcie Cooper, RN, MSN, AHN-BC
Marcie Cooper is Board Certified as an Advanced Holistic Nurse and licensed as a Registered Nurse in Colorado. Originally from Memphis, Tennessee, she started her nursing career on a general med-surg hospital floor in 2004 and began a focus specializing in Oncology.
Lisa Buchanan, RN, OCN
Lisa Buchanan is an Oncology Certified Nurse (OCN) in Washington state who has worked with the seriously ill and dying for more than 20 years. She a member of the Oncology Nurses Society (ONS), American Cannabis Nurses Association (ACNA), and the Washington State Nurses Association. She has earned certificates in the Core Curriculum for Cannabis Nursing and the Advanced Curriculum for Cannabis Nursing through ACNA.
Jennie Stormes, RN, BSN
Jennie Stormes, RN, BSN lives in the state of Colorado, and formerly in both New Jersey and Pennsylvania, is a member of the ACNA, a board member of American Medical Refugees as Vice Chair, Colorado Springs Chair for CannaMoms, and a parent member of the Special Education Advisory Committee for Colorado School District 49 (Falcon). She specializes in Pediatrics and neurology and has a passon for education.
Contributors
Contact Information Bryan Krumm MSN, CNP, RN, BC is a Psychiatric Nurse Practitioner at Harmony Psychiatric, LLC in Albuquerque New Mexico. He specializes in the non-pharmaceutical treatment of PTSD and provides comprehensive evidence based psychiatric care to patients with a variety of disorders using Cannabis, dietary supplementation, diet, exercise and Mindful Awareness. He is a Nationally recognized expert on the role that dysfunctional endocannabinoid signaling plays in the etiology of PTSD, and on the use of Cannabis for treating PTSD. He is a Veteran of the US Army, the Director of New Mexicans for Compassionate Use and Bishop of Medicine for the Zen Zion Coptic Orthodox Church. He helped author New Mexico’s Medical Cannabis law and he maintains close to a thousand patients in New Mexico’s Medical Cannabis Program, the majority of which have been referred to the program for PTSD. He currently has a rescheduling petition for Cannabis pending with the DEA that is awaiting a ruleing this summer 2016.
Heather Manus, RN Heather Manus is a native New Mexican and Registered Nurse specializing in all aspects of medical cannabis care. She is currently a board member of the American Cannabis Nurses Association, serving as Chairwoman for the ACNA conference committee. She also holds a certificate of completion for The Core Curriculum for Cannabis Nursing. Nurse Heather has shared her knowledge and assistance regarding cannabinoid therapies in Colorado, Massachusetts, California, Nevada and Arizona. She was honored to be a presenter and panelist for multiple conferences in 2013 and 2014. Her deep understanding, unique perspectives and professional delivery make learning, a positive and enriching experience. In addition to educating, advising, and speaking; under Nurse Heather’s direction, the Arizona Cannabis Nurses Association was successful in petitioning and appealing for the inclusion of Post-Traumatic Stress Disorder (PTSD) as a recognized debilitating condition under Arizona’s medical marijuana act.
ROGER B. MARTIN Founder and Executive Director of Grow for Vets, is a proud Veteran of the United States Army who has been coping with constant pain since the 1970’s. He credits cannabis with having saved his life in 2010, by helping him overcome a ten year dependency on dangerous prescription drugs, including Oxycontin and Ambien. In addition to his military service, Roger has a background in law enforcement. As a result, it was not easy for him to accept the fact that, like most Americans, he had been duped into believing that cannabis was a dangerous drug. He blames greedy politicians, driven by the billions of dollars in “contributions” they receive from pharmaceutical companies, for deceiving the American public about the true benefits of cannabis. He is a visionary light and provides hope for our American Veterans.
Publisher ND1Media Editorial Robert Herman
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Reach Us By Post Cannabis Nurses Magazine 4780 W. Ann Rd., Suite 5 #420 N. Las Vegas, NV 89031 info@cannabisnursesmagazine.com www.cannabisnursesmagazine.com
Table of
July/August
Contents WHAT'S INSIDE P.2
EDITORIAL PAGE
P.6
Cannabis for Posttraumatic Stress Disorder: A Neurobiological Approach to Treatment
P.14
Oaths, Duties and the Pursuit of Harmony
P.16
CHOICES The Tipping Point... A Major Crisis for Vets
P.19
Growing Through Trauma
P.21
How CBD'S Can Effectively Treat Bipolar Disorder Symptoms and Manic Episodes
P.24
Backyard BBQ & Summer Party Chef Herb
P.29
Medical Cannabis as a First Treatment Option for Veterans Needing Mental Health
2016
FEATURES Cannabis for Posttraumatic Stress Disorder: A Neurobiological Approach to Treatment
PAGE. 06 Oaths, Duties and the Pursuit of Harmony PAGE. 14 Growing Through Trauma
P.31
Resourcess
P.33
Job Opportunities
P.34
Nursing Conferences for 2016
PAGE. 18 How CBD’s Can Effectively Treat Bipolar Disorder Symptoms and Manic Episodes
PAGE. 19 Medical Cannabis as a First Treatment Option for Veterans Needing Mental Health
PAGE. 29
Cannabis for Posttraumatic Stress Disorder: A Neurobiological Approach to Treatment Abstract: Abstract: The Endocannabinoid System is intricately involved in regulation of the neurobiological processes, which underlie the symptomatology of posttraumatic stress disorder (PTSD). This article discusses the neurobiological underpinnings of PTSD and the use of cannabis for treating PTSD in the New Mexico Medical Cannabis Program.
The State of New Mexico has approved Posttraumatic Stress Disorder (PTSD) as an indication for its Medical Cannabis Program, and patients with PTSD currently comprise the largest segment of any approved indication.
Cannabis remains in Schedule I of the Controlled Substances Act (CSA) in the United States, making it illegal to use under federal law. In the case of Krumm Author Information: vs. Holder, the Drug Enforcement Bryan A. Krumm is a Psychiatric Nurse Administration argued that they did not Practitioner at Sage Neuroscience Center, need to defer to state laws regarding Albuquerque, N.M. scheduling decisions for controlled The author has disclosed that he has no substances.1 Due to the federal financial relationships related to this article. prohibition against cannabis, research looking into its therapeutic value has faced significant barriers, rendering it Credit Information: nearly impossible to conduct controlled clinical trials of cannabis in treating PTSD. However, the U.S. Supreme Court Reprint with permissions for Bryan A. has upheld that practitioners have a right to recommend cannabis to patients when Krumm and the Nurse Practitioner it is deemed appropriate.2
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PTSD can occur when a patient is exposed to one or more traumatic events leading to the development of characteristic symptoms following exposure. Patients may exhibit fear-based re-experiencing with emotional and behavioral symptoms. Others may present with anhedonic or dysphoric states and negative cognition. Patients may exhibit arousal and reactiveexternalizing, while others may exhibit dissociative symptoms. Some individuals may have combinations of symptom patterns.3 PTSD is considered the fourth most common psychiatric disorder, affecting 10% of all men and 18% of women, with rates approximately 40% in high-trauma populations, such as soldiers in combat, low-income individuals, and those living in inner cities.4 PTSD often occurs comorbidly with other psychiatric disorders.4 Originally, PTSD was considered a normative response, related
primarily to stressor intensity, but individual response to trauma depends on stressor characteristics as well as neurobiological factors.5 The endocannabinoid system appears to be involved in the extinction of aversive memories, and patients with PTSD claim that cannabis use helps alleviate their symptoms.6 Cannabinoids stimulate receptors in the prefrontal cortex, amygdala, and hippocampus, activating signaling pathways, which appear to inhibit anxiety.7 Alterations in the endocannabinoid system are seen in depression, including changes in levels of cannabinoid 1 (CB1) receptors and endogenous CB1 receptor ligands.8 Stimulation of cannabinoid receptors enhances stress-coping behaviors and increases spontaneous firing of serotonergic and noradrenergic neurons in the midbrain.9 Phytocannabinoids, including delta 9 tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabichromene exert antidepressantlike actions and may be useful in the treatment of mood disorders.10 High rates of suicidal behavior have been found among patients with PTSD.11 It appears that sensitization of CB1-receptor-mediated G-protein signaling in the prefrontal cortex contributes to the pathophysiology of suicide and likely contributes to suicidal behavior.12
The role of the endocannabinoid system in the pathophysiology of PTSD suggests that cannabinoids may be an effective modality to treat both PTSD and suicidal behavior in patients with PTSD.11 Many patients in New Mexico's Medical Cannabis Program for PTSD have reported reductions in frequency and severity of suicidal thoughts at Medical Advisory Board meetings. Some reported complete cessation of suicidality. The military is currently facing an epidemic of suicide, and the U.S. Department of Veterans Affairs has called on all mental health and substance abuse healthcare providers to share responsibility for zero tolerance regarding suicide.13 An estimated 22 veterans die via suicide daily, accounting for at least 22.2% of all reported suicides.14 There were also 349 suicides among active duty troops in 2012, accounting for more deaths than by enemy fire.15 Developing new treatment modalities for PTSD is critical given the number of returning veterans who require psychiatric help and are at high risk for suicide. Raphael Mechoulam, PhD, perhaps the world's leading authority on cannabinoids and the endocannabinoid system, points out the following: “It has been suggested that pharmacologic treatments in psychiatry have been overly reliant on neurotransmitter systems and
advances in psychopharmacology have reduced adverse reactions but have failed to lead to major disease improvement. The endocannabinoid system may shed new light on the physiologic basis of psychiatric diseases, leading to new and more effective treatments.�6
The Neurobiological basis of PTSD After exposure to a traumatic event, patients may experience recurring memories of the event, including distressing dreams, dissociative reactions/flashbacks, or increased stress responses to external cues and physiological reactions to external cues resembling aspects of the traumatic event. They try to avoid distressing memories or external reminders of the event. They experience negative changes in mood and cognition associated with the event in addition to marked alterations in arousal and reactivity, beginning or worsening after the traumatic event. These disturbances continue for over 1 month and cause significant disturbances in social, occupational, or other important areas of function. These disturbances cannot be attributable to the physiological effects of substances or other medical conditions.3
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The broad range of symptoms seen in PTSD have made treatment challenging. PTSD involves central neurotransmitter imbalances and neuroanatomical disruptions, with potential dysregulation of immune, autonomic, endocrine, and cardiovascular function.16 Recent neuroimaging studies have helped elucidate the underlying neurobiological processes involved in the symptomatology of PTSD as well as the role of the endocannabinoid system in managing these neurobiological pathways. CB1 receptor availability is upregulated in an amygdalahippocampal-cortico-striatal neural circuit implicated in PTSD and in brain regions outside this circuit. This may result from a combination of both receptor upregulation and low receptor occupancy by anandamide, an endogenous cannabioid. This suggests that abnormal CB1 receptor-mediated anandamide signaling is implicated in the PTSD etiology.17
Sustained glucocorticoid exposure leads to reduced dendritic branching, loss of dendritic spines, and impaired neurogenesis of the hippocampus.5
Role of the Endocannabinoid system in PTSD THC has a significant and selective impact on amygdala reactivity to threat signals in humans.19 Endocannabinoids are crucial for the extinction of aversive memories.20,21 Activation of CB1 receptors in the amygdala blocks reconsolidation of aversive memories, which suggests that cannabinoids might help patients with PTSD prevent relapse after a stressful experience.22
PTSD is associated with amygdala dysfunction, the anterior cingulate cortex (ACC), the medial prefrontal cortex (mPFC), and the hippocampus. Structural impairments include decreased hippocampal volume and decreased ACC volume. Dysregulation in threat-related processing in response to trauma exposure leads to a cascade of neural changes, causing a state of amygdala hyperresponsivity, which triggers hyperarousal and vigilance. Inadequate top-down control by the mPFC and ACC perpetuates the state of amygdala hyperresponsivity, increasing attention to trauma-related stimuli.18
The endocannabinoid system plays a significant role in the function of the prefrontal cortex (PFC). The PFC receives and modulates information processing throughout the brain and projects to subcortical arousal systems, regulating monoamine and cholinergic inputs.23 Activation of cannabinoid receptors in the mPFC enhances serotonin 5-hydroxytryptamine (5-HT) neurotransmission, eliciting potent antidepressant effects.24 Disinhibition of excitatory projections from the mPFC to serotonergic neurons in the dorsal raphe may underlie antidepressant activity in the mPFC.25 The endocannabinoid system may be involved not only in the extinction of conditioned fear but also adaptation to aversive situations in general.26
The hypothalamic-pituitary-adrenal (HPA) axis coordinates neuroendocrine stress response systems and has been a major focus of scrutiny in patients with PTSD. Exposure to stress triggers neurons in the hypothalamic paraventricular nucleus to secrete a corticotropin-releasing hormone, corticotropin-releasing hormone, which stimulates the production and release of adrenocorticotropic hormone (ACTH) from the anterior pituitary. ACTH then stimulates the release of glucocorticoids from the adrenal cortex, which modulate metabolism, immune function, and brain function to manage stressors.
Cannabinoids have diverse effects on hippocampal memory and plasticity. The effects of cannabinoids on anxiety appear to be biphasic, with low doses being anxiolytic and high doses being ineffective or possibly anxiogenic.27 However, chronic high-dose cannabinoid treatment has been shown to induce hippocampal neurogenesis, which may contribute to the anxiolytic and antidepressant effects of cannabinoids.28 Modulation of hippocampal memory and plasticity by targeting the endocannabinoid system may aid in the treatment of impaired extinction-like processes seen in PTSD.29
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Endocannabinoid signaling negatively modulates function of the HPA axis. Short-term activation of the HPA axis is beneficial to survival; however, longterm activation can impact mood, cognition, and metabolism. Chronic activation of the HPA axis is associated with a variety of neuropsychiatric disorders.30 Cannabinoids, through action on both limbic and paralimbic brain areas, reduce activity of the amygdala and hypothalamus.31 Retrograde endocannabinoid signaling in the hypothalamus is responsible for regulating HPA output.32 Acute administration of exogenous cannabinoid ligands also activates the HPA axis indirectly through an increase in serotonergic and noradrenergic neurotransmission.33 Chronic exposure to desipramine (and perhaps other antidepressants and therapies) has been shown to upregulate the endocannabinoid system, which, in turn, dampens the stress axis in a manner similar to habituation.34 Endogenous cannabinoid signaling is essential for stress adaptation and is fundamental to the intrinsic regulation of the HPA axis.35
Discussion: Because PTSD is often difficult to treat with a single medication, it is common to see the use of “drug cocktails,� which may cause significant adverse reactions. This may include treatment with combinations of antidepressants, antipsychotics, benzodiazepines, anticonvulsants, sedative/hypnotics, and antihypertensives. Cannabis may address symptoms across all 3 major symptom clusters in PTSD with few clinically significant adverse reactions. A review by Grant and colleagues found that inhaled cannabis is a rapid and efficient method of delivery for THC, allowing for self-titration of medication.36 Although cannabis may cause dizziness, anxiety, paranoia, dry mouth, fatigue, or weakness, tolerance to adverse reactions develops rapidly. There are no reports of fatal overdose with cannabis, and long-term use is not
associated with increased risk of lung or gastrointestinal cancers. There is little evidence of important CYP 450 system drug-drug interactions, and the acute medical risks of THC as used in clinical trials are low.36 Inhaled cannabis is generally well tolerated and has been shown to reduce the pain intensity, decrease anxiety, and improve sleep.37 Cannabinoids may reduce or entirely eliminate nightmares; patients using cannabinoids report improvement in sleep time, quality of sleep, and reduction of daytime flashbacks and night sweats.38 Alcohol abuse has been significantly linked to PTSD,39 and cannabis has been shown to act as a substitute for alcohol.40 Many patients with PTSD struggle with alcohol abuse, often in an attempt to selfmedicate. The majority of these patients referred to the Medical Cannabis Program, who have co-occurring alcohol abuse issues, have reported significantly decreased use, and in many cases, complete cessation of alcohol. have reported significantly decreased use, and in many cases, complete cessation of alcohol. A patient survey conducted by Berkeley Patient's Group, a medical cannabis dispensary in Berkeley, CA, found that 65% of those surveyed reported using cannabis as a substitute because it has less adverse reactions than alcohol and illicit or prescription drugs.41 Cannabinoids have been shown to reduce aggressive behavior, which has important implications in PTSD.42-44 Patients commonly report significant reductions in irritability and anger. Patients are often accompanied by family members, friends, and/or treatment team members who confirm reductions in aggressive behavior. Many patients with PTSD have cooccurring psychotic disorders. Although use of cannabis in patients with schizophrenia has typically been reported to worsen psychosis, increases in population cannabis use have not been followed by increases in psychotic incidence.45,46 THC has been shown to improve symptoms in treatment-refractory patients with schizophrenia,
including reduction in core psychotic symptoms, with no clinically significant adverse effects.45 When compared to nonusing patients, patients with schizophrenia who use cannabis and patients with a history of cannabis at first episode of psychosis have superior neuropsychological functioning.47 Medical cannabis patients with co-occurring psychotic disorders often report reductions in both positive and negative symptoms of schizophrenia, which have failed to resolve with traditional antipsychotic medications, consistent with the findings of Schwarcz and colleagues.45 Strains of cannabis-containing CBD in addition to THC may prevent the psychoticlike symptoms sometimes caused by strains with high levels of THC but a lack of CBD.48 Cannabis of the sativa and ruderalis biotypes typically contain higher levels of CBD and lower levels of THC, while indica biotypes tend to have higher levels of THC and more variable levels of CBD. 49 Unfortunately, finding consistent access to CBD-rich strains is difficult for many patients, and finding the best strain for any individual is largely a matter of trial and error. A comprehensive study of four (4) legal, medical cannabis patients in the federal Investigational New Drug Program found only mild changes in pulmonary function associated with long-term, heavy use. No functionally significant adverse effects were noted in any other physiologic system examined in the study.50 Although changes in pulmonary function can be seen with chronic high use of cannabis, occasional and low cumulative marijuana use of up to 1 joint a day for 7 years is not associated with adverse effects on pulmonary function.51 New Mexico incorporated a definition of “practitioner” that allows advanced practice nurses with prescriptive authority to refer patients to the Medical Cannabis Program.52 Unfortunately, most states with medical cannabis programs do not allow Advanced Practice Nurses to refer patients. Many providers are not able to refer patients to medical cannabis programs due to institutional regulations. Some providers may have concerns about potential adverse
reactions reported with cannabis. However, for those who are able and willing to refer patients to medical cannabis programs, these programs offer a unique opportunity to investigate the safety and efficacy of cannabis while providing relief from pain and suffering.
Marijuana as medicine Cannabis is effective in treating PTSD, even when there are other co-occurring psychiatric and/or medical disorders. The broad range of therapeutic effects seen in treating PTSD with cannabis suggests that it may be beneficial in treating other disorders as well. Rather than targeting neurotransmitter systems and their agonists, cannabinoids target the underlying neurobiological processes that lead to imbalances in these neurotransmitter systems, helping to return them to a state of homeostasis. As with any medication, caution must be used when recommending medical cannabis. Patients should be warned of potential risks, including the potential legal and occupational repercussions that can arise the use of cannabis. Some patients may experience increased levels of sedation, anxiety, or paranoia, and cannabis may induce psychosis in certain individuals. Many patients may opt to use cannabis in spite of these risks. “Based on evidence currently available, the Schedule I classification is not tenable; it is not accurate that cannabis has no medical value or that information on safety is lacking.”36 Healthcare providers have an obligation to provide the best possible care based on the best available scientific evidence. Until cannabis is removed from Schedule I of the federal CSA, the barriers to controlled clinical trials of cannabis in treating PTSD and other medical conditions will remain.
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22. Lin HC, Mao SC, Gean PW. Effects of intra-amygdala infusion of CB1 receptor agonists on the reconsolidation of fear-potentiated startle. Learn Mem. 2006;13(3):316–321. Cited Here... 23. Gamo NJ, Arnsten AF. Molecular modulation of prefrontal cortex: rational development of treatments for psychiatric disorders. Behav Neurosci. 2011;125(3):282–296. Cited Here... | View Full Text | PubMed | CrossRef 24. Bambico FR, Katz N, Debonnel G, Gobbi G. Cannabinoids elicit antidepressant-like behavior and activate serotonergic neurons through the medial prefrontal cortex. J Neurosci. 2007;27(43):11700–11711. Cited Here... | PubMed | CrossRef 25. Moreira FA. Serotonin, the prefrontal cortex, and the antidepressant-like effect of cannabinoids. J Neurosci. 2007;27(49):13369–13370. Cited Here... | PubMed | CrossRef 26. Lin HC, Mao SC, Su CL, Gean PW. The role of prefrontal cortex CB1 receptors in the modulation of fear memory. Cereb Cortex. 2009;19(1):165– 175. Cited Here... | View Full Text | PubMed | CrossRef 27. Akirav I. The role of cannabinoids in modulating emotional and nonemotional memory processes in the hippocampus. Front Behav Neurosci. 2011;5:34. Cited Here... 28. Jiang W, Zhang Y, Xiao L, et al. Cannabinoids promote embryonic and adult hippocampus neurogenesis and produce anxiolytic- and antidepressantlike effects. J Clin Invest. 2005;115(11):3104–3116. Cited Here... | PubMed | CrossRef 29. Abush H, Akirav I. Cannabinoids modulate hippocampal memory and plasticity. Hippocampus. 2010;20(10):1126–1138. Cited Here... | View Full Text | PubMed | CrossRef 30. Patel S, Roelke CT, Rademacher DJ, Cullinan WE, Hillard CJ. Endocannabinoid signaling negatively modulates stress-induced activation of the hypothalamic-pituitary-adrenal axis.Endocrinology. 2004;145(12):5431– 5438. Cited Here... | View Full Text | PubMed | CrossRef 31. Crippa JA, Zuardi AW, Garrido GE, et al. Effects of cannabidiol (CBD) on regional cerebral blood flow. Neuropsychopharmacology. 2004;29(2):417–426. Cited Here... | PubMed | CrossRef 32. Wamsteeker JI, Kuzmiski JB, Bains JS. Repeated stress impairs endocannabinoid signaling in the paraventricular nucleus of the hypothalamus. J Neurosci. 2010;30(33):11188–11196. Cited Here... | PubMed | CrossRef 33. McLaughlin RJ, Hill MN, Gorzalka BB. Monoaminergic neurotransmission contributes to cannabinoid-induced activation of the hypothalamic-pituitaryadrenal axis. Eur J Pharmacol. 2009;624(1–3):71–76. Cited Here... | View Full Text | PubMed | CrossRef 34. Hill MN, Ho WS, Sinopoli KJ, Viau V, Hillard CJ, Gorzalka BB. Involvement of the endocannabinoid system in the ability of long-term tricyclic antidepressant treatment to suppress stress-induced activation of the hypothalamic-pituitary-adrenal axis. Neuropsychopharmacology. 2006;31(12):2591–2599. Cited Here... | PubMed | CrossRef 35. Hill MN, McLaughlin RJ, Bingham B, et al. Endogenous cannabinoid signaling is essential for stress adaptation. Proc Natl Acad Sci U S A. 2010;107(20):9406–9411. Cited Here... | PubMed | CrossRef
37. Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010;182(14):E694–E701. Cited Here... | View Full Text | PubMed | CrossRef 38. Fraser GA. The use of a synthetic cannabinoid in the management of treatmentresistant nightmares in posttraumatic stress disorder (PTSD). CNS Neurosci Ther. 2009;15(1):84–88. Cited Here... | View Full Text | PubMed | CrossRef 39. Coughlin SS, Kang HK, Mahan CM. Alcohol use and selected health conditions of 1991 Gulf War veterans: survey results, 2003-2005. Prev Chronic Dis. 2011;8(3):A52. Cited Here... 40. Mikuriya TH. Cannabis as a substitute for alcohol: a harm-reduction approach. Cannabis Therapeutics. 2004;4(1):79–93. Cited Here... 41. Reiman A. Cannabis as a substitute for alcohol and other drugs. Harm Reduction. 2009. 6(35):1–5 Cited Here... 42. Passmore MJ. The cannabinoid receptor agonist nabilone for the treatment of dementia-related agitation. Int J Geriatr Psychiatry. 2008;23(1):116–117. Cited Here... | View Full Text | PubMed | CrossRef 43. Volicer L, Stelly M, Morris J, McLaughlin J, Volicer BJ. Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 1997;12(9):913–919. PubMed | CrossRef 44. Walther S, Mahlberg R, Eichmann U, Kunz D. Delta-9-tetrahydrocannabinol for nighttime agitation in severe dementia. Psychopharmacology (Berl). 2006;185(4):524– 528. Cited Here... 45. Schwarcz G, Karajgi B, McCarthy R. Synthetic delta-9-tetrahydrocannabinol (dronabinol) can improve the symptoms of schizophrenia. J Clin Psychopharmacol. 2009;29(3):255–258. Cited Here... | View Full Text | PubMed | CrossRef 46. Frisher M, Crome I, Martino O, Croft P. Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005. Schizophr Res. 2009;113(2–3):123–128. Cited Here... | PubMed | CrossRef 47. Yücel M, Bora E, Lubman DI, et al. The impact of cannabis use on cognitive functioning in patients with schizophrenia: a meta-analysis of existing findings and new data in a first-episode sample.Schizophr Bull. 2012;38(2):316–330. Cited Here... | View Full Text | PubMed | CrossRef 48. Morgan CJ, Curran HV. Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis. Br J Psychiatry. 2008;192(4):306–307. Cited Here... | View Full Text | PubMed | CrossRef 49. Hillig KW, Mahlberg PG. A chemotaxonomic analysis of cannabinoid variation in Cannabis(Cannabaceae). Am J Bot. 2004;91(6):966–975. Cited Here... | PubMed | CrossRef 50. Russo E, Mathre ML, Byrne A, et al. Chronic cannabis use in the Compassionate Investigational New Drug Program: an examination of benefits and adverse effects of legal clinical cannabis. Cannabis Therapeutics. 2002;2(1):3–57. Cited Here... 51. Pletcher MJ, Vittinghoff E, Kalhan R, et al. Association between marijuana exposure and pulmonary function over 20 years. JAMA. 2012;307(2):173–181. Cited Here... | View Full Text | PubMed | CrossRef 52. The Lynn and Erin Compassionate Use Act, NMSA § 26-2B-1 et.seq. 2007.
36. Grant I, Atkinson JH, Gouaux B, Wilsey B. Medical marijuana: clearing away the smoke. Open Neurol J. 2012;6:18–25. Cited Here...
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Oaths, Duties and the Pursuit of Harmony By: Bryan A. Krumm CNP, MSN, RN, BC In April of 1984, after failing out of College and entering into a 2 year enlistment in the US Army, I took an oath to “defend the Constitution of the United States against all enemies, foreign and domestic”. Since swearing that oath, my battles have been not with foreign enemies of the United States, but rather with domestic terrorists who are waging a war against sick and suffering Americans. In 1993 I graduated from Nursing School and I pledged to “devote myself to the welfare of those committed to my care”. Little did I realize, that striving to fulfill these duties would turn into a decade’s long battle against well entrenched bureaucratic agencies and a medical establishment that oftentimes seems more interested in demonizing a plant, than in saving lives? The prohibition of Cannabis has led to the deaths of countless Americans, by denying them access to needed medication. It has led to a dependence on petrochemicals that has destabilized governments and contributed to global warming. It has led to deforestation and pollution in order to make paper. It fuels a legal/prison-industrial complex that has destroyed millions of lives. The prohibition of Cannabis violates fundamental Constitutional rights and undermines the safety and welfare of the citizens of the United States. As a Veteran and as a Nurse, I recognize that I have a duty to stand up for those who are not able to stand up for themselves. I helped draft New Mexico’s Medical Cannabis Law, incorporating the New Mexico Nurses Association’s recommendation that Advanced Practice Nurses be allowed to refer patients to the Program. Now, as a Psychiatric Nurse Practitioner, I manage over a thousand patients in our Program for PTSD. In my practice, Cannabis has proven to be the only medication that’s effective for treating PTSD. Not only does Cannabis alleviate symptoms in every symptom cluster of PTSD, it is the only medication that rapidly alleviates suicidal thinking in many patients. Suicide has reached epidemic proportions in the United States with over 100 suicides every day, 22 of which are Veterans. Unfortunately, too many politicians and doctors suffer from “Marijuana Derangement Syndrome” (MDS), a shared delusional system in which sufferers become incapable of
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distinguishing between the reality of science, and the pseudoscientific rantings of those who owe their careers to the demonization of a life saving plant. It seems that many who suffer from MDS would prefer to see Vets go through “high velocity transcranial lead therapy” (AKA, a bullet through the head), than to admit they are wrong about Cannabis and allow these brave men and women to smoke a joint to alleviate their suffering. Many politicians and bureaucrats continue to denounce “Marijuana” as the root of all evil, even as science proves the safety and medical utility of Cannabis every day. Fortunately, the tide finally seems be turning in the favor of science and compassion rather than intolerance and political expediency. I filed a rescheduling petition for Cannabis in late 2009, demanding that Cannabis be removed from Schedule I of the Controlled Substances Act because it clearly has “accepted medical use in the United States”. Early in 2011 the Governors of Washington and Rhode Island also filed a rescheduling petition but they asked for Schedule 2 placement of Cannabis. The FDA sat on the petitions for many years but last fall they finally completed their review (after denying me access to the hearings) and sent a scheduling recommendation to the DEA. Although I filed a Freedom of Information Act request, neither DEA nor FDA will tell me what the recommendation is. However, under recent pressure from the US Senate, the DEA has said it will issue a determination on scheduling for Cannabis by the end of June 2016. I anticipate that FDA has told DEA to move Cannabis to Schedule 2 of the CSA (keep in mind this is only speculation). This will finally allow research into Medical Cannabis and may allow restricted access to whole plant Cannabis for medical use. I also expect to see Sativex and Epidiolex, 2 patented pharmaceutical Cannabis extracts, to be placed in Schedule 3, along with Dronabinol (synthetinc THC). This would allow a pharmaceutical monopoly on “legal Medical Cannabis” while allowing the DEA to claim that State Medical Cannabis Programs are still illegal. If I am correct, I will soon be back in the Court of Appeals to continue the battle for patient rights.
Nurses are consistently rated as the most trusted medical professionals in the United States. We are trained to identify problems and to find ways to fix them. We learn the importance of listening and collaborating, rather presuming we have all the answers. We are taught to practice critical thinking skills, instead of believing everything we are told. We advocate for the rights of patients even if that means going against the establishment. We are inspired by the empathy and compassion that is at the heart of nursing. We inspire others through our actions. I’ve been honored to meet so many other Nurses who are working as advocates to advance Cannabis policy in the United States, and around the World. You inspire me to keep fighting on. It’s the care you provide that will inspire future generations of Nurses to carry on these traditions. Nurses are at the forefront in teaching each other, politicians, other medical professionals and the public about the importance of Medical Cannabis. As I mentioned earlier, I manage over a thousand patients in New Mexico’s Medical Cannabis Program for PTSD. As a prescriber, I’ve compared pharmaceuticals to Medical Cannabis, with and without additional dietary supplements for the last decade. A majority of my Medical Cannabis patients have been able to reduce the use of pharmaceuticals and many have stopped pharmaceuticals altogether. I have now moved away from prescribing pharmaceuticals and I started my own practice, Harmony Psychiatric. I’ve developed “The Harmony Treatment Algorithm for Psychiatric Wellness” to help people take more control of their own psychiatric care, instead of seeing a psychiatrist for a new prescription every month. These methods do not require prescriptive authority and can help guide Nurses to provide more effective patient care.
the World a better place for everyone. Nurses may be the best hope for those Veterans who have given so much of themselves in order to protect the American way of life. I encourage you to review The Harmony Treatment Algorithm at harmonypsych.org. In my clinical practice, these recommendations have proven far safer and more effective for treating PTSD than any pharmaceutical or pharmaceutical combination. Recommendations about diet, exercise and stress reduction are within the scope of Nursing practice. These recommendations can help empower Nurses to provide better care to those we serve. By educating ourselves we can better educate policy makers and other healthcare professionals about the value of Medical Cannabis. The misguided policies of Cannabis prohibition have caused great harm to society and have led to countless deaths. The Nursing Profession has a duty to continue to guide policies regarding Medical Cannabis, in order lead us to a brighter future and ensure the safety of our patients and the public.
If you have any questions about the use of Cannabis for treating PTSD I encourage you to read the article I recently had published in The Nurse Practitioner (pg. 7). I explain the neurobiological processes involved in PTSD and the role of the Endocannabinoid System (ECS) in regulating those processes (if you’re looking for references, here they are). I conclude, “Cannabis is effective in treating PTSD, even when there are other co-occurring psychiatric and/or medical disorders.” (I think this may be the first time a peer reviewed journal has published a statement this definitive regarding the psychiatric use of Cannabis). You can find a link to the full text of the article in the Patient Information section at: www.harmonypsych.org. Patient education is a critical component of Nursing care, so it’s important for Nurses to understand the role of Cannabis in psychiatric care. Dysfunction of endocannabinoid signaling has been implicated in most psychiatric disorders. Cannabis has unique therapeutic effects for treating PTSD which can’t be replicated by any other class of medication. Cannabis is the only medication that has proven effective in treating every symptom cluster of PTSD. Remember, Nurses are the front line of defense in the War against ignorance, intolerance and pseudoscience. Nurses have a duty to protect patients from the unethical and dangerous actions of other healthcare providers, and from the reckless actions of ignorant politicians who prefer political expediency, to the protection of human life. Nurses play a critical role in changing the political landscape regarding Medical Cannabis, and will continue to make
Bryan Krumm MSN, CNP, RN, BC is a Psychiatric Nurse Practitioner at Harmony Psychiatric, LLC in Albuquerque, New Mexico. He specializes in the non-pharmaceutical treatment of PTSD and provides comprehensive evidence based psychiatric care to patients with a variety of disorders using Cannabis, dietary supplementation, diet, exercise and Mindful Awareness.
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NURSE DELVES INTO PTSD TO UNCOVER NEW TREATMENTS, PREVENTION
CHOICES The Tipping Point... a Major Crisis for Vets By: Dannion Brinkley, Co-Founder, The Twilight Brigade The time has definitely come to make new choices in the medical care of our Veterans, for we are at the tipping point of a major crisis. This quote says it all…
“The unprecedented use of prescription drugs by soldiers and Veterans began during the second Gulf War and continues unabated today, Dr. Peter Breggin said, adding, “The combination of increasing prescribing of such drugs during and after military service has led to violence and suicide and in many cases to chronic mental disability while being treated at the VA. This becomes a disability from which they often can’t recover because of multiple psychiatric drugs.” ~International Business Times April 2014
A
After reading several studies on the ability of hempwoven sheets to kill Staph infections, I quickly jumped on the Hemp, Inc. train. These scientific studies were profoundly eye-opening to the many medical implications of hemp.
If you know anything about Staph (Staphylococcus aureus), you know that it is at epidemic proportions in hospitals, nationwide and MRSA (Methicillin-resistant Staphylococcus aureus), a highly contagious form of Staph, is now completely resistant to all antibiotics. So, the very thought that sheets made of hemp could destroy this dastardly bacteria left me wanting to know more about the medical uses of the cannabis plant, especially for our nation’s Veterans. Both for those returning from war, and those in transition, I was determined to discover if cannabis could play a positive role. This was a major turning point in my life, and my personal mission.
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I’ve personally spent more than 30 years as an end-of-life-care volunteer, in the Veteran’s Administration. As a Veteran myself, I have acquired an acute awareness of the Veteran’s needs. Along the path of the volunteer, I’ve accrued a pretty good idea of how the VA system works to treat illnesses that were usually contracted while the Veterans were still in active serve. At the very forefront, these conditions include Traumatic Brain Injury, and Post-Traumatic Stress Syndrome. This fact led me to do some research on the organization, Weed for Warriors Project (www.wfwproject.org). This group of diligent Veterans is committed to creating a national awareness of the unbelievable possibilities found in cannabis as a medical option to all other prescription drugs they are been given. Many Veterans are living in a total fog due to the “drug cocktails” (a combination of several pain and psychiatric drugs) they are taking on a daily basis. In combination, these drugs are causing our Veterans to feel lost, become enraged and perpetrate violence on those they love the most.
PTSD is a chronic debilitating disorder. It not
only affects the individual, but the family as well. Within the general population, about 70 percent will experience
trauma. However, only 10 percent will develop PTSD.
“You can tell a lot about a country by the way they treat their Veterans.”
In the military, the rate is much higher.”
—M. DANET LAPIZ-BLUHM, PH.D., RN
Feeling driven to change the reality of this egregious condition plaguing our Veterans, I reached out to the founder of Weed for Warriors, Kevin Richardson. In my many conversations with him, and other members of the project, I was astounded to learn that when Veterans were weaned off of the prescription drugs, and were prescribed cannabis instead – either edibles or vaporizers – their behavior was altered in the most amazing way. Subsequently, all of the things that usually would irritate and annoy them, suddenly did not. Their family relationships improved as cannabis helped them to be empathetic, calm and present. Thoughts of suicide, divorce and homicide have been dramatically decreased as the result of Veterans implementing their choice for medical cannabis. I found this to be amazing and of paramount importance. It was awe-inspiring for me to hear that cannabis was actually helping these courageous men and women rebuild their lives and closest relationships. “The number of Veterans prescribed opiates and other
pain medications through Veterans Affairs has declined under a drug safety initiative but the aggressive monitoring program may have deadly consequences for some who turn to street drugs or suicide to stop their pain.” ~Military Times March 2014 I was elated by the thought of Cannabis - a simple weed found on all five continents – as a mighty medical agent capable of restoring sanity and a sense of self-pride to our Veterans after they’ve survived the atrocities of combat. Therefore, we must make what appears to be an easier choice: that the Veteran’s Administration starts to prescribe medical cannabis. If this action will save American families from the often fatal side effects of military service, what are we waiting for? We cannot allow the marriages of our Moms and Dads, sons and daughters, sisters and brothers, who have risked everything for our freedom, to become just more casualties of war. I believe it is time for all of us to become involved in this issue. Please do your own research on this subject, and I urge you to write your members of Congress regarding the passage of bills to legalize the use of medical cannabis. By taking these simple, proactive steps we can all make a difference in the quality of life our Veterans can enjoy.
Dannion Brinkley Co-Founder, The Twilight Brigade www.thetwilightbrigade.com
As I read recently, and agree vehemently:
Our country has always been known for its greatness and commitment to the inalienable right to freedom for all. Understanding the use of medical cannabis and fighting for our Veteran’s rights to a fulfilling life, post military service, is now one of the crucial factors in our country’s continuing commitment to freedom and greatness. We must now, as a nation, take a united stand for cannabis as an alternative choice in the medical protocol available to our Veterans!
Weed for Warriors
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Growing Through Trauma BY: Nurse Heather Manus, RN
"Hippocrates said, “Healing is a matter of time, but it is sometimes also a matter of opportunity." Trauma does not have to mean defeat. It can be a perfect opportunity for growth, and can be used as a catalyst to move lives forward in unexpected ways. This concept actually has a name, Posttraumatic Growth (PTG). According to the Posttraumatic Growth Research Group for the Department of Psychology at the University of North Carolina Charlotte (UNC), PTG is defined as “positive change experienced as a result of the struggle with a major life crisis or a traumatic event.” [1] PTG is measured scientifically by the Posttraumatic Growth Inventory (PTGI) which measures five (5) areas of life that indicate mental health and appropriate lifespan growth.
1.. Relating to Others 2.. New Possibilities 3.. Personal Strengths 4.. Spiritual Change 5.. Appreciation for Life Traumatic events can occur in a split second or over an extended period of time. According to the American Psychological Association, “Most people will experience a trauma at some point in their lives, and as a result, some will experience debilitating symptoms that interfere with daily life. The good news is, research has shown that psychological interventions can help prevent these long-term, chronic psychological consequences.” [2]
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An individual’s internal coping mechanisms, life skills, and external support system are factors related to health and growth after a traumatic event. This article is intended to introduce you to the concept of Post-Traumatic Growth (PTG), and provide hope and positive empowerment to those who have suffered traumatic events. UNC Charlotte’s Posttraumatic Growth Research Group answers the question, “What is posttraumatic growth? It is positive change experienced as a result of the struggle with a major life crisis or a traumatic event. Although we coined the term posttraumatic growth, the idea that human beings can be changed by their encounters with life challenges, sometimes in radically positive ways, is not new. The theme is present in ancient spiritual and religious traditions, literature, and philosophy. What is reasonably new is the systematic study of this phenomenon by psychologists, social workers, counselors, and scholars in other traditions of clinical practice and scientific investigation.” [1] PTG refers to multiples levels of trauma and “has been researched in a hugely diverse set of traumatic events from divorce and death to natural disasters and terrorist attacks (Haidt, 2006) [3]. The literature on PTG shows that even though the causes of PTG are vast, the benefits reported fall into three categories.”
1.Finding personal strength and abilities. 2.Improving positive relationships. 3.Positive change in priorities and philosophies.
Literature and research are“mixed when it comes to explaining the link between PTG and wellbeing”. Three main hypotheses have been put forward.
Dr. Nancy Snyderman, Medical Correspondent for ABC News, reported on this study saying, “The review says that the power of positive thinking is real. This mind-body connection that we have been toying with for the past couple of decades really does have hard science behind it. You can't 1. PTG leads to positive life changes and this improves wellbeing. blame people for their diseases, but how you go through your life with the grit and determination to make it through, that you do have control 2. PTG does lead to life changes but this is stressful and so leads over and that makes a difference.“ [5] to lowered wellbeing. Cannabis has shown the ability to facilitate systematic balance and 3. PTG is a coping strategy and its effectiveness as a coping strengthen “this Mind-Body connection,” while assisting patients to feel strategy mediates the relationship between PTG and wellbeing. more optimistic about creating healthy lives through positive growth. During the Cannabis Health Summit, Cannabis Health Index author Uwe Research is inconclusive as to which hypothesis is accurate and Blesching, PhD explained that Cannabis sets the stage for deeper healing so further work is required.” [3] by producing a relaxation response, modulating the endocannabinoid system, altering state of consciousness, and increasing emotional An article published in the Journal of Trauma Stress describes the authenticity and positivity. [6] assessment tool used to evaluate and determine an individual’s level of growth after trauma. The Posttraumatic Growth The goal of Nursing is to assist in increasing health and well-being Inventory: measuring the positive legacy of trauma, details areas through individualized patient care. This goal leads to the question: of assessment for positive life changes and personal growth, What is health? utilizing trauma as a catalyst to achieve a more meaningful life. The Posttraumatic Growth Inventory (PTGI) is an instrument for assessing positive outcomes reported by persons who have experienced traumatic events. The PTGI consists of a 21-Item Scale which includes factors of:
1. 2. 3. 4. 5.
New Possibilities Relating to Others Personal Strength Spiritual Changes Appreciation of Life
“Women tend to report more benefits than do men, and persons who have experienced traumatic events report more positive change than do persons who have not experienced extraordinary events. The Posttraumatic Growth Inventory is modestly related to optimism and extraversion. The scale appears to have utility in determining how successful individuals, coping with the aftermath of trauma, are in reconstructing or strengthening their perceptions of self, others, and the meaning of events.”[4] A study published in the August 2015 issue of the Canadian Medical Association Journal found that an optimistic attitude can do wonders for patients' recovery. Researchers reviewed 16 studies that looked at patients' attitudes toward health that spanned over 30 years and looked at the patients' attitudes after medical procedures and surgery. Donald Cole, the article’s author from the Institute for Work & Health in Toronto reports, "In each case the better a patient's expectations about how they would do after surgery or some health procedure, the better they did. Across a wide range of clinical conditions, from lower back pain to heart surgery, patients who felt they would do well in recovery, did. Patients who were scared or pessimistic about their recovery did not recover as quickly as the optimists or as well.” [5]
According to Merriam Webster’s dictionary, “Health is the condition of being sound in body, mind, or spirit; especially: freedom from physical disease or pain.” However, it is possible, even when not in optimum health, to begin “feeling” healthier & happier now. In the words of Terry Waite, who survived four years in solitary confinement, chained, beaten and subject to mock execution, ‘Suffering is universal: you attempt to subvert it so that it does not have a destructive, negative effect. You turn it around so that it becomes a creative, positive force.’ [7] Could cannabis be used as a tool to assist patients by serving as a Gateway to Health and a Pathway for Growth? Health is defined as the condition of being sound in body, mind, or spirit. BODY- Physically, the Endocannabinoid System is known as the homeostasis or balancing system of the human body. Health can be increased through Life Balance, and if disease, inflammation, or Endocannabinoid deficiencies are present, Cannabis can begin to balance the body systems to assist in obtaining physical homeostasis. MIND- Mentally, Cannabis can assist with stress reduction and relaxation. CB1 Receptors (CBR1) located in the brain are associated with the limbic system involving motivation & emotional behaviors. The hippocampus, also part of the limbic system is responsible for mood, emotions, and memory. Research has identified the limbic system as the central area of the brain involving laughter. It’s said that laughter is the best medicine, perhaps cannabis is the best medicine to tickle the limbic system and make laughter easier. Positive thinking, uplifting self-talk, and laughter, are good coping skills to develop. It could be suggested that the Endocannabinoid system and the cannabis plant are both naturally designed to support mental well-being and assist humans in the quest for personal growth and happiness.
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SPIRIT- Spiritually, the feeling of love and gratitude are fast routes to experiencing happiness and well-being. “Thank you,” “I’m grateful,” “I am blessed beyond measure.” The list of things to be thankful for could be endless. Take a moment now to think of one thing you are grateful for. Focus on the thoughts and feelings generated. This simple gratitude exercise can generate good feelings of peace, ease and well-being. If an individual chooses to sit in a state of gratitude long enough, their mood will likely shift into a happier and calmer state of being. Cannabis can assist patients to calm the mind, sit in retrospective thought, and with gratitude as the intention, experiences of spiritual health and growth become the result. Cannabinoid therapeutics may aid in PTG by supporting physical health with balance & homeostasis, mental health with a greater ability to cope, and spiritual health by allowing the energy of gratitude and peace to be generated and expressed from the inside out. The mind, body, and spiritual connections are addressed and utilized by the PTGI to measure posttraumatic growth in human beings. Could a theory be developed that the health of one’s Endocannabinoid (eCB) system has an impact relating to PTG? The journal article entitled, Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study, was published in the September 2013 issue of Molecular Psychiatry reports, “Three biomarkers examined collectively—OMAR VT, anandamide and cortisol— correctly classified nearly 85% of PTSD cases. These results suggest that abnormal CB1 receptor-mediated anandamide signaling is implicated in the etiology of PTSD, and provide a promising neurobiological model to develop novel, evidencebased pharmacotherapies for this disorder.” [8] Could Cannabinoid Therapeutics address underlying biochemical imbalances and assist individuals in experiencing greater PTG? Trauma of any kind can trigger systematic inflammation or chemical responses within the body. Inflammation or body system imbalances, if left unaddressed may lead to chronic conditions, including clinical Endocannabinoid deficiency. It is common medical practice for healthcare providers, when patients present with endogenous deficiencies (B12, Calcium, Vitamin D, or Iron) to supplement the deficiency with an exogenous replacement to assist body system mechanisms and functions for optimum health. Phytocannabinoids found in Cannabis, provide an excellent source of exogenous cannabinoids to supplement the Endocannabinoid system when addressing conditions related to oxidative stress, inflammation, or Endocannabinoid Deficiency. [9] Dr. Ethan Russo’s work and letter entitled, Clinical Endocannabinoid Deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?, concludes by stating, “Migraine, fibromyalgia, IBS and related conditions display common clinical, biochemical and pathophysiological patterns that suggest an underlying
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clinical Endocannabinoid Deficiency that may be suitably treated with cannabinoid medicines.” [10] Dr. Russo is also quoted saying, “Cannabis is the single most versatile herbal remedy, and the most useful plant on Earth. No other single plant contains as wide a range of medically active herbal constituents.” This parallels with Hippocrates who stated, “Healing is a matter of time, but it is sometimes also a matter of opportunity.” Healthcare providers and patients deserve the opportunity to utilize all medications, plants, tools, methodologies, and skills to assist in the promotion of health, well-being, and posttraumatic growth. Through awareness, assessment, and guidance related to PTG, medical professionals have an opportunity to assist patients in reaching their greatest potential for health and wellbeing. Trauma does not have to mean defeat. In fact, many times the most beautiful opportunities for growth can only be obtained as a result of growing through trauma. In her memoir, A Lotus Grows in the Mud, Goldie Hawn wrote, “The lotus is the most beautiful flower, whose petals open one by one. But it will only grow in the mud. In order to grow and gain wisdom, first you must have the mud --the obstacles of life and its suffering. The mud speaks of the common ground that humans share, no matter what our stations in life. Whether we have it all or we have nothing, we are all faced with the same obstacles: sadness, loss, illness, dying and death. If we are to strive as human beings to gain more wisdom, more kindness and more compassion, we must have the intention to grow as a lotus and open each petal one by one. ” [11] Sources: 1. Posttraumatic Growth Research Group. Department of Psychology, University of North Carolina Charlotte. Retrieved from website June 7, 2016 https://ptgi.uncc.edu/what-is-ptg/ 2. American Psychological Association. The Effects of Trauma Do Not Have to Last a Lifetime. Retrieved from website May 2016. http:// www.apa.org/research/action/ptsd.aspx 3. Positive Psychology, UK. Post Traumatic Growth. Retrieved from website May 2016. http://www.positivepsychology.org.uk/pp-theory/posttraumatic-growth/105-post-traumatic-growth.html 4. Journal Trauma Stress. 1996 Jul;9(3):455-71.The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. Tedeschi RG, Calhoun LG. http://www.ncbi.nlm.nih.gov/pubmed/8827649 5. Positive Thinking, Faster Recovery. ABC News. Retrieved Jan 2016. http://abcnews.go.com/Health/story?id=117317&page=1 6. Cannabis Health Index. Uwe Bleshing, PhD. http:// cannabishealthindex.com/talks/ 7. Psychology Today. Stephen Joseph, PhD. What doesn’t kill us. Posttraumatic Growth, the subversion of suffering. https:// www.psychologytoday.com/blog/what-doesnt-kill-us/201402/ posttraumatic-growth 8. Molecular Psychiatry. Sept 2013. Neumeister A., et al. Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study.http://www.ncbi.nlm.nih.gov/ pubmed/23670490 9. US Patent on Cannabinoids. http://www.google.com/patents/ US6630507 10. Neuro Endocrinol Lett. 2008 Apr;29(2):192-200. Russo, EB.Clinical Endocannabinoid Deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? http://www.ncbi.nlm.nih.gov/ pubmed/18404144 11. A Lotus Grows In The Mud. Author Goldie Hawn and Wendy Holden.
spotlight
How CBD’s Can Effectively Treat Bipolar Disorder Symptoms and Manic Episodes
A
s medical marijuana becomes legal in more
states across the country, there’s been a spike in public interest to see whether cannabis can
effectively treat mood disorders such as anxiety, depression, and psychosis that are commonly associated with bipolar disorder. Unfortunately, there are conflicts in scientific consensus for both supporting and opposing views of cannabis use for the treatment of mood disorders. Some studies1 have linked marijuana use with early-onset psychosis, while others suggest2 there are anti-psychotic benefits3 of cannabis in bipolar disorder patients. It has been shown4 that cannabidiol has anti-psychotic properties, particularly anxiolytic benefits in humans. CBD possesses hypnotic5, anti-convulsive6, neuroprotective7, and anti-stress benefits8. Based on this evidence, research studies have begun to investigate the anxiolytic and antipsychotic benefits of CBD, which may be useful in effectively treating bipolar disorder.
The Neurochemistry of Bipolar Disorder and Cannabinoids A dysfunctional Endocannabinoid system (ECS) has been implicated9 in mood disorders such as bipolar disorder, and modulation of the ECS system by exogenous cannabinoids such as cannabidiol, tetrahydrocannabinol and anandamide can potentially treat bipolar disorder symptoms by exerting antipsychotic, anticonvulsant, and anxiolytic effects. Research studies have demonstrated10 the antipsychotic mechanism action of cannabidiol. Administration of cannabidiol may indirectly influence endogenous anandamide signaling by inhibiting intracellular metabolism by fatty acid amide hydrolase (FAAH).
Elevated levels of anandamide can attenuate mood disturbances and treat bipolar disorder symptoms. Research studies have pointed11 out the role of the dopamine (DA) system in mood disorders, including bipolar disorder. The key role of the mesoaccumbens DA system has been proven in the reward pathway (neural circuitry) and motivational behaviors. Experimental studies being conducted to investigate12 the efficacy of antipsychotic drugs are based on the hypothesis of dopamine, glutamate, and other neurotransmitters. These drugs exhibit13 antagonism to dopamine D2 receptors which is commonly linked14 with hyperprolactinemia due to action of anterior-pituitary mammotrophic cells. These drugs are called typical anti-psychotics (Clozapine) which cause Parkinson-like symptoms, while atypical anti-psychotics are also effective15 without causing serious adverse events, which can be confirmed16 by a catalepsy test. Atypical anti-psychotic drugs inhibit17 hyperlocomotion and the stereotype that results due to dopamine antagonists at lower doses. Effective anti-psychotic action requires the blocking18 of D2 receptors as well as glutamatergic N-methyl-D-aspartate (NMDA) receptors.
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A comparative study assessed19 the anti-psychotic efficacy of haloperidol (an anti-psychotic drug) and cannabidiol (CBD) found that CBD inhibited hyperlocomotion without causing catalepsy, even at higher doses; while haloperidol caused prolactin disturbances. The pharmacological action of CBD mimics clozapine. Another neurochemical experimental study reported20 similar results. These results prove that21 CBD acts like an atypical anti-psychotic drug without causing serious and long-term side effects. study22 investigated
One the anti-depressive action of CBD in an experimental animal model (AKA olfactory bulbectomy mouse model) of depression (OBX). The results suggest that cannabidiol exerted rapid and sustained antidepressant action in the depressed animals by significantly augmenting cortical serotonin and glutamate levels in a dose-dependent manner. Receptor studies have shown that the action was exerted via a 5HT1A receptor-dependent mechanism, which represents novel drug functionality. After prolonged CBD administration notable adaptive changes were documented in pre and post-synaptic 5-HT1A receptor action. CBD can inhibit23 glutamate toxicity and offers anticonvulsant and mood-stabilizing benefits, which are similar24 to the benefits of conventional therapeutic drugs such as valproate and lithium that are indicated for bipolar disorder. In open-label human clinical trials, CBD has significantly reduced25 psychotic symptoms and normalized motor functions in psychiatric patients. These benefits can be useful to treat manic episodes in bipolar disorder patients. Cannabinoids influence mood perceptions and exert antidepressant action by acting as an agonist in central CB1 receptors. 5-HT is believed to be responsible for mood control and implicated in antidepressant-like actions. Research evidences26 have pointed out the action of CBD in the serotonin (5-HT) system and related neurons. Administration of CB1R agonists such as phytocannabinoids into the ventromedial prefrontal cortex of the brain has resulted in enhanced 5-HT neuronal activity and CB1R-dependent antidepressant-like effects in the experimental animals. This study clearly shows the dose-dependent antidepressant benefit of CBD, which can be particularly useful for the treatment of mood disorders, including bipolar disorder.
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The Neuroprotective, Anti-psychotic, and Anxiolytic Benefits of CBD Recent studies27 have found that CBD can provide28 neuroprotection in acute and chronic neurodegenerative disorders. Published studies29 have shown30 that oxidative stress and free radical generation may play an important role31 in the pathogenesis of bipolar disorder. In vitro studies32 and in vivo33 studies have confirmed that CBD possess neuroprotective properties. CBD can exert34 anti-oxidative (scavenging free radicals) and neuroprotective benefits in humans. In this study, CBD was found to be an inhibitor of oxidative damage (free radicals) and increased BDNF (brain-derived neurotrophic factor) levels in the brain regions. BDNF is vital for synaptic plasticity and hence for neuro-protection. Similar results were reported35 by another study. By mitigating the oxidative stress in the brain, cannabidiol can treat and prevent the symptoms of bipolar disorder. Not only research studies, but even anecdotal, subjective reports and case studies36 have shown anti-psychotic benefits of cannabis. Most of the bipolar disorder patients studied use cannabis either to treat the symptoms or to reduce the side effects of conventional therapeutic drugs, such as lithium. Although this evidence looks promising, stringent laws and anti-drug campaigns have made it impossible to conduct largescale, controlled studies to fully explore the anti-psychotic benefits of marijuana to treat bipolar disorder. One prospective study37 that collected mood data of bipolar disorder patients over two years has reported marijuana use was associated with complete abstinence of substance abuse in bipolar disorder patients. Although cannabis did not reduce total number of days of abnormal mood, marijuana increased the number of hypomanic days and decreased the number of depressed days in bipolar disorder patients. Bipolar disorder patients often report subjective mood improvement after marijuana use. A small research study that enrolled 43 bipolar disorder patients reported38 remarkable reduction in total mood disturbance in marijuana smokers, while a slight worsening of symptoms was observed in pure marijuana users. Most of the patients who reported mood improvements were diagnosed with worse mood ratings before marijuana use. This empirical evidence can support the anecdotal claims that cannabis can treat mood-related symptoms. One open-label clinical trial study38 that enrolled a 19-year old schizophrenic woman who suffered serious adverse events after standard anti-psychotic therapeutic drugs use has compared the use of CBD oil followed by interruption of treatment and placebo administration. Finally, the patient was treated with increasing doses of haloperidol. The treatment benefits were assessed by the Brief Psychiatric Rating Scale (BPRS).
Significant improvement in mood symptoms was observed during the CBD oil treatment period, and found to be worsening during treatment the interruption period and placebo treatment. These reported improvements were not further improved by haloperidol treatment. This evidence clearly shows that bipolar disorder symptoms are poorly controlled by conventional therapies, while marijuana is a reliable option to treat mood disorders, including bipolar disorder. By employing the Ugvalg for Kliniske Undersgelser (UKU) scale, the study observed no serious side effects after marijuana use.
Considering this evidence, we can clearly see the antipsychotic benefits of marijuana for treatment of bipolar disorders. Based on all of this irrefutable scientific proof, large-scale, prospective, controlled clinical studies should be conducted by renowned academic institutions to provide sound evidence to support the use of CDB to treat bipolar disorder, and therefore benefit mankind.
In a double-blind, placebo-controlled study, CBD was equally effective40 in treating anxiety, compared with diazepam and ipsapirone, in humans. The study results were concordant with another clinical trial study as evidenced41 by cerebral activity pattern. This evidence is further strengthened by other independent academic studies that indicated42 cannabidiol as an effective and safer anti-psychotic treatment option for bipolar disorder. One study43 has reported that CBD has a similar pharmacological profile as like mood stabilizing drugs, albeit without serious side effects. characterized44
Bipolar disorder is by impaired learning abilities and verbal fluency. One study reported45 that cannabis treatment can significantly improve learning abilities and verbal fluency in bipolar disorder patients. However, comparatively slighter improvements were observed in patients who were treated with conventional therapies such as antidepressants and lithium. Cannabis therapy generally causes fewer but temporary side effects, whereas conventional therapy can cause prolonged and serious adverse events. In addition to human clinical trial evidence, let’s have a look at the pre-clinical studies that demonstrate46 the benefits of cannabis on symptoms of bipolar disorder. CBD’s anti-psychotic effect has been demonstrated in several experimental studies based on encouraging results in conditioned emotional response, the Vogel conflict test, and the elevated plus-maze studies.
Sources:
http://goo.gl/h4ktTV 1: studies http://goo.gl/rqj6dO 2: suggest http://goo.gl/lJm8dI 3: benefits https://goo.gl/D2DH1w 4: shown http://goo.gl/85VazG 5: hypnotic 6: anti-convulsive http://goo.gl/bVfhxV 7: neuroprotective http://goo.gl/mt6I68 http://goo.gl/uXYj78 8: anti-stress http://goo.gl/GO7ENf 9: implicated 10: demonstrated http://goo.gl/5F0EAg http://goo.gl/SfCqdj 11: pointed http://goo.gl/x3Mdav 12: investigate http://goo.gl/cQ1zrS 13: exhibit http://goo.gl/qoP4me 14: linked 15: effective http://goo.gl/T9ZPGb
16: confirmed 17: inhibit 18: blocking 19: assessed 20: reported 21: prove that 22: One study 23: inhibit 24: similar 25: reduced 26: evidences 27: studies 28: provide 29: Published Studies 30: shown
Author: Prakash Janakiraman Prakash is a biomedical researcher and medical writer by profession with extensive experience in pharmacology, molecular oncology, stem cells science and clinical trials. He authored medical textbooks and several research publications in peer-reviewed medical journals. Prakash is an ardent advocate of medical marijuana, wants to educate the science of medical marijuana to general public. Twitter: FaceBook:
https://twitter.com/prakashbioc https://www.facebook.com/prakashbioc?fref=ts
http://goo.gl/PcZNDE http://goo.gl/KeMwpx http://goo.gl/xsbk4j http://goo.gl/yXllhR http://goo.gl/8MrWCV http://goo.gl/Ff2G1A http://goo.gl/ZrKT5v http://goo.gl/jS86nN http://goo.gl/4XgfM3 http://goo.gl/eqwISk http://goo.gl/puz8Cx http://goo.gl/5aj0Sw http://goo.gl/RKc1k8 http://goo.gl/96GYU9 http://goo.gl/VGG8t0
31: important role 32: In vitro studies 33: in vivo 34: exert 35: reported 36: case studies 37: prospective study 38: reported 39: clinical trial study 40: equally effective 41: evidenced 42: indicated 43: One study 44: characterized 45: reported 46: demonstrated
http://goo.gl/tvHcnO http://goo.gl/sd2YMl http://goo.gl/uN0z2n https://goo.gl/BGj8Kv http://goo.gl/iWgf5h http://goo.gl/Zc1bXE http://goo.gl/F9ldf3 http://goo.gl/kYs5Sr http://goo.gl/MKFvjs http://goo.gl/tKnBF0 http://goo.gl/HWbq8i http://goo.gl/JTGjn6 https://goo.gl/QxUi5K http://goo.gl/r0yr9t http://goo.gl/4NWg7C http://goo.gl/zcnSdm
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!Z\drZ k] !!0 2nff^k /Z kmr Host your own Chef Herb-style summer party and backyard BBQ!
AND FOR MORE
CHEF HERB COOK WITH HERB
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GO TO WWW.COOKWITHHERB.COM
FRESH AND TASTY BROCCOLI SALAD
INGREDIENTS 2 heads fresh broccoli 1 red onion 1/2 pound bacon 3/4 cup raisins 3/4 cup sliced almonds 1 cup mayonnaise 1/3 cup THC olive oil 1/2 cup white sugar 2 tablespoons white wine vinegar
DIRECTIONS Place bacon in a deep skillet and cook over medium high heat until evenly brown. Cool and crumble. Cut the broccoli into bite-size pieces and cut the onion into thin bite-size slices. Combine with the bacon, raisins, and your favorite nuts and mix well. To prepare the dressing, mix the mayonnaise, THC olive oil, sugar and vinegar together until smooth. Stir into the salad, let chill and serve.
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GREEN BEAN AND PECAN SALAD INGREDIENTS For the pecans: 2 tablespoons corn oil 2 cups shelled pecan halves Lemon Vinaigrette: 1/2 cup lemon juice, freshly squeezed (2 to 3 whole lemons) 1-1/2 teaspoons sugar 1-1/2 teaspoons Dijon mustard 1 cup grape seed oil 1/3 cup THC olive oil Salt & pepper to taste 2 pounds green beans DIRECTIONS Heat peanut oil over medium heat. Add pecans and salt to taste. Toast lightly, stirring constantly. (Nuts cook quickly, be careful not to burn them.) Whisk lemon juice, sugar, and mustard together, then slowly drizzle in Grape seed and THC olive oil until emulsified. Add salt and pepper to taste. (Or, use a hand-blender to make the whole thing go quicker and emulsify better.) Trim beans and cut into 3-inch lengths. Place in a microwavable serving bowl and cover with plastic wrap, leaving a slight space for steam to escape. Steam until crisply tender. (You may also use a regular steamer.) Rinse with water to arrest the cooking process. Drain thoroughly. Lightly coat the beans with the dressing, adding only as much dressing as you need, and toss in the nuts. Adjust the salt and pepper. Serve at room temperature.
HERB’S HERO SANDWICH
INGREDIENTS 1/2 cup THC olive oil 1 tablespoon lemon juice 3 tablespoons red wine vinegar 3 cloves garlic, minced 2 tablespoons chopped fresh parsley 2 teaspoons dried oregano 1/2 teaspoon black pepper 1 cup black olives, chopped 1 cup mushrooms, chopped 1 (1 pound) loaf round, crusty Italian bread 1/2 pound sliced deli smoked turkey meat 1/2 pound sliced Italian ham 1/4 pound sliced salami 1/2 pound sliced mozzarella cheese 6 leaves lettuce 1 tomato, sliced
DIRECTIONS In a medium bowl, combine THC olive oil, lemon juice, vinegar and garlic. Season with parsley, oregano and pepper. Stir in olives and mushrooms. Set aside. Cut off the top half of the bread. Scoop out the inside, and leave a 1/2 inch outside wall. Spoon 2/3 of the olive mixture into the bottom. Layer with turkey, ham, salami, mozzarella, lettuce and tomato. Pour remaining olive mixture on top, and replace the top half of bread. Wrap securely in plastic wrap, and refrigerate overnight.
GRILLED SHRIMP AND TEQUILA SALSA INGREDIENTS Salsa: 1 cup chopped red onion 1/4 cup green bell pepper, chopped 1/4 cup red bell pepper, chopped 1/4 cup yellow bell pepper 4 cups tomatoes, chopped 1/4 cup jalapeno peppers, seeded and chopped 1/4 cup garlic, minced 1/4 cup limejuice 1/2 cup THC olive oil 1/4 cup tequila
1/4 cilantro, finely chopped 1 1/2 teaspoons oregano 1/4 cup white wine vinegar Salt and pepper to taste Shrimp: 1 1/2 lb large shrimp, peeled and deveined 1/4 cup butter, melted 2 tablespoons garlic, minced 1 lemon juiced DIRECTIONS In a medium mixing bowl, whisk together limejuice, THC olive oil and tequila. Stir in all salsa ingredients to blend well, then set aside. Heat grill to medium high. Whisk together butter, garlic and lemon juice in a small pan over low heat until well blended. Place 4 shrimp on each skewer then brush with lemon mixture, and place shrimp on grill, basting with mixture. Grill each side 2-3 minutes. Remove from grill; stir salsa and drain any liquids. Set shrimp on plate with 1 cup salsa on the side. Garnish with twisted lime slices. Serve with crusty bread.
GRILLED PORTABELLA MUSHROOM PIZZA (FOR MY VEGGIE FRIENDS) INGREDIENTS 2 large Portobello caps, cleaned 4 tbsp THC olive oil 1 tsp of Italian seasoning 1 tsp of garlic powder 1 tsp salt 1 tsp fresh black pepper Crushed red pepper, optional 2 tbsp of marinara sauce 2-3 tbsp shredded mozzarella DIRECTIONS Preheat your grill. Place Portobello caps, gill side up, on a foil lined baking sheet. Drizzle each with a small amount of THC olive oil and spread around with your fingers or the backside of a small spoon. Next, sprinkle on Italian seasoning, garlic powder, salt and pepper. Add crushed red pepper to your liking of heat level. Place on the grill and roast for about 30 minutes or until fork tender. Remove mushrooms from grill and place a tablespoon of marinara on each and spread evenly. Top with mozzarella and place back in the grill on a top shelf until cheese begins to brown.
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Grilled romaine Hearts with Olive Dressing Ingredients 1/2 cup pitted black olives, not too salty 2 cloves garlic, roughly chopped Zest and juice of 1 lemon 1/4 cup THC olive oil + more for brushing 4 pieces rustic bread 4 romaine lettuce hearts, halved lengthwise 1 small cucumber, thinly sliced 1 ripe tomato, sliced A few thin slices of red onion or shallot A few shavings of parmigiano-reggiano Fresh ground black pepper DIRECTIONS In a mini-food processor, thoroughly puree the olives and garlic. Add the lemon zest and juice and process for 20 seconds. Add the 1/4 cup of THC olive oil, 2 teaspoons at a time, processing for 15 seconds after each addition to emulsify. Let rest and then taste and adjust acid and salt before serving. You want it at room temperature for serving. Heat a grill pan over a medium-high flame. Brush the bread with THC olive oil and toast on each side until nicely browned and marked by the grill. Push down a little to get nice marks. Brush the cut side of the romaine and grill for about 30 seconds, pushing down gently. To serve, put each piece of bread on a plate. Top with two romaine halves, some of the cucumber, tomato, red onion, and the parmigiano. Drizzle on the dressing and finish with a grind of black pepper.
HEALTHY SWEET TREAT GLUTEN FREE INGREDIENTS 3/4 sweet rice flour 3/4 gluten-free flour blend 1/2 cup unsweetened cocoa powder 3/4 cane sugar 1/3 cup THC oil 1 cup water 1 tbsp vanilla extract 3/4 teaspoon sea salt 1 tbsp baking powder DIRECTIONS Preheat oven to 350F. Spoon flours into measuring cup, level off. Add cocoa powder to flour. Stir in sugar, THC oil, water, vanilla, salt and baking powder. Pour into oiled 8x8” glass baking dish.
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Bake for 30-35 minutes. Frost with butter cream frosting or sprinkle with powdered sugar for fast brownies! Notes: Frost with vegan butter-cream frosting, or just dust with powdered sugar for fast, super-moist brownies. Sweet rice flour can be found in the Asian section of the grocery store.
PEANUT BUTTER CHOCOLATE CAKE INGREDIENTS 1 low sugar cake mix 3/4 cup sugar free chunky peanut butter 2 tsp vanilla 1 tbsp sugar free caramel syrup 3 eggs 1 cup water 1/3 cup THC oil Frosting: 2 tbsp butter 3/4 cup no sugar chunky peanut butter, 4 tbsp skim milk 2 tbsp sugar free caramel syrup 1 tbsp vanilla 1 lb powdered sugar Peanuts to sprinkle on top, optional DIRECTIONS Place peanut butter in a bowl, add THC oil and eggs then beat well. Add cake mix and water, beat well, then add flavorings and mix. Pour into sprayed cake pans, bake at 350 degrees for 35 minutes, or until cake tests done. Let cool in pans for 10 minutes then place on racks to finish cooling. To prepare frosting, place all ingredients in a mixing bowl and beat until creamy and thick enough to spread on cooled cake.
Make sure to check out CannabisCookoffChallenge.com, where some of the top cannabis chefs, including our own Chef Herb, will compete for the title of ‘Best Medicinal Chef.’ Event will take place in Los Angeles, California on August 25 2011.
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MEDICAL CANNABIS AS A FIRST TREATMENT OPTION FOR VETERANS NEEDING MENTAL HEALTH
Please stand stand up up and and Please let your your voice voice be be heard! heard! let By: Roger B. Martin, Founder and Executive Director Let me try to shed some light on why so many Veterans, dating back to Grow for Vets USA the beginning of warfare, end up living a life filled with mental anguish. I wish that I were able to site a litany of medical studies pertaining to the use of cannabis in the treatment of Veterans’ mental health conditions. Unfortunately, thanks to the federal government, I know of no such studies. However, I am able to share some of what I have personally learned in my more than 2-1/2 years as the Executive Director of a national nonprofit organization serving Veterans; many of whom suffer from severe mental health issues. Thought this article, I will use “man” or “women” when referring to Veterans. In “my day,” which granted was not long after the conclusion of the Civil War, women did not serve in combat. In fact, great effort went into keeping women as far away as possible from hostile fire zones. The lone exception were the women I still refer to as “Angels” —The Nurses. I am painfully aware that females now fight shoulder-toshoulder with men. I have the utmost respect and admiration for these women and my use of “man” or “men” here is for the purposes of simplification. Mental health issues are rarely openly discussed within the military. Typically, those showing signs of mental fatigue, stress, or breakdown were told to suck it up - to be strong. Members of the military who find themselves unable to cope are often called weak or, worse yet, branded as cowards.
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Imagine for a moment that you are a young man who grew up in a small Midwestern farming community. Barely out of high school, you decide that you want to fulfill your patriotic duty and you join the military. In basic training you face physical and mental challenges that push you to the edge. You are taught how to survive and trained how to kill. Weeks later, you find yourself in combat. Your only hope of survival is to rely on the man on your left and the man on your right. Your only hope of getting out of this alive is to kill people who would like nothing better than to end your life in the most horrific and painful way possible. One day, the man on your left takes a bullet in the head. Bullets and shrapnel flying everywhere, you and the man on your right have no choice but to fight on. Two hours later, the battle is over and, exhausted, you fall to the ground. The man on your left was not just a battle buddy; he was your best friend. Only now do you realize that his blood and brain matter is splattered all over your face. It’s in your left ear, in your eyes, inside your nose. You can taste it in your mouth. Water eventually washes away the physical reminders. Your mind races as you replay the entire firefight in your head, over and over again. “Why him?” “Why not me?” Questions that, no matter how many times asked, have no answer. Eleven days before you are scheduled to return home, a bullet with your name on it finds its mark. You’re hit….a medic drags you to a waiting
chopper. You on your way to the only people who can save you now — the Angels. You awaken hours later and realize that the Angels have saved you. You’re badly wounded, but you will survive. An Angel holds your hand as she tells you that you will be back in the peace and safety of your hometown soon. Four months later, as you leave the hospital, your doctor gives you a huge bottle of pills, instructing you to take 3-a-day for the pain from the bullet wound. The big day finally arrives — you’re home! You soon discover that there have been some changes while your were away. A local church has been resettling families in your hometown. Families from the very country where you lost your best friend; where you almost lost your life. One day, you spot one of these new “residents” on the street. Your neck and back stiffen and you feel your heart pounding in your chest. In an instant you are back on the battlefield. Your ears ring with the cries and screams of soldiers and civilians alike. And, the smell and taste of death is as strong as the day you lost your best friend. You thought you had left that all behind you, but it has followed you home. The months and years pass slowly as you struggle to find the man you were when you left your little town. Sometimes he’s there. Other times, especially when you are trying to sleep, he’s back in the battle. With each passing day, it’s harder to cope with the memories. The day you lost your buddy. Your “alive day” — the day you were hit. You’re angry, confused, and desperate. You drive two hours to the nearest VA Medical Center and tell the doctor that you are having trouble sleeping. “Take this pill, it will help you” the doctor says. You take the pill, but it gives you indigestion. The next week, it’s back to the VA looking for help for your indigestion. The doctor says, “Take this pill, it will help you.” You take the pill. You are sleeping more soundly and your indigestion is gone, but your waking hours are still filled with that one question that you seem unable to find the answer to, “Why him and not me?” You wonder if taking your own life is the only way you will find the peace that you so desperately seek. You tell your doctor about your dark thoughts. He tells you to “Take this pill, it will help you.” And on and on it goes. One pill after the other. Within months, you are taking seventeen different prescription drugs. You feel worse than ever before; like your life is over. The doctor said that the pills would help you. They haven’t. They have instead turned your life into a 24-hour-a-day nightmare.
I wish that this was a story that I made up to shock you, or to simply illustrate a point but, this is a true life story. Over the past twentyeight months, I have heard similar stories from hundreds of Vets and their loved ones. The stories that are the most difficult to hear are those told by wives and children who are struggling to understand what is wrong with their husband or father. As it has probably been since the first VA medical facility opened on June 11, 1932, at Fort Hunt, Virginia, the VA’s policy is to keep Veterans in a drug stupor until they either die from a prescription drug overdose, or worse yet, give up all hope and take their own lives. Today, more than fifty Veterans will die from prescription drug overdose and suicide. More than fifty died yesterday. More than fifty will die tomorrow and every day that follows until the VA is forced to admit that American heroes deserve better. Hope shines brightly on the horizon. With each passing day, more and more Veterans are utilizing a safe alternative to deadly drugs cannabis. Thousands of Veterans have told me that cannabis is the only thing that has ever helped them with post-traumatic stress. Thousands more have told me that cannabis has either helped them dramatically reduce the number or prescription drugs they are taking, or allowed them to stop taking their prescription medications all together. I don’t need some study to convince me that cannabis is a safe alternative to deadly prescription drugs. It should be, in most cases, the first treatment option offered to any Veteran wishing to use it. This is especially true as it applies to mental health conditions. The most heartwarming stories I hear come from women who, often through a river of tears, tell me that cannabis has given them back their husband and from children excited that they have their Daddy back. Grow for Vets USA chapters receive pleas for help from Veterans and their families every day. Veterans, some neglected or abused by the VA healthcare system, simply trying to make it through one more day. Some will live to see tomorrow’s sunrise; more than fifty will not. As part of our effort to reach as many Veterans as possible, Grow for Vets will be the lead sponsor of The American Hero Cannabis Tour this summer 2016. We will be giving thousands of Veterans free medical cannabis. To date we have given away more than $750,000 worth of cannabis products. I hope that you will join Grow for Vets USA and Cannabis Nurses Magazine and the National Cannabis Nurses in acting as an agent for change. “Silence” may well be “golden” as the old saying goes, but it won’t save the more than 18,000 Veterans who die each year from prescription drug overdose and suicide.
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Resources
Recommended Books
Understanding Marijuana By Mitch Earleywine A New Look at the
The Pot Book: A Complete Guide to Cannabis by Julie Holland M.D.
Scientific Evidence
Marijuana is the world's most popular illicit drug, with hundreds of millions of regular users worldwide. One in three Americans has smoked pot at least once. The Drug Enforcement Agency estimates that Americans smoke five million pounds of marijuana each year. And yet marijuana remains largely misunderstood by both its advocates and its detractors.
Beyond Buds: Marijuana Extracts Hash, Vaping, Dabbing, Edibles and Medicines by Ed Rosenthal and David Downs Beyond Buds is a handbook to the future of marijuana. Prohibition’s end has led to a technological revolution that’s generated powerful medicines and products containing almost zero carcinogens and little smoke. Marijuana icon, Ed Rosenthal, and leading cannabis reporter, David Downs, guide readers through the best new consumer products, and demonstrate how to make and use the safest, cleanest extracts.
Exploring the role of cannabis in medicine, politics, history, and society, The Pot Book offers a compendium of the most up-to-date information and scientific research on marijuana from leading experts, including Lester Grinspoon, M.D., Rick Doblin, Ph.D., Allen St. Pierre (NORML), and Raphael Mechoulam.
The Cannabis Grow Bible: The Definitive Guide To Growing Marijuana For Recreational And Medical Use The Cannabis Grow Bible is an authoritative source that features almost 200 color and black-and-white photographs, charts, and tables. With an emphasis on the day-to-day aspects of maintaining a garden and European expertise, this book ensures that growers will enjoy a successful harvest.
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Job Opportunities Perm & Travel
Cannabis Nurse Job Board has over 2,000 job opportunities in all nursing specialties.
Get started... High paying travel nursing positions all over the country!
Emerald currently provides travel nurses to hundreds of hospitals and currently is offering assignments in every major specialty (ICU, L&D, ER OR, TELE PACU, PICU, NICU, and PEDS). Contact Emerald at any time at 1-800-917-5055, or respond to this message via E-mail or you can also visit us on the web at www.emeraldhs.com
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If you are available for consideration, please reply to this email and a recruiting specialist will contact you as soon as possible. Call us immediately: 800-591-7860 or scan the QR code To complete a full application, please scan the QR code
Apps for Health-Care Professionals Smartphone apps and web-based tools are increasingly important resources for health-care practitioners. Check out these great tools and put a wealth of health-care information in your pocket.
01 NURSING CENTRAL
06 EPONYMS
Nursing Central is the complete mobile solution for nursing produced by Unbound Medicine. The app includes disease, drug and test information for nurses. http://goo.gl/XWglb
A browse-able and searchable app that provides short descriptions of more than 1,700 obscure medical eponyms. http://goo.gl/BKP0H
02 LIPPINCOTT NURSING
07 NETTER’S ANATOMY FLASH CARDS
DRUG HANDBOOKS
Keep over 300 outstanding anatomical flash cards on your device. This app enables you to carry the popular Atlas of Human Anatomy (4th edition) and its detailed anatomical illustrations on your phone or tablet. http://goo.gl/jr9Th
This app provides up-to-date drug information on your device, including contraindications, nursing considerations, patient teaching and integration of the nursing process. http://goo.gl/em9E1
03 MANAGEMENT GUIDELINES FOR NUSING PRACTITIONERS WORKING WITH ADULTS The app is a best-practice guide for health-care professionals who work with adult patients. Other apps in the series provide guidelines for working specifically with women, with children, with older adults or in family practices. http://goo.gl/o2hC6
04 JOURNAL WATCH This tool from the Massachusetts Medical Society notifies you about new papers published on topics of your choice. http://goo.gl/dxbrd
05 3M PREP This app provides a detailed rationale for selecting surgical prep solutions. You can view how to correctly apply solutions while listening to a detailed set of instructions. http://goo.gl/QGwsY
08 CNOR EXAM PREP The Competency and Credentialing Institute, the governing body of the Certified Nurse Operating Room (CNOR) credentialing program, has created the CNOR exam prep app to help perioperative nurses prepare for the CNOR exam. The app helps individuals assess their exam readiness and develop critical thinking skills; it also provides tips for success, reviews knowledge related to the CNOR exam and can enhance test-taking confidence. http://goo.gl/n1DMo
09 EPOCRATES Rx The app includes a drug guide, formulary information and a drug interaction checker. This product also includes continual, free updates and medical news. Additionally, the app works on your device when you are offline, so you can look up information without a wireless connection. http://goo.gl/fqchG
10 MACEWAN LIB The MacEwan University Library app simplifies searches for books and articles. It allows you to place a hold on library catalogue items, renew items, download full-text resources and perform many other tasks. http://goo.gl/YAUQe
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Nursing Conferences Come meet the National Cannabis Nurses at these future Events!
2016
June Conferences NCIA presents the 3rd Annual Cannabis Business Summit & Expo Pre-Summit Morning Workshop: Cannabis Nurses: The Role of Nursing in the Cannabis Industry June 20-22, 2016 | Oakland, CA http://www.cannabisbusinesssummit.com
August Conferences South West Cannabis Conference + Expo (SWCCE) Nature Nurse™ Product Line Launch | National Cannabis Nurse Expert Panel August 6th & 7th, 2016 | San Diego, CA http://www.socalccexpo.com Seattle Hempfest- National Cannabis Nurses Speaker Bureau August 19th - 21st, 2016 | Seattle, WA654 http://www.hempfest.org
September Conferences Association of Pediatric Hematology/Oncology Nurses (APHON) September 29-Oct 1, 2016 | Indianapolis, IN http://www.aphon.org/meetings/confindex.cfm
October Conferences
Take Note
Cannabis Nurses Magazine 1-Year Anniversary Party Cannabis Nurses Network Workshop (4 CEU's) Sept.30th - Oct. 2nd, 2016 | Las Vegas, NV www.CannabisNursesMagazine.com
!
November Conferences Marijuana for Medical Professionals National Cannabis Nurses Expert Panel CME Certified Conference on Canabis Medicine November 14th - 16th, 2016 | Denver, CO http://www.marijuanaformedicalprofessionals.com If you know of other Conferences available that are based on Cannabis Therapeutics that you wish to be listed in future issues please email us at: editor@cannabisnursesmagazine.com
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