Itchy? Medical Marijuana Can Help With Cases Both Severe And Minimal

Pruritus is a medical/show-off way of saying “itchy.” Obviously, it has many causes, such as dry skin, allergies, or woolen undergarments. But itching is also a symptom of much more serious conditions, including liver disease and kidney failure. It’s also one of the common miseries that accompany chemotherapy.

While pruritus is not life threatening, anyone who’s suffered through, say, a case of chickenpox or poison oak knows that chronic itching is a genuine torment. A case study of three patients with chronic pruritus caused by liver disease describes them initially as suffering from “significant decreases in their quality of life, including lack of sleep, depression, inability to work, and suicidal ideations.” Been there; done that.

Happily for this trio, 5mg per day of THC at bedtime resolved the itch, and all of them were able to return to work. (One did remain depressed, however; maybe it was work that was the problem, or, you know, having a potentially fatal liver disease.)

These results are matched by lots of evidence, both anecdotal and clinical, from MS and chemotherapy patients.

At the level of basic science, a consensus seems to be emerging: Cannabinoids just might be good for itch. A 2009 overview of new research into endocannabinoid system and skin skin health wrote: “The ECS has a crucial role in central and peripheral processing, and in the control of such skin-derived sensory phenomena as pain and itch.”

This conclusion was based on a solid body of research suggesting that blocking the cannabinoid receptors induces itching in lab mice. (It’s a super complex topic, but a 2011 report gives a good overview of the research as well as more-or-less comprehensible introduction to recent revisions in how biologists understand and differentiate pain and itch.)

What about itching caused by plain old dry skin? There might even be evidence that cannabis topicals can help with that. But at this point we’re veering dangerously close to the realm of cosmetics and natural remedies—and we at RX are far too snobby to engage with any of that.

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Can Medical Marijuana Cure My Fear Of Public Speaking?

Toking out in the green room might not make you better at speaking in public, but it will make you a more courageous one.

That’s the result of a 2011 study published in Neuralpsychopharmacology (my favorite nonosyllabic word). In an experiment sublime in both its simplicity and cruelty, a team of researchers from the University of Sao Paulo tested two sets of nervous speakers by dosing one with CBD, one of the active ingredients in marijuana, and giving the other a placebo. They then instructed the subjects to compose a four minute speech (on the scintillating topic of public transportation), which would be videotaped. Both were compared against a group of un-nervous speakers, a so-called healthy cohort.

The researchers were genuinely undecided going into the experiment, noting in the report that “the relationship of cannabis with anxiety is paradoxical.” On one hand, many cannabis users smoke specifically to manage their anxiety. But on the other hand, intense panic attacks are some of the most common of marijuana’s undesirable side effects.

The results, however, were unambiguous: The phobic speakers who had taken CBD felt less anxious and uncomfortable than their un-dosed peers. Their thinking was less impaired and they also felt less dread anticipating their performance. In fact, there was no appreciable difference between them and the healthy control group.

On the downside, the CBD cohort all delivered variations of the same talk, exhorting listeners to examine their hands—really examine their hands.

OK, that was a cheap joke. And an incorrect one too, because it’s not CBD, but the intoxicating THC that’s the cannabinoid responsible for stoney logic. But there was at least one nonfictional cause for possible concern in the trial: CBD “almost abolished” negative self-evaluation.

While it’s true that negative feelings perpetuate anxiety, it’s also true that negative self-evaluations are what drive us to improve. What’s missing from the study is whether the speakers’ self-satisfaction was warranted. In this age of TED-talk proliferation, the last thing we need is another influx of supremely confident speakers who actually have nothing to say.

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What The Heck Is Trichotillomania And Can Cannabis Help?

Trichotillomania is an irresistible urge to to pull out one’s hair, usually from the scalp, eyebrows, and eyelashes. It is an impulse control disorder related to obsessive compulsive disease that can leave patients with patchy bald spots — which can be a source of embarrassment that, of course, leads to even more compulsive pulling.

Some people pull their hair with great focus and determination, often as a means of controlling or dissipating anxiety, while others simply pluck in a desultory, unselfconscious way. People with trichotillomania may also be inclined to skin picking (excoriation) or nail biting (onychophagy).

Like most psychological conditions, trichotillomania arises from a complex combination of genetic and environmental factors.

Like most psychological conditions, trichotillomania arises from a complex combination of genetic and environmental factors. It’s possible that cannabis can help at both ends.

To the degree that marijuana can ease anxiety, it can give relief to sufferers of trichotillomania. But it’s not an absolute good: Anecdotally, casual hair pullers can lose track of time while high and end up on hours’ long plucking jags. On the other hand, as we know (just guessing!), weed can also temporarily induce paranoia, and that can also intensify hair pulling.

When it comes to neurochemistry, there is some evidence suggesting that trichotillomania is linked with the overproduction of the neurotransmitter glutamate—and THC can have a moderating affect there. A study from 2011 found that THC “demonstrated statistically significant reductions in trichotillomania symptoms, in the absence of negative cognitive effects.”

If you want to know more about trichtillomania, this review of the medical literature is a good place to start.

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Is It Okay That I Smoke To Mellow Out Before Social Events?

“Shyness is nice, and
Shyness can stop you
From doing all the things in life
You’d like to.”

Right again, Morrissey. Millions of us suffer from debilitating shyness. The medical term is general social anxiety disorder, or SAD, and, by some reckoning, it’s the third most common psychological ailment, affecting about 7 percent of people globally. It’s also extremely well represented among cannabis users. Anywhere from almost a third to almost half of people who ever use marijuana also meet the criteria for SAD at some point.

SAD is essentially our fight-or-flight response run amok, until the act of mingling with strangers over cocktails and snacks feels as existentially threatening as facing down a ravenous sabertooth cat on an empty savannah.

Medication can lessen the symptoms, but the preferred treatment is cognitive-behavioral therapy, which focuses on training the mind to react differently to stressful situations. It may even include desensitization exercises, in which patients deliberately seek out stressful situations to confront.

This is obviously as scary as hell. It’s also a slow and potentially expensive process. That’s why many sufferers of SAD prefer to bolster themselves with a dose of “Dutch courage,” taking the edge off their anxiety with a nip of alcohol or a toke of marijuana.

Dr. Julia D. Buckner of Luisiana State University has made a career out of studying the links between extreme social anxiety and self-medication with cannabis. In the last decade or so she has coauthored at least half a dozen papers on the subject. It might seem much ado to prove something we all intuit is true, but she’s managed to put a number to it: Socially anxious people are 6.5 times more likely to be dependent on cannabis than their socially confident peers. They are also 4.5 more likely to use alcohol the same way. What’s particularly interesting, though, is that they are no more likely to abuse either drug than the general public does. In other words, anxious people find the dosage that works for them and they maintain it.

Brain scans show that cannabis is active in regions that process fear and anxiety, but our understanding is still rudimentary. In fact, in its 2015 review of medical cannabis studies, JAMA found only one specifically addressing SAD that met its criteria. The results were favorable, although the study itself was determined to have a “high risk of bias.”

Whether or not cannabis is a medically sound treatment, many thousands of socially anxious individuals currently look to it for relief.

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Bad Childhood: Can Marijuana Help Me Cope With Traumatic Memories?

Frank Sinatra: Why do you drink so much?
Dean Martin: I drink to forget.
Sinatra: Forget what?
Martin: I don’t know. I forgot that a long time ago.

The quest for an elixir that can relieve us of the burden of memory from a bad childhood and more is a longstanding one. Delivered at the swinging-60s crest of the Rat Pack era, when high-functioning alcoholism was regarded more as an aspirational lifestyle than a debilitating disease, Frankie and Dino’s exchange suggested one possible answer. But the promise of booze as a soothing balm of forgetfulness is mostly a delusion. Alcohol works with what you give it: If you are fixated and depressed when you start drinking, odds are you’ll just end up a fixated, depressed drunk.

Of course, it’s true that if you drink enough, you’ll black out. But that’s not forgetting, more like targeted oblivion.

Marijuana, on the other hand, has been shown to play a role in producing, sustaining, and—most important here—dulling traumatic memories. The science is still in its infancy, but it offers great promise for helping people anxiety disorders, like post traumatic stress.

Anecdotally, there’s been plenty of evidence that cannabis helps ease the symptoms of PTSD. But it wasn’t quantified until 2014. That’s when a study conducted in New Mexico on PTSD sufferers reported that cannabis use reduced symptoms by an average of 75 percent. The study itself acknowledges that this figure might be exaggerated, but, even accounting for bias, it’s an impressive result.

Another study from 2014 may provide a neurological explanation for this mitigation. [Trigger warning: contains scenes of rat-directed sadism.]

Researchers at the University of Haifa attempted to induce PTSD in lab rats, first by shocking their tiny, pink feet and then by following up on ensuring days with “trauma reminders”—which are probably not something that makes a pleasant ping! as it flashes a text box across your smartphone screen. Predictably, the distressed rodents began to exhibit classic PTSD symptoms, including jumpiness, avoidance, “impaired plasticity” in the brain’s reward center, and a tendency to hang out by the methadone clinic with a dude named Rico.

Here’s the interesting point: Similarly traumatized rats that were injected with synthetic cannabinoids did not present these symptoms. In fact, these rats responded even better than a control group that was given  Zoloft, an antidepressant often prescribed for PTSD. And it wasn’t just because they were too high to care. Something in the cannabinoids actually prevented their brains from altering in response the repeated stress. In other words, the rats remembered the trauma; it just didn’t fuck them up.

Recently, researchers from the University of Colorado have cleared the last regulatory hurdle for what will be to date the most comprehensive—and, at $2 million, the most well-funded—clinical trial of cannabis on PTSD.  There’s every reason for optimism. But we’ll have to curb our enthusiasm: The results are not expected until 2019.

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How Weed Helps Burning Mouth Syndrome

Burning mouth syndrome—known, to the fifteen to twenty people who’ve ever heard of it, as BMS—is a mysterious oral condition with no known cause and no known cure.

In fact, the International Association for the Study of Pain defines BMS as “chronic oral mucosal pain or discomfort that has no identifiable causative lesions and is not caused by any other condition or disease,” which literally means that, if your mouth hurts and nobody can tell why, then you’ve got BMS. It’s just that mysterious.

Sufferers from BMS say it feels like a scald from hot food, and that it is sometimes accompanied by a sour, bitter, or metallic taste as well as, not surprisingly, a loss of enjoyment in food.

BMS afflicts women over men by an overwhelming seven to one, and it has a particular fondness for those nearing or just past menopause.

BMS favors women over men by an overwhelming seven to one, and it has a particular fondness for those nearing or just past menopause. (So, yes, ladies, one more damned thing to worry about). Furthermore, contributing factors include not-so-easily quantifiable conditions, such as mood disorders (like depression and anxiety) and adverse life events (like the loss of a job or a death in the family), as well as fibromyalgia and chronic fatigue syndrome—which means that BMS is another painful, chronic condition that absolutely no one close to you will take seriously.

There may be one upside, however: weed.

A 2014 study from the University of Brescia, Italy (where they take dining-inhibiting disorders extremely seriously), recounts how researchers biopsied tongue samples from eight women suffering from BMS and discovered decreased numbers of CB1 cannabinoid receptors and increased numbers of CB2.

What does this mean? No one knows yet—although it could be the first step in establishing specific markers for BMS (besides its simply “not being anything else”).

But does this mean that people with BMP should try marijuana? We don’t need to be a doctor to answer this one: If your mouth hurts, and you’re retired, and maybe you’re a little depressed or anxious—smoke dope. Smoke dope, and have a big, icy martini. You’ve earned it. It won’t cure your BMS, but it’ll probably make you feel a lot better.

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Can Pot Brownies Guard Against Getting Diabetes?

You might intuitively think that eating tons of sugar can’t be good for you and may even lead to developing diabetes. But au contraire. In fact, pot brownies may even guard against it.

How’s that, now?

Regular marijuana users don’t seem to lead necessarily to the munchies, but smoking pot will always give them an urge to snack. That’s one of the reasons why cannabis works so well helping AIDS and chemo patients put back on lost pounds. And yet there is an anomaly: While regular marijuana users tend to have a higher calorie intake than nonusers (the munchies effect), they also have lower body mass index as well as lower rates of obesity and diabetes.

A 2013 study took a closer look at that paradox and found evidence suggesting that regular cannabis use may stabilize blood sugar and ward off diabetes. Compared with nonusers, the cannabis achievers had on average 16 percent lower fasting insulin levels and 17 percent less resistance to insulin. Higher levels of both are associated with adult onset diabetes, which is itself associated with obesity. Moreover, users were an inch and a half slenderer than nonusers and had higher levels of high-density lipoprotein (that’s the “good” cholesterol that protects you from heart disease).

The results of the study were clear (“Bite it, abstainers!”), but the explanation still is not. One avenue of speculation focuses on neurological tolerance. While regular users might never habituate to the munchies, receptors in the brain become less responsive to other signals from cannabis, including the ones that tell the body to fatten up. There was, in fact, a weight-loss drug that acted precisely on this idea, by offsetting the body’s natural cannabinoids. (It worked but was pulled from the market because it made users want to kill themselves.)

If we understand this interpretation of the evidence correctly, it means that regular cannabis use protects you from diabetes by simulating the way your brain works without cannabis. Which is a seriously heavy head-trip. Perhaps this calls for a meditational marijuana brownie.

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How Medical Marijuana Can Calm OCD

Obsessive compulsive disorder (OCD) is a mental health disorder that traps people in cycles of unwanted thoughts or actions that can feel damned near unbreakable. We all have sudden eruptions of nagging doubt—did I lock the door? Is my zipper up? Did that oyster I ate smell funny to you?—but, for someone with OCD, these thoughts open a rabbit hole of escalating urgency and ritualized, repetitive behaviors.

Kind of sounds like the paranoia that can sometimes creep up on you when you’ve gone one toke over the line. And maybe that’s no mistake.

A growing body of research suggests that cannabinoids may have a role in OCD. What’s less clear is whether that role is helpful or hurtful.

Ever find yourself driving, lost in thought, only to realize you’re now turning into your driveway, with no recollection how you got there? That was the habit-forming part of your mind taking over, allowing you to do, without any conscious direction, an activity ingrained through long-term repetition.

And that’s distinct from the part of your mind that was in control when you set out earlier that evening to search out the new gastropub that opened in what’s still the most dangerous part of town. (The hand-sourced sycamore-sap and absinthe shrub was sheer poetry!)

Every day our brains transition countless times between habitual behaviors and goal-directed behaviors, and most of us are never even aware of it. In people who suffer from obsessive-compulsive disorder (OCD), however, that transition is a fraught one. and unwanted habits intrude uncontrollably.

A new study on mice appearing in the July 2016 issue of Neuron and funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that the endocannabinoid system helps regulate that transition between habitual and intentional action.

The mice were trained to get food in two different ways: one through habit and the other through novel, goal-directed action. When researchers blocked CB1 receptors (the “CB,” of course, stands for “cannabinoid”) in the brain, the mice were unable to form new habits. Instead, they searched for food only through directed action.

The report’s first author, Dr. Christina Gremel of the University of California, San Diego, summarizes the findings: “Our results suggest that alterations in the brain’s endocannabinoid system could be blocking the brain’s capacity to ‘break habits’ as observed in disorders that affect switching between goal-directed and habitual behaviors.” In other words, overactive CB1 receptors may may make it more difficult for OCD patients to break cycles of compulsive behavior.

However, this new report conflicts with earlier data on cannabis and OCD—sort of.

CB1 receptors are what respond to the presence of THC, the intoxicating element in cannabis. Parallel to them are the network of CB2 receptors, which respond to another cannabinoid, CBD. Two studies, from 2010 and 2013, found that CBD actually lowered compulsive activity in lab mice.

That’s not the first time THC and CBD have been found to work at seemingly cross purposes. And it’s another indicator that, when it comes to medical efficacy, whole-plant cannabis might have to step aside for specialized synthetics.

Romanticism, alas, does not always win.

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