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Category: Qualifying Conditions

Qualifying Condition: Posttraumatic Stress Disorder

Posttraumatic stress disorder is the most recent addition to the list of qualifying conditions for the New Jersey Medical Marijuana Program. PTSD is an anxiety disorder that is triggered by an extremely disturbing or mentally stressful event. This disorder can develop after a person witnessed or experienced a traumatic event that includes a threat of harm or actual physical harm. Traumatic events that can cause PTSD include sexual or physical assault, an unexpected death, an accident, war or natural disasters. Many people who experience traumatic events will have reactions such as anger, fear, guilt, nervousness and shock. For most people, these feelings will decrease and go away over time. However, those who have PTSD will experience these effects, possibly in an increasing manner, for longer than one month. As a result of experiencing these prolonged effects, patients with PTSD see a decreased quality of life compared to before the event.
 
 

“A study of Medical Marijuana patients in New Mexico
found more than a 75 percent reduction in the Clinician Administered Posttraumatic Scale symptom scores
when the patients
were using cannabis compared
to when they were not….”

 
 
The symptoms of PTSD are grouped into four categories. First, reliving is when patients relive the thoughts and memories of the trauma. This category can include flashbacks, hallucinations and nightmares that can occur out of nowhere or when triggered by a reminder such as an anniversary date of the event. Second, avoiding is when patients avoid people, places or situations that remind them of the trauma. Avoidance can lead to detachment or isolation from loved ones, as well as a loss of interest in activates that one used to enjoy. Third, increased arousal includes patients having excessive emotions, problems feeling or showing emotions, difficulty sleeping or concentrating, irritability, bursts of anger and being jumpy. Lastly, patients may experience negative cognitions and moods, referring to thoughts and feelings of blame, estrangement and memories of the traumatic event.

PTSD is often treated with antidepressant medications, which may carry detrimental side effects, or different forms of psychotherapy. Our patients have reported many positive effects using indica dominant strains such as Blackberry Kush and Hindu Kush for PTSD, and a study of Medical Marijuana patients in New Mexico found more than a 75 percent reduction in the Clinician Administered Posttraumatic Scale symptom scores when the patients were using cannabis compared to when they were not.

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Scientific Focus: The Endocannabinoid System

Did you know that you have an endocannabinoid system?


The endocannabinoid system was initially discovered in the late 1980s when scientist studied how THC and other cannabinoids interact. Cannabis can function efficiently in mammal’s due to a series of receptors in the pathways of the brain called the endocannabinoid system (ECS).

 

Cannabinoids bind with the endocannabinoid
receptors, creating medical effects
by suppressing signals
such as pain, nausea and depression
while boosting appetite and euphoria.

 

It was discovered that humans are designed to interact with cannabinoids through the ECS which consist of CB1 and CB2 receptors. Cannabinoids and terpenes are delivered to the bloodstream either through the lungs (when inhaled), the digestive system (when consumed) or the skin (when applied topically). From the blood stream, cannabinoids become available to the central nervous system through the CB1 receptors and the immune system through CB2 receptors.

These receptors influence the flow of chemical signals to the brain and digestive system. Cannabinoids bind with the endocannabinoid receptors, creating medical effects by suppressing signals such as pain, nausea and depression while boosting appetite and euphoria. Cannabis use effects the neurotransmitter GABA by blocking it. The result is increasing dopamine levels which GABA normally inhibits or regulates. Dopamine offers a mood shift of reward for the brain that is released with sex, exercise, appetite, learning, sleep, movement and mood.

 
Cannabis effects the cannabinoid receptors, namely CB1 and CB2 that mimic a naturally created endogenous molecule, anandamide. Anandamide is an Omega 6 fatty acid that regulates appetite, cognition, emotion, memory, mood and pain. Delta-9-tetrahydrocannabinol (THC) and other cannabinoids found in cannabis can affect anandamide and therefore effect the endocannabinoid central nervous system.

 
The most exciting and promising lines of research into the role of the endocannabinoid system is in the regulation of inflammation and the immune system. Clinical evidence has shown the effectiveness of endocannabinoids on treating epilepsy, multiple sclerosis, muscle spasms and other neuromuscular system disorders.

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Approval of New Qualifying Conditions Still Pending

In early May, the Medicinal Marijuana Review panel voted 5-1 to approve new qualifying conditions including different types of chronic pain, Tourette’s syndrome, Irritable Bowel Syndrome and anxiety related to Autism or Alzheimer’s disease. The board voted against recommending medical cannabis for treating asthma and chronic fatigue.  Although the board has voted to approve these conditions, after a 60 day period and another public hearing, the decision to add the conditions comes down to Health Commissioner Cathleen Bennett who was appointed by Gov. Chris Christie. The program’s already limited list restricts those who suffer from chronic pain to qualify if it’s a result of cancer or HIV/AIDS, even though many patients in the program experience chronic pain as a symptom of their qualifying condition.

The New Jersey Medical Marijuana Program has been criticized for being too restrictive, but its recent growth has been attributed to a series of small changes.

Ken Wolski, executive director of the Coalition of Medical Marijuana New Jersey, told the Philadelphia Inquirer that the approval of chronic pain could potentially allow 150,000 chronic pain suffers to join the New Jersey’s Medical Marijuana Program. According to the health department there are currently 11,659 patients enrolled in New Jersey’s Medical Marijuana Program. Upon the addition of chronic pain, regulatory adjustments may be necessary for ATCs to successfully supply the oncoming surge of patients.

 

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Qualifying Condition Focus: Crohn’s Disease and Colitis

This month we are highlighting Crohn’s disease and Colitis, which are classified as Inflammatory Bowel Diseases and listed as a qualifying condition for the New Jersey Medical Marijuana Program.

There is no “cures” for Crohn’s disease or Colitis, and most treatments are aimed to ease inflammation, prevent flare-ups and keep patients in remission. Considering that patients may have to take medicine constantly to keep these conditions under control, medical cannabis may be a viable, less harmful alternative medicine for their symptoms.

Crohn’s Disease and Colitis are Inflammatory Bowel Diseases that are defined by parts of the digestive system becoming swollen and having deep sores known as ulcers. Crohn’s Disease is usually apparent in the end of the small intestine and the beginning of the large intestine, but it has been found in other places along the digestive tract. Colitis, on the other hand, often only affects the colon and the rectum.
The direct cause of Crohn’s Disease and Colitis is unknown. It is thought that people may develop Crohn’s Disease or Colitis when their body has an abnormal response to the bacteria in their intestines, or other bacteria and viruses may play a role in causing the disease. The diseases may also be hereditary.

CSATC carries multiple strains that patients say have positive effects in treating gastrointestinal issues. For example, ACDC, Blue Dream and Willy Jack tend to be patient favorites for helping these issues.

Typically strains with higher CBG help regulate the digestive tract.

The symptoms of Crohn’s Disease and Colitis are stomach pain, diarrhea and weight loss. Some patients may experience diarrhea 10 to 20 times a day, sometimes with blood in their stool. Other less common symptoms of Crohn’s disease include mouth sores, bowel blockages, fissures (anal tears) and openings (fistulas) between organs.

Some of the more recent research on medical cannabis use for Inflammatory Bowel Diseases is promising. A study published in 2011 in the Israel Medical Association Journal focused on 30 patients who had not responded to standard treatments.  Twenty-one of the patients said their overall well-being improved with cannabis use, and the need for other medication was significantly reduced.

Studies have suggested that THC administration was associated with delayed gastric emptying of a standard solid and liquid meal. A second study by the same group demonstrated that THC was associated with relaxation of the colon and inhibition of the increase in tone after a meal.

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Seizures and Epilepsy

Epilepsy Graphic

This month we are highlighting Seizure disorders including Epilepsy, which is on the list of qualifying conditions for the New Jersey Medical Marijuana Program. Considering that 20-30 percent of epileptics are not adequately controlled with conventional medicine, more patients and physicians should be aware of the use of medical cannabis and these disorders.

The general term seizure disorder is used to describe any condition of which seizures are symptoms. Seizures are described as abnormal movements or behaviors due to unusual electrical activity in the brain. Brain cells communicate through electrical signals. When the electrical signals become abnormal it produces a sort of “electrical storm” causing a seizure. On the other hand, Pseudoseizures or non-epileptic seizures, which are not caused by abnormal electrical signals in the brain, are thought to be caused by physiological issues or stress.

Unfortunately, many cases of epilepsy can’t pinpoint a specific cause. Some of the more common causes of epilepsy include low oxygen during birth, head injuries, genetic conditions such as tuberous sclerosis, infections such as meningitis or encephalitis, stroke or other damage to the brain and abnormal levels such as sodium or blood sugar. There are various types of epilepsy; Generalized tonic-clonic seizures are when the person falls to the ground and the person’s muscles will begin to convulse (jerking or spasm); Absence seizures are when a person unknowingly stares into space for a few seconds and then “wakes up”; and Myoclonic seizures are known to make a person’s body jerk like it is being shocked.

Scientific studies show anecdotal but reproducible findings that cannabis has anticonvulsant properties and would be effective in treating partial epilepsies and generalized tonicocolonic seizures.

In a review  of the effects of cannabinoids, it stated that CBD and THCV have been suggested to exert antiepileptic actions in experimental studies.

A double-blind clinical study  of 18 patients suffering from secondary genralized epilepsy that was inadequately controlled by conventional medicine, showed promising results. Of the eight patients who received doses of cannabidiol, four were convulsion-free during the study and three other showed a clinical improvement.

 

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Qualifying Condition: Intractable Skeletal Muscular Spasticity

Muscle-Postier

Among the 14 qualifying conditions that allow New Jersey residents to register for the Medical Marijuana Program is Intractable Skeletal Muscular Spasticity.

Spasticity is caused by an imbalance of signals from the central nervous system to the muscles. This neurological condition is most often related to disorders like multiple sclerosis, cerebral palsy, traumatic brain injury, stroke, spinal injury and other conditions that harm parts of the nervous system.

This disorder presents symptoms mostly in skeletal muscles including involuntary overactive reflexes and movements, which may include spasms (brisk and/or sustained involuntary muscle contraction) and clonus (series of fast involuntary contractions), increased muscle tone, muscle stiffness and the inability to stretch the affected muscles.

 

In one of the largest studies conducted regarding cannabinoids and the treatment of spasticity, it showed evidence of improvements regarding patient-reported spasticity and pain, suggesting the
clinical usefulness of cannabinoids.

Other symptoms include contractures (a state of permanent contraction of a muscle /tendon due to severe and repetitive stiffness and spasms), decreased functional abilities, difficulty with care or hygiene, bone and joint deformities, abnormal posture and pain.

The pain a patient can experience from this condition can range from mildly stiff muscles to painful spasms in extremities, particularly one’s legs. Pain may also be present in a patient’s lower back or as pain or tightness around their joints.

In one of the largest studies conducted regarding cannabinoids and the treatment of spasticity, it showed evidence of improvements regarding patient-reported spasticity and pain, suggesting the clinical usefulness of cannabinoids.

According to MarijuanaDoctors.com, an Oxford study corroborated that medical cannabis could decrease muscle spasticity and pain. Other notable findings in the study were that the side effects of cannabis-based medicine had been predictable and tolerable, and the loss of bladder control was alleviated by cannabis extracts.

Similar findings were found in a review of multiple studies, which stated that a wealth of anecdotal studies show that cannabis and cannabinoids have “beneficial effects on disease-related pain, bladder symptoms, tremor and particularly spasticity, but until recently, little scientific evidence existed for their efficacy.”

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March is Multiple Sclerosis Awareness Month

ms-robbon-blue-orangeIn light of Multiple Sclerosis Awareness Month, we want raise awareness about the scientific evidence showing cannabis as a palliative treatment for Multiple Sclerosis.

Multiple Sclerosis [MS], as we know it, is an autoimmune disease that results in the slowing of the speed of signals sent from the central nervous system to the peripheral nervous system and can even result in irreversible damage to the nerves in the central nervous system that were once protected by the myelin sheath. This condition can leave a patient suffering from a wide range of symptoms including fatigue, depression, weakness, spasms, spasticity, pain, sleep disturbances and more.

One of the largest studies on the effect of medical cannabis on patients with MS stated that patients who used Tetrahydrocannabinol reported improvements in pain, sleep quality, spasms and spasticity.

There is even evidence that suggests that cannabinoids may have immunomodulatory effects, and have therapeutic benefits in treating MS. 1

Current studies show that patients who perceive initial benefits from their cannabis medication experienced persisting positive effects into extended trials without tolerance.[1]

Of a small group of MS patients who participated in an abrupt interruption of their cannabis medication, there was no consistent withdrawal symptoms and five patients had to resume taking their medication due to reemergence of symptoms.

Symptomatic medications often do not provide adequate relief and may have toxic effects that can worsen a patient’s already diminished quality of life.1 These effects can be weighed in comparison to cannabis’s relatively limited side effects.

For more information on research studies relating to cannabis click here.

 

[1] Hazekamp, Arno, and Franjo Grotenhermen. “Review on Clinical Studies with Cannabis and Cannabinoids 2005-2009.” 5.Special Issue (2010): 1-21. Print.
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