Why do Ukrainians need medical cannabis? German professor on the effect of drugs on PTSD

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Recently, representatives of the Dutch non-governmental organization Drugs Peace Institute approached the charity fund “Patients of Ukraine” with the question of whether Ukrainian patients have sufficient access to painkillers and drugs against PTSD. Our European colleagues understand well that in the conditions in which Ukraine found itself, patients absolutely need the maximum range of all drugs available in the world. It was not easy for us to answer this request. The fact is that one of the important substances on the basis of which medicines are produced in Europe for seriously ill patients or those with PTSD – i.e. medicines based on medical cannabis – is not available in Ukraine. Because such drugs are prohibited. The “Patients of Ukraine” Foundation has been fighting for the adoption of the law on medical cannabis for 6 years, and all our efforts are in vain. Every 6 years, about 2 million patients who have serious chronic diseases (oncological diseases, epilepsy, Parkinson’s or Alzheimer’s diseases, as well as other rare diseases) have completely legal access to heavy opiates. As for medical cannabis, which does not even affect a person’s consciousness – no. Seriously ill children with epilepsy and cerebral palsy who suffer from muscle spasticity are prescribed, in fact, hard drugs, absolutely legally, and drugs based on medical cannabis, which does not cause either addiction or any health consequences for children, are not appoint Because medical cannabis is prohibited in our country. At that time, back in 2019, the European Parliament adopted Resolution 2018/2775 (RSP) of February 13, which calls on the governments of the member states of the European Union to ensure the availability of medicines based on medical cannabis (through import or own production, subject to compliance with domestic conditions and standards ). To say that our colleagues from the Netherlands were surprised is an understatement. How can you not have access to important medicines at such times? The news of this spread quickly throughout the medical community of Europe, and colleagues of the world-famous researcher of the medical properties of cannabis Franjo Grotengerman came to us. Franjo Grotengerman is a legend of European science. Born in the mid-1950s, he studied medicine at the University of Cologne and received his doctorate in medicine with honors in 1996. He also worked as a doctor until 1992, when he developed microangiopathy and microcirculation disorder (leading to problems with the cardiovascular system, heart and orthostasis). Grotengerman’s disease completely confined him to bed, and for many years the professor has needed the help of outsiders. But this did not stop his active scientific activity. He speaks a lot, gives lectures and interviews, works in his own practice in Steinheim with an emphasis on the therapy of serious diseases with cannabis and cannabinoids. In addition, he is a researcher at Nova-Institut GmbH in the department of renewable raw materials, where he also works on medicinal cannabis. Last year, he became the subject of a documentary called The Doctor, which chronicles his prominent role in the acceptance of medical cannabis by the medical community around the world. On June 22, Professor Grotengerman sent a letter to our organization regarding the use of medical cannabis in the treatment of post-traumatic stress disorder in patients. In the accompanying note to his letter to us, he wrote: “I have many patients in my practice who are treated with cannabis for PTSD. And they have better sleep and fewer or no nightmares.” We publish Mr. Grotengerman’s letter in an abbreviated form. You can read the full content and a list of studies that the professor relies on at the link. WARNING! The letter contains a lot of special scientific terms, so we have omitted some of them, while adding some explanations to make it easier for readers. Professor Grotengerman talks about the positive effects not only of medical cannabis on people with PTSD, but also of recreational cannabis in cases where people are forced to use it because they do not have access to medication. However, it is worth noting that the BF “Patients of Ukraine” together with many activists and people’s deputies are in favor of the legalization of exclusively cannabis-based medicinal products, which must be dispensed according to a doctor’s prescription and whose circulation must be strictly controlled. LETTER FROM FRANDO GROTENGERMANN Basic research in the field of medical cannabis Let’s start with the theory. Together with the human body’s own cannabinoids – so-called endocannabinoids, as well as enzymes for the formation and destruction of endocannabinoids – cannabinoid receptors form the human endocannabinoid system. Endocannabinoids are found in all organs of the human body and perform many functions in the body, including stress regulation. The best-studied endocannabinoids are anandamide (arachidonoylethanolamide) and 2-AG (arachidonoylglycerol). In total, about 200 endocannabinoid-like substances have been identified in the human body today. As recently as 2003, according to an article in the journal Nature, a research group led by Prof. Zieglgensberger of the Max Planck Institute for Psychiatry in Munich was able to demonstrate that the endogenous cannabinoid system plays a central role in the erasure of unpleasant memories in humans and animals (Marsiano et al., 2003 ). Thus, transgenic mice lacking brain cannabinoid receptors (CB1) and mice treated with a CB1 receptor antagonist showed significantly impaired fear extinction during experiments. The team of scientists found that the amygdala (the area of ​​the brain responsible for storing memory and fear) was filled with endocannabinoids when the mice gradually forgot the learned shock response. Clinical Studies Some clinical studies show that the use of tetrahydrocannabinol or cannabis provides significant relief in patients with post-traumatic stress disorder. We present a selection of some studies without pretending to be exhaustive. Thus, THC significantly improves the symptoms of post-traumatic stress disorder. This is the result of an open study from the Hebrew University in Jerusalem (Israel) (Roitman et al., 2014). The study evaluated the tolerability and safety of oral THC in chronic PTSD. 10 patients on stable treatment received 5 mg of THC twice daily as an adjunctive treatment. 3 patients had mild side effects, none of which led to treatment discontinuation. Treatment produced statistically significant improvements in overall symptom severity, sleep quality, nightmare frequency, and hyperarousal symptoms. According to another study, in 150 patients suffering from PTSD, the use of THC led to a reduction in symptoms after one year compared to those who did not use cannabis (Bonn-Miller et al., 2020). The study was conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, USA, and was published in Cannabis and Cannabinoid Research. This study examined PTSD symptoms and functioning in two samples of participants diagnosed with PTSD: individuals with PTSD who used cannabis, individuals with PTSD who did not use cannabis. At one year, cannabis users reported a significant reduction in PTSD symptom severity compared to non-cannabis users. Also, according to a placebo-controlled study involving 71 patients, THC reduced the reactivity of the brain’s amygdala (Rabinak et al., 2020). The study was conducted by scientists from Wayne State University in Detroit, USA, and was published in the journal Psychopharmacology. 3 groups of adults were formed: 25 healthy controls who did not experience trauma 27 adults without PTSD who experienced trauma 19 adults with PTSD who experienced trauma. They received either THC or a placebo. In adults with PTSD, THC reduced threat-related amygdala reactivity and demonstrated other functional markers of threat resilience in brain activity. The authors concluded that these “may prove useful as a pharmacological approach to the treatment of stress- and trauma-related psychopathology.” Another study. According to data from 404 medical cannabis users from the United States who had PTSD, medical cannabis was effective in reducing symptoms by more than 50% (LaFrance et al., 2020). The data comes from a mobile app that patients use to track changes in symptoms across different strains and doses of cannabis. Participants used the app 11,797 times over a 31-month period to assess symptoms (obsessions, flashbacks, irritability, and/or anxiety) immediately before and after admission. All symptoms decreased by more than 50% immediately after taking the drug. Over time, even greater reductions in obsessions and irritability were observed, with later sessions of cannabis use predicting greater symptom relief than earlier sessions. Conclusions Modern scientific data on the effectiveness of cannabis-based drugs for the treatment of PTSD indicate the following: the endocannabinoid system of the human body plays an important role in forgetting and erasing unpleasant memories; the endocannabinoid system is hypoactive (that is, it reduces its activity – ed.) in PTSD. This reduction in activity makes people with PTSD less resilient to stressors; increasing the level of endocannabinoids alleviates anxiety in experimentally stressed rats; initial research suggests that cannabis therapy may alleviate PTSD symptoms; the current scientific evidence base is quite sufficient to meet the requirements of § 31 (6) SGB V (Sozialgesetzbuch or SGB V – is the social insurance code, part V, on compulsory health insurance – ed.) for marked relief of PTSD symptoms with medication based on cannabis. (In other words, the European medical system is already studying the process of reimbursing patients for cannabis-based drugs through mandatory health insurance – ed.). To our knowledge, THC is the first pharmacological substance that can affect the symptoms of PTSD, helping patients to largely erase unpleasant experiences from their consciousness by affecting certain areas of the brain to reduce nightmares and flashbacks. So far, no other drug has been able to do this. Inna Ivanenko, executive director of BF “Patients of Ukraine”, specially for UP. Life Publications in the “View” section are not editorial articles and reflect exclusively the author’s point of view.

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