Ecstasy and mushrooms are being used by the medical and psychiatric community to help heal depression, anxiety, and PTSD. Both these substances have recently been approved for further studies of their ability, with highly trained support in a controlled setting with active therapy, to help patients who have not found relief elsewhere.
A story in the New York Times today discusses the use of psilocybin, also known as magic mushrooms, in patient’s whose cancer brought them to a desperate place of depression and anxiety. While the researchers are not clear on how this drug works exactly, the trials thus far show it is effective, and after only one dose when administered in a controlled setting by psychiatrist and a social worker in a session lasting 8 hours. There were two small studies and both reported success with patients in whom traditional treatment had not led to improvement. There are also studies being done to look at its role in addiction treatment and non-cancer depression.
A story linked to in this same article discusses the use of ecstacy, or Molly/MDMA, in treating PTSD (post traumatic stress disorder). We think of this in soldiers who have returned from war, but it occurs in civilians with the same triggers- either a single traumatic event or repeated traumas like abuse. It seems that while the brain is under the influence of this medication, it can finally confront the trauma that caused the condition and this trauma can be dealt with during a therapy session much like the one used in the psilocybin trials. The brain and body overreact in an inappropriate way to a given stimulus and can’t stop- to the point where it interrupts the person’s life. This can manifest in nightmares or panic attacks or other reactions that make daily living incredibly difficult.
While psilocybin is a natural substance, and MDMA was created in a lab, both seem to allow the patient to look at themselves and their experiences from a detached perspective and examine thoughts and emotions. Despite a number of treatment approaches including medications and psychotherapy techniques, there is none that hugely effective in treating PTSD and many other mental illnesses. The FDA is allowing these studies to proceed in hopes of offering a cure, in a relatively short course of treatment, for illness that is resistant to conventional therapies. Moving these drugs off the most restrictive DEA schedules is essential to conducting clinical trials, just like what needs to be done for marijuana (which I wrote about last week). I’m looking forward to a day when all medications that have the potential to be medically useful are allowed to be fully investigated in clinical trials.
Our November election offered good news for marijuana. Several states, including California, Nevada, Maine and Massachusetts, voted to legalize recreational marijuana, joining Colorado, Oregon, Alaska, and Washington State. Many more states have legalized marijuana for medical purposes- although the qualifying conditions vary by state. A total of 26 states, plus the District of Columbia, have approved this use and these states have been helpful for studying the effects of marijuana on patients as a group.
Overall the studies show that marijuana legalization decreases the deaths from opioid overdoses. Scientific American wrote a great article summarizing the recent studies on marijuana and opioid use. Marijuana (cannabinoids are the names of the chemical group) has been shown to decrease dependence on prescription opioid pills like Percocet and oxycontin and is a pathway for people to get off the dangerous drugs. As people become accustomed to an opiate, they require a higher dose for the same effect. Since these substances can be lethal, the dose required to relieve pain can near the lethal dose and lead to death. In 2014, 14,000 people died from unintentional overdose of prescribed opiates. Guess how many people died in 2014 from marijuana overdose? Zero, and that’s according to the DEA. Marijuana use does not lead to overdose and it is far less addictive than opiates or even alcohol or cigarettes. This is why so many states have passed legislation to legalize it. The hold up, in terms of wider use of cannabinoids in medicine, is with the DEA (Drug Enforcement Agency) which still classifies it as a drug with no medical use. With the Class I status it is difficult to procure the substance in order perform clinical trials. Since the pharmaceutical companies don’t stand to profit from marijuana there is no financial incentive for funding studies or money for lobbying the DEA. Currently, it is easiest to look backwards at data and plainly see how different symptoms or behaviors changed, how many fewer opioids were prescribed, and how many fewer people died when medical marijuana was available to patients. We are also starting to see the benefits of cannabinoids in treating not just pain or nausea, but also in helping with mental health issues as well, such as PTSD and depression. The use of cannabinoids for pain is so widespread now that the NFL is about to consider allowing their players to use cannabinoids for pain as so many ex-players have found relief from its use and have cut their opiate use.
Here in the District of Columbia, the use of medical marijuana is legal, as well as the recreational use by private citizens if it is not sold. Let’s hope the federal government allows states to keep the laws here in DC and across the nation. Let them also see the wisdom in correcting the DEA classification so that bigger studies can be performed and we can incorporate cannabinoids into everyday evidence-based practice.
While fewer people are smoking nowadays, there are still plenty of people who smoke. It may be only when they are out with friends, or with family who smokes, or when they are extra stressed. Some people can stop for years but fall back into it quickly due to a big stressor in their life. We understand. Most of us need help with healthier coping mechanisms and can develop addictive behaviors (think food, alcohol, wasting hours on Netflix, or getting grumpy with our loved ones). But nicotine is an incredibly addictive chemical and it’s a behavioral habit. For this post let’s focus on cigarettes. The New York Times this week had an article reporting on a recent study that 28.6% of cancer deaths nationally are caused by smoking tobacco in some way. The rate varies on location, with a low of 21% in Utah and a high of 38% in Kentucky. There is also a big difference rates between genders with men significantly more affected than women. What are these 12 cancers that are directly related to cigarettes? Obviously lung, mouth and throat cancers. But also stomach, colon, bladder and even a type of leukemia. This study did not include cancers due to other types of tobacco like chewing tobacco which would add many more life altering and deadly cancers. How do we get these numbers to decrease? By implementing recommended programs in each state that help people stop smoking and prevent them from ever starting in the first place. The World Health Organization recommendations come down to three basics: prohibitive cost of tobacco products, no advertising, no smoking in public, and an engaged health system.
Here in primary care we can be engaged in finding out your smoking habits and helping you quit when you’re ready. We won’t shame you- promise- but we ask if you are ready to quit or reduce smoking. This upcoming cold and flu season is a great time to quit! Most people don’t have the urge to smoke as much when they’ve got a cold so take advantage of this fact and don’t resume your usual smoking frequency. Come in and see us as you may need antibiotics for your bronchitis (smoking changes the bronchi and lungs and encourages the growth of different types of bacteria) and we can discuss medications to stop smoking at the same time. Whether you’d like some accountability while you use the patches and/or gum from the drugstore, or you’d like to try Zyban or Chantix tablets to help reduce the cravings, we are here for you. People often tell us about some creative ways they have reduced or stopped smoking. They’ve had success with a transition to e-cigarettes, or cigars/cigarillos, or water pipes, to keep up the nicotine while they transition off the physical cigarette habit and then transition off nicotine slowly. Different studies have shown varying levels of success with this type of method, but only you know the method that may work for you. We’ve also had patients who found hypnotherapy incredibly helpful in as little as one visit.
Think about the factors that make quitting difficult or that have caused you to relapse in the past. Do you have a friend or family member to encourage you on the way? What has worked to help you reduce or quit in the past? Did you know you can start on a medication while still smoking? Starting on it for a few weeks prior to a quit date can ease a lot of the anxiety that goes along with quitting. And we will meet with you and support you through the ups and downs of the process for however long it takes. There are many methods to quit or reduce smoking so come in and see us at any of our Kelly Goodman Group Locations so we can find one that will work for you!