Cannabis and Complex Neuropsychiatric Treatment

A perception persists in popular culture of cannabis primarily being taken by “stoners,” Cheech and Chong types, those among us wanting to leave the realities of life behind for a few fleeting moments or hours.

A subset of people fitting that characterization certainly exists, and yet, when used properly, cannabis is one of the safest substances to take to have that escape, that recalibration before diving back into the exigencies of daily life.

Through my experiences as a registered medical cannabis MD in New York State for more than 10 years, I’ve come to a broader understanding of our relationship to cannabis. This is not to say that cannabis, like any other substance with psychoactive properties, can’t be abused. On balance, however, in my practice and those of many of my colleagues, we have encountered a more nuanced landscape where patients, their families, and caregivers have gotten significant help in lives ravaged by an array of diseases, both physical and emotional.

Our vast endocannabinoid system (ECS), having connections in nearly every corner of our body and minds, seems to truly regulate overall homeostasis. When there is a disturbance in any bodily system, many have discovered that using cannabis can bring things back into balance. I don’t intend to claim that cannabis is a panacea, but rather to say that as a member of an increasingly large international community of cannabis practitioners and researchers, I have been involved with very gratifying shared experiences revealing how much cannabis can help with so many medical conditions.

Regarding that work and my clinical encounters, none is more personally and professionally exciting, intellectually provocative, and gratifying than the benefits I am seeing with my patients who have neuropsychiatric diseases, including neuropathy, epilepsy, migraines, Parkinson's disease, autism spectrum disorder (ASD), and Alzheimer's disease (AD).

In spite of their diverse clinical manifestations, these neuropsychiatric diseases share common features and disturbances that occur in the nervous system. They include oxidative stress, inflammation, mitochondrial dysfunction, and impaired calcium homeostasis. These abnormalities are interconnected in a complex network that ultimately leads to cellular dysfunction and demise, and though they have mostly different etiologies, all ultimately share similar flawed pathways that cannabis seems to be able to combat.

What has been most striking to me in the diseases listed above is how effective the plants’ components are proving to be, especially in treating those with ASD and AD. In addition to the remarkable benefits we are seeing directly in these patients, as importantly, cannabis can allow their caregivers to avoid burnout, to learn that there is a medication that can make their difficult jobs easier, as they watch some of the people in their charge open up, become more interactive, less agitated, and at times, (re)gain verbal skills.

Though it may seem that they are two wildly different diseases, ASD being a neurodevelopmental disorder beginning in early childhood and AD being a neurodegenerative disorder starting later in life, it turns out that they actually share an array of similarities.¹ Looking at the neuropsychological profiles of both groups, we see similarities in terms of repetitive behaviors, social difficulties, eating disorders, behavioral rigidity, anxiety and irritability, communication deficits, emotional dysregulation, sleep disturbances, and depression.²

Interestingly, as well, recent data seem to indicate that patients with ASD have an increased incidence of developing AD later in life. In addition to that array of overlapping issues, AD and ASD actually share similar genetic markers, plus many underlying biochemical molecules, including similar central nervous system breakdown products that show up in the saliva. Recent studies have shown that these salivary biomarkers may be helpful to personalize specific cannabinoid treatments in ASD and potentially in AD and other neurodegenerative diseases as well (3,4).

What has been fascinating in the research and clinical experiences that my colleagues and I have had is that medical cannabis is showing itself as a large lens that allows us to peer into the brain on a genetic, molecular, neurologic, and behavioral level. It is now starting to reveal how the brain's pathways and connections, in disease and degeneration, work and how cannabis may be useful in treating many of these processes.

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What we have been finding is that cannabis allows some patients in both groups to evolve. In patients with ASD, children are able to express themselves and sometimes verbalize the love they feel for their parents and caregivers. Anecdotally, two of my colleagues and I have watched patients with AD re-emerge, some who are once again able to verbalize, to show us that they are still there.

We can see that they are noticing, are aware of what their families and caregivers are doing. When they are given these abilities, either because they are less anxious, we've brought down that inflammation in their neural pathways, or we’ve allowed for renewed plasticity in their brains, these improvements are among the most gratifying, heart-warming, and rewarding benefits we as practitioners can be involved in. Even when these improvements are transient, family members are thankful because they have regained an ability to connect that they were sure was gone forever.

The research is promising but still inconclusive. With cannabis classified federally as a Schedule 1 narcotic, it is difficult to do the large-scale studies needed to confirm the findings we are seeing. Funding, as well, is difficult to obtain for that reason, and because of the persistent stigma cannabis has.

Despite the support I have had at a couple of adult living facilities and the enthusiasm that on-the-ground aides, nurses, and administrators show for bringing cannabis in as a treatment modality, when things reach the C-suite, there has been, up till now, reluctance and refusal to consider cannabis. Hopefully, this will change. Commonly used psychotropics have black box warnings, dangerous side effects, drug interactions, and show disturbingly low rates of efficacy. Medical cannabis, given under the supervision of a qualified practitioner, can be safer and more effective.