In the latest episode of Civilized's new podcast 'Cannabis & Main,' host Ricardo Baca spoke with Marcel Bonn-Miller - Assistant Professor of Psychology and Psychiatry at the University of Pennsylvania, and one of the leaders in the world of cannabis research.
Ricardo and Marcel spoke discussed current research on cannabis and PTSD, the different properties and uses for THC versus CBD and the current state of cannabis research in the US, and the absurdity of the American government's insistence on placing cannabis alongside heroin in the list of Schedule I drugs
Transcript: 'Cannabis & Main: Cannabis & PTSD'
Ricardo: Hello, hello, and welcome to Cannabis & Main, a Civilized podcast where we extract one sliver, one tiny slice from today's cannabis scape and go deep. I'm your host, Ricardo and it's great to be back in your earbuds. Thank you for joining us, and please hit that subscribe button of course because we will be back here every week with thoughtful interviews that will entertain and educate and even potentially enlighten. And yes, I feel confident in saying that because we're going for some of the top subject matter experts in this field so I think you do want to subscribe. Check it out.
Some of you might remember me from The Cannabist. Where my colleagues and I cover the implementation of the world's first adult use cannabis economy from before its inception but now I'm a free agent. I run a public relations firm based out of Denver called the Grasslands. I'm hosting this podcast for Civilized and you can learn more about this show from Civilized found on the worldwide web over there at Civilized.life.
Our subject is cannabis and PTSD: post-traumatic stress disorder. Our guest is one of the most respected researchers studying the plant, we're here to discuss and I'm ready, I'm going for it. Let's do this.
My guest today is Marcel Bonn-Miller. A clinical researcher who has dedicated much of his professional life to better understanding the relations between cannabis use and post-traumatic stress disorder. Marcel is also a worldwide authority on marijuana research and an assistant professor of psychology and psychiatry at the University of Pennsylvania. Marcel, did I get everything in there?
Marcel: I think so. Thanks so much for having me.
Ricardo: Thanks and welcome to Cannabis & Main. Where are we catching you at today?
Marcel: I'm in North Carolina. I have a house down here so I do some work looking at the lake and trying to relax while I write.
Ricardo: On Cannabis & Main we pick one subject here. We attract the right subject matter expert and then we go deep so today we are talking about PTSD and cannabis with a gentleman who knows more about cannabis and PTSD than pretty much anybody else on the planet. Marcel can we talk about the basics? PTSD: It's a disorder that develops in people who experience something dangerous or traumatic. Is that right?
Marcel: Yeah. That could range, those sorts of events, what they call triggering events can range from assault, to a life threatening event, natural disasters, combat. All sorts of different events can trigger PTSD if you will.
Ricardo: Now let's go to the other equation of this episode. Cannabis medically, it's authorized to service a number of conditions throughout various state programs across the country but when you're looking at the hard science, there's only actually a couple conditions and ailments that it's known for true efficacy. Can you just talk about the medical environment surrounding cannabis right now in 2018? There's probably 20, 30, 40 conditions that it's authorized for treating across the US and other countries. But really, there's not quite that medical acumen or background to really backup those placements.
Marcel: Yeah, that's right. Even within the US. It's different in terms of the core conditions, that they allow medical use of cannabis. There's a wide range of evidence depending on the condition like you said. Really that's because a lot of the laws passed because of lobbying and advocacy from different patient groups more so than where the literature stands.
We know for some conditions, like multiple sclerosis—since spasticity is associated with that—there's a decent amount of evidence there that certain preparations at least of cannabis maybe helpful. Epilepsy, particularly in children, is another one. Well, we have a decent understanding now and a number of clinical trials have taken place in that space, but if you flip that on, there are other areas like glaucoma.
PTSD I would put in still scanned evidence and lots of other conditions. Depression, anxiety, there's a little bit more but there's lots out there that there's just, we're missing a lot of data.
Ricardo: I guess that lack of data is one of the reasons why you've dedicated so much of your life to this important work. Let's bring these two things together, cannabis and PTSD. Here we are in the middle of 2018. What do we know right now?
Marcel: Really the research in this domain is only half within the past 15 years or so and most of it has been observational. This feeling that there are people with PTSD, and they're using cannabis. Why might they be using cannabis? Well, it seems like they're using cannabis to help with sleep, to help with anxiety, to help cope with negative aspect if you will, negative mood or things like that.
And then we've delved into what are people choosing? Out in the field. What are people using and choosing for these different symptoms, and doing those sorts of in the field observational type studies. When it wasn't until probably within the past five or so years, where we started to see the beginnings of some clinical trials and very small scale open label, meaning that the people knew that they were getting the drug.
10 people, 15 people, just starting to look at does THC help with nightmares? So if we give some people THC or if we give them nabilone which is a analog of THC synthetic, do we see that nightmare is reduced along people with PTSD, and so there's been some scratches and really important data that have come from those. But it's not until right now where we're embarking on the first real full blown randomized double blind placebo controlled trial, which is like the gold standard for starting to understand this.
Ricardo: I remember the first time that I heard this often repeated statement that there's more that we don't know about cannabis than what we do know. I think that really opened my eyes and definitely it was surprising but has the national institute on mental health or NIH or some of these other federal organizations do you feel that they have given a fair shake to the research that's come their way? Have their fairly funded these initiatives to better understand this plant in previous decades to this recreational era that we've embarked on?
Marcel: It's a good question. My understanding is that there hasn't been much funded in these other institute so I think that's changing. I think the national institute of mental health for example is starting to look at potential therapeutics of cannabis for different mental health conditions. So I think that's good, and I think that it's great that these institutes are starting to set these as a priority, and that really happens through those observational studies and these sorts of epidemiological studies that say hey this is what's going on out there.
That's how you get NIDA to say maybe we should put some money behind looking at cannabis and opiate use, and opiate use problem. Because hey look there's a couple studies out there that show this, this, and this. Maybe this is worth putting some money behind. Once you start, that's kind of the process that it goes and so I think it's going in the right course.
Again research in this area is new, and I'm not one to vilify one group for another. This is how it goes. I think the hardest part of research in this space is the scheduling of cannabis. So cannabis is considered a schedule one drug which means that it has high abuse potential and no therapeutic benefit, and that's the DEA that said that. And that is tough. That's made research more difficult.
Ricardo: You personally, do you think that cannabis should be a schedule one substance?
Marcel: No. I don't. Really, even if you look at the DEA scheduling. It starts breaking it down by cannabinoid but even there, CBD extract is schedule one. They made a specific code for CBC extract and it's schedule one. Should CBD extract be schedule on? No. There's no data to support it being in schedule one, so it's that's kind of frustrating and difficult and hopefully it'll change.
Ricardo: What do we know now going into this year-long year plus study that you're working on. Do we know that CBD is more is better for PTSD or veterans suffering from this? Do we know if terpenes play a role in this conversation?
Marcel: Great question. The terpene one is an excellent question. We are so far behind on the science side. A colleague of mine just got a grant to start looking at terpene cannabinoid interactions but man, we have some catching up to do so I can't really speak to that piece. I can speak to the cannabinoid piece and say if you look at, and this is the hard part.
If you look at people with PTSD, the vast majority are using high THC cannabis but from a scientific perspective. If you were to look at THC versus CBD, and there's definitely a cost differential. There's all sorts of differences between these two. There's a lot of reason to believe that CBD might be helpful and our study is hopefully going to shed some light on this.
So THC produces euphoria, it puts you high. It's that feeling that you get when you typically think of smoking cannabis, that's THC, it's intoxicating and because of that, and it also has withdrawal. You can build tolerance to it and so it has a profile that for some people, not everybody but for some people it can lead to addiction. It'd be very difficult, you use more and more to get the same effect, and it can be difficult to stop using.
That's an important caveat for THC that you don't see with CBD. CBD has been tested at quite high doses. We don't see that intoxication. You don't see that withdrawal or addiction sort of profile of CBD and that's an important thing to think about as you start talking about medications or drugs or herbs or whatever it is for PTSD is because there a lot of people with PTSD that suffer from addiction.
We know that CBD is an anxiolytic so it can reduce anxiety. We know that CBD is an anti-inflammatory which is important for things for folks that have been in combat, for folks that may have traumatic brain injury. The anti-inflammatory properties could be helpful here. It's a neuro-protectant. It kind of goes hand in hand with this, and its potential benefit. It can help with sleep, improving sleep.
There's some early studies that have shown it might actually help with reduced depression. Might be an anti-psychotics. There's really fascinating work and part of it is because CBD works in so many different mechanism. It's not like when you hear about endocannabinoid system and CB1 and CB2 receptors. CBD doesn't really, it doesn't bind really to CB1 or CB2. It acts indirectly on those but it also works on serotonin and it also works on all these other different areas that might really be helpful for folks with PTSD. So whereas THC has much narrower mechanisms of action, now THC is helpful for paying, and a lot of folks with PTSD suffer from pain. So it's not to say THC is out.
Ricardo: Sure, but I guess your gut is leaning towards CBD being, if the substance really is helpful to this patient base then it's potentially CBD being the bigger player in that mix.
Marcel: I have colleagues who I respect very well who would argue hard against me on this. People don't always choose what's best for them and people a lot of times choose what's easiest to get and provide immediate relief but not necessarily what's best and it's hard. I get why people just gravitate toward THC, it provides immediate instant relief for symptoms. It helps you escape and avoid certain symptoms.
Is that good in the long-term? That's my argument is, I don't know. I have my money on CBD, but who knows. Like many times in the past, I could definitely be wrong. Places like Colorado in the initiative to fund research like this is amazing. Really they stepped up and provided support where there really isn't much at this point.
Ricardo: Yeah. We're talking millions of dollars. Didn't you guys get two points something million dollars to study PTSD?
Marcel: Yeah. Two point something and then the one that I'm running in Denver is one point something. So it's great. I think they're expensive. That's the thing that a lot of people don't understand is for observational research you can do relatively speaking inexpensively, 100,000, couple 100,000 do a great study. Clinical trials and start moving into this space, it's multiples of millions. That's unfortunately the reality of it, and so it's more difficult to get those studies going and that's why kudos and hats off to Colorado for funding those.
Ricardo: Yeah. I certainly was a proud Colorado medical marijuana patient knowing that these excess fees and taxes from the MMJ program locally were being put directly into this very, very important space where there just hasn't been enough investment. I'd love it if you could break down each of these studies. So one is being conducted in Arizona. One is being conducted in Denver, is that right?
Marcel: The one in Arizona, it's a randomized placebo controlled trial. We're focusing on veterans and really they come in. The crux of it is they come in and we randomize them to one of four different conditions. We simplistically draw a straw out of a hat or whatever it is, and put some folks get placebo. In this case, it's cannabis with a cannabinoid that's been sucked out of it.
Another group is gets high THC, low CBD. So cannabis that has relatively speaking significantly more THC than CBD. Very little to trace amounts of CBD in there. The next group of the four is the reverse. High CBD, low THC. The last group is a one to one, so about equal parts CBD and THC, and we're doing pretty well. We've surpassed not that long ago, surpassed 50 people enrolled of the target 76, so we're getting there.
Of course if any listener out there is from Arizona or the Phoenix area, please call. We're always looking for new folks and we'll be enrolling through the beginning of the fall.
Ricardo: You joke saying please call, but is there an email or a website or a phone number that any veterans in the Arizona could check out if they are listening?
Marcel: Yeah, absolutely. So it's called wecanstudy.org.
Ricardo: What about the Denver study? How does that one differ from what you're doing in Arizona?
Marcel: It technically falls under the observational side because we're not giving cannabis to folks but we actually finished enrollment. We hit our target of 150 folks for that study, and now there are a bunch of people that are in the study that are completing, we just closed enrollment not that long ago, and that study really, the criteria is pulling people in with PTSD.
Half of whom so 75 of the 150 are cannabis users right of the bat. The other half are non-cannabis users. The goal of the study is and matching those, so it's not like, because you might think inherently there's some differences between cannabis users and not cannabis users. Maybe it's people that were in the combat or more likely to use cannabis whereas people that had PTSD from another trauma source might not use cannabis.
Other things like that. We try to balance these groups out and match them in a bunch of different characteristics, and then the goal is to follow them over the course of a year. The other piece of this that's really interesting to me is switching groups. By that I mean only requirement is half-half users and non-users is just for the entry of study.
If you are non-user that begins using, we don't kick you out. In fact, that's some of the richest things. Because then we can look at the natural course of uptake of cannabis use among a non-user and see how that impacts that PTSD symptom, but they choose, how that choice changes maybe over time as a function of what their PTSD symptoms are doing.
And then on the flip side, similarly very interesting is among the cannabis users who might stop for one user or another. What happens to their PTSD symptoms? Are they able to stop and stay off? Those sorts of things is people that switch groups during the course of study to me is probably the most fascinating part of this, and there are definitely people that have done that throughout the course of the study.
That's the crux of it. Whereas the one study short duration, this is following folks for a year. Whereas one study got cannabis from NIDA. This study is getting it, the people are getting it from dispensaries.
Ricardo: I'm curious who's your partner here in Colorado that you're working with on that?
Marcel: Yes. Actually plug for government. We're running this at the VA. Also the department of Veterans Affairs in Denver is where we're running the study.
Ricardo: That is fantastic. That's a triumph for the VA. They've had a complicated road when it comes to marijuana.
Marcel: Like I say and I used to work for the VA for a long period of time. They're stuck between a rock and a hard place, and I definitely sympathize for their position and not to say that they've made the right decisions across the board but they're not in a great spot to begin with because they're a federal agency that's operating within the state with different laws. So it's a tricky one but yeah, it's definitely great.
Ricardo: Well, that's huge, and of course this question maybe it's answerable, maybe not. But when do you expect to be publishing the results and the findings from each of these studies? Are we thinking mid-2019, late 2019?
Marcel: The Arizona study as I like call it [inaudible 00:20:25] because the multi-disciplinary association of psychedelic studies is helping oversee in addition to myself the day to day operations of this so it's really a group family effort if you will and that study is a randomized double blind placebo controlled trial. In those types of studies, you don't know and you can't look at the data until everything is done, and so for that reason, data from those won't be published until about I would say summer or so of next year, 2019.
The Colorado study on the other hand is observational which means that you can look at the data, there is no blind, there is restriction in looking at the data in the interim, and we are starting to look at the data for Colorado. We're actually presenting some of it in a couple of weeks in San Diego and it's fascinating and I would say we're just scratching the surface so I don't want to lead folks down one path or another, but we are starting to see differences between group and I'm about to look at the data again this weekend, prep everything for our presentation in San Diego so we'll see how it all shakes up. It's definitely fascinating stuff.
Ricardo: It is, it definitely is. Marcel as I told you before we started recording, I'm a fan of your work and seriously as journalist who's been trying to put into context what legalization is meaning for our collective physical and mental health for our communities, for our children, and of course, it's just so damn early to even try to tell people that, but of course people are impatient.
I've relied heavily on the work that you and other respected researchers have done, and so please accept my heartfelt thanks for the work that you've done and the work that you will be doing in the years to come.
Marcel: Thank you and thanks for having me on.
Ricardo: Yeah. We are proud to be here. We are proud to be produced by Civilized, F420 films, and Grasslands. And you know we will be back here next week. In the meantime, keep it chill friends and we'll talk to you later.
'Cannabis & Main' is a Civilized podcast. Our executive producers are Ricardo and Derek Riedle. Our producers are Vince Chandler and Katie Labrie. We are hosted by Ricardo and directed by Vince Chandler. Follow us online at Civilized.life. Thank you for University of Pennsylvania professor Marcel Bonn-Miller for joining us on this episode of 'Cannabis & Main.'