A question from a doctor. Need some info.

[Dr.G.H.]

Hello.

I am an M.D. (Neurology).

And I have a few questions to ask so I decided to ask here (since I donâ??t know exactly who to ask that would have extensive knowledge in this area).

I have a patient that has a very serious form of MS. The symptoms have progressed to a very terrible point. Many of the traditional meds have not been able to subdue the symptoms.

The patient decided to try marijuana to see if it would help (I was a little hesitant at first, but seeing this patient suffer a lot deeply troubled me, so I thought it wouldnâ??t technically hurt anymore than the symptoms do).

The patient never used marijuana before, and I had no knowledge than the basic medical and media knowledge of it.

The patient tried it. It worked unbelievably, and the patient said it was nice as well and ended up liking the feeling associated with it.

After 3 months of using it, the patient purchased some more, and used it. The results were not good! The patient suffered from a type of psychotic episode. The way the patient described it, it sounded like a very terrible hallucinogenic effect.

The patient said the effects were almost immediate. It included a complete distortion of reality, a distortion of the vision, and hearing. He said its like everything slowed down and that time was â??warpedâ?� and that his legs felt heavy. The patient said it felt like he was dieing. The patient said that he apparently started screaming in fear, and felt like he had jumped outside of his body (the way he described it, it sounded like a dissociative-personality type of symptom). The patient additionally described an extreme form of paranoia. And all these effects last for roughly several hours.

Since then, the patient has developed severe anxiety attacks, sensory-motor distortions, and he says whenever he thinks of the incident, he immediately feels like it will happen again, and he begins to shake and gets scared, and then a panic attack sets in.

I want to know if the incident that this patient felt was normal amongst marijuana users?

I decided to research this a little more since it didnâ??t make sense to me. How can this patient use marijuana for 3 months with no hallucinogenic effects, then all of a sudden one day completely lose control and have effects similar to LSD.

So I ended up asking the patient to tell me what (if anything was different than before) and this is what I found out. Apparently this patient first purchased marijuana that smelt good, he said it was a very nice smell, and that were lots of seeds. The marijuana the he purchased just prior to the incident was different. He said this new one had no seeds at all and appeared to have orange hairs over it, and that it smelt very different, almost like citrus and skunks.

The patient said the marijuana purchased with the seeds gave him a very relaxed feeling almost to the point of falling asleep (with no mental/visual/auditory distortions) and he said that it made him feel really happy. But this new stuff didnâ??t make him relax at all, it made him very terrified.

Iâ??ve researched information on the internet about marijuana, and I never knew there were so many different strains.

My second question is: were his negative effects caused by a certain strain, or did it have to do with the fact of seeds or no seeds in the marijuana?

If it is a question of strain/type of marijuana, do you know which strain/type is relaxing and â??not trippyâ?� (as the patient would say)?

Thanks,

Dr. G.H.

[Cyclonite]

Some strains are more of a trippy high but that is not common among marijuana users. Predominate indica will give more of a medical sedative effect, harvest time matters as well.

If harvested when the trichromes are just a little cloudy will give a more up trippy high, harvested later when amber will give more of a sedative high. Seedless has a higher THC %.

[mrdevious]

I want to know if the incident that this patient felt was normal amongst [QUOTE]marijuana users?

"normal" for a small percentage of innexperience marijuana users, yes. When I first started using it I tripped out pretty hard myself, but eventually learned that you have to know your safe-dose. After a decent tolerance builds up, as with every smoker, the safe dose has a significantly larger margin for error.

Most likely though, what your patient experience was due to anxiety attacks, in themselves, triggering the psychotic episode. Marijuana can already increase anxiety levels if a person has any kind of negative mindset, or chemical inbalance. When a person trips that hard, they feel out of control and this can cause more anxiety than anything if you don't know how to calm your mind. From a Buddhist perspective, I'd also suggest the possibility (held by many people regarding many drugs) that such "freak-outs" are the result of clinging to ones ego, so much that being torn away from it by the drug can be psychologically devestating.

Also, I really think you should check out the weed he was smoking, to be sure it's not laced (it my not be visible to the naked eye).

Anyway, just advise your patient to slowly take it one toke at a time and wait to observe the effects of each toke.

[QUOTE]So I ended up asking the patient to tell me what (if anything was different than before) and this is what I found out. Apparently this patient first purchased marijuana that smelt good, he said it was a very nice smell, and that were lots of seeds. The marijuana the he purchased just prior to the incident was different. He said this new one had no seeds at all and appeared to have orange hairs over it, and that it smelt very different, almost like citrus and skunks.

Actually, this is a pretty common strain. I'm not an expert on all the varieties, but there's 2 main groups of which are "indica" which has more painkilling-effects and more of a body-stone, and "sativa" which is more psychadelic and somewhat less of an analgesic. But the strain you describe, I smoke most commonly with no negative effects.



My second question is: were his negative effects caused by a certain strain, or did it have to do with the fact of seeds or no seeds in the marijuana?

The seeds just mean less potency/quality. But yes, the strain (indica or sativa) may have caused it.


If it is a question of strain/type of marijuana, do you know which strain/type is relaxing and â??not trippyâ?� (as the patient would say)?

Indica.

- courtesy of a very-currently-stoned toker:thumbsup:

---------------------------------------------------------------

On a separate note, this is quite fortuitous that your a neurologist, as I've been desperately trying to see one for years now (damn canadian medical system). Anyway, if you could spare me a bit of your time, I've been in terrible chronic pain for almost 5 years now, and I'm only 21 and don't know what's causing it.

I injurred my low back in Judo when I was 16, just as soft tissue-damage, and it's just gotton worse since then. A year later, I unjurred an mid-upper vertebrae in Aikido (which I thought I could handle as a very light martial art) by falling on it several times in a practice involving throws. Then a month later, An overzealous chiropractor decided to adjust my neck because of a minor kink, and it's been in HORRIBLE pain ever since. Now everythwhere in my back, neck, head, legs, and sometimes arms, hurt like hell all the time.

X-rays show nothing except mild compression in the one upper vertebrae in my back. The neck and low back look fine.

I've tried (repeatedly) chiropractic, massage therapy, physio therapy, accupuncture, stretching, ice, hot baths, and yoga, all of which only somewhat alleviate the symptoms for a few hours.

I've used:

Accetaminophen: which doesn't work at all anymore
Ibeprophen: which I need to take 4 of just for mild relief
Robax: Does nothing
Cannabis: which used to work amazingly but does nothing now.
Celebrix: Does nothing
Flexeril: Does nothing for pain, barely lowered my back spasms, made me feel almost "drunk".
Tramadol (In tramacets): I need to take 150mg to get the usual 60-75% pain relief.
And, though I really want some to finally have some relief, I can't seem to get a prescription for Oxycontin because my doctor's clinic can't prescribe narcotics of any sort, and I can't change because docs here won't accept new patients who already have a family doctor.

Hope that wasn't too long, but would you have any idea what might be wrong with me, or what I should do?

Thanks

- James

[FakeBoobsRule]

Hello.

I am an M.D. (Neurology).



I want to know if the incident that this patient felt was normal amongst marijuana users?

My second question is: were his negative effects caused by a certain strain, or did it have to do with the fact of seeds or no seeds in the marijuana?

If it is a question of strain/type of marijuana, do you know which strain/type is relaxing and â??not trippyâ?� (as the patient would say)?

Thanks,

Dr. G.H.

The incident is rare but if it does occur it seems to happen to new smokers more than chronic or experienced smokers. Sometimes people don't get high the first time they smoke so the next time they try to get they smoke a lot and then the effects hit them and they have a bad experience. I know of someone who got high for the second time this past weekend. The first high was enjoyable for him but this past high he lost complete time/space orientation and became paranoid that everyone in public knew he was high. A couple of things may have contributed to this:
-He was having a very bad day to begin with before smoking.
-He smoked a lot because he was afraid that he wasn't going to get high.
-The setting was not a good mellow one for him as he is shy out in public to begin with.

He is going to try again but this time he will smoke a little, wait about 10 minutes, then smoke again is he needs to. He has also arranged a better setting including exactly where, who will be with him, activites such as music and movies, and even his snacks. Maybe your patient should assemble a game plan like this and slow the smoking down, start low and go slow, wait, then smoke as needed.

Yes there are a lot of strains and even a big difference between the strains. Marijuana can range from plants that should barely be qualified to be called pot to a middle grade of well grown pot that comes from a "mutt" strain or maybe another level slightly better than mid grade that consists a pot from a high quality seed strain but wasn't grown to its full potential to high potency pot that was taken from a high quality seed strain or a clone of a high quality plant and cultivated to near perfection. It has been a while since I have grown pot (12 years ) but you will find many people grow indoors and spend thousands of dollars on the equipment and it shows in the product. If they go through the trouble of spending that much,. they will start with very high quality stock of seeds or clones. In this case, the type of high that will be produced is know before the plants even start. There are even basic differences between pot grown outdoors versus indoors that others may be able to explain better. If the pot contains seeds then basically the female plant has been pollinated and spent some of its energy on those seeds instead of producing THC.

Also, someone mentioned it might be laced. If he just smoked a day or two ago, you may want to drug test him to see if he is positive for other drugs that might give you an idea as to whether or not it was laced with other drugs. Hopefully you are aware of how most drugs have very short detection times in the body (3-5 days) except for THC.

Too bad Marinol is not indicated in MS or you may be able to go that route.

[Storm Crow]

Just to make sure you get the site info, I double posted, too. As everyone has been saying, it's an indica vs sativa thing. Tell your patient to ask for a "couchlock" indica. I wanted to thank you for looking here with the people who know, rather than depending on government propaganda. Since you have an open mind on the subject, may I suggest the following sites to broaden your education? CCRMG.org marijuana.researchtoday.net ccicnewsletter.com and finally, an excellent medical marijuana community- treatingyourself.com I would like to extend a personal invitation to you to visit Treating Yourself. TY is comprised of medical marijuana users and/or caretakers for medical marijuana users and we would welcome the chance to answer any questions about medical marijuana use that you might have. We also would welcome any of your patients who might benefit from medical cannabis. :thumbsup:

[birdgirl73]

Hello, Dr. G.H.,
I was pleased to read your question, although saddened, as I'm sure your patient was, by the effects he experienced upon smoking the second batch. I'm a first-year med student (albeit a 45-year-old one) and am married to a cardiologist. We have my older sister, who's in the process of dying from widely metastasized ovarian cancer, living here at our house, and I came to this forum several months ago looking for info for her, particularly while she was still struggling with the side effects of her last round of chemo.

She experienced similar differences to what your patient experienced from different strains of weed she tried. Some, and I now know these were the Indica-dominant strains, were relaxing, comforting and easy to take. But the more sativa-dominant strains caused her to be jittery, uneasy and panicky. I'm firmly convinced it's sativa-heavy strains that set off complete panic attacks and even psychotic episodes in some susceptible people. Most of the reading I've done about differences between strains confirms this. You can Google marijuana strains and read the differences in effect between indica vs. sativa. I'm not at all convinced these reactions have anything to do with the smoker being new to the smoking experience. Certainly some people have more experience and comfort than others, but the anxious, psychotic-like response happens even to people who are seasoned mj users on occasion.

Therein lies the problem with buying mj from a street dealer rather than in a state with real medical dispensaries that know the characteristcs of the weed they're providing to medical users. I'm guessing you're in a non medical mj state. That second batch could indeed have been laced or tainted with something. It could have simply been a sativa-heavy strain that set off the jittery, anxious, psycotic episode. It could have been the unique ability of one patient's brain to take a psycho-neuroactive chemical and interpret it in some unique and unsual way. Just as neurontin might act differently in 10 different people who took it, so can weed. And if might have been aggravated by combination with any other meds the patient was on.

The solution my sister ultimately arrived at was to find a weed source from someone who provided to medical patients and knew the strains he was selling. This wasn't a street dealer, and unearthing this provider involved some discreet work. If your patient is brave enough to try again, I'll be happy to share with you how we did this. For medical users, I'm firmly convinced, after watching my sister's experience, that weed from street dealers is not the way to go.

Let me know if you'd like further information, and we can make an arrangement to use this forum's chat feature, where I'll be happy to share information with you through a private chat. That'll keep any names and emails I may share with you out of the public eye. Nice talking with you!

[Inferius]

Sounds like he smoked a very potent sativa strain, possibly too much, and in the wrong mindset.
Indica is the more dreamy, relaxed, sleepy high that he smoked first. It simply has a higher ratio of certain cannabinoids vs. other cannabinoids.
The second batch sounds like "dank" weed, which means very potent, very desirable stuff. However, it was probably a more sativa-oriented variety.
Sativa isn't the same type of high, it's clearer, less sleepy, slightly more trippy. Your patient most likely should stop smoking this type, his high is never going to return to the previous one unless he attains a more indica strain.
Also, a very good rescource for you and your patient: Erowid.org. Very organized, up-to-date info on all drugs, and the cannabis section is a very good one.

[Dr.G.H.]

Hello again,

Thanks for the responses.

It did come to mind that may have been laced, and I was going to run a tox screen, but unfortunately the patient saw me roughly 2 and a half weeks after the incident happened.

He is actually terrified to try it again, but all of his symptoms did return, and now is stuck whether or not to try it again. Personally seeing how bad his symptoms are, he has almost no choice. Because while he was using it, all of his symptoms completely disappeared, and he actually was able live a normal lifestyle (well, normal for some with MS).

Heâ??s getting to a stage where it could be considered terminal. So, hopefully this issue can be identified.

From the info Iâ??ve looked up on the net (from Wikipedia, and other sources) there appears to be confusion between what Sativa and Indica seem to do.

One site says Indica causes psychological/psychedelic effects, and the other says it Sativa is the one that does it. Now Iâ??m unsure of what to recommend. The stuff he used for the first three months did nothing more than relax him, relieve his pain, spasms, and make him feel happy. Besides that he felt nothing in terms changes of body sense, or mental perception. The one time I saw him while he was on it he had a large smile, and could barely open his eyes.

But since the consensus seems to be that Indicas are the best way to go, Iâ??ll probably recommend the patient to try that strain. If he is still reluctant, I may have to be the guinea pig and try out the two different strains on myself (theres no need for the patient to go through something like that again, since he suffers enough, and plus Iâ??m old if something happens to me it wont matter much).

And yes I live in an area where there is no medical support for its use. (Which personally I think is illogical, seeing how many patients come in suffering from the negative effects of alcohol).

---------------------------
For Mr.Devious (James):

The first thing that comes to mind is that the chiropractor caused major nerve damage!

I absolutely do not recommend any of my patients to ever see a chiropractor. You have no idea how many I see come in that have had strokes, or other serious nerve damage as a result of chiropractic adjustments.

Hereâ??s a tip, never let anyone adjust your neck or back. They are the major highway to your body.

Since you mentioned that the pain can hit your arms and legs I can assume that the damage was done near the base of the neck. (Which is absolutely terrible for someone your age).

The spinal/nerve damage must be so small that itâ??s undetectable. It could be a micro-tear in the nerve or it may have been pinched at that moment and has damaged itself during repair.

Unfortunately, those meds will not heal the injury, they will on mask the pain. Currently there is no way to repair any such damage (except for stem-cell treatments).

What I can recommend is that you never go to a chiropractor again. Definitely go to see a neurologist, or a back/spinal specialist, and make sure you tell them this was due to chiropractic adjustments.

The other thing I can recommend is this: In order to try to repair the nerves there are a few non-conventional things you could try.

1. Cardio exercises: A research study a few years back found that cardio exercises release neural growth hormones (still unknown as to why).
2. Lift weights, more specifically focusing in the back, arms and legs. The weight lifting will force new muscle growth, which causes new neural connections for those new muscle fibers (which may re-route damaged nerve connections to the new ones).
3. A high protein diet supplemented with B-complex vitamins (no more than 50mg for each B vitamin), and gingko and ginseng.

Nerve repair will definitely take a while, probably several months, but you should see result within a month (especially since youâ??re so young)

--------------------------

[FakeBoobsRule]

Dr. G.H.

I'm not sure if this is the case for the treatment of MS, but patients with chronic pain who use marijuana do get initial relief but then there can be a rebound effect and the pain becomes worse. I would like to post a link for something I would like you to read about several questions you asked but I'm not sure if I can. Check my profile for messenger services if you are interested.

[Breukelen advocaat]

I would strongly advise you to have your patient begin a gluten-free diet. It's not recognized as a "cure" by medical science, but there is anecdotal evidence to suggest that it can work for MS, Lupus, and other autoimmune disorders. I was in really bad shape until I discovered that I had Celiac in 2005, after a lifetime of undiagnosed disease. Your patient has nothing to lose by trying this diet, and possibly may get his health back.

http://www.celiac.com/st_prod.html?p_prodid=126

http://www.dogtorj.net/id4.html

http://www.paleodiet.com/ms/

Below: Dangerous Grains turns the U.S. Food Guide Pyramid upside down by exposing the myriad health risks posed by gluten grains (wheat, rye, barley, spelt, kamut, and triticale). The authors, leading experts in the field of food allergies, and celiac disease, present compelling evidence that our grain-centered diet is to blame for a host of chronic illnesses. Largely misunderstood and frequently misdiagnosed, these disorders can be prevented and reversed by the useful program outlined in this important new book.

[birdgirl73]

Hello again. Dr. G.H,
I’ve found these two sites to be immensely helpful in providing reliable, credible information about medical mj and strain characteristics. Hope they come in handy:

http://www.erowid.org/plants/cannabis/cannabis.shtml
http://www.norml.org/index.cfm?Group_ID=3376

I certainly can understand why your patient would be wary about trying weed again. Frankly, if I’d had a psychotic episode, I don’t believe I would. But potential relief of advanced MS symptoms might make my mind up for me.

Hats off to your particular medical specialty! It’s one of the areas that holds a lot of appeal for me, and I know I’m going to enjoy my neuro rotation when the time comes. Heck, I’ve already enjoyed neuro rounds as a patient. I have type I Arnold-Chiari malformation (repaired years ago with decompression surgery), and so my cerebellum salutes you and your colleagues. Best of luck to you and this patient. Keep us updated on how things turn out, OK?