Cannabis and Traumatic Brain Injuries

Overview of TBI/CTE:

Traumatic brain injuries (TBI) are more prevalent than one might expect. In the United States, TBI’s account for about 30% of all injury-related deaths. TBI’s can be caused by bumps, blows, and jolts to the head which can occur in a variety of different ways. These impacts that cause TBI’s disrupt the normal functioning of the brain which can have long-lasting and oftentimes devastating effects. It is important to note that not all impacts on the head will result in a TBI. TBI’s range from mild to severe with most falling into the mild category which we call concussions. Mild TBI’s are indicated by a brief change in mental status or consciousness. Severe TBI’s are indicated by an extended period of unconsciousness or memory loss. In 2013 there were about 2.8 million TBI-related emergency department (ED) visits and hospitalizations, 50,000 of which resulted in death, in the United States alone. Falls are the leading cause of TBI’s and disproportionally affect the youth and elderly. Other major causes of TBI’s are being struck by or against an object, motor vehicle accidents, and self-harm. Symptoms of TBI’s include impaired thinking, memory, movement, sensation, and emotional functioning ("TBI: Get the Facts | Concussion | Traumatic Brain Injury | CDC Injury Center", 2017). Repeated TBI’s can result in chronic traumatic encephalopathy (CTE) which has been linked to military personnel, Martial Artists, and football players. CTE results in a progressive decline of memory and cognition, as well as depression, suicidal behavior, poor impulse control, aggressiveness, parkinsonism, and, eventually, dementia (Stern et al., 2011).


Cannabis and TBI/CTE:

Cannabis may possess a unique ability to protect the brain against TBI’s and the development of CTE. In a 2013 study published in the Journal of Experimental Brain Research, researchers demonstrated that ultra-low doses of THC could protect against the cognitive deficits of a variety of neural insults if applied 1-7 days before or 1-3 after the insult. The dose given was 0.002mg/kg which would be 0.136mg for a 150lb individual and the effects lasted for 7 weeks. These long-lasting effects indicate that a single treatment with an ultra-low dose of THC can modify brain plasticity and induce long-term behavioral and developmental effects in the brain (Fishbein et al., 2012). CBD may offer additional benefits when it comes to neuroprotective effects. In a 2007 study published in the Journal of Neuropharmacology, researchers demonstrated that CBD was superior to THC in protecting the brain against cerebral ischemia. This was in part due to the fact that no tolerance developed to CBD’s promotion of increased blood flow in the brain and it did not lead to desensitizing and down-regulating the CB1 receptors (Hayakawa et al., 2007).


Cannabis and TBI/CTE Symptoms:

TBI’s and the development of CTE can create serious long-lasting symptoms. Such symptoms are often combatted with a large list of medications in an attempt to stop them all. The major TBI/CTE related symptoms cannabis shows promise in treating is as follows:

 

  • Chronic Pain - Cannabis can improve pain and functional outcomes for patients who experience chronic pain. Patients can also use cannabis to significantly reduce the amount of opiates they need to manage their pain levels (Haroutounian et al., 2016). 

  • Sleep disorders - Cannabis offers relief for a variety of sleep-related disorders. CBD may be helpful in the treatment of insomnia as well as for REM sleep behavior disorder and excessive daytime sleepiness. THC can decrease the amount of time required to fall asleep, help prevent nightmares, improve sleep among chronic pain patients, and improve sleep apnea. It should be noted that THC can impair sleep quality long-term (Babson, Sottile & Morabito, 2017). 
  • Mood Disorders - Clinical studies have shown altered endocannabinoid signaling in patients who experience mood-related disorders. Certain genetic variations in CB1 and CB2 receptors have been found to be associated with major depression and bipolar disorder. Several studies indicate that THC may be helpful when pain, anxiety, and depression are present together (Huang, Chen & Zhang, 2016). Recent studies are indicating that CBD may hold promise in providing rapid and sustained antidepressant effects in animal models through a variety of mechanisms (Sales et al., 2018). 

Know Your Dose

TBI’s and CTE can often go undiagnosed due to the symptoms being related to a variety of other disorders. When working with patients or loved ones, it is important to consider whether or not a TBI could have been a root cause in their symptomology. Many of these symptoms can be helped by cannabis and the following suggestions may be useful:


  • CBD and ultra-low doses of THC is going to be the best option for aiding in the treatment of TBI’s and CTE. Because CBD is not a potent molecule, most patients need 50mg or more to find relief. I recommend starting with 10mg for 3 days and working up by 10mg per 3days until desired relief is achieved. THC dosages should not exceed 0.002mg/kg per 7 weeks as indicated by the research.
  • In terms of pain, THC can help provide relief and reduce the use of opiates. Strains high in myrcene such as Blue Dream may provide better relief and opiate reduction due to myrcenes ability to relax muscles and provide added pain relief (Russo, 2011)
  • Higher doses of CBD (160mg+) can be used to help insomnia while small doses (15 mg) can aid in reducing excessive daytime sleepiness (Linares et al., 2018). THC should be used intermittently to aid in the time required to fall asleep but long-term can impair sleep quality.
  • For mood disorders, strains high in limonene are ideal as they synergize with CBD to provide relief from depression and anxiety (Russo, 2011). Tahoe OG is a great option as it is high in limonene and myrcene. 

 

Derek Espinoza, Baked Bros Director of Education



    References


    Babson, K., Sottile, J., & Morabito, D. (2017). Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Current Psychiatry Reports, 19(4). doi: 10.1007/s11920-017-0775-9


    Fishbein, M., Gov, S., Assaf, F., Gafni, M., Keren, O., & Sarne, Y. (2012). Long-term behavioral and biochemical effects of an ultra-low dose of Δ9-tetrahydrocannabinol (THC): neuroprotection and ERK signaling. Experimental Brain Research, 221(4), 437-448. doi: 10.1007/s00221-012-3186-5


    Haroutounian, S., Ratz, Y., Ginosar, Y., Furmanov, K., Saifi, F., Meidan, R., & Davidson, E. (2016). The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain. The Clinical Journal Of Pain, 32(12), 1036-1043. doi: 10.1097/ajp.0000000000000364


    Hayakawa, K., Mishima, K., Nozako, M., Ogata, A., Hazekawa, M., & Liu, A. et al. (2007). Repeated treatment with cannabidiol but not Δ9-tetrahydrocannabinol has a neuroprotective effect without the development of tolerance. Neuropharmacology, 52(4), 1079-1087. doi: 10.1016/j.neuropharm.2006.11.005


    Huang, W., Chen, W., & Zhang, X. (2016). Endocannabinoid system: Role in depression, reward and pain control (Review). Molecular Medicine Reports, 14(4), 2899-2903. doi: 10.3892/mmr.2016.5585


    Linares, I., Guimaraes, F., Eckeli, A., Crippa, A., Zuardi, A., & Souza, J. et al. (2018). No Acute Effects of Cannabidiol on the Sleep-Wake Cycle of Healthy Subjects: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study. Frontiers In Pharmacology, 9. doi: 10.3389/fphar.2018.00315


    Russo, E. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal Of Pharmacology, 163(7), 1344-1364. doi: 10.1111/j.1476-5381.2011.01238.x


    Sales, A., Fogaça, M., Sartim, A., Pereira, V., Wegener, G., Guimarães, F., & Joca, S. (2018). Cannabidiol Induces Rapid and Sustained Antidepressant-Like Effects Through Increased BDNF Signaling and Synaptogenesis in the Prefrontal Cortex. Molecular Neurobiology. doi: 10.1007/s12035-018-1143-4

    Stern, R., Riley, D., Daneshvar, D., Nowinski, C., Cantu, R., & McKee, A. (2011). Long-term Consequences of Repetitive Brain Trauma: Chronic Traumatic Encephalopathy. PM&R, 3, S460-S467. doi: 10.1016/j.pmrj.2011.08.008


    TBI: Get the Facts | Concussion | Traumatic Brain Injury | CDC Injury Center. (2017). Retrieved from https://www.cdc.gov/traumaticbraininjury/get_the_facts.html

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