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Case Report

Medical Condition:Psychiatric disorders

Description

The use of Cannnabidiol (CBD) to Reduce Insomnia and the Urge To Use Alcohol in a Geriatric person in on going Behavior Therapy.
Medical Condition
Adverse effects
Symptoms
300.02 (Generalized Anxiety Disorder), 296.32 (Major Depressive Disorder Recurrent Moderate), 303.90 (Alcohol-Related Disorder Moderate), 301.89 (Other Specified Personality Disorder Mixed Personality Features, Dependent, Schizoid).
Abstract
This case highlights a trail of CBD in an ongoing behavior therapy. CBD was used to: break a cycle of insomnia, secondary to a major depressive episode and reduce alcohol consumption as per an addiction.
Patient information
Gender
Female
Age
65 or Above
Brief history and target symptomatology
Patient sought treatment (cognitive behavioral therapy) after the sudden loss of partner after 30 years of co-habituating / marriage. This was a traumatic event and came not to long after the trauma of 911 in New York City. She presented as anxious and depressed and as treatment progressed disclosed a moderate alcohol addiction. The patient was willing to attend sessions and willful as per reduction of substance abuse. The patient has had difficulty with medical doctors as per trust based on the medical treatment of her significant other. An increase in symptoms of anxiety and depression occurred after a diagnosis of a urinary tract issue warranted a surgical consultation. Target symptoms for CBD: insomnia and alcohol.
Previous and current conventional therapies
Cognitive behavioral therapy, functional analysis of drinking, relaxation techniques, cognitive restructuring, and schema focused therapy. The patient started Escitalopram Oxalate on 3/25/13 and discontinued the anti depressant secondary to the side effect of dizziness on 4/1/13.
Clinical response to Cannabis
To assess tolerability and using the concept of ‘start low and go slow’ for geriatrics, the patient was recommend on 5/2/13, CBD drops, once in the morning, then after one week, morning and evening doses. The CBD was tolerated without side effects. The patient however reported no change in insomnia or drinking. To break the cycle of insomnia Diphenydramine was recommended on 5/13/13. The patient stopped the evening dose of CBD and tried Diphenydramine, reporting that 25mg of Diphenydramine was helpful but not enough to break the cycle of insomnia. The next recommendation 5/20/13 was to keep the morning dose of CBD and in the evening 45 minutes prior to going to bed to add CBD drops with 1 25mg of Diphenydramine. By 6/10/13 the combined treatment broke the cycle of insomnia. The patient reported an increase in better quality of sleep, feeling more restoration post waking and a decrease in depression. Based on the efficacy of this intervention the patient was willing to try 1 CBD pill in the A.M. instead of CBD drops to reduce alcohol use. Morning doses did not produce a therapeutic response and like the drops, the pill form was well tolerated by the patient. Based on a reduction in depression secondary to better sleep the patient was willing to try 1 CBD pill 45 minutes before she started to drink, which started at 5pm and continue till 11pm. She was very ambivalent about giving up alcohol, refused Alcoholics Anonymous and was still willing to try CBD. By 6/24/13 the patient reported a reduction in the urge to have the first drink. On 7/1/13, the patient was encouraged to try to push back the first drink. The patient reported on 7/15/13 that she was able to cut her drinking by one drink.
Additional Comments
The treatment is ongoing. The patient still is very ambivalent about stopping drinking all together. This is exacerbated by the anxiety secondary to the prospect of surgery. However based on the CBD treatment she is surprised that she is able to reduce the urge at all and is contemplating the concept of controlled drinking. The successful cessation of insomnia was a major gain for the patient, improving her mood and her ability to think more clearly about her decision making as per surgical intervention. Standing dose of CBD is: drops in the morning, 45 minutes before her usual drinking time 1 CBD pill and before bed CBD drops and 1 tab 25 mg of Diphenydramine 45 minutes before bed. The biggest challenge to continuing CBD treatment is the expense of the treatment.
CBD was first used in the form of drops and then combined with a pill. Trying to control the use of CBD in the form of a dropper without milligram markings and as the drops were used less would come up in the dropper receptacle from the bottle rendered drops under the tongue difficult to quantify. The patient was encouraged to use 2-3 drops. Due to the current lack availability of CBD, as per state regulations, CDB products were bought online via Dixie Botanicals.
Due to age of the patient and to assess tolerability, drops were introduced first in the morning then morning and night. Sleep was dramatically improved by the combination of CBD drops and Diphenydramine 1 tab 25mg. Alcohol use was reduced by the use of 1 CBD pill 45 minutes prior to drinking pattern started which resulted in a reduction in the urge to drink.
Cannabis
Usual method of Cannabis administration
Ingested
Cannabis strain (if known)
Mono therapy with CBD
Frequency of Usage: Time Per Day
3
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Psychiatric disorders

Description

Mixed mood disorder
Medical Condition
Psychiatric disorders
Symptoms
Generalized anxiety, panic attacks, seasonal depression, suicidal thinking, insomnia
Psychiatric Disorders
ADD / ADHD
Abstract
52 y/o male with mixed mood disorder on muliple medications with incomplete improvement, responded well to CBD rich strains of cannbis.
Patient information
Gender
Male
Age
45-54
Brief history and target symptomatology
52 year old male with greater than 30 year history of mood disorder. Past medications included multiple SSRIs, SNRIs, mood stabilizers, benzodiazepines and hypnotics. Cannabis had been quite effective at reducing need for antidepressants for 5 years, however anxiety, panic and insomnia had remained intermittently problematic, and medication side effects were significant. Switched to high cbd strain (Cannatonic) as a bedtime unheated dose with near complete resolution of insomnia and generalized anxiety. Using L-theanine during the day for occasional panick attacks.
Previous and current conventional therapies
Numerous SSRIs, SNRIs, benzodiazepines and zolpidem, talk therapy, numerous traditional herbs, meditation and exercise.
Clinical response to Cannabis
Used as an evening unheated oral preparation, response has been remarkable and improving. CBD dose is estimated to be about 100mg.
Additional Comments
Patient has resumed aerobic exercise and is working to restore previous social activities.
Cannabis
Usual method of Cannabis administration
Ingested
Cannabis strain (if known)
Cannatonic, AC/DC
Frequency of Usage: Time Per Day
1
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Infections

Description

Chronic recurring uveitis / iritis responds to cannabis
Medical Condition
Autoimmune disorders
Symptoms
Pressure, pain in both eyes
Autoimmune Disorders
Alopecia
Abstract
60 y.o. woman with 37 year history of iritis/uveitis. Inflammation and dull aching eye pain was managed with oral prednisone followed by continuous use of steroid eye drops until two years ago when the treating ophthalmologist recommended a trial of cannabis which she found eliminated her need for all oral steroids and nearly all topical steroids for the past 2 1/2 years.
Patient information
Gender
Female
Age
45-54
Brief history and target symptomatology
Onset of iritis / uveitis at age 23, associated with mildly elevated antinuclear antibody, but no evidence of other autoimmune or neurodegenerative disease. Both of the irises became "sticky" and asymmetrical but "cooled off" with oral prednisone over the first year. The condition never completely resolved as recurrences began in her late twenties and have continued for thirty years.
Previous and current conventional therapies
For 37 years the patient has frequently used a Medrol Dosepak or prolonged and greater doses of oral steroids and steroid eye drops to reduce the pain and sense of pressure in the eyes. In the past two years she reports using Pred Forte 1% for only a couple days at the hint of eye pain.
Clinical response to Cannabis
Cannabis has been effective at diminishing iritis and uveitis recurrences almost entirely since 2009. Preferred method of administration is ingesting a cannabis infused brownie in the evening, along with infrequent cannabis smoke and/or vapor.
Additional Comments
IOPs have remained in normal range. ANA is reportedly normal. No signs of autoimmune or neurodegenerative disease have occurred.
Cannabis
Usual method of Cannabis administration
Ingested
Frequency of Usage: Time Per Day
1
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Adverse effects

Description

Cannabis Overdose
Medical Condition
Adverse effects
Symptoms
Dizziness, Loss of muscle control, Inability to move
Abstract
After smoking an unknown (organic) sample of high-THC cannabis, patient became dizzy and anxious. Symptoms rapidly progressed to complete inability to use voluntary muscles for a period of approximately 30 minutes. All symptoms resolved after several hours of sleep.
Patient information
Gender
Female
Age
55-64
Brief history and target symptomatology
Patient had ingested one margarita approximately one hour prior to smoking a single inhalation of high-THC cannabis. 15 minutes after inhaling, dizziness and anxiety symptoms occurred. 10 minutes later all ability to move voluntary muscles was lost with no effect on breathing or involuntary muscle control. No loss of continence. Speaking was not possible but patient was able to 'grunt'. Catalepsy without rigidity lasted for approximately 30 minutes, but dizziness persisted. Patient was assisted to bed and after several hours of sleep was once again normal. No residual symptoms persisted.
Previous and current conventional therapies
Patient is a many-year experienced cannabis smoker, rarely ingests it due to fear of overdose. Rarely drinks alcohol but is not overly sensitive to alcohol. Taking no other medications - either prescription or OTC.
Clinical response to Cannabis
Loss of muscle control without loss of consciousness.
Additional Comments
Although patient was anxious about the reaction, she does continue to use cannabis. She is careful about the source and the content prior to inhaling or ingesting.
Cannabis
Usual method of Cannabis administration
Smoked
Cannabis strain (if known)
Unknown
Frequency of Usage: Time Per Day
1
Frequency of Usage: Days per Week
7
Reported by
Contributing Physician (optional)
Stacey Kerr MD

Case Report

Medical Condition:Cancer

Description

Cancer pain alleviated
Medical Condition
Cancer
Symptoms
bone pain, from metastatic disease
Cancer
Breast, female
Abstract
Female patient, age 37, presented with stage 4 breast cancer. Four years previously she presented for medical consultation elsewhere with a 14 cm breast mass, despite having 2 young children. After bilaterlateral mastectomy (one prophylactic, but the second breast turned out to also have neoplasms) she did a short course of typical Adriamycin, 5FU type therapy, which she did not tolerate well. Decided to assiduously remove sugar and processed foods from diet. Did quite well for nearly 4 years when I first met her. She had, according to her, become "a little careless" with diet and was getting increasingly severe rib, pelvis and femur pain. Work up revealed extensive metastatic disease, with only the brain spared. One doctor wanted her to start hospice care right away and she tried morphine but this made her extremely constipated and lethargic. I recommended a high CBD "goo" (kind of like a gooey shatter, which is CO2 extracted from a slurry of the entire hemp plant, grown in Holland, pelletized in Germany and packed in San Diego, CA) and I estimate she took about 200-250 mg CBD daily, which controlled her pain well.
Patient information
Gender
Female
Age
35-44
Brief history and target symptomatology
Metastatic breast cancer and bone pain
Previous and current conventional therapies
Adriamycin, 5FU, morphine
Clinical response to Cannabis
excellent
Additional Comments
Of course I want to know whether the cannabis could have extended her life, or even have been curative, if applied much earlier in the dz process
Cannabis
Usual method of Cannabis administration
Ingested
Cannabis strain (if known)
not sure of strain -- a high CBD product from CannaSciences, San Diego
Frequency of Usage: Time Per Day
3
Frequency of Usage: Days per Week
7
Reported by
Contributing Physician (optional)
Emily Kane ND
Email
dremilykane@gmail.com
Follow-up
The patient died, but peacefully, at home, and with minimal use of morphine.