Marijuana and Traumatic Brain Injury: Things to Know
Concussions are a lot more common in the United States than most people realize. According to the Centers for Disease Control, well over 1 million Americans suffer from a diagnosed event each year.
Millions more suffer from undiagnosed events. Tens of thousands of these patients are children aged 5 to 18. Studies have shown that early-age concussions can lead to an increased dependence on drugs and alcohol later in life.
What Is a Concussion?
To understand how marijuana helps the brain recovery process after concussion, we first have to understand what a concussion is. Then, we need to identify what its immediate and long-term effects are.
According to the National Institute on Drug Abuse, a concussion takes place when the brain “bumps” the skull after a significant impact to the head.
Symptoms of a concussion include:
- Vomiting and nausea
- Difficulties with motor skills and balancing
- Light sensitivity and seeing bright lights
- Blurred or double vision
- Speech difficulties
- Noise sensitivity
- Troubles concentrating and confusion
- Numbness in limbs
DID YOU KNOW: The majority of concussion-related hospital visits are the result of sports injuries or car accidents?
Every concussion – even mild ones – are classified as a traumatic brain injury or TBI. Whenever the brain gets injured, it releases compounds called glutamates. This results in the build-up of calcium over time, as well as neurological cell degeneration. The antioxidative properties of cannabis may be able to help prevent this cell degeneration and its long-term effects.
When speaking of TBI, it’s important to understand that a spectrum exists relating to the severity of brain-related injuries. Most TBI cases (up to 80%) fall under the mild spectrum, which includes concussions (often referred to as ‘mild TBI’).
The Dangers of Concussions
The real danger of concussions lies in what’s known as ‘concussion plus’; this is aside from the temporary headaches and nausea that it produces.
This term, coined by Dr. Gillian Hotz, describes the long-term impact of concussion, as well as its debilitating (and sometimes even fatal) effects.
Calcium buildup and damage to brain cells can result in a variety of long-term psychological conditions. These include early-onset dementia and chronic traumatic encephalopathy (CTE) – both of which can be deadly.
The prevalence of long-term concussion side effects among former NFL players has been well-documented in recent years. The TBI-related deaths of Pittsburgh Steelers Lineman Ralph Wenzel and Philadelphia Eagles fullback Kevin Turner highlight the dangers associated with suffering a traumatic brain injury.
But is there anything doctors can do to prevent the long-term impacts of concussions, or to reduce the prevalence of related onset conditions like dementia or CTE?
Concussions: How Are They Typically Treated?
The biomechanical impact that takes place when the brain comes into contact with the skull produces headaches, dizziness, and nausea. These symptoms typically persist for 8-12 days. The only real “treatment” is rest, as well as the administration of mild OTC analgesics like Tylenol and ibuprofen.
However, repeat concussions over an extended period can result in very serious long-term conditions.
In a 2015 study, researchers from Boston University observed that 96% of former NFL players showed early symptoms of CTE.
The scary thing about CTE is the fact that it is a progressive brain disease. This means that it inherently gets worse over time with no known treatment. Some of CTE’s long-term symptoms include depression, aggressive behavior, memory loss, impaired judgment, loss of motor function, suicidal thoughts, and dementia.
Adequate treatment of concussion is something that clinical researchers have been taking very seriously in recent years. The active chemical compounds within marijuana may be a viable option in terms of limiting long-term brain cell deterioration.
Marijuana for Concussion: What You Need to Know
If you are considering consuming cannabis with a concussion, then it is extremely important that you consult your medical professional beforehand. We are not medical professionals. The information contained in this article is for educational purposes only.
Cannabidiol (CBD) and tetrahydrocannabinol (THC) are two of the most studies phytocannabinoids. The use of these cannabinoids in the treatment for TBI and concussion is the subject of ongoing research. So far, it appears that these cannabinoids may be able to help alleviate some of the symptoms of a TBI and post-concussion syndrome.
Some ways that they can do so is by providing an anti-inflammatory response, helping to reduce pain, mitigating hypotension in the brain, as well as helping to control seizures. The use of CBD for concussion is being taken very seriously by some of the top doctors, psychiatrists, and neurological researchers in the world.
Back in 2014, after being astonished by the protective effects of cannabis on brain cell deterioration, Harvard Medical School professor Dr. Lester Grinspoon penned an open letter to the NFL pleading for the issuance of grant money to research the clinical effects of cannabis on concussion-related symptoms.
In 2016, researchers from the University of Miami were awarded a $16 million grant to try and develop a patented “cannabis pill” that individuals could take after suffering a concussion (or other forms of TBI).
The goal of the 5-year clinical investigation (which is currently ongoing and led by University of Miami’s Dr. Michael Hoffer), is to create a CBD-based medicine that would “disrupt the series of chemical reactions that follow a concussion and lead to brain-cell death.”
Understanding CBD and Its Relationship to Concussions
CBD – short for cannabidiol – is a natural cannabis extract that unlike THC, does not get users high. For obvious reasons, it is being regarded as the preferred compound of choice in many instances of therapeutic marijuana use.
The five-year-long study involves a multidisciplinary team who will examine the effects of combining CBD with an NMDA antagonist (anesthetic) in the treatment of TBI and concussion. The hope is that the combination of CBD and the NMDA antagonist will be successful in reducing post-injury related symptoms.
The findings from the pre-clinical pre-study were recently released, and the results so far have been very encouraging. The researchers found that the combination therapy resulted in improved cognitive functions in animals when compared with animals which received only CBD or the NMDA antagonist. Further encouragement was drawn from the fact that neither the combination therapy nor the individual components produced any adverse reactions.
Helen M. Bramlett, a professor of neurological surgery, and a member of the multidisciplinary team involved in the research says:
“These findings, which represent the initial results from our TBI study using this novel combination therapy, merit further investigation in other pre-clinical models of brain injury, including concussion.
More work needs to be done, including evaluating the use of these compounds in other injury models and in preparing for a clinical trial of these compounds if their use is supported by the ongoing basic research.”
Robert Reid, the CEO of Scythian Biosciences, which is the company funding the research, says that he is “encouraged by the initial findings of the study. We are just beginning to tap the potential healing power of medicinal cannabis and (are) exploring its growing number of benefits.”
The second phase of the study will involve a small human pilot study. It will likely involve the administering of the compounds in pill form to a control group as well as to two groups of TBI patients. One suffering from an acute TBI, and the other with a chronic TBI.
The researchers will use nine different outcome fields to determine the efficacy of the treatment. These are: cognitive, behavioral, psychosocial, sleep, pain, sensorimotor, cardiovascular, inflammatory biomarkers, and neuroimaging studies.
Upon completion of the study, the data from the nine outcome fields will be analyzed. Additionally, any safety concerns will also be addressed. If the treatment is deemed safe and effective, then the third phase of research will begin.
This will involve a full-scale clinical trial with FDA oversight over a three-year period. Furthermore, by the end of the clinical trial, researchers will better know whether or not the compound is an effective treatment for TBI and concussion.
Results of the clinical investigation will not be out for several years. However, early signs have indeed been promising, with Dr. Hoffer claiming that “if we can stabilize those [brain cells at risk], we can prevent the dominos [of onset CTE] from falling.”
“What that pill would do is stabilize the brain, so that when you get a head injury, there may only be a few brain cells that are injured to the point of no return.”
-University of Miami’s Dr. Michael Hoffer
What Does the Research Say?
In one 2017 study, Schurman and Lichtman determined that endocannabinoids represent “important areas of basic research and potential therapeutic interest to treating TBI [including concussion].”
The researchers also noted that “phytocannabinoids represent an understudied yet promising group of compounds given the neuroprotective results obtained from other types of CNS injury.”
Shurman and Lichtman believe that “CBD as well as other phytocannabinoids which do not bind cannabinoid receptors, represent promising molecules to treat TBI.”
Another study, entitled, “Effect of Marijuana use on outcomes in traumatic brain injury” was published in 2014 in The American Surgeon. Interestingly, the researchers based at the Harbor-UCLA Medical Center in California found that “a positive THC screen is associated with decreased mortality in adult patients sustaining (a) TBI.”
The researchers also say that while cannabis won’t save the life of someone suffering a catastrophic injury; it “does seem to protect the brain in people who have lived through a TBI.”
Final Thoughts on Marijuana for Concussion
It is clear, as Gillian A. Hotz, Ph.D., professor of neurological surgery, puts it, that “there needs to be more systematic research in this field in order to study the neuroprotective properties of CBD, and to improve treatment for those sustaining mild-to-moderate TBI (traumatic brain injury) and concussion.”
Holtz and colleagues are carrying out research in relation to the effectiveness of treatment for TBI and concussions. This involves a combination of CBD and an NMDA antagonist, is a particularly significant and important area of current research. For now, though, the jury is still out on that one. So far, the initial preclinical findings have been very encouraging.
Again, as already mentioned, if you have suffered a concussion or TBI, and are considering consuming cannabis, it is important to speak with your medical professional before doing so.
Research on marijuana for concussion has been compelling, to say the least. In this article, we discuss some of the long-term positive effects.
Can a Pill Replace Pot for Treating Concussions?
The Atlantic – In 2012, the former Pittsburg Steelers lineman Ralph Wenzel died from early-onset dementia. It was brought on by his severe chronic traumatic encephalopathy (CTE), a progressive brain disease triggered by repeated concussions. Earlier this year, the former NFL fullback Kevin Turner was diagnosed with CTE, too, after dying from the disease at age 46. Doctors thought Turner had ALS until they performed the autopsy.
In a 2015 study, researchers with the Department of Veterans Affairs and Boston University examined the brains of 91 former NFL players. They found 96 percent showed signs of CTE. Many players suffering the debilitating mental effects of CTE have committed suicide—Steelers offensive lineman Terry Long, Chargers safety Paul Oliver, and Eagles safety Andre Waters, to name a few.
Some former NFL players, like Eugene Monroe, argue that marijuana could combat the debilitating long-term health effects of repeated concussions. But while NFL team owners are beginning to talk about the need to reform their policy, smoking weed continues to be a punishable offense.
Now, a team of researchers at the University of Miami may be on to a less contentious solution—a treatment with the medicinal benefits of marijuana but none of the psychoactive kick.
The researchers recently began a five-year study aimed at creating a pill that athletes could take after a concussion to avert brain damage. They plan to develop this pill using cannabidiol and dexanabinol. Cannabidiol, also known as CBD, is one of the-113 plus chemical compounds found in cannabis known as cannabinoids. Dexanabinol is a synthetic cannabinoid. Current evidence suggests these two particular cannabinoids have the capability to disrupt the series of chemical reactions that follow a concussion and lead to brain-cell death. CBD activates receptors that trigger a cellular repair mechanism in the brain, while dexanabinol prevents calcium from accumulating in the cells and draining their energy.
“What that pill would do is stabilize the brain, so that when you get a head injury, there may only be a few brain cells that are injured to the point of no return,” says Michael Hoffer, a professor of otolaryngology at the University of Miami Miller School of Medicine who will conduct trials for the study. “There are a lot of brain cells at risk right around those cells. If we can stabilize those, we can prevent the dominos from falling.”
There is some evidence that this effect could be achieved simply by smoking marijuana, but the major benefit to working with isolated cannabinoids is that researchers can choose which compounds to use and which to exclude. With the cannabinoid THC absent, the concussion pill, which could be taken up to 24 hours after an injury, won’t get anyone high and presumably won’t inspire the institutional backlash of its leafy progenitor.
Stripped down to its cannabinoid components, marijuana has already made a powerful foray into the mainstream medical world. “We’re starting to learn more and more [about marijuana],” says Gillian Hotz, another researcher at the University of Miami Miller School of Medicine who is working on the study. “It’s not [just] the guy who sits in the basement smoking a joint and playing video games anymore. We’re way past that.” Research suggests CBD may be effective for treating epilepsy and cancer. A few cannabinoid-based drugs, including nabilone and dronabinol, are commercially available for treating cancer side effects.
If the Miami team’s pill succeeds, the compound could become a neurological game changer. The Centers for Disease Control reports that about 1.28 million people suffer a concussion or other form of mild traumatic brain injury each year. And while professional football has grown notorious for its high concussion risk, the epidemic isn’t limited to the pros. From 2001 to 2005, 135,000 children ages 5 to 18 reported to the emergency room for concussions sustained while playing sports. While they are prevalent in football and boxing, concussions are common in sports ranging from basketball to hockey, with research suggesting female athletes actually experience them at a higher rate than males. Concussions are also widespread in the military, with 300,000 service members diagnosed between 2000 and 2015.
There is no prescription for concussions; the standard treatment is simply to rest until the symptoms fade. But the unseen damage from repeated concussions doesn’t really fade—and it can change the brain in ways that may take years to surface. For those unlucky enough to develop CTE, the brain gradually descends into a state of progressive degeneration associated with memory loss, impaired judgment, loss of impulse control, aggression, depression, suicidal thoughts, and—ultimately—dementia.
Despite the apparent need for research like theirs, the Miami research team has a challenging road ahead—starting with the legal hoops they must jump through to get the compounds they need. Marijuana, a schedule 1 drug, is notoriously difficult for researchers to obtain, and CBD is no easier. “As far as the DEA is concerned, they’re the same,” says Hoffer. “While almost all doctors have class 2 through 5 licenses, getting a class 1 addition to your license requires a lot of paperwork.”
When they begin clinical trials in about a year, the team will be stepping into relatively uncharted territory. Not only will this be the first large-scale study in the U.S. to look at cannabinoids as a treatment for concussions, it will be one of just a handful of concussion treatment studies currently underway.
“Designing treatments has not really taken off because, despite the fact that millions and millions of people are having concussions every year, we’ve just been behind the game,” says David Wright, a neurologist at the Emory University School of Medicine. Wright also studies traumatic brain injuries, although his work focuses on moderate to severe head trauma rather than concussions. In 2014, he led a study investigating the hormone progesterone’s effect on traumatic brain injuries. It proved unsuccessful despite promising preclinical trials.
“Right now, we’re all trying to better define the disease and figure out what in the world is going on,” he says.
One reason concussions are tricky to study is that they are difficult to define. There is no one characteristic doctors can use to diagnose a concussion beyond doubt. “It’s a clinical system, almost like a psychiatric disorder,” says Wright. “So there’s not currently a good marker.”
To deal with this, the Hoffer and his colleagues at the University of Miami will use I-Portal goggles, a device that measures eye movements to diagnose concussions with 95 percent specificity. The team tested the device with a 2014 grant from the NFL. Hoffer also says that each individual patient’s criteria will be clearly recorded, so that later on the researchers can see if all the patients with headaches, for example, respond differently from those with dizziness.
Another challenge will be figuring out how to measure whether patients’ brains are truly healing. “We don’t know what’s going on microscopically within their brain, but at least functionally their memory and things like that return back to normal [without treatment],” says Wright. The team plans to draw from peer-reviewed research to find measures that have proven successful in other studies.
Whatever the end result, Hotz believes the team’s quest for a concussion pill will be a meaningful step in traumatic brain-injury research, not to mention an imperative plunge into the medicinal components of one of the most hotly debated drugs in America. “Because cannabinoids and marijuana are getting such big press and usage now, I think somebody has to step out and start really doing the hard work, to really start looking at therapeutic windows, dosing, safety, and timing to make sure this is efficacious,” she says.
The Atlantic – Some former NFL players argue that marijuana could combat the debilitating long-term health effects of repeated concussions. But smoking weed continues to be a punishable offense. Now, a team of researchers may be on to a less contentious solution.