Cannabinoid hyperemesis syndrome and Energy Focus Therapy are two interesting topics in the news, that came up during the course of recent addiction conferences which Dr Inaba attended. Cannabinoid hyperemesis syndrome is characterized by recurrent nausea, and severe vomiting as well as abdominal pain. Energy Focus Therapy is finding some adherents in counselors and practitioners addressing chronic severe pain. We explore these and other issues.
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions. I am Howard La Mere. A number of stories have popped up recently, but first some random facts about substance abuse and addiction. One in 8 Americans lives with some sort of addiction. Suicide now kills more Americans than car wrecks there is speculation that it has a lot to do with prescription drugs. One quarter of all hospital admissions are alcohol related, 2 of the most common addictions are legal substances – tobacco and alcohol. Up to one quarter of 8th graders admit to smoking pot regularly, and 53% of regular adult pot smokers say they began smoking between the age of 12 and 17. So those are just a few of the random observations that we can think a little bit more about. Another story in the news reports how morphine and cocaine act differently, but have the same addictive properties and there’s an interesting story about cannabinoid toxicity effects, which seem to be increasing as the THC levels continue to rise in the hybridization of marijuana. Darryl, I know you wanted to talk about that and you also attended a couple conferences in the last week or two in Yakima, Washington and beautiful Hawaii, so maybe you can share something about that. Let’s talk about this cannabinoid toxicity effect though.
DARRYL: Yes, Howard. It’s quite fascinating because I hadn’t heard of it until just recently, it’s called the cannabinoid hyperemesis syndrome, meaning that in response to exposure to marijuana or a cannabinoid, people develop horrendous, uncontrollable vomiting and nausea and it’s reported more and more frequently. There is a lot of Google chatter about it and there are papers being published on it. A few weeks ago the brother of our colleague, Bill Cohen, called me, he is a nephrologist, a kidney doctor, in South Carolina and wanted my opinion on symptoms one of his patients was experiencing – the patient was a marijuana user and was vomiting so severely that nothing could control it. They tried the classic antinauseathings like Phenergan and Vistaril, Compazine, Reglan, and they even injected the very powerful drug, Inapsine and that did not control his vomiting. This was the first time I heard about this symptom and it struck me as strange because one of the indications for medical marijuana is to control the nausea and vomiting that occurs from chemotherapy.
HOWARD: Right.
DARRYL: The nephrologist had actually done all the research before he called me and he knew quite a bit about it more than I did. And it came up again when I was in Hawaii giving a seminar – people were asking about this hyperemesis syndrome.
HOWARD: Now is this related to the various spices and K2 and whatnot?
DARRYL: I think it’s partially related – all of the research that I’ve seen sort of relates it to an ever increasing concentration of the chemicals THC, the brain chemicals in marijuana.
HOWARD: And we know that synthetics are way, way stronger.
DARRYL: Synthetics are anywhere from five to eight hundred times stronger than regular THC.
HOWARD: Much more than what would be found by simply growing a plant.
DARRYL: Exactly but here’s the strange diagnostic feature of it that I discovered and was confirmed by colleagues in Hawaii – the vomiting is not eased by any of the commonly used drugs to treat nausea, but the patient can find relief in a hot tub, taking a hot shower or bath. One person I spoke to in Hawaii said their client was spending 14 hours a day in a hot bath and smoking dope so that they wouldn’t be as nauseated. There is a sufficient amount of this happening that some doctors found that treating it with Lorazepam, which is a benzodiazepine, Ativan seems to be the only thing that’s effective to control it. They were giving patients about 1 mg by intravenous injection and then 1 mg 3 times a day for about 3 to 5 days to a week to control this syndrome, which is very dangerous. Just imagine, if you can’t hold anything down, you’re not going to get any nutrition because you’re vomiting everything in your system and that can potentially kill you. So it’s a serious condition. They control it with Ativan, but here’s the catch, Howardhere’s the real non-starter in all this – it goes away if you stop smoking dope! If you don’t use synthetic spice and stuff and you don’t smoke dope, you don’t have this syndrome anymore and it goes away eventually. You may have to treat it, you might not, but that’s what I don’t understand. Why don’t you just stop smoking dope?
HOWARD: Well yes!
DARRYL: Where doctors wind up dealing with it is in the emergency room. People are coming in severe dehydrated and in horrendous nutritional states because they can’t stop vomiting caused by the marijuana or cannabinoid hyperemesis syndrome. So this is really something to consider as we steam forward in many states allowing medical marijuana, and legalizing it in Colorado and Washington.
HOWARD: Well, it just goes to confirm and underline once again the dangers of the potency of synthetic cannabinoids and how like anything that’s new and experimental, we have no idea what the medium and long-term consequences are. So, moving on to some of these other articles.
DARRYL: Well, many of these actually are related to the conference, meaning that the conferences are very good at keeping their pulse on what’s happening with drugs. All the conferences that I went to – in Yakima, Washington and then the one in Hawaii on Maui and 2 on the island of Oahu, – presented similar material Addiction specialists and pain specialists were talking about the need to learn about hyperalgesia and allodynia, which is a condition where the body reacts to chronic exposure to opiates for the treatment of pain and starts creating its own pain – the hyperalgesia.
HOWARD: Right.
DARRYL: And the allodynia is in the brain. Hyperalgesia is believed to occur pretty much on the nerve impulses in the periphery that are transmitting the impulses pain to the brain and then there is where pain is felt in the brain, a reaction, an adaptation to chronic opioids that result in allodynia, which when someone just touches you it feels like they are stabbing you with needles, or holding a warm soda that’s been out in the sun feels like it’s scalding your skin. There is a need for chronic pain specialists to avoid chronic administration of opiates- especially to addicts – and to look to alternative forms of treatment. this is to protect the patient from developing that condition as well as to protect them from relapse. So, a lot of presentations have focused on this. Tomorrow ARC (Addictions Recovery Center)is having its first national conference. We’re going to have a presentation on chronic pain in the treatment of addiction. It’s a huge topic right now as we move out of the era of prescription drug abuse and try to move into an era of more rational treatment of pain, especially for those who are prone to an addiction. Another thing that I noted several papers had topics related to the growing utilization of energy focused therapy, EFT, EMDR, rapid eye movement desensitization techniques and other tapping techniques. I was exposed this kind of therapy by Caroline Osaki in Honolulu who works for Kaiser, and she actually began to change my opinion on this. Tapping involves using your fingers to tap along acupuncture points on the body to respond to stress, posttraumatic stress or pain or any emotional issue. It’s one of the weirdest things to watch – you wonder what the heck is that person doing and how can that help with any emotional state? What can change just by tapping above your eyes or under your eyes or under your arms or along the edge of your hands and thumbs and places like that. A lot of research I found on eye movement desensitization research, EMDR pretty much attributed the effectiveness of EMDR and EFT and tapping to the skills of the therapist to the ability of the therapist to walk you past the trauma, walk you past the stress, walk you past your experiences of pain and whatever you’re going through and that had more effect than the actual eye movements or tapping. Dr. Osaki said t she doesn’t care what’s causing the posttraumatic stress, she doesn’t care what’s causing the emotional stress or pain because that’s not important. She doesn’t even get into that, what she teaches people is the techniques. She’s one of the advocates of thought field therapy and there are 3 meridians that she looks at in the body. You tap and if you’re stuck, you use some breaking meridians along your hands and other places. I sat through the presentation and participated and I want to tell you, it felt weird, Howard! It’s like one a revival meetings or one of those sales pitches for time share condominiums where people start jumping up in the air and says, “I got it! I got it!”, you know “I want 10 of those things!” but She demonstrated these techniques with the audiences and then she evaluated or had everybody evaluate the pain they were feeling, the stress they were feeling, and the emotions that were tied to something. There was very quickly within 10 minutes people reporting tremendous relief because of this thought field therapy. There was research conducted in Rwanda involving several hundred kids refugees from the horrendous civil war that took place there. Kids who suffered just unbelievable atrocities to themselves and to their families who were experiencing a lot of emotion, experiencing a lot of pain and Dr. Osaki didn’t even speak the language, she didn’t sit down and talk to any of them, she just sat there and through an interpreter, taught them how to do this thought feel therapy and work the meridians and tap. She had them measure their anxiety and stress levels were beforehand and then compare those levels after the therapy. There were several research papers published after the experiment showing a significant relief of symptoms. So I might
have second thoughts about this. Maybe – although it looked weird, it is useful. There’s also eye spotting or brain spotting which employs different acoustical sounds in each ear, while the patient walks through stress and the origin of the stressful condition, a lot of people are being helped by this and maybe it has nothing to do with the therapist at all, but there has to be some sort of therapeutic bond between the person teaching the technique and the person performing the technique. But, in the case of Rwanda – there are a hundred kids the therapist doesn’t know the language, she never sat down with any of them and she just showed them what to do – I can’t imagine there was a lot of engagement in terms of therapeutic bonding – it was how these kids reacted to her personality that seemed to have effect. So, that’s something else that I think we need to reconsider and take a look at.
HOWARD: So is it mostly along acupuncture meridian points?
DARRYL: Yes,
HOWARD: Certain ones?
DARRYL: Yes, you tap along specific acupuncture meridian and acupuncture points to stimulate those points. If your main issue is pain then these are the places you should tap, if the issue is stress – these are the places you should tap, and so on.
HOWARD: Well, that’s fascinating.
DARRYL: A lot of good information was shared. There was a strong presentation about the 7 dimensional evaluation of clients to assess how they’re doing in treatment – this technique involves questionnaires to rate 7 specific dimensions of a person’s emotions and feelings and it helps to determine whether or not they have the ability to be safely exposed to triggers again and leave treatment. I thought this was interesting because it coincides with the brain imaging research that can recognize places in the brain have low activity. This type of evaluation also provides a way to predict relapse with 90 to 95% accuracy if the questionnaire is filled out honestly by individuals. Computers can graph how a client is reactingthere’s a lot of movement in this field and it’s inspiring to go to these conferences and learnwhat other people are doing. The most inspiring thing is that people are doing these things not because they’re gaining fame or fortune, they’re doing it because they really do care about the best treatment and more positive outcomes for their clients.
HOWARD: Well, it’s nice to see. I’ve been an advocate of exploring alternative health modalities most of my life, so it’s nice to see some interesting validation of these alternative techniques and I think that’s very promising. Are there any other topics..
DARRYL: Just one quick one you were reading about the 10 most wasted countries and how the countries like Iran consider heroin as their number one drugUnited Kingdom, alcoholin Afghanistan, it was heroin and basically whatever is most available in those countries becomes their drug of choice which is no surprise. But I wanted to quickly mention another instance that validates the neurobiology of addiction – a Canadian who was a chronic cocaine addict had a stroke and obviously his stroke was probably related to his cocaine addiction, because that’s one of the complications of being a methamphetamine or cocaine addict, it makes you more prone to have strokes but he was lucky in a way. It was a right-sided stroke, so it probably won’t too much of his functioning because it’s deep in the basal ganglia, in what’s called the reward center the reward/reinforcement center the first unconscious neuropathway that is associated with addiction and since the stroke, the guy has absolutely no desire to ever use cocaine again and when he is exposed to it, he gets no effect. So he’s been cured of his cocaine addiction because of a stroke.
HOWARD: Now that’s interesting.
DARRYL: Which validates what we’ve been saying all along, it’s all about biology. It’s not about getting high. It’s about how your brain is wired for these things that causes you to be an addict or a normie.
HOWARD: That’s something a little bit different, but it is very, very fascinating. So, we’ll keep our eyes peeled for more of these kind of pieces of news and we’ll share them with our listeners. We invite your comments, questions or your suggestions.
That wraps our pod for today. Thanks for visiting the CNS Podcast. Please check back soon for the next in the series and visit our website, www.cnsproductions.com