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Utah in the Weeds Episode #85 – PTSD & Cannabis with Clif Uckerman

What to Expect in This Episode

Episode 85 of Utah in the Weeds is for anyone interested in using cannabis to treat PTSD. Utah Therapeutic Health Center clinicians Tim Pickett, PA-C and Clif Uckerman, LCSW, hosted an online webinar and Q&A session on the subject.

We started with some details about Clif’s background as a licensed clinical social worker and therapist. [4:18]

He and Tim talked about some of the ways post-traumatic stress order can be defined. [8:35]

They went over some of the most common symptoms associated with PTSD. Clif says anxiety tops the list of the most common PTSD symptoms. “Hyperarousal” or, as Clif puts it, a state of “hypervigilance,” is another common  experience among PTSD patients. [10:10]

Clif went over the clinical processes for diagnosing PTSD, and some of the other mental health issues that can accompany PTSD. [13:35]

Tim talked about some of the existing research regarding PTSD and cannabis, and some of the related biochemistry. [17:45]

Clif discussed the use of cannabis in conjunction with a therapy session. According to Clif, some patients find their therapy sessions are more meaningful when they’ve used cannabis beforehand. Clif says a good therapy session can be cathartic, but it often leaves the patient feeling anxious and insecure afterward. This, he says, is another time when cannabis can be very useful. [23:05]

Tim talked about the “mechanism of action” by which cannabinoids like THC and CBD interact with the body’s endocannabinoid system. Then, he talked about some of the most common cannabis delivery methods and their effects. [29:45]

Next, Tim went over the importance of keeping a journal when using cannabis to treat a medical condition. [36:38]

Cannabis has several chemical compounds (cannabinoids and terpenes) useful in treating PTSD. Tim talked about some of the most important compounds and their effects. [37:50]

Tim recommends hybrid and indica strains for PTSD patients. He says the Ice Cream Cake and Do-Si-Dos cannabis strains are easy to find at most of Utah’s pharmacies, and they work well for treating PTSD. For PTSD patients who prefer edibles, Tim recommends Zion Medicinals’ Plush Wild Cherry gummies. Tinctures also work well for treating PTSD. Tim recommends tinctures with THC/CBD ratios ranging from 1:4 to 1:10. [40:24]

Clif says low-THC, high-CBD cannabis products work well for his patients. Most of his patients who use cannabis prefer edibles. [41:51]

Next, Tim talked about finding the right cannabis doses for treating PTSD. He said scientific evidence shows a “sweet spot” for THC dosing between 7.5 mg and 12 mg. Too much THC can worsen anxiety associated with PTSD. [42:44]

Tim answered a question about Utah’s Compassionate Use Board, which can approve cannabis recommendations for people under 21. [44:48]

If you’re interested in talking with Clif about using Medical Cannabis to treat PTSD, call 801-851-5554 to schedule an appointment.

Podcast Transcript

Tim Pickett:
Tonight’s webinar is by utahmarijuana.org. I’m Tim Pickett, a medical cannabis provider here in Utah. We’re going to do just a conversation really around PTSD and I am so happy that we have an expert essentially on PTSD and behavioral health, Cliff Uckerman. Will you introduce yourself, Cliff and talk a little bit about your background and you?

Clifton Uckerman:
Yeah. Well, thanks for inviting me to this webinar, if that’s what we’re going to call it, the metanar. So I’m a licensed clinical social worker. Graduated from the University of Utah, 2010. So since then have been providing substance use addiction, mental health services, clinical services for the last, what now, 12 years.

Clifton Uckerman:
And a lot of different settings, cradle to the grave, all different ages. Where I’m at right now, in my career, I think I’ve gravitated towards treating PTSD, trauma, understanding really what that is, what that can look like for so many different people. I’ve worked with thousands of different people, one on one, in groups, with families, and also gravitating more towards the use of medical cannabis in conjunction with trauma treatment or trauma therapies.

Clifton Uckerman:
So I also teach up at the U of U as an associate instructor and I am currently the senior clinical director and founder of Altium Health which is an addiction and wellness center out in Jordan Landing. But I’m just in the process of really trying to be a behavioral health provider in the medical cannabis industry. Unlike, I think, anybody is doing right now, I think a lot of us are trying to figure out with insurances and philosophies of therapy and trying to break down all the stigmas and stereotypes around marijuana and cannabis, trying to figure out where a lot of us behavioral health providers are trying to figure out how does this work and how can we make this work and be a good thing for a lot of people with PTSD. So I’m really interested in continuing to find the model that works for this in the medical cannabis industry.

Tim Pickett:
It’s cool to have you as part of this, and I think we’ll get into some discussions that I haven’t been able to have with anybody in the clinical setting regarding PTSD specifically and medical cannabis. So topics, we’ll try to go over tonight. What is PTSD? Some symptoms of PTSD. What the effects of THC and CBD are in general, but also specifically four symptoms of PTSD.

Tim Pickett:
We’ll discuss a little bit of the mechanism of action, what we think is happening. There’s some of this we know and some of this that’s assumed, right? You think, “Well, maybe we should know more before we use it, but frankly we don’t know the mechanism of action of a lot of drugs we use in “normal medicine” Right? So then we’ll talk about suggestions and uses of medical cannabis. And at the end, I’m going to make a couple of product recommendations that I think are similar to products that you might want to try or really products you might want to go out and try yourself.

Tim Pickett:
This webinar and more videos can be found at Discover Marijuana. This is a QR code. You can just take a picture of it right now. If you are not subscribed, and you’re somebody who is interested in medical cannabis, there are a lot of videos there. There’s a lot of videos with me and Blake Smith who’s a bio analytical chemist for Zion Medicinal, lot of mechanism of action for other conditions. A lot of discussion around different forms and delivery.

Tim Pickett:
I like this YouTube channel. There you go. Subscribe to that. So let’s talk to about PTSD in general. So Cliff, this is really your wheelhouse, right? What is PTSD?

Clifton Uckerman:
Well, the way that you’ve got it listed up here referencing the APA, American Psychiatric Association. So the DSM, the Holy Bible of Psychiatry where we get all of our mental health diagnoses disorders would say anybody who’s experienced or witnessed a traumatic event or been threatened with death, sexual violence or serious injury.

Clifton Uckerman:
So that’s one way to define it. But when I work with patients and the way that I define it is it’s that negative life event that a lot of us may experience in our lives at one point in time in our life, that kind of leaves a sense of shock, internalized shame, grief, and makes us feel really bad about ourselves in a lot of different ways. A lot of times the trauma is something that leads to detrimental development, and we look at it and we can’t see any good from it. We can’t see any positive coming away from it.

Clifton Uckerman:
So it just leaves the mind, the body, the spirit in a lot of distress. So we later on, if we don’t talk about it and we’re not processing the trauma in order to reverse the trauma or heal the trauma, then we end up having nightmares flashbacks, lots of anxiety. Anxiety is probably number one when it comes to PTSD in terms of symptoms. So that’s how I would probably define PTSD. You got a list of symptoms right here, again, nightmare effects.

Tim Pickett:
Do you find that there are symptoms that are more common in this list or is everybody really different?

Clifton Uckerman:
Well, everybody’s symptoms express and manifest differently in different kinds of ways, but generally across the board, the common things that I see is lots and lots of anxiety. And that would include social anxiety, sleep problems, insomnia, of course the flashback and nightmares. But essentially, one thing that is common between everybody with a PTSD diagnosis is this kind of state of hypervigilance, being very hyper aroused.

Clifton Uckerman:
So getting triggered from something or someone in some kind of setting or context, and having a really bad, negative, distressing reaction to that. So that could lead to some kind of flare up of blowing up, acting out, getting angry and explosive. Running away, avoiding, shutting down hiding out and isolating from people is typically what I would see between a lot of different people diagnosed with PTSD.

Tim Pickett:
Is this something like with chronic pain, when we look at it clinically, we would say, “Okay, is this pain something that is affecting your ability to do the things that you want to do?” Right?

Clifton Uckerman:
Yes.

Tim Pickett:
So that’s the physical part of you use a physical symptom and then you say, “Well, is this actually harming or keeping you from doing other things like your leg pain? Then I would say, “Oh yeah, you have chronic pain. We need to deal with that because it’s affecting your ability to do things.” Is that one of the criteria when you’re diagnosing somebody with PTSD? It’s not just I’m anxious all the time, or I have these triggers, it’s that I’m actually doing things differently because of the trauma.

Clifton Uckerman:
Yeah. And with PTSD and all disorders in the DSM, you really can’t make a formal diagnosis unless there’s some life domain impairment. So between all of the people that I work with that have an actual precise accurate diagnosis of PTSD, employment is disrupted. A lot of people have a hard time going to work or being at work. Relationships with family, spouses, children, friends, parents, siblings are pretty impacted and there’s a lot of relational distress that can occur and happen.

Clifton Uckerman:
Then so many other life domains can be affected too. Sometimes in an attempt to escape or even avoid a person can start to maybe self-sooth or use different types or forms of medication, whether it be legal and prescribed or elicit and off the street. So sometimes with that kind of use can come health problems, emergency room visits, sometimes criminal charges and incarceration. So anytime there’s a life impairment, that would be one criteria of meeting a diagnosis.

Tim Pickett:
Is typically the diagnosis done with like a paper evaluation. You have of like a questionnaire people fill out and then you score it and then you take that with a behavioral health like evaluation?

Clifton Uckerman:
Yep. There’s so many different instruments, but we use the instruments that were developed and certified by the VA, which diagnosing PTSD originally when it came along to be a formal diagnosis was with military coming from post deployment and combat. So the VA has a lot of specialty in diagnosing and screening for PTSD. So we use what’s called the LEC-5 and then the PCL-5 which screens for the life events and the symptoms. It’s like a symptom checklist.

Clifton Uckerman:
If that has a positive suggestion for PTSD, then we do a full on behavioral health assessment which takes about an hour. And we look at self-reporting, we look at presentation in the symptom. We’re making observations around the information that’s being provided. And then we do a collateral kind of clinical collection of documentation from other providers or history of providers.

Clifton Uckerman:
Now, what we notice is most people that I work with, chances are have some kind of trauma that’s still affecting or impacting them and causing some disruption in life domain. A lot of times we look at a diagnostic matrix, how many symptoms or sets of symptoms come into the picture or with that patient that might indicate a particular mental health diagnosis like anxiety and depression and bipolar and those kinds of things.

Clifton Uckerman:
What we notice is a person that comes in with a history of three or more diagnoses in their diagnostic matrix, chances are that is all falling under the umbrella of a PTSD diagnosis.

Tim Pickett:
Okay. I think in medicine that I have experienced in, it is much more… It’s 15 minutes. I get 15 minutes, 20 minutes with the patient. We’re going to talk about it real quick. And then I’m going to pick a medication to put them on. What you’re essentially saying is that that doesn’t really help people in some ways, right?

Clifton Uckerman:
It’s part of it. It can help and it’s part of it, but it’s not the end of the road for a lot of patients for sure.

Tim Pickett:
Right. Okay. So in Utah, PTSD is the only condition that is in the mental health world, in the behavioral health world. PTSD has to be diagnosed by one of these psychiatrist, psychologist, LCSW, psychiatric APRN. And you also have to be in ongoing treatment, in ongoing treatment. So it’s the only condition in Utah that requires not only the diagnosis, but you must be an ongoing treatment which I think is a good thing. Would you agree with that?

Clifton Uckerman:
Yeah. I mean, I think people have a hard time when they feel like they’re forced to do something. So if a person has choice and control and they’re getting good quality therapy to treat trauma takes a lot of expertise. I think most people probably would want good therapy over the long-term. We screen patients and we say how long do you think you want to be in therapy? And most people with a true precise, accurate diagnosis of PTSD are wanting to be in therapy for a year or more because there’s so much that they need to work through and be able to process.

Tim Pickett:
So let’s talk a little bit about… We’re not going to go through these very much, but there are some studies and I find these are particular ones that I picked out. So some Israeli research is very interesting. They have given a hundred grams of cannabis flower per month to some of their soldiers, right? A hundred grams. That’s a lot of flower. Okay. In Utah, four ounces, 113 grams. So we’re talking more than three ounces, three and a half ounces of flower.

Tim Pickett:
You’re smoking more than not quite an ounce a week. I don’t know how much in this study, the patients we’re actually using, but they’re measuring symptoms before. They’re measuring symptoms after. And they’re showing really good results with access to cannabis flower in this study.

Clifton Uckerman:
Right.

Tim Pickett:
In 2017, there was a really good review too about CBD specifically that it produces an enduring reduction in learned fear expression. So one of the things that we’ll go into, and maybe we have a slide on it, I don’t really know. But what’s happening from a brain chemistry standpoint is you’re building callouses between the amygdala, the emotional part of brain and the frontal lobe, which is your reasoning. You’re building these pathways that it’s hard for the brain to get out of. And that is what we would consider learned fear. Right? If we can reduce that learned fear, then in theory, we can reduce the impact of the trauma to the patient’s life experience.

Clifton Uckerman:
Right. Yeah. Lessening the anxiety, reducing the symptoms so that we can slow things down and lessen the reactivity that a person often exhibits to be able then to do more work below the symptoms of it all.

Tim Pickett:
Yeah. So that makes sense. You’re basically utilizing it to soften the clay so you can mold it a little better.

Clifton Uckerman:
Yep.

Tim Pickett:
Right?

Clifton Uckerman:
That’s a great analogy.

Tim Pickett:
Okay. So the effects of Delta-9, this is kind of a fun little video where Blake talks about it.

Tim Pickett:
What’s happening in the body chemically with depression? Why is cannabis good or bad? Tell us about that.

Blake Smith:
If someone is having depression, this is not going to really inspire you not to be depressed, right?

Tim Pickett:
Right.

Blake Smith:
This is just a chemical explanation about this and really work with your doctor. Everyone deserves to be happy and have joy. It’s not just the interplay of dopamine by itself. It’s melatonin, it’s serotonin, and you have a whole slew of other neurotransmitters that are all oscillating. So what you’re trying to do is get to homeostasis or this natural typical curve.

Tim Pickett:
I show that partly because if you want more information about this, you can go to Discover Marijuana and you can listen to Blake talk a lot about stuff like that. All these different pathways that THC and CBD are affecting, and really not necessarily what we’re talking about here in depth, but that’s the chemical explanation of how these things are helping because CBD and cannabis in general is really trying to get the body back to homeostasis.

Blake Smith:
Yes.

Tim Pickett:
It’s a very, very interesting substance that will stimulate certain pathways in the neurons and inhibit other pathways in order to maintain that balance. It’s what you and I really like about the cannabis treatment in general. We find that the things that cannabis can be really good for is improving sleep, decreasing anxiety to a certain extent if you’re using it correctly in the correct dosing and delivery forms for the patient, having the right kind of intention around the cannabis use tends to help lower anxiety, anger outbursts, and avoidance behavior.

Tim Pickett:
Have you found, Cliff that the avoidance behavior goes down? This is somebody who doesn’t want to interact with that individual because in the past they had a traumatic event with somebody who looked like that.

Clifton Uckerman:
Yeah. Or sounded like them.

Tim Pickett:
Or sounded like that.

Clifton Uckerman:
I said the same things that they said. I think that with the use of cannabis… And lot of times I think the CBD, that’s part of the ratio. A lot of these symptoms are lessened. I think when they’re in session and doing therapy then… Because trauma is really memory. So you have a traumatic memory with a lot of feeling embedded into that memory. So anything that triggers the memory is going to trigger a feeling.

Clifton Uckerman:
So if I have somebody that’s coming in to do trauma therapy and it’s in conjunction with medical cannabis, then they have a whole hour that they can sit without running away and really confront and face the memories and then process the emotions. The trick in the trauma therapy, which is why I love the use of medical cannabis, because it allows the person to be able to release and relinquish themselves from those feelings being calm enough and slowed down enough, and less anxious enough to be able to have a really good cry.

Clifton Uckerman:
A cathartic moment like that releases those emotional molecules, which are just really built up toxins stored in all of those old memories that’s creating disturbance internally. So that’s what I love about the medicinal cannabis. [crosstalk 00:20:27]

Tim Pickett:
Are you specifically having certain patients or are certain patients choosing to use cannabis during their sessions?

Clifton Uckerman:
Yeah. Whether it’s cannabis or an anti-anxiety pill or an antidepressant, typically people who are on some form of medication are taking their daily dose in the morning before they get up for the day and get ready and do something with their life including therapy. So if it’s medical cannabis that they’re using when they get up and before therapy, that’s what they use. And oftentimes if that’s what they do, the therapy session is just a much more meaningful for them and much more quality with the time that we have to be able to work through and process things that they normally would be hyperaroused by, hyperreactive to avoiding, not wanting to talk about being afraid or too anxious to talk about.

Clifton Uckerman:
Sometimes the medical cannabis actually helps restore the memory because a lot of times people don’t remember what there is to talk about and they can’t recall what to talk about in the first place. And that’s just because of that hyperaroused kind of state of mind that they might be in or that hyperactive emotional state that they might be in.

Clifton Uckerman:
So if they take their medicinal cannabis in the daytime and the morning when they get up, they come to therapy, they’re much more able to remember and recall, have an emotional release and then be able to confront and face those fears without all of the anxiety.

Tim Pickett:
I love this, and I don’t think there’s enough of this going on in… Certainly we’re not talking about it enough, and I think people really need to hear that this is an option. When you talk about like the mechanism of action, which is the next slide, which we don’t really… This isn’t something that I want to spend much time on in detail, but we’re… Cannabis enhances the present by disconnecting us from our short term memory a little bit. But you are bringing up that you can access these long-term memories, and it seems like that would be more clear because there’s not so much distortion or noise. There’s not so much noise in the mind. Right? You’re able to really focus like you say and slow down and talk it out. Right?

Clifton Uckerman:
Right.

Tim Pickett:
And like you say, have a good cry. I think there are a lot of us and probably even in the participants, in the audience here that have experienced that. It’s not all just euphoria and giggles with cannabis. There are times when you can have an incredibly meaningful conversation with somebody and learn a lot about yourself and about your perception of reality and very, very meaningful experiences.

Clifton Uckerman:
Right. Getting real with some stuff. The other thing too, that I don’t think most people realize is that in trauma work, even being able to talk about these kinds of things in session, and a lot of times people are sharing things in ways of themselves that they’ve never shared before with anybody else at all, because it’s been so buried and it’s been kind of trapped and contained in shame and secrecy because a person feels like it was their fault. They’re to blame. They did something wrong. They weren’t good enough. There’s something wrong with them.

Clifton Uckerman:
Now, the thing that most people don’t realize is that after that session, because that person has been able to disclose so much in such a vulnerable way, it likely will leave them feeling insecure when they walk away and after they go home questioning, “Should I have brought that up? I shouldn’t have said that. I shouldn’t have told him that. I wonder what he’s thinking about me now.”

Clifton Uckerman:
So there’s a really can be in trauma work after a really good, meaningful, positive session, a whole lot of increased anxiety and securities in the aftermath of it. So that’s one thing that I also think that medical cannabis can help with. Oftentimes, I tell my patients, “Go home and take a good nap and try to sleep really well tonight.” And the one thing that helps them sleep and take a really good nap so that their brain can do pruning after all those oxytocins are released because of that good cathartic cry is use cannabis to help them get there to lessen the anxiety and to help them get to sleep so that their brain can do some repair work.

Tim Pickett:
I think the other thing I would add to that is allowing your… The nice thing about having a therapy session and having a professional that you work with, or a really, really good friend, somebody that you have as a trusted confidant giving you permission to be vulnerable so that you don’t have that. There is this anxiety associated with THC use as well. And a lot of times people have to give themselves permission to talk, and to be open.

Tim Pickett:
And to use and to be a little stony, I guess, for lack of a better word. Nathan has a question, but we’re going to get to that in just a second. And I think we can help with that question. So this slide talks about the mechanism of action of the endo cannabinoid system, which really the keyword there is modulation.

Tim Pickett:
So we’re creating things. We’re consolidating things. We’re trying to get back to a balance. We’re trying to get back to this homeostasis and we’re using the CB1. The CB1 receptor system is in the brain and the nervous system and the CB2 receptor system is in tissues. And we’re using both in trauma therapy and PTSD therapy.

Tim Pickett:
There’s this hypothalamic pituitary… This is emotional brain talking to the frontal lobe. That’s the simple version of that. And then the 5-HT1A, that’s that serotonin kind of pathway. That’s that depression pathway. It’s modulated a little bit, not so much activity with depression specifically with THC and CBD use more help with anxiety and that part.

Tim Pickett:
So let’s move on to some interesting stuff. So the tinctures and edibles, I want to teach everybody, remind everybody that tinctures and edibles are going to be a slower onset to peak effect. You’re looking at, I would say an hour to two hours to peak effect. You’re going to have a slow decrease over the course of four to six hours typically with oral methods of cannabis.

Tim Pickett:
Really good for consistent dosing. And if you’re taking it morning, noon, and night. If you’re taking it at night, tinctures and edibles tend to be really, really good because they last a long time and you can sleep. Then you have flower and vaporizers, inhaled methods, which are quick to action, but they decrease over a shorter amount of time, much more rapid.

Tim Pickett:
So this tends to be good for triggering events, things that you either know something is going to be triggering. So you can dose, or you have a triggering event and then you dose where an edible or a tincture is going to take a little too long to take effect. And this goes to the question, and I’ll read this question out.

Tim Pickett:
So the question is really around, “So there’s edibles before bed, but found myself super groggy in the morning.” And over the last few months, he switched to a dryer vaporizer, usually a one-to-one type strain. So that means a one part CBD, one part THC. We’ll talk about that in a couple of slides coming up, does not have the same effect, meaning not groggy. I’m hoping that I’m getting that right. “Any suggestions on methods might be better that will lead me functional in the morning?”

Tim Pickett:
So using these two slides as your guide, if you’re using a dryer vaporizer, you’re only going to get effect between two and four hours, but if you’re using an edible, you’re going to get effect for a long period of time. So usually it’s depending on the dosing and how long before bed, or how early you wake up.

Tim Pickett:
We can get a little more nuanced than that with absorption. Absorption can happen depending on what you eat, either slower or faster. So if you weigh a high fat meal, you might have more effect because it’s a absorbed with the fat, and that may actually last longer as your gut slows down with these big meals. So you can tend to get an eight to 12 hour sometimes almost high from an edible and leave people groggy in the morning.

Tim Pickett:
So I think if the question is trying not to feel groggy in the morning, then the answer is using shorter methods like flowers. That’s the answer. If the question is you want to sleep as good as you did with the edible, and you’re not getting that effect with the flower, that’s probably strain related or level of dose related more so than the duration of effect. And there’s a couple of suggestions in my last slide about products.

Clifton Uckerman:
Is it also possible too that with the edible before bed that all has to digest and then it has a longer span of time to take effect and stay in effect?

Tim Pickett:
Yes. Because you might only be absorbing one or two milligrams at a time and you might be absorbing clear through the night.

Clifton Uckerman:
Right. Go ahead, Tim.

Tim Pickett:
No, go ahead.

Clifton Uckerman:
I was going to say, so just my part as a therapist, as a medical cannabis therapist because we really want to try to have the greatest and most positive effect of what’s being consumed, be on the most effective of the least amount of things, right?

Tim Pickett:
Yes.

Clifton Uckerman:
So something that I’m seeing here, if Nathan came to me to therapy, I would probably really want to explore, also, what is the antidepressant? What is the anti-anxiety? And what kind of edible is it? What strain and ratio is it? Because I want to understand the interaction risks between all of these things, but I would want to also understand is sometimes if I wake up groggy and still tired, something has been flooded, chances are, and you got antidepressant and an anti-anxiety depending on what types of medications those are and the dosage that he might be on in combination with the edible, whatever that is, could actually be not the best concoction or mixture of medications.

Clifton Uckerman:
So I’d want him to explore that and really then talk to somebody like you, and see if there’s a way to get on the least amount of the most effective. As a medical cannabis therapist, I typically would tell my patients, “Gosh, you know what think about one or the other.” I mean, medical cannabis is very natural, organic. It’s a plant based medicine and the antidepressants and anti-anxieties come from the lab and are based… It’s pharmaceutical based.

Tim Pickett:
Completely synthetic, yep.

Clifton Uckerman:
Synthetic. So you never know, and there’s no recurrent research that tells us, “Hey, this is what happens when you put these things together in your unique body.” So that’s the kind of conversation that I would also probably want to be having as well.

Tim Pickett:
And that brings up Colin’s point, which is here, that it’s best to start low and go slow and then keep a journal. So keeping a journal, not only of your cannabis use, but of your other medications that you take, and maybe even what you’re eating for dinner. I know that these journals… We don’t want these journals to be so detailed that you’re not going to do it, but if you have a set of things that you’re tracking and then a couple hours later, how you feel, especially with cannabis, if you’re tracking how much you take and when you take it, and then how you feel a couple of hours later, then you’re going to… Over time, you’re going to get a sense.

Tim Pickett:
You’re going to be able to go back and get a sense of what’s working and what might not be. But the whole old point of a journal is to keep the record. And like Nathan said, I mean, if you’re tracking too much data, you’re not going to do it. So only track enough data that you’re going to do it every day or do it every session. And over time you find like I definitely have things that I will not take at certain doses. I promise you.

Tim Pickett:
I am very specific at about a couple of things. Let’s talk about that specifically, what to take and what to look for, for PTSD and mental health really. And maybe what to avoid a little bit. So terpenes are found in everything, right? When you go through the forest and you smell, you’re smelling pine. When you eat a lemon or smell an orange, or there’s a lot of limonene in that. Myrcene is the most dominant terpene found in cannabis.

Tim Pickett:
It’s up to, I think, 4% in some strains, but definitely the most common. Linalool is very much like lavender. That’s the smell that we have. And caryophyllene, beta-caryophyllene is a common anti-inflammatory terpene. It’s very common in strains that tend to help with chronic pain, but these three are my favorite terpenes when it comes to PTSD symptoms. If you have the ability to look for terpene, product with these terpenes, either added or these terpenes are dominant in the flower, then these would be pretty good.

Tim Pickett:
The cannabinoids, there’s about 120 cannabinoids we know of. THC is a cannabinoid, CBG, CBC, CBD, and CBN. CBN is known for its relaxing properties. It’s known to be very calming. It is very good for sleep and calming anxiety during the day.

Tim Pickett:
So if you’re looking for products with cannabinoids or terpenes that may help a PTSD type of condition, these would be where I would start. And you can find this particular graphic on utahmarijuana.org. And you can find information on terpenes. It’s readily available online. Terpenes are essential oils, right, which a really common thing in Utah to treat things.

Tim Pickett:
One warning about terpenes, you do not want to inhale terpenes on their own, right? You’re not vaping terpenes. Don’t vape your essential oils. That is very, very dangerous. It’s not recommended. You’ll notice in these products, there’s very small percentage of terpenes added because they can be very strong in low doses.

Tim Pickett:
And then product recommendations, for me, I’m going to tend to recommend indica or hybrid type products. A couple of things in Utah that are fairly common and easy to find are ice cream cake and Dosie Dough. Dosie Dough is a vape cart and a flower. There’s a bunch of different companies that make these products with the Dosie Dough kind of breakdown.

Tim Pickett:
The only edible that I could find with a breakdown of what’s actually in it was a Zion Medicinal, the Plush Wild Cherry gummies. The reason why I like this one is because of the ratio. I think you want that ratio of THC to CBD, which brings me really to my favorite products for PTSD and for new patients, which are tinctures. I recommend ratios of one to four, up to one to 10 THC to CBD.

Tim Pickett:
If you go back in our slides, you’ll find that that CBD research is really good and CBD tends to smooth out the rough edges of the THC effect. So patients who use them together tend to have better sessions when they’re in that one to four ratio or at least one to one ratios. Cliff, do you have any favorite products?

Clifton Uckerman:
Yeah, I think anything that is higher CBD, lower THC. For me and my patients, the one to one sometimes can be a little too much. The one to four, what do they got, one to 10, one to 30. And then some people really do like flower and there are flower products out there that are mostly, if not all CBD with a little bit of THC, which can be really helpful. But they’ve got vapes and tinctures and edibles. But I think for me and my patients, the tinctures are great, but edibles tend to kind of be what I hear a lot of my patients using a lot more is the edible.

Tim Pickett:
This is good slide for reference for dosing. Just like Cliff was saying, the one to 10 THC to CBD, that seems to be a really good sweet spot for people who are new to cannabis, to people who want to decrease anxiety, help their sleep, decrease their dreams. That 2.5 to 12.5 milligrams per dose also seems to be, when you look at the evidence, we tend to come to this 7.5 to 12.5 has the sweet spot for THC dosing.

Tim Pickett:
A lot of that is around, if you get too much THC, the brain starts to spin and you’re watching the waterfall. You’re behind the waterfall and this is just going and going and going. And that can ruin your sleep.

Clifton Uckerman:
Especially the sativa. I you already come with a lot of anxiety and anxiety is a big part of PTSD, but if you already have a lot of anxiety and then you’re using really high dosages of THC and sativa chances are, you’re probably going to get a little bit more paranoid. Anxiety can turn into paranoia if your brain is overactivated.

Tim Pickett:
The last thing I’ll say before we get to questions is if you are concerned about the high start with CBD one milligram per kilograms, take your body weighting pounds, divide it by 2.2, that’s your kilograms. One milligram per kilogram per day. Start with that, right? So I’m 170 pounds. That’s 80, 75 kilos. So I’m going to take 75 milligrams of CBD every single day divided. So I take a slug, I call it. Just take a good slug in the morning, good slug in the middle of the day. And that will help on its own without any psycho activity, and can be used during the day, because it’s not psychoactive and you don’t get that high feeling.

Tim Pickett:
So let’s go to some questions. We’ve got a question about a teenage child who’s been diagnosed with PTSD at a loss for how to handle the compassionate service board. Yes. I have some comments about that, if I have any advice. She has a diagnosis from her therapist who’s an LCSW. Her therapist is supportive, but not a QMP. So this is a great question and there’s a couple of things about this. Cliff is an LCSW, right?

Clifton Uckerman:
Yes.

Tim Pickett:
So Cliff cannot be a QMP under state law because he doesn’t have a controlled substance license or a license to prescribe controlled substances in Utah. That requires somebody like me, a PA with a controlled substance license. So in this case, no matter what, if the patient is diagnosed with PTSD from a LCSW and you then go to see a QMP, you can take that diagnosis and that letter of treatment, and you can then get a recommendation from the QMP for medical cannabis.

Tim Pickett:
So these two things go together, right? You’re going to get the cannabis recommendation from the QMP. You’re going to get the help and the therapy from the clinical social worker. And I hope that makes sense. That’s just in general, the process. Then you add on to that the Compassionate Use Board for somebody under 21.

Tim Pickett:
So that application has to be done through the QMP with help from the social worker. So there’s an entire application process that has to be done. They have to take that application to the Compassionate Use Board, which is seven physicians in Utah. And that board will make a recommendation for medical cannabis and allow them access.

Tim Pickett:
Then you, as the parent have to have a guardian card or a caregiver card to help them access that medication, if they’re under 18. The process takes one to two months. And really if the patient is between… If they’re 16 and over, you can go to utahmarijuana.org, and you can see us. We will help. The Compassionate Use Board has been a little hesitant to use specialist providers as QMPs. It’s a tricky scenario, but we can help guide you through it.

Tim Pickett:
So give us a call. We have somebody who’s actually an expert on the Compassionate Use Board and, and does all of that for us. So hopefully that helps, and we can get you more resources as well.

Tim Pickett:
Okay, perfect. I’m going to answer that one. There we go. And then we had a nice comment. Very thankful to us for… We’re exploring the cannabis family. Yeah. Thank you. I don’t know if it’s Jeanie or Jean, but thanks for those kind words.

Tim Pickett:
Yes. Cliff and I actually really like this stuff. I don’t know if you noticed, but we’re all jazzed up about this, about this topic, right? I’m fascinated with the idea that you can manipulate the mind and you can change like you can change behavior and you can change your perception of your own life and your experience. I think that’s so important and I think that’s missing with modern medicine. I just feel like a lot of the times we just prescribe, and prescribe, and prescribe and dull everything.

Clifton Uckerman:
Yeah. Yes.

Tim Pickett:
And cannabis is like a turning point. It’s not about the cannabis. The cannabis is just unlocking something that is allowing us to take a step forward in our life and in our growth.

Clifton Uckerman:
And there also may be some healing properties too. I mean, I think for me, I grew up as a delinquent youth. So I was in the system a lot. As a way to prevent youth from getting into trouble, they made us feel like all drugs and alcohol were bad and to never use it. Well, when my brother had diabetes and it went blind because of glaucoma, he started using cannabis and brought his vision back. And with all the people that I’ve worked with, especially when I worked in the jail and I ran a program there, we could not talk about it, yet most of the people in there were in there because of drug charges and a lot of it marijuana and were also using cannabis when they were in jail. Sometimes they would use it in jail too.

Tim Pickett:
Oh my gosh.

Clifton Uckerman:
But we couldn’t talk about it. So in the last couple years, as I’ve been working more with patients with trauma and seeing how much this can help and have healing properties, I think it’s something that I want to be a part of and be involved in the conversation about, for sure.

Tim Pickett:
Okay. We have a last question and it is perfectly timed, so thank you Nathan for asking it, and that is this, “Any recommendations to find a therapist willing to work with a cannabis patient like him?” Well, yes, there you go. Call Cliff. And you can get a hold of Cliff by reaching out to us because that’s not part of this presentation as far as our… And I think probably just an oversight on my part, frankly, Cliff, so sorry. So go to utahmarijuana.org, reach out to us, mention the webinar. We will set you up, right?

Tim Pickett:
We’ll give you all the information you need and you can just call our office. We have locations and Cliff is going to be involved with us clinically in our locations, specifically in Bountiful, if that’s somewhere that you want to go. To be honest, I want to do it because I’m just interested in utilizing cannabis like going to the next level and getting really serious about my mental health and use some cannabis.

Tim Pickett:
You can also follow us on Twitter, Facebook, Instagram. We’re on all the things. And at the end of this, hopefully if you’ve signed up for this, then there’ll be a feedback poll. So we really appreciate the feedback. One way to get ahold of me or Cliff is when this is posted on YouTube. If you make a comment on any of the videos that I have, we answer all those questions. It’s better than email because when we answer the question, we get to answer it for everybody and not just keep it a secret for only you.

Tim Pickett:
I think that’s the best way to get the information out is just go to YouTube, comment away and we’ll get it. Anything else that we missed, Cliff?

Clifton Uckerman:
Nope. I think that was great. I appreciate it. It sounds like everybody had a good time. The one thing I wanted to mention is if you can’t journal, some people have a hard time writing and tracking stuff, come to therapy. Let me be your journal. I’ll keep a documented record of it. Every time you come in, we’ll measure it every time. We’ll send it to Tim and we’ll all work together to make something work for you in the best kind of way.

Tim Pickett:
That is a great idea. All right. Thanks, everybody. Stay safe out there, will you?

Clifton Uckerman:
See you later.

 

By UtahMarijuana.org
Published January 31, 2022
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