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Long Term Affects of Medical Marijuana on the Brain and Cognitive Function; A discussion

Posted By Dr. Sean Breen on July 29th, 2010

As medical director for Medical Cannabis of Southern California I evaluate patients daily for the use of medical marijuana.   Often patients ask me if cannabis (marijuana) has any long term adverse effects on the body.  It is a great question and one that can not be answered with 100% confidence until more research and studies are completed.   Cannabis research has been limited because of the federal governments currently classification system which states that cannabis is a schedule 1 drug (no medicinal value).  It is difficult to get any funding to study this incredible plant.

Before I discuss what is currently known about marijuana’s affects on the central nervous system short and long term I want to stress that you always have to weigh the benefits and risks of any medication that you take.  And in the case of marijuana you have to consider what medications you WOULD BE TAKING instead of using cannabis and the risks that they pose as well.   Most of the time cannabis is much safer and effective.

Most people have heard someone say at one time or another “that guy is burnt!”… meaning their brain is pretty much fried and they are not solving any calculus equations anytime soon.   The question becomes: does long term use of cannabis adversely affect the brain.   Short term, while acutely medicated, it is pretty clear that cannabis has an affect on short term memory, attention, coordination, balance, reflexes and hinders higher executive functioning (learning and problem solving).   It is for this reason that patients must be very responsible when medicated.   Researches believe that most of these symptoms are a result of THC (tetrahydrocannabinol) which is that main psychoactive ingredient in the plant.   There are over 60 other cannabinoids that we know of in the plant which also exert their effects on the body. An example is cannabinol which is believed to have anti-inflammatory and analgesic properties without the psychoactive affects that THC has.   This is significant as we move forward with therapeutic applications of the plant.

In the long term the research is less clear.   There have been studies that have shown that long term (chronic  daily) heavy users do exhibit some impairment in higher cognitive function (executive functions such as learning and problem solving) but it is difficult to distinguish from the loss of cognitive functioning that occurs naturally with aging.   There have been studies that demonstrated that chronic cannabis users also have a higher incidence of psychiatric comorbidity like anxiety, depression and irritability.    Certainly I have discussed cannabis use with patients who have been medicating for 30 years or more and they do say that if they don’t have access to cannabis they experience increased irritability, mood swings, insomnia and at times depression.   These are considered moderate withdrawal symptoms that some patients can experience.  It is for this reason that we suggest patients take “drug holidays” every few months for about 1-2 weeks to give their bodies a break and chance to “reset” their natural endogenous cannabinoid system.

One of the other questions is if regular heavy use of cannabis affects an individuals drive or motivation.  People describe users having “amotivation syndrome.”   They question whether cannabis affects their ability to reach goals etc.     My personally feeling is that in recreational users this can be the case.    However using cannabis as a medication is completely different.  Patients typically use less psychoactive strains of cannabis and are using much smaller doses.   Most patients just want relief of their symptoms and nothing more.   In these situations I have not found cannabis to affect a patients ability to work or reach goals.   Most get more sleep, are less stressed and have less pain which allows them to be more productive.

Overall I would say that cannabis in therapeutic doses for medicinal purposes poses very few adverse affects to overall patient functioning.  The major organ systems are not affected and the the acute psychiatric affects of the medication are limited.   Long term, patients do much better because 1) they are not dependent on other medications and 2) their day to day quality of life is improved.  I clearly think that the benefits most patients receive outweigh the risks of using cannabis long term.

If you have questions or comments feel free to contact me at any time or come in for an appointment. 877-721-0047 or www.mcsocal.com

We have two full time offices in Irvine and Long Beach California.

Be blessed,

Dr. Breen

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Medical Marijuana Patients In Irvine, CA July 27, 2010

Posted By Dr. Sean Breen on July 28th, 2010

If you are wondering what types of patients come in to see me for a medical marijuana recommendation, here is a list of all the complaints for the patients I had in Irvine today.  Most patients are coming in because of pain.   They are typically tired of using opiates such as vicodin and oxycontin and want an alternative.   Many of my patients are women in their 50’s and 60’s who are willing to try anything to get relief.

61 year old white female who using cannabis for her restless legs syndrome.

34 year old white male who has a diagnosis of anxiety and depression.

61 year old white female who suffers from arthritis

55 year old white male who had surgery to repair C5-6-7 herniated discs following a motor vehicle accident

51 year old white female who is going through menopause.  She has symptoms of anxiety, hot flashes, insomnia and is easily irritated.

41 year old white make who had reconstructive surgery on his right ankle and suffers from arthritis.

27 year old white female who suffers from anxiety since the age of 17.  She uses cannabis instead of xanax.

25 year old white make who injured his C6-7 vertebra surfing.   He uses cannabis for pain management.

59 year old white female who has sciatica and chronic lower back pain.  She uses cannabis instead of oxycontin.

You would be very surprised by the typical patients that I see using cannabis for their symptoms.   I think the majority of people when they think of medical marijuana envision “teenagers getting stoned.”  That is not the case and quite the opposite.

If you are suffering and would like more information on whether or not cannabis can help you improve the quality of your life feel free to call our office at 877-721-0047 or contact us online at www.mcsocal.com

Be blessed,

Dr. Breen

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Sjogrens Syndrome, Rheumatoid Arthritis and Medical Marijuana

Posted By Dr. Sean Breen on July 22nd, 2010

Today I took care of a 58 year old women who suffered from Sjogrens Syndrome and Rheumatoid Arthritis who had tried medical marijuana recently and found relief of her symptoms.   Her arthritis mostly affected her hands and shoulders and required multiple drugs for pain management.     She had been on Bextra then Vioxx then Celebrex but had to stop all of them because of kidney disease.    She was at her “wits end” and wanted an alternative to help her get some relief and sleep throughout the night.

Sjogrens syndrome is an autoimmune disease where the bodies white blood cells attack the lacrimal glands which produce tears for the eyes (lubrication) and also the salivary glands.   Most commonly patients complain of dry eyes and dry mouth.  Patients often walk around sipping water all day to keep there mouth moist.   In this patients case her taste buds were affected as well which made it difficult for her to enjoy food.   She found that certain strains of marijuana really improved her appetite and helped her deal with this debilitating disease.

Many patients with Sjogrens syndrome also develop rheumatoid arthritis.   Unfortunately there is no cure or way to reverse the arthritis so patients must learn way through nutrition, physical therapy and medication to improve the quality of their lives.   I have found many patients who use cannabis do REALLY well and don’t require near as much medication as patients who do not use cannabis.  The medically active ingredients in the plant bind to receptors on the white blood cells that cause inflammation and help reduce the pain.

The great thing about marijuana is that is is not toxic to any of the major organs in the body, is not addictive and can be taken over long periods of time.   It can be inhaled without having to smoke it by using a vaporizer and it is almost odorless.

If you would like more information on whether or not medical marijuana can improve the quality of your life feel free to give us a call at 877-721-0047 or contact us though the website at www.mcsocal.com

Be blessed,

Dr. Breen

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PTSD (Post Traumatic Stress Disorder) and Medical Marijuana; A supplemental Treatment Approach

Posted By Dr. Sean Breen on July 20th, 2010

Lately I have been seeing more and more patients with PTSD looking to medical marijuana as an alternative to the medications that their psychiatrists have prescribed.   Because I have an office in Long Beach next to the VA and also take care of many Marines from Camp Pendleton I am seeing more and more how cannabis is helping them.

Let me make one point that is very important for PTSD patients to understand.  Medical Marijuana is not going to cure your symptoms. You will still need ongoing therapy and psychiatric counseling to REALLY get past this time in your life.   What medical marijuana can do if help you reduce your dependence on drugs like Trazodone/Xanax/Ambien for sleep and reduce your dependence on mood stabilizers like paxil/prozac/seroquel.  Often these medications have side effects that do not justify the benefit of taking them daily.    Many of my patients tell me that one or two doses using a vaporizer when they come home from work helps them relax and get a good nights rest.

Being a combat veteran myself I understand the stresses that our veterans go though and what they experience when they get home.  I spent 9 months with an infantry unit (1/4 out of Camp Horno, 1MARDIV) in Iraq from Jan-Sept 2003.   I definitely witnessed my share of casualties and had more than one RPG sent my way.   I have lost Navy Corpsman to bullets and covered a KIA marine with a US flag in the heat of battle.   There is nothing more terrifying than the thought of being killed on a regular basis.

I do not take this medication lightly and want to make sure that our military leadership and veterans understand that medical marijuana is an option for them to consider.   It make work and it may not.  But I think it is worth discussing and you should be willing to give it a try if you are frustrated with your current treatment plan.

I have offices in Long Beach and Irvine and see patients 5 days per week.   Our office number is 877-721-0047 or contact us through the web at www.mcsocal.com

Semper fi,

Dr. Breen

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Behcet’s Syndrome and Medical Marijuana; Case Study

Posted By Dr. Sean Breen on July 17th, 2010

Yesterday in my Irvine office I evaluated a 27 year old male for medical marijuana who complained of pain secondary to Behcet’s Disease (Pronounced Bah-shets) He had been using medical marijuana for the past 12 months to reduce the pain as a result of joint disease in his knee’s and ankles and also to help him eat when he gets painful ulcers in the mouth.

Behcet’s Syndrome is not common in the United States.  It primarily affects people from Turkey and the Middle East.   Is is believed to be an autoimmune disorder but the etiology is unclear.   The hallmark of the disease are PAINFUL ORAL AND GENITAL LESIONS (EXACTLY LIKE CANKER SORES IN THE MOUTH).  The sores are exactly the canker sores that most people get from time to time when stressed.    These are NOT herpes lesions as commonly thought by patients and medical professionals.

In addition, 2/3’s of patient develop and arthritis in their knees and ankles. Rounding out the common triad of symptoms is a rash that is commonly referred to as erythema nodosum (google “erythema nodosum picture” to see what it looks like). They are painful red nodules which commonly affect the anterior aspect of leg below the knee.

In this patients case he had gong to his doctor initially because he was having painful ulcers in his mouth.   He doctor told him it was a type of herpes and put him on an anti-viral medication called acyclovir.    Obviously it did not work or go away.   On a separate occasion he went to see another doctor for pain in his lower legs (arthritis from the disease) but was again mis-diagnosed with a muscle strain and given NSAID’s like motrin.

It wasn’t until he visited his ophthalmologist about a year later because he was having some vision changes and wanted to have his eyes checked out.   Behcet’s syndrome can affect the eyes and cause uveitis which ultimately can influence the retina.    His eye doctor had taken a pretty detailed history and asked him about having oral ulcers.   He then asked him about his rash and DIAGNOSED HIM ON THE SPOT!!!! That is pretty amazing that his eye doctor was the one who put all the pieces of the puzzle together.

In the end he was placed on oral steroids to reduce the inflammation throughout his body.   Unfortunately he was having residual pain in his knees and also having a difficult time eating when he had ulcers.   He stated that cannabis really helped him with his symptoms.

I am amazed at the variety of illnesses that I see patients using cannabis for.   It really helps an incredible amount of people who would otherwise have to suffer.

If you would like an appointment to see if cannabis can improve the quality of your life feel free to contact us through our website www.mcsocal.com or by phone 877-721-0047

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Medical Marijuana and Withdrawal Symptoms;

Posted By Dr. Sean Breen on July 14th, 2010

As medical director for Medical Cannabis of Southern California I often evaluate patients who had used cannabis extensively for a long period of time prior to using it as a medication.   Many of these patients do in fact discuss similar withdrawal symptoms if they abruptly stop medicating.    Common complaints are irritability, anxiety, insomnia and difficulty focusing. Although cannabis as a medication is generally very safe I think these withdrawal symptoms warrant discussion.

Cannabinoids (the medically active ingredients in the plant) work by entering our body and bind to receptors on individual cells in the nervous and immune system.    Once the medicine binds to the receptor it causes changes to occur in the cell.   What can happen over time is that when receptors are constantly being bombarded(stimulated) by cannabis they can become less responsive to the cannabinoids (almost like “oh its you again… what do you want this time).  We see this in patients who develop diabetes.  High blood sugars lead to an increase and continuous release of insulin (which binds to cells and tells the cell to eat up the sugar) which bombard insulin receptors.  Over time these receptors are less responsive to the insulin and patients have hhigh blood sugar levels.

Although much more research needs to be done it makes sense that a similar situation occurs with cannabis.  The receptors most likely get fatigued and become less responsive to the cannabinoids.   The question becomes what happens if you stop using cannabis.  What makes sense is that these receptors are so used to becoming stimulated daily that the body reacts on a cellular level causing the symptoms people describe.    This is very similar to SSRI’s that patients take for depression.  Abruptly stoping them causes A LOT of issues.  THis is why patients are told to taper off slowly over time.

What I recommend for patients who regularly use cannabis is to give their bodies a break pretty frequently is possible.   Once a month go 3-5 days without it and let you body adjust naturally.   If you find that you are still having symptoms of withdrawal then maybe take breaks more frequently.

Whenever you use a medication you always have to weigh the benefits and risks.  If you are using cannabis for pain and your symptoms improve but you have to deal with mind withdrawal symptoms if you stop for a few days then it is probably worth it to continue.  You ultimately have to determine if the benefits outweigh the risks.

Be blessed,

Dr. Breeen

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Medical Marijuana and Your Sex Life; SSRI’s for Depression and Anxiety

Posted By Dr. Sean Breen on July 13th, 2010

Today I spoke with two female patients who were taking anti-depressants (SSRI’s) for depression and experiencing significant sexual side effects.   In both cases, their lack of libido and inability to orgasm were causing significant challenges in their relationships.   They came to me to use medical marijuana to help their depression and anxiety and also in turn repair their sex lives.

Selective Serotonin Reuptake Inhibitors (SSRI’s- i.e Prozac, Paxil, Zoloft, Lexapro etc) are drugs commonly used to treat depression and anxiety.  They work by increasing the amounts of serotonin that build up and concentrate around nerve cells in the brain which in turn elevates patients moods.   They are THE most common drug to treat depression and anxiety.

One of the downsides to using these medications is that they can reduce a patients libido and also make orgasm very difficult.

My first patient was a 27 year old women who had been taking Lexapro for the past 12 months for her Social Anxiety.    She went on to tell me that she is engaged to her boyfriend of 7 years.  Over the past year her sex drive has been “non-existent” which has made her relationship very challenging.   Even though her fiance has been extremely supportive she told me she feels “inadequate”  because of this.   Her boyfriend decided to search out alternative therapies when he came upon my website and read about previous patients in similar situations.

SHE TOLD ME THAT FOR THE PAST MONTH SHE HAS BEEN MEDICATING WITH CANNABIS AND HER SEX LIFE HAS BEEN GREAT. In addition to having sex more she stated that she was less inhibited which even enhanced her sexual experience with her fiance.   Her plan is to continue to use the Lexapro and use cannabis to stimulate her sex life.

My second patient was a 44 year old women who came in with her husband of 13 years.  She had a very similar story although she had been taking lexapro for depression which she had “as long as I can remember.”   They also had two autistic sons ages 10 and 8 which made time for romance very difficult.    Although she initially felt apprehensive about using marijuana as a medicine those feeling quickly subsided as her sex life started to improve.   Her husband was definitely supportive as he said there marriage is “in a place that it hasn’t been in… in a long time.”

I tell every patient that comes into my office that there are benefits and risks to using every medication.  Cannabis is no different.   In these two examples both women had to weigh the benefits they were receiving from using Lexapro from the risks… which in this case were a decline in their sex life—-> leading to stress in their relationships.

The plan was simple.  If cannabis improved the quality of their lives and relationships then they would use it… if not no harm done.  Cannabis is relatively benign if used responsibly.


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Medical Marijuana and Amyotrophic Lateral Sclerosis, ALS, Lou Gehrig’s Disease; Supportive Treatment

Posted By Dr. Sean Breen on July 12th, 2010

Yesterday in my Long Beach office I evaluated a 45 year old man with Amyotrophic Lateral Sclerosis, commonly known as ALS or Lou Gehrig’s disease.   He came in requesting an evaluation to use medical marijuana for constant muscle pain and to help with his appetite. He was wheelchair bound and his speech was unintelligible  because his disease was progressing rapidly over the last nine months.    Unfortunately once ALS progresses to this point life expectancy is only months to a few years. It is with my utmost compassion that I assist him in any way so that the rest of his life can be a little bit more comfortable.

ALS is a disease which affects the nerves that provide motor function to the muscles.   It typically presents in patients age 30-60 and affects the muscles of the limbs.   Patients can complain of muscle weakness, fasciculations and loss of coordination.  If it affects the muscles of the face and neck patients can experience changes in speech, loss of control of tongue, drooling and drooping of facial muscles.   It typically is progressive and is fatal in 3-5 years.

Treatment options are limited.   There is no cure.    Most treatment centers around supportive measures and physical therapy.  In this patient he was using cannabis because he had been losing his appetite and was in constant pain from being wheelchair bound.   It also helped elevate his mood because he has been experiencing periodic episodes of depression.    After 15 minutes of speaking with him it was clear CANNABIS IMPROVES THE QUALITY OF HIS LIFE and he plans on using it until he succumbs to his illness.  Typically patients with ALS die from pulmonary infection (muscles of respiration become affected ultimately)

Using cannabis as a supportive medicine for ALS is certainly all physicians should consider.    If you or a loved one feels uncomfortable about discussing cannabis use with your doctor  feel free to contact me at 877-721-0047

Be blessed,

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How does medical marijuana (cannabis) reduce pain?

Posted By Dr. Sean Breen on July 6th, 2010

As medical director for Medical Cannabis of Southern California (MCSoCal) I regularly evaluate patients with chronic pain for a medical marijuana recommendation. (approximately 65% of the patients I see are for pain)  The question that many patients ask is: How does marijuana reduce pain? Although cannabinoids (medically active ingredients in marijuana) effects on pain have been studied there is a lot of research left to do.   My goal of this post is to break down “barney-style” how cannabis reduces pain.  I am not going to bore you with the specific scientific details as you will most likely fall asleep like I often do reading typical double-blind placebo studies!

OK here it is.  The brain is considered our central nervous system.  The spinal cord and the nerves that exit the spinal cord that project to all of the organs, muscles, vessels and skin are considered the peripheral nervous system (there is also an autonomic nervous system but ignore that for now)   Think of nerves like the electrical wiring that runs throughout the house.   To keep this simple let’s take the bones and tissues of the knees (a common complaint I see is arthritis of the knee)  If you have pain in the knee it is because the nerves (wires) that originate at the knee are in a very excited state.  They get activated and send the signal through the nerve (headed to the brain ultimately) which makes it first connection in the spinal cord.

Once at the spinal cord that nerve typically connects and communicates (via neurotransmitters… chemicals that allow one nerve to communicate with another) with a new nerve in the spinal cord which runs all the way up the spinal cord and terminates in the brain.

Once in the brain that signal is processed and it sends it back down a new set of nerves (originating in the brain) which run back down through the spinal cord.   So thus far we have knee—–>Spinal Cord—–>Brain—–>Back down spinal Cord—–> lastly a nerve leaves the spinal cord and ends back at the knee where ultimately the patient feels pain.

They way marijuana works (that we know of thus far) is that it specifically binds to a receptor on the nerves themselves and blocks or slows down the transmission of pain up and down the spinal cord to the brain. The electrical wiring (nervous system) in our body has what we call receptors on it along the way (Think of receptors as door locks).   Each of these locks has a specific key that opens it and causes it to have a specific function.   When you inhale cannabis you inhale specific “keys” that go and search out these specific locks on the nerves.   When they find them they bind to them and cause the nerve to be less excitable which ultimately slows the transmission of pain throughout the nervous system.

Now, in my effort to keep things simple and stupid I know that there are scientists out there who will read this and say… “yeah but thats not exactly how it works.”  However, in a more general sense this is how marijuana reduces pain in the body.

If you are a person that wants to get into the nitty-gritty science behind this you can read plenty of studies which discuss the physiology of CB1 and CB2 receptors.   The CMCR at UCSD has published a study on cannabinoid analgesia and it is accessible online.

If you suffer from pain and would like to discuss using cannabis to improve the quality of your life please feel free to make and appointment to come in and see me at my Irvine or Long Beach CA office.   Simply call 877-721-0047 or pre-qualify for FREE at www.mcsocal.com

Be blessed,

Dr. Breen


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Medical Marijuana (Cannabis) and Carpal Tunnel Syndrome; An Alternative Treatment

Posted By Dr. Sean Breen on June 24th, 2010

Today in my Long Beach medical marijuana (cannabis) office I evaluated a 60 year old man who has been suffering from carpal tunnel syndrome.  He explained that he gets a burning sensation in his right hand and also has pain with any type of wrist movement that involves flexing his wrist.   The pain is most pronounced in the evenings and at night and it has caused significant problems with sleeping.   He has been using cannabis successfully for the past 2 months and wanted to receive a physician recommendation so he can safely access medicine to treat his symptoms.

The hallmarks of carpal tunnel syndrome are pain (burning, tingling, numbness) and inflammation with use of the wrist as a result of compression of the median nerve which is one of the nerves that goes to your hand (specifically the thumb, index, middle and half of the ring finger and the palm next to the thumb) Most commonly it is tied to overuse (repetitive motion) involving the affected wrist.    The pain can cause significant discomfort with loss of sleep and also loss of the ability to perform simple tasks pain free.  Other causes can be physical abnormalities (bone spurs, tumors, old healing fractures) and some systemic diseases such as diabetes or rheumatoid arthritis.

Typically patients are treated with immobilization (splints) for 2-6 weeks and NSAID’s such as ibuprofen.    The main goal is reduce the amount of inflammation.    If rest and NSAID’s do not work orthopedic surgeons will sometimes perform corticosteroid injections to reduce inflammation.  If that fails then surgery can be recommended.

However, I typically recommend that patients use medical marijuana to help reduce pain, reduce inflammation and improve sleep  as an alternative to NSAID’s and sleeping pills at night. If patients work during the day then NSAIDS can be appropriate as it is illegal to drive and use cannabis.

Marijuana is a great medication for sleep.  Patients typically only have to use very small amounts of an INDICA strain which is much less psychoactive.   Meaning they don’t have to experience the “high” that most patients associate with marijuana use.    It can be vaporized 20 minutes prior to lying down.  Patients using the vaporization method are NOT exposing themselves to any smoke and there is next to NO SMELL.

The cannabinoids in the plant also act as potent anti-inflammatory agents.   Therefore any inflammation of the tendons (attach muscle to bone vs. ligaments which attach bone to bone) will also be reduced thus relieving the patient of their symptoms.

In light of continued studies showing an increase risk of heart attack and stroke in patients who regularly take NSAIDS (such as motrin/ibuprofen/diclofenac) I highly recommend limiting the amount of medications that you take.

If you have any questions about medical marijuana and want to see if you can benefit from it’s medicinal use feel free to give us a call at 877-721-0047 or pre-qualify for free online at www.mcsocal.com

Be blessed,

Dr. Breen

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