Use of Medicinal Cannabis and Synthetic Cannabinoids in Posttraumatic Stress Disorder (PTSD): a systematic review

Background and Objectives: Post-traumatic stress disorder (PTSD) is a common psychiatric disorder resulting from a traumatic event, is manifested through hyperarousal, anxiety, depressive symptoms, and sleep disturbances. Despite several therapeutic approaches being available, both pharmacological and psychological, recently a growing interest has developed in using cannabis and synthetic cannabinoids stems from their consideration as more efficient and better tolerated alternatives for the treatment of this condition. The present paper aims to evaluate the clinical and therapeutic potentials of medical cannabis and synthetic cannabinoids in treating PTSD patients. Methods: A systematic electronic search was performed, including all papers published up to May 2019, using the following keywords (((cannabis[Title/Abstract]) OR (synthetic cannabinoids [Title/Abstract])) AND ((PTSD[Title/Abstract]) OR (Posttraumatic stress disorder[Title/Abstract]))) for the topics ‘Cannabis’, ‘Synthetic Cannabinoids’, ‘PTSD’, and MESH terms, on the PubMed, Cochrane Library, and Web of Science online databases. For data gathering purposes, PRISMA guidelines were followed. Results were organized into two groups, considering cannabis and synthetic cannabinoids as different therapeutic approaches for PTSD. Results: Present data show that cannabis and synthetic cannabinoids, both acting on the endocannabinoids system, may have a potential therapeutic use for improving PTSD symptoms, e.g., reducing anxiety, modulating memory-related processes, and improving sleep. Conclusions: Even though the current literature suggests that cannabis and synthetic cannabinoids may have a role in the treatment of PTSD, there is currently limited evidence regarding their safety and efficacy. Therefore, additional research is needed in order to better understand the effectiveness and therapeutic usage of these drug classes and monitor their safety.Peer reviewe

Post-traumatic stress and substance misuse; neurobiological and clinical pharmacological correlates

In post-traumatic stress disorder (PTSD) clients, the use of drugs and alcohol may be used as a self-prescribed treatment to both avoid trauma reminders and cope with the related distress. Conversely, substance misuse ‘per se’ might predispose to experience traumatic events. The present study aimed here at presenting an overview of most recent studies covering a range of issues relating to PTSD and substance misuse; namely: substances most frequently ingested by PTSD clients; neurobiological correlates; and treatment/management of these clients. Beyond the alcohol abuse/misuse, drugs most frequently misused are represented by opiates/opioids; sedatives; cannabis; and cocaine. PTSD-related khat misuse issues are here briefly discussed as well. From the neurobiological point of view, issues relating to amygdala and hippocampus dysfunction, with consequent altered levels of fear extinction/memory disruption, have been considered. Furthermore, PTSD may be characterized by imbalance of a range of neurotransmitter pathways, mainly cannabinoid-receptor (CB1); serotonin; and oxytocin. Although there is currently no effective pharmacotherapy for PTSD, most clients may be regularly prescribed with antidepressants; anxiolytics/sedative-hypnotics; and antipsychotics. Due to the heterogeneity of PTSD phenotype, focusing on the symptoms/signs of the PTSD client would allow for more personalized treatment. Although more research is needed, the development of chemoprophylactic treatments, e.g., intervening pharmacologically after trauma to prevent the occurrence of PTSD seems particularly promising.Peer reviewedFinal Published versio

Psychiatry Trainees' Attitudes, Knowledge, and Training in Addiction Psychiatry-A European Survey

Background: Although psychoactive substance use disorders (PSUDs) are a domain of mental health, addiction psychiatry is only formally recognized as a subspecialty in a few European countries, and there is no standardized training curriculum. Methods: A 76-item questionnaire was developed and disseminated through an online anonymous data-collecting system and hand-to-hand amongst psychiatric trainees from the 47 European countries of the Council of Europe plus Israel and Belarus. Results: 1,049/1,118 psychiatric trainees from 30 European countries completed the questionnaire. Fifty-nine-point nine percent of trainees stated to have training in addictions. Amongst the trainees who described having training in addictions, 43% documented a not well-structured training and 37% an unsatisfactory training, mainly due to poor acquired knowledge. Overall, 97% of trainees stated that addiction represents a core curriculum for their training. Overall, general adult psychiatric trainees reported a better knowledge in addictions, compared to trainees in child and adolescent psychiatry. Conclusion: Despite a growing spread of PSUDs in European countries, addiction psychiatry is a relatively poorly trained field within psychiatry training programs. Further research should investigate reasons for poor training and timings of the educational activities to optimize experiential education training in addiction psychiatry.Peer reviewe

The consequences of drug misuse on post-marketing surveillance

Fabrizio Schifano, Gabriele Duccio Papanti, Laura Orsolini & John Martin Corkery, Editorial, 'The consequences of drug misuse on post-marketing surveillance', Expert Review of Clinical Pharmacology, Vol. 9 (7): 867-871, April 2016, doi: http://dx.doi.org/10.1080/17512433.2016.1178571. Published by Taylor & Francis.Over the past decade, the ‘traditional’ drug scenario has shown significant changes because of the emergence of a range of molecules, e.g. the novel psychoactive substances (NPS), which are either already existing or newly created molecules [1]. A range of prescribed medications are currently being used as NPS [1]. Overall, the misuse and diversion of medications is a significant and increasing public health concern [2], with 5.4% of British respondents aged 16–19 years old having abused a prescription drug in the past 12 months [3]. It is a matter of concern that, for a range of prescribing molecules (e.g. gabapentinoids), the formal pre-marketing processes had not been able to appropriately identify their potential for abuse, a potential which has however emerged overtime [4,5]. Similarly, drugs such as benzodiazepines and z-hypnotics were considered ‘safe’ for many years before their addictive liability levels were identified. Hence, in this article, we aimed at commenting on the different factors relating to pre- and post-marketing prescription drugs’ abuse liability assessment; issues likely to be complicated by recent changes in drug scenarios.Peer reviewe