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

Focus on Cognitive Enhancement: A Narrative Overview of Nootropics and “Smart Drug” Use and Misuse

Whilst “nootropics” are meant to treat a range of medical disorder-related cognitive impairments, the typically healthy “smart drugs” user ingests a range of drugs/molecules to achieve improved mental performance. Given the increasing levels of related concerns, this study aimed to provide an overview of the clinical pharmacological issues relating to both the most popular nootropics and the vast range of drugs that are being used as putative cognitive enhancers/smart drugs. In terms of the cognitive decline associated with neurological degenerative disorders, a significant variation in research methodology was observed. Therefore, the overall usefulness of these pharmaceuticals in various central nervous system disorders as supplements/adjuvant therapy needs to be better established before their widespread use can be recommended. The most popular smart drugs, self-administered to cope with high-perceived stress and academic/work-related pressure, were methylphenidate, modafinil, amphetamine-based compounds, and psychedelics. At present, however, there are relevant levels of uncertainty in terms of smart drugs’ effectiveness in improving executive functions. Addressing the health harms associated with cognitive enhancers’ intake remains challenging due to the lack of updated and contextualized epidemiological data. In particular, there appears to be a range of clinical concerns relating to the non-prescribed intake of stimulant smart drugs by otherwise healthy individuals. Enhanced training for prescribers, pharmacists, and healthcare professionals can strengthen monitoring and early intervention efforts

Drugs Used in “Chemsex”/Sexualized Drug Behaviour—Overview of the Related Clinical Psychopharmacological Issues

Background: “Chemsex” involves the intake of a range of drugs (e.g., synthetic cathinones, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), ketamine, methamphetamine, “poppers”, type V phosphodiesterase (PDE) inhibitors, MDMA/ecstasy, cocaine, cannabis, and occasionally a few other molecules as well, to enhance and prolong sexual experiences. This paper aims to provide an overview of the clinical pharmacology of the vast range of drugs that are being used for chemsex with a focus on both the medical and psychopathological disturbances that they can produce. Methods: A narrative literature review was conducted using Pubmed, Scopus, and Web of Science databases. A total of 273 papers published up to January 2025 were screened; articles were selected based on relevance to chemsex/sexualized used behaviour and related substances. Both human and preclinical studies were considered. Results: The use of stimulants is likely related to the need to increase as much as possible both sexual arousal and performance but also to increase social interactions. Furthermore, the empathogenic/entactogenic activities of some MDMA-like “love drugs” facilitate the occurrence of “feeling closer/more intimate” emotional sensations, and GHB/GBL may provide the user with a subjective sensation of disinhibition, hence facilitating condomless meetings with a higher number of random partners. Conversely, ketamine may be used to both enjoy its psychotropic dissociative characteristics and facilitate the potentially painful receptive anal intercourse and/or fisting experiences. Most typically, these drugs are consumed in combination, with polydrug exposure possibly facilitating the occurrence of serotonergic syndrome, seizures, drug–drug pharmacokinetics’ interaction, and sympathomimetic overstimulation. Following these polydrug exposures, a range of psychopathological conditions have at times been reported. These issues may lead to misuse of opiates/opioids, gabapentinoids, and/or antipsychotics. Conclusions: Further actions should aim at reducing the stigma that prevents individuals from accessing necessary healthcare and support services. A multidisciplinary approach that combines medical, psychological, and social support remains key to managing the complex challenges posed by chemsex-related drug use

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