Anxiety Panic Disorder and Cannabis

By Hal Lubinsky

My name is Hal Lubinsky. I’m in my forties, a husband, a father, a grandfather, a U.S. Army veteran who served  in the 101st Airborne, a blue-collar worker, and a medical cannabis patient enrolled in the Arizona Medical Marijuana Program. I suffer from Anxiety Panic Disorder,   a lifelong illness with no known cure.

I had my first panic attack in the year 2000 and I had no idea what was happening to me. I didn’t  even know what a panic attack was. One panic attack sent me to the emer- gency room. After a battery of blood tests and other med- ical tests found no cause for what happened, it was sug- gested to me that I was having panic attacks. So, I referred myself to a psychiatrist. You see, Anxiety Panic Disorder, which is what I later learned I have, is usually diagnosed and treated by a psychiatrist. That’s who has to write you the prescription for the medication. By the time you get in to see the psychiatrist, a wait time that can be up to six months in certain states in the U.S., you’re so desperate you’ll take any medication they offer that will stop the panic attacks. These medications are known as antide- pressants and Selective Serotonin Reuptake Inhibitors. No one is absolutely certain what exactly causes panic attacks or even if it is the classic “Nature or Nurture” or perhaps  a combination of the two. Before we go further, let’s talk about what a panic attack is and how it manifests.

Panic attacks manifest in different ways with different people. With me, they usually manifest as severe nausea, severe gastrointestinal distress, and an overwhelming sense of fear and impending doom. I have had one severe attack that mimicked a heart attack. You have no control over them and you have no warning of when or where they might happen. You might have one every day or you might go for months before having another one. When they happen, you have the nearly unstoppable urge to run away from where you are at the moment and get to what you feel is a “safe” place.

Imagine this happening on an airliner in flight and you can imagine how humiliating and embarrassing APD is on top of the terrible psychological as well as physical pain of these attacks. I have had to get up in the middle of meals in restaurants and leave. I’ve lost time at work because of this. This, in turn, leads to depression because you literal- ly have no control over your body.  In short, you are betrayed by your own mind. The worst thing about this is that there is no cure. You go through life having to explain to everyone, such as your employer, that you have this dis- order and that you have no control over it. You don’t “look” sick, but inside you live in a world of fear: Fear of the next attack and then the drowning whirlpool of the panic attack when it happens. You’ll  do almost  anything to avoid another panic attack. You’ll almost quit living your life.

So, the psychiatrist prescribed me a medication called Remeron, which is mirtazapine in the antidepressant fam- ily. One thing that should be mentioned is these medica- tions begin to lose effectiveness at prescribed dosages over time. Basically, you become used to them and your body no longer responds to the dosage. So, you then require a higher dosage for it to be effective. How do you know when that happens? Well, that’s easy to answer. You start having panic attacks again and often. Bear in mind the psychiatrist has to up the dosage. You can’t just do it your- self (unlike cannabis, which we’ll get to later) because there can be dire consequences from fooling around with powerful psychoactive medications such as these. Anything from a bad psychological reaction to overdoses. This is a reason why you just can’t stop taking these med- ications “cold turkey” once you’re on them.

I had been on mirtazapine for about three years when the psychiatrist mentioned that this medication could cause high lipids in the liver. So, I was tested and showed high lipids. So, the doctor decided to put me on a new medication called Cymbalta.

I should mention that the doctor did not ask about my diet, which was the real cause  of the high lipids. I have since corrected that problem on my own. The Cymbalta was a nightmare. It had the strange side effect of causing you to void your food before full digestion took place. In other words, you could count on spending half an hour on the toilet each morning. I am a very thin man and this side effect caused me to lose weight rapidly. People that knew me were doing the “Are you all right???” when they saw me. Later,  they told me they thought I had cancer because I was so thin. I lost all my subcutaneous fat and quite a bit of muscle as my body basically started eating itself. On top of this, the medica- tion wasn’t all that effective in managing the APD and caused some very unwelcome changes in my personality. Later, I found out that several people had committed sui- cide and several had attempted suicide while taking Cymbalta and the drug was implicated in the cause. Little “side effects” the doctors don’t tell you about. I’d say sui- cide is a pretty serious side effect. In fact, some doctors tell you not to go looking up the medications on the internet; to just take the medicine and trust them. I went to the doc- tor and demanded to return to using mirtazapine and be off the Cymbalta. The doctor at first refused to believe the Cymbalta could be causing the voiding  and wasting.  This is the kind of reaction you sometimes get from psychia- trists when you tell them the medication isn’t all  that great. But I said I knew about the suicides and, gosh, the doctor agreed to put me back on mirtazapine. Which brings me to my next point.

In the United States these days,  we have a very high rate of people on antidepressants and antianxiety medications. I don’t know the figures, but I think we’re  probably  among the highest in the world. We can partially blame what I call the “Next Day Air Culture” of unreasonable demands placed on us by employers and society in terms of pace, output, and speed. Even vacations are a headache when you have to go through Soviet-like security meas- ures just to board a plane. Everything is rushed and hur- ried and no one has anything in terms of job security. Is it any wonder why people are on these medications? But these people are, in great measure, also being exploited by the pharmaceutical companies and our for-profit medical care establishment. When you get a business card from a psychiatrist, you will see that many of them have, after their name and title, the words “Medication Management”. This basically means this psychiatrist will prescribe medication and keep your refills coming with a session of fifteen minutes or less. Psychiatrists aren’t so much counselors these days as they are legal pushers. They shouldn’t just prescribe this medication without making sure someone is going through some therapy or counsel- ing on how to deal with their emotional problems. A sad commentary on this is that there is a bridge here in Northern Arizona where several people have committed suicide by jumping off of it. All of these people were under

the so-called “care” of a psychiatrist. The problem is, this “care” is just handing out pills. I myself have had an open prescription for xanax since the year 2000. It’s an “emer- gency medication” to use in case of a panic attack.

In late 2010, I started having massive panic attacks again.  I lost my appetite and and started losing weight rapidly. This was, in part, due to extreme stress. I wanted to make an appointment with a psychiatrist but there was a three month wait to get an appointment with one who took my health insurance. This is another failing of the American medical system. In the meantime, I went to my physician to see if there was anything he could do to help. He sug- gested I look into medical cannabis since it had just been made legal in Arizona. He said the only other thing he knew of that would help with appetite would be Ritalin and with my APD, he thought that would be a very bad idea. I was surprised because very few “mainstream” doc- tors will dare to suggest medical cannabis to anyone. It’s something that is almost taboo to even discuss. But by this point I was willing to try anything to find relief and start- ed to look for a doctor who could write me the recom- mendation. In the meantime, I was existing on what I called my “Anxiety Cocktail”.

This was  a  xanax,  a  pepcid, an anti-gas pill, and an anti-diarrheal pill. I’d take all of these at once in hopes they would work. This isn’t a pleasant way to live.

When I got in to see the psychiatrist, I asked her if she would write me the recommendation for medical cannabis. She was vehemently against it. She listed a lot of nonsense reasons as to why it was a bad idea. So, I dropped the subject. Then she started me on another med- ication called guanfacine. The theory was, slowing my metabolism (which the medication does since it’s used for hypertension) would somehow help the situation. I start- ed on the lowest possible dose. I took it in the evening before bed and by the time I laid down, I was afraid I wouldn’t wake up. I was gasping for breath. I felt like my heart wasn’t beating. It made me panic because I felt I was going to stop breathing. The next day, I called the psychi- atrist’s office and said I can’t take this medication. She insisted I give it at least seven days. I said I was not going to give it another seven seconds and that I was going to go find a doctor to write me the recommendation for medical cannabis. I saw an ad in the newspaper about a doctor who was coming to the city here to do exams for medical cannabis and I called right away and made an appoint- ment. It would be another few weeks, but I was deter- mined to try medical cannabis and stop being a guinea pig for the next round of pills.

I had my medical records sent to the doctor writing the recommendations. The day of the exam, I could finally see some light at the end of the tunnel. I had a feeling that things were going to get better. The doctor examined me and discussed medical cannabis with me at length and thought it would help me for the cachexia (wasting) and severe nausea. Now, I had smoked cannabis in the past. I never could understand where the paranoia against this plant comes from since I knew it didn’t do all the terrible things the government says it does. But I hadn’t consid- ered the possibility that this plant could help me until my doctor had suggested it. I knew about medical cannabis but I thought that it was only for the terminally ill. I had- n’t imagined that it could help me. When the doctor wrote me the recommendation, the law stated that I could begin using medical cannabis with just the recommendation in hand. The ID card from the state was basically what’s termed a “shall issue”, meaning that they have to issue the card when they receive the doctor’s recommendation. Now, in the meantime, the feds decided to once again threaten sick people and sent out a letter to our state DA saying they can still arrest and prosecute people for cannabis if they felt like it regardless of the state law. How a government that does things like this to sick people pre- sumes to lecture the rest of the world about human rights is dark comedy, to say the least. But our governor used this as a way to thwart the opening of cannabis dispensaries. The dark comedy of that is that our governor got a lot of publicity by sticking her thumb in the eye of the feds on other issues.

But in the case of medical cannabis, she actually went running to the feds to help her find a way to keep the dispensaries from opening. So, how did I get my medicine?

When I was seeing the doctor doing the medical cannabis exams, they also helped you fill out the paperwork for the state. I discovered that if there was no dispensary within 25 miles, you could check a box to get the right to culti- vate. In other words, you could grow your own medicine.   I wisely checked that box. I figured, hey, if I can grow culi- nary herbs, I should be able to grow cannabis. Since I did- n’t know when there would be a dispensary, or even if there would be any, this was a smart choice. I was also  able to get some cannabis later that day from another patient I knew who had already gotten a card, which the law allows for. The law allows sharing between registered patients. I want to stress I did everything “by the book”. I waited until I had my recommendation before even trying the cannabis. I went through about four months of suffer- ing knowing the cannabis could probably help me. But I waited and did everything “by the book”. I also want to stress I did everything “their way” first. In other words, I tried the pills. I gave the pills a chance. They didn’t help me. So, what happened when I tried the cannabis?

Never in my life have I tried a medicine that has such beneficial effects you notice immediately. The first thought that entered my mind was: “Why is this plant illegal?!” I felt great, I had an appetite, and I felt the mouse running  in the wheel in my mind had gotten off the wheel and let me rest. The next day, I was more relaxed than I had been in a very long time. My wife noticed an immediate improvement. I had only wanted this medicine to restore my appetite and help me gain weight. And it did this quickly and more effectively than anything else I know of. But what suprised me was how the cannabis greatly helped me with Anxiety Panic Disorder. I started seeing huge improvements in my reactions to stress, the way I deal with stress, and my inner well being. I had been read- ing about Ginseng and one researcher used a term for it and that term is “adaptogen”. An adaptogen is something that helps the body adapt to stress and anxiety. I have come to think that cannabis is an adaptogen, based off my own experiences with it. Let me put it this way. Before the cannabis, during this highly stressful period of severe panic attacks in late 2010 and early 2011, I was taking a xanax nearly every day to remedy a panic attack or stop one I felt was starting to happen. After starting with the cannabis, I have not needed to take a xanax since, and it’s been almost a year now. How can you argue with that success? The proof is in the prescription—-of lack of renewals thereof. This is why I think cannabis is an adap- togen. I also think that cannabis affects serotonin in a pos- itive way. A lack of serotonin can cause anxiety and mood problems, so if cannabis assists the body in creating sero- tonin, this could be of great benefit. The tragedy is that cannabis is not being researched for these things because

the research remains technically illegal. I could sit here all day and tell doctors how cannabis has changed my life for the better but I won’t be believed by most of them. Another tragedy is that medical research is mostly done by the pharmaceutical companies and they’re not about to applaud the virtues of a medicine anyone can grow in their closet with about $60 worth of equipment.

Expaning on the previous statement, I had obtained some seeds from another medical cannabis patient. I had no  idea that cannabis is so easy to grow. It’s easier to grow than a lot of garden vegetables and herbs, in fact. I grew some very wonderful cannabis with clamp-on work lights, compact flourescent light bulbs, and some regular  pots and organic potting soil. I did everything organically. Growing your own medicine is highly empowering. You take charge of your own health care, relying on yourself, and understanding your medicine and knowing where it comes from. I can’t fully explain the dynamics of this except to say it’s something like harmony and  balance. You see the medicine growing, you take care of it, you nurture it, and you enjoy the presence of the plant in your life. When you harvest it and cure it, it then takes care of you. It’s a “full circle holistic healing”.

Now, some people fear the paranoia and anxiety that tends to be associat- ed with cannabis. So far, I have not had this problem. I tend to think the paranoia comes from the fact that this plant is illegal in many places and so this thought resides in the subcon- cious and comes up for some people.

It’s also all about the dosage. Remember, you can have these same side effects and worse from prescription med- ication. One advantage is that cannabis can’t kill you or cause you harm. If you have an unfavorable reaction, you need to moderate your dosage. Or you might  need to try  a different strain. The first strain I tried was Sour Diesel and I have delightful success with it. The strain I grew was predominantly Indica and Indica-dominant strains are reputed to be a very good “fit” for anxiety. This  is true.  But don’t count out Sativa-dominant strains, either. Some Sativa-dominant strains tend to be more cerebral in nature and one thing this can do is focus your mind off of anxi- ety-causing obsessions and more on to creative pursuits that are actually relaxing in nature. I also have a Sour Diesel and Hawaiian Skunk hybrid that works quite well for me. Bear in mind, all of these work outstandingly for the reasons I officially need medical cannabis which is cachexia and nausea. Another advantage to cannabis is that it won’t react with your medication if you’re taking medication. You can’t say that for a lot of things,  even other herbs. Saint John’s Wort is often suggested as an herbal  remedy  for anxiety  and depression. Unfortunately,

Saint John’s Wort will also react negatively with most of the antidepressants and Selective Serotonin Reuptake Inhibitors prescribed for anxiety. Saint John’s Wort will also react negatively to other prescription medications as well. In short, cannabis is safer than even some of the over-the-counter herbal remedies that are out there. But remember, your dosage is your homework to do. Start small on your dosages and find what works for you. You can also rely on trusted friends, caregivers, and fellow patients to help you if you’re new to this. Sometimes, the mind is open to the power of suggestion. If you proceed with cannabis with suspicion and fear it’ll cause you anx- iety, well, it just might in some cases. Approach cannabis with an open mind and a desire for its benefits. Don’t be afraid to lower your dose or increase it if you need to. Remember, this isn’t a prescription medication. It’s not going to hurt you. It’s all set and setting.  Make  taking  your medicine part of a relaxing experience with soothing music or CDs of the ocean or rainfall. Don’t rush it. The point is to slow down, relax, and heal.

Cannabis can be a big part of a total holistic system of healing. There are other things you should be doing in addition to the cannabis. When you have Anxiety Panic Disorder, you should be aware that you need to relax. Meditation and yoga are great for this, as well as anything else that relaxes you. You need to eat healthy meals. You should try to eliminate processed foods from your diet as several of the various forms of chemicals, sodiums, and corn syrups in these foods tend to “amp” you up. If you’re drinking “energy drinks”, you need to stop. Energy drinks are “panic attacks in a can”. You might find you need to stop drinking caffeinated coffee. I have found that green tea has a totally different effect as the caffeine in it is mod- erated by the actions of certain phytochemicals in the tea, so I can drink tea and enjoy it. You will have the best results with cannabis if you do your part and eliminate the “clutter and crap” from your diet.

It needs to be said that I am not suggesting that psychia- try and mental health professionals are all quacks. There are some excellent mental health professionals out there who are doing what, in this society, is a very thankless job. There is a lot of discrimination against people with men- tal health issues and there are slurs used for people who are mentally ill that need to be challenged the same as eth- nic slurs are. People will use the words “nuts”, “loonies”,

We need mental health professionals willing to look deeply into the use of cannabis for anxiety disorders, obsessive compulsive disorders, and Post Traumatic Stress Disorder. Real people are suffering every day. It is immoral for a government, and especially immoral for doctors, to stand in the way of medical cannabis.

and “loony bin” for the mentally ill and psychiatric hos- pitals. A mental illness is as real as any physical illness. The difference is that a mental illness can never be cured. You can only treat it. This is why we must have access to medical cannabis. For something this effective to be illegal is beyond tragic. For a long time now, the psychiatric establishment has classified cannabis use with “substance abuse” which they see as a psychological problem like addiction. Yet, many of them see no problem with basical- ly being dependant on xanax, which truly can be physical- ly addictive. These dogmas need to be challenged. We  need mental health professionals to take more holistic approaches that extend far beyond just prescribing pills. We need to look deeply into how we care for the mental- ly ill. We need to look deeply into our medical system and ask ourselves what motivates its decisions. We need to lis- ten deeply to what people with mental illnesses have to say. Just because we have something like Anxiety Panic Disorder does not mean that we are not rational, intelli- gent human beings. Just giving us pills and wanting us to go away doesn’t help us. We need mental health profes- sionals who are genuinely interested in healing, regardless of what the government says. The government was once wrong when slavery was legal and they’re wrong about cannabis now. We need mental health professionals will- ing to challenge the status quo as they did when homosex- uality was once considered a mental illness. We need men- tal health professionals willing to look deeply into the use of cannabis for anxiety disorders, obsessive compulsive disorders, and Post Traumatic Stress Disorder. Real people are suffering every day. It is immoral for a government, and especially immoral for doctors, to stand in the way of medical cannabis. In sitting in the psychiatrist’s office, I

noticed the waiting room was crowded. This wasn’t the case a few years back. Obviously, something is seriously wrong. Many of these people were frustrated and at the end of their ropes. If our medical system is such a success, why is the waiting room crowded and a waiting list to see a psychiatrist so long? This is not a success, this is a disas- ter. We need to realize this system is deeply flawed and its motivations are profits, not healing. A great many people are suffering and if medical cannabis can help them, then this medicine must be made available without stigmatizing people already stigmatized by society because of the nature of their illness. A few words about our state program. In the State of Arizona Medical Marijuana Program, you must get a new doctor’s recommendation each year and also pay $150 to the state to renew your registration each year. What other medication forces a person to have to do this? They don’t even do this when doctors prescribe morphine. It’s hard enough to find a doctor willing to write the recommenda- tion because so few are willing to even discuss it. So, now, the state wants to investigate doctors writing what they think are “too many recommendations”.  Well,  when only a handful will write the recommendation, how can it be that they’re writing “too many”? I don’t see the same con- cern over the tens of thousands of prescriptions for hydrocodone that “mainstream” doctors write. What gets me about having to renew the registration each year is that, what, I’m going to be cured in a year? There is no cure for Anxiety Panic Disorder! Medical care is a human right. I have a right to be healthy and to have access to the medicine that helps me without having to go through red tape. I’ve suffered enough.

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