Cannabis and The Treatment of Traumatic Brain Injury (TBI)

Leah Shin, PA student at Case Western Reserve University and Corie Kovach, MD, FACOG, MBA 

Traumatic brain injury (TBI) is a disruption of the normal function of the brain. It occurs
when a sudden trauma causes damage to the brain. According to CDC, TBI accounted for
approximately 2.5 million ED visits, hospitalizations, and deaths in the United States, either as
an isolated injury or in combination with other injuries. It is a leading cause of death, especially
in young male population. Symptoms of a TBI can be mild, moderate, or severe, depending on
the extent of the damage to the brain. TBI can cause immediate brain tissue damage such as
contusion, blood vessel disruption, and brain edema. But more importantly, TBI can continue
over a period of days to months via the inflammatory process. This inflammatory pathway
makes lots of changes in our body in terms of cellular and molecular aspect such as CNS cell
death, excitotoxicity, neuroinflammation, cerebrovascular breakdown, cell
structure/remodeling, and neurogenic pulmonary edema.

Then what is the best way to prevent further damage after TBI? Medical marijuana can
be the answer for TBI patients. Plant cannabinoids such as THC and CBD mimic and augment
the activity of endogenous cannabinoids which are part of the endocannabinoid system. The
endocannabinoid system has been found to have neuroprotective effects that are beneficial to
TBI, including a significant reduction of brain edema, increase cerebral blood flow, and decrease
inflammatory pathway. Even a study in 2014 found that TBI patients who tested positive for
THC were more likely to survive with less impairment than TBI patients who abstained from
marijuana.

Not only that, TBI patients report a change in mental health, sleep disturbance, post-
traumatic headaches, persistent fatigue, epilepsy, learning and memory deficits, and balance
disorders. Endocannabinoid system can regulate not only cellular, molecular pathology as well
as TBI induced behavioral deficits. Pathophysiology is not yet fully defined, but there are
evidence exists that endocannabinoids are involved in the prevention of motor deficit,
amelioration of pain, blocking of working memory, enhancement of appetite, and suckling, and
cardiovascular modulation.

The endocannabinoid system is a massive part of the human body that we are just
beginning to understand. There is abundant clinical research and clear evidence of
neuroprotective effects of cannabinoids. It is crucial for us to educate people about the
endocannabinoid system and the evolving science of medical cannabis that can be widely and
expeditiously utilized in most cases. We are continuing to explore the proven therapeutic
modalities as well as further understand the additional benefits in order to prevent further
brain damage by adding medical marijuana to the different treatment regimens for traumatic
brain injury.