Cannabis Studies and PTSD: More Studies Needed Concludes Veterans Administration

PTSD and Cannabus StudyPhoto byBudding .onUnsplash

In New Mexico is a state with a large concentration of military personnel and a large number of military personnel concentrated on treatment for PTSD, backups in treatment have been an ongoing concern reported as far back as 2015, thus multiple studies have originated from the state related to PTSD Treatments. New Mexico was the first state to list post-traumatic stress disorder (PTSD) as a condition for the use of medical cannabis. There are no published studies, other than case reports, of the effects of cannabis on PTSD symptoms. The purpose of the study was to report and statistically analyze psychometric data on PTSD symptoms collected during 80 psychiatric evaluations of patients applying to the New Mexico Medical Cannabis Program from 2009 to 2011.

The results then were that than 75% reduction in CAPS symptom scores were reported when patients were using cannabis compared to when they were not.

The Study Conclusion was that Cannabis is associated with reductions in PTSD symptoms in some patients, and prospective, placebo-controlled study is needed to determine efficacy of cannabis and its constituents in treating PTSD.

With years of study; evidence about the relationship over time between whole plant cannabis use and PTSD symptoms is mixed. One recent study comparing cannabis users to non-using controls found that cannabis users reported greater improvements in PTSD symptoms when observed over the course of a year.

However, this study recruited individuals who endorsed already using cannabis to treat their PTSD symptoms before enrolling in the study. Because these individuals were not initiating cannabis as a novel treatment, it is somewhat surprising that their PTSD symptoms abated at the initiation of the study, rather than earlier in the course of their cannabis use. It is possible that including individuals who believed cannabis to be helpful for their PTSD may have selected for participants who were more likely to report greater symptom improvement related to their cannabis use. In addition, the study did not control for other variables that could explain differences in symptom reduction between the groups, leading to a high risk of bias.

Meanwhile, another study found that medical cannabis users with self-reported PTSD experienced short-term symptom relief when using cannabis but no long-term changes in PTSD symptoms, suggesting that cannabis may not effectively treat PTSD. In addition, other research shows that chronic cannabis use might worsen trauma-related symptoms over time.

Preliminary studies suggest that oral CBD might decrease anxiety in those with and without clinical anxiety. This work has led to the development and testing of CBD treatments for individuals with social anxiety and PTSD.

Post-traumatic stress disorder (PTSD), a common condition with potentially devastating individual, family, and societal consequences, is highly associated with substance use disorders (SUDs). The association between PTSD and SUD is complex and may involve adverse childhood experiences (ACEs), historical and multi-generational traumas, and social determinants of health as well as cultural and spiritual contexts. Current psychosocial and pharmacological treatments for PTSD are only modestly effective, and there is a need for more research on therapeutic interventions for co-occurring PTSD and SUD, including whether to provide integrated or sequential treatments.

There is a current resurgence of interest in psychedelics as potential treatment augmentation for PTSD and SUDs with an appreciation of the risks in this target population.

Another paper released reviews the historical perspective of psychedelic research and practices, as well as the intersection of historical trauma, ACEs, PTSD, and SUDs through the lens of New Mexico. New Mexico is a state with high populations of Indigenous and Hispanic peoples as well as high rates of trauma, PTSD, and SUDs.

Researchers in New Mexico have been leaders in psychedelic research. Future directions for psychedelic researchers to consider are discussed, including the importance of community-based participatory approaches that are more inclusive and respectful of Indigenous and other minority communities.

Per a release from the VA, Cannabis use in the general population has increased over the past decade. From 2013 to 2022, the number of Americans over the age of 12 reporting past month cannabis use rose from 19.8 million to 42.3 million. Likewise, daily use has increased 60% in the prior decade. Cannabis use among U.S. military Veterans has also increased. In 2019, 9.8% of Veterans in the U.S. reported using cannabis in the past year. In 2019-2020, the prevalence of past-6-month cannabis use among Veterans was 11.9% and was over 20% among Veterans aged 18-44.

Per the VA, the belief that cannabis can be used to treat PTSD is primarily based on anecdotal evidence from individuals with PTSD who report that cannabis helps with their symptoms or improves their overall life and functioning. In a recent systematic review of 14 studies evaluating the evidence on the clinical effects of cannabis on PTSD symptoms, results did not support the use of cannabis for improving overall PTSD symptoms. Randomized controlled trials (RCTs), which are a necessary "gold standard" for determining safety and efficacy, are needed to test the use of whole plant cannabis to treat PTSD. There has only been 1 RCT comparing whole plant cannabis and placebo for treating PTSD. This trial included 2 phases. The first phase compared effects of 3 active cannabis preparations (high THC, high5 CBD, balanced THC+CBD) and placebo on PTSD symptoms in 80 U.S. military Veterans. Results showed no significant difference in PTSD symptom reduction between placebo and any of the active cannabis preparations. In the second phase, 74 Veterans were re-randomized to receive 1 of 3 active cannabis preparations. Results showed a significant reduction in PTSD symptoms in the THC+CBD group only; however, because there was no placebo group in this phase, it is not possible to draw conclusions about the efficacy of cannabis to treat PTSD from these results.

Thus the Veterans Administration is suggesting more studies around PTSD and cannabis usage and is not as onboard for cannabis as other departments with the federal governmen.