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2023 Study: Cannabis for Treatment-resistant PTSD

Updated: Dec 10, 2023

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A 2023 study entitled "Medical Cannabis for Treatment-resistant Combat PTSD" that was published in the journal Frontiers in Psychiatry explored the potential efficacy of marijuana in the treatment of Post-traumatic Stress Disorder (PTSD).

A soldier in the field.
Does cannabis help PTSD?

Cannabis for Treatment-resistant PTSD Study

"We followed 14 relatively mature (32-68 years of age), treatment-resistant chronic combat-PTSD patients who remained severely symptomatic despite treatment with many lines of conventional treatment prior to receiving medicinal cannabis," reported the study's authors.

PTSD is a mental disorder resulting from a traumatic event. Such events include being "threatened or actual death, serious injury, or sexual violence."

The study explained that PTSD is a mental disorder resulting from a traumatic event. Such events include being "threatened or actual death, serious injury, or sexual violence." The researchers reported that these traumatic events can occur directly to a patient or to a co-worker or loved one. Sometimes PTSD patients witness a traumatic event that directly affects another person.

The study involved 12 men and two women featuring a mean age of 50. Most (86 percent) were currently married and had children. Each PTSD patient had suffered with their condition for an average of 28 years and had been undergoing treatment prior to consuming medical cannabis for nearly eight years.

A woman with her hands over her face.
Cannabis may help PTSD.

PTSD Symptoms

According to the scientists, symptoms of PTSD include:

  • Fear-based reexperiencing (such as in intrusive recollections, nightmares, or dissociative states).

  • Intense physiological or psychological distress when exposed to triggering cues that remind of the traumatic events and persistent avoidance of such cues (internally or externally).

  • Negative alterations in cognition or mood including difficulty in remembering important parts of the event, negative expectations about oneself, others, or the future.

  • Persistent negative mood states with decreased ability to hold positive feelings.

  • Diminished interest in previously enjoyed activities and feelings of detachment or estrangement from others.

  • Alterations in arousal and reactivity, including irritable behavior, hypervigilance, exaggerated startle response, and more.

Interest in the potential efficacy of medical cannabis for PTSD has emerged due to the sometimes poor results obtained from conventional therapies, including cognitive behavioral therapy and pharmaceuticals. "A large proportion of patients avoid psychological treatment and the dropout rate among veterans is high," reported the study.

A cannabis joint
Cannabis for trauma

Cannabis for Treatment-resistant PTSD Study Results

Cannabis for Treatment-resistant PTSD. Sleep disturbances and disorders are among the most common PTSD symptoms. The scientists reported that the PTSD patients treated with medical cannabis "significantly improved" in terms of subjective sleep quality and sleep duration. Despite this, improvement in difficulty falling asleep in under 30 minutes "was statistically only marginally improved."

Sleep disturbances are common PTSD symptoms. PTSD patients treated with medical cannabis "significantly improved" in terms of subjective sleep quality.

Overall PTSD symptoms showed improvement after cannabis treatment, but no improvement was observed in terms of frequency of nightmares. Study participants consumed cannabis only before going to sleep and the quantity of cannabis "did not exceed 20 grams per month, but the minimal amount used could not be discerned."

A commercial greenhouse full of cannabis plants.
Does marijuana help PTSD patients?

Cannabis for Treatment-resistant PTSD Study Conclusions

Cannabis for Treatment-resistant PTSD. The scientists concluded the following from their data and analysis:

"Many studies have found a possible role for medical cannabis in the treatment of PTSD with no definite conclusion due to the paucity of studies and methodological limitations. We aimed to add to the building body of knowledge by demonstrating the possible usefulness of cannabis for at least a subset of patients with specific properties. In this retrospective naturalistic study, we used the files of patients diagnosed with chronic combat-PTSD who were treated with cannabis after exhausting all other treatment options. Our study is unique primarily due to the nature of the participants.

"Participants were mature (mean age was 50), treatment-resistant, chronic combat-PTSD patients who had undergone several pharmacological treatments."

"All participants were relatively mature (mean age was 50 years old) treatment-resistant chronic combat-PTSD patients who had undergone several pharmacological treatment lines and prolonged exposure therapy prior to receiving treatment with cannabis. They were all treated in the same clinic by the same expert psychiatrist in the field of PTSD.

Cannabis Prescribed as Last Resort

"Prior to treatment with cannabis, patients continued to suffer from moderate to high-level PTSD symptoms despite being in treatment for an average of [more than] seven years. Cannabis was only prescribed after receiving the standard treatment and not as primary treatment, with none of the patients having a background of substance abuse. All of them had never used cannabis before the study.

"In addition, the study's uniqueness is also in the long follow-up of patients, averaging over a year (range 0.5-3 years). This enabled the assessment of the effect of cannabis on not only PTSD symptoms, but also investigation of possible side effects and addiction.

A woman holds a cannabis leaf in a field of plants.
Cannabis may help some with PTSD.

"The study's findings show an overall improvement in sleep quality and duration, as well as a decrease in PTSD symptoms. According to the PDS questionnaire, there was a reduction of at least 20 percent in PTSD symptoms in over 65 percent of patients, with nearly 80 percent showing improvement. Surprisingly, unlike other studies, the decrease in nightmares was observed but was not significant, maybe due to the small number of participants.

"We have shown that cannabis may be beneficial and alleviate some suffering among patients resistant to evidence-based treatments."

"The widespread use of cannabis today in patients with PTSD, whether legally or otherwise, is often problematic due to the onset of use at a young age and the potential for addiction and dependence. There is also a problem with patients preferring cannabis treatment as their first treatment over evidence-based pharmacological and psychological treatments.

"In our study, the pre-selection process created a mostly homogeneous group of relatively mature patients without prior use of cannabis who were treatment-resistant to several evidence-based therapies. By selecting this group, we have shown that cannabis may be beneficial and alleviate some suffering among patients resistant to evidence-based treatments.

A soldier cries during a ceremony.
Marijuana and PTSD.

"It is known that subjects suffering from PTSD tend to use cannabis as a form of self-medication more widely than the general population, thus suffering from high rates of substance-related disorders. Our long-term follow-up allowed us to see that none of the patients suffered from side effects and symptoms of addiction.

"It is possible that the characteristics of our participants (mature, in treatment for many years by the same physician, mostly married with children) led to a more responsible use (just before bedtime, in a fixed amount, without recreational use) which played a role in the good outcome.

"Our long-term follow-up allowed us to see that none of the patients suffered from side effects and symptoms of addiction."

"The limitations of the study should be noted. First, the study is retrospective and does not include placebo or control groups. However, it may be argued that as patients were stable in their symptoms prior to cannabis treatment, they were their own controls.

"Second, while we ensured that the dose of cannabis did not exceed 20 grams per month, the type of compounds, the ratio of CBD to THC, the route of administration, timing of usage, and the actual amount [consumed] were not controlled as patients are mainly free to try different strains (cultivars) without notifying their psychiatrist.

A soldier in a therapy session.
Do you have PTSD?

"Third, formal validation of the Hebrew translation of the PDS has not been published as of yet, though several translations were used in various theses and studies. Therefore, we used an unpublished translation that we found most accurate and faithful to the original.

"Lastly, the sample is relatively small, consisting of only 14 patients, and the majority (86 percent) were men. Although it seemed that women benefited more from cannabis treatment, the sample size was too small (a total of [only] two women) to draw any conclusions. The gender difference may warrant further study.

"Existing literature indicates a decrease in PTSD symptoms under medical cannabis treatment."

"To the best of our knowledge, this is the first published study examining long-term cannabis efficacy in chronic combat treatment-resistant PTSD patients. The study we conducted is consistent with existing literature which indicates a decrease in PTSD symptoms under medical cannabis treatment. There are still very few studies examining the effectiveness of medical cannabis for PTSD patients.

"One needs to remember that the endocannabinoid system works in different ways, even in the same disorder and among different genders and ages, which may also affect outcomes. Our results suggest the importance of the selection process in terms of patients receiving medical cannabis. Future research should clarify the long-term effects of cannabis on different groups of patients suffering from PTSD."

View the original study.

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