Medicinal Marijuana and PTSD: Not All It's Puffed Up To Be? • The Havok Journal

by Frank Jefferson

Post Traumatic Stress Disorder (PTSD) is a troublesome process that has crippled up to 13% of the veterans of Operation Iraqi Freedom and Operation Enduring Freedom.¹ In a recent article Donald Bumanglag discussed his personal journey with PTSD and how he found relief with medicinal cannabis. My fellow Ranger and fellow Havok Journal writer Donovan Ronin recently wrote a similar article about his own experiences.

The Veterans Affairs (VA) uses evidence-based algorithms for the treatment of PTSD and relies on psychotherapy and a class of medications called Selective Serotonin Reuptake Inhibitors (SSRIs).² This has worked for large populations of Veterans, however, there are new modalities available and being investigated for the treatment of PTSD, medicinal cannabis is one of them.

Medicinal cannabis use has gained popularity in 21 states and the District of Columbia.³ Some data shows cannabis can help PTSD symptoms, however, there is also a strong correlation between substance abuse and PTSD.⁴ Despite the potential for abuse, research should continue to evaluate the benefits of medicinal cannabis for the treatment of PTSD symptoms.

Other options available for PTSD are also in development. The use of ketamine to control PTSD symptoms is an option for some. Recent studies show that ketamine can be effective in the treatment of chronic PTSD symptoms.⁵ The author also discussed his version of complementary and alternative medicine (CAM). CAMs include natural products, mind-body medicine, other alternative practices, and whole medicine systems.⁶ The effectiveness of CAM for the treatment of PTSD does not have definitive evidence, but there are several case studies that show it is effective.⁶

Cannabis is for the most part harmless and no more dangerous than other pharmaceuticals we ingest. However, we cannot overlook the fact that there is increased substance abuse in Veterans with PTSD.³ One study noted that only a minority of Veterans with PTSD that regularly used cannabis had reduction PTSD symptoms.³ However, treating symptoms is an important part of recovery. Greer and colleagues demonstrated the positive effects of cannabis on PTSD symptoms.⁷ Another aspect that cannot be overlooked is the treatment goals. While cannabis may help alleviate the symptoms, it is not treating the underlying problem of PTSD. The changes that happen to someone for developing PTSD cannot simply be solved with cannabis: There must be a multidisciplinary approach to properly treat PTSD.

When patients take a more active role in their care, better results are almost guaranteed. The author mentioned above is on his way to taking back his life and cannabis may be a part of that for a significant period of time. Unfortunately, many still seek out cannabis for recreational uses and regularly lie and mislead healthcare providers to gain legal access to cannabis, which could lead to restrictions. However, there should be prospective, placebo-controlled studies on the use of cannabis or its constituents for the treatment of PTSD.

Gradus JL. Epidemiology of PTSD. 2014; http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp. Accessed March 25, 2015. [Editor’s Note: not active March 31, 2020]
The Management of Post-Traumatic Stress Working Group. VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress. In: Department of Veterans Affairs and Department of Defense, ed2010.
Bohnert KM, Perron BE, Ashrafioun L, Kleinberg F, Jannausch M, Ilgen MA. Positive posttraumatic stress disorder screens among first-time medical cannabis patients: prevalence and association with other substance use. Addictive behaviors. 2014;39(10):1414-1417.
Bohnert KM, Ilgen MA, Rosen CS, Desai RA, Austin K, Blow FC. The association between substance use disorders and mortality among a cohort of Veterans with posttraumatic stress disorder: variation by age cohort and mortality type. Drug and Alcohol Dependence.128(1-2):98-103.
Feder A PM, Murrough JW, Perez AM, Morgan JE, Saxena S, Kirkwood K, Rot M, Lapidus KAB, Wan L-B, Iosifescu D, Charney DS. Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder. JAMA Psychiatry. 2014:E1-E8.
Strauss JL, Lang AJ. Complementary and Alternative Treatments for PTSD. PTSD Research Quarterly. 2012;23(2).
Greer GR, Grob CS, Halberstadt AL. PTSD symptom reports of patients evaluated for the New Mexico Medical Cannabis Program. Journal of psychoactive drugs. 2014;46(1):73-77.

This first appeared in The Havok Journal on April 6, 2015.