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November 11, 2015

StrongVeterans.com BlogDoes Medicinal Marijuana Help People With PTSD?

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Stephanie Yarnell, MD, PhD

Yale University, New Haven, Connecticut

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Medicinal marijuana . . . it is all over the media. Some people are for it, some against. But do we actually know whether or how it works in the treatment of various diseases? The reality is that marijuana, especially as a form of medicine, is still in the very early stages of research. Yes, people have been studying it for many decades, but the Drug Enforcement Administration label of schedule 1 has made conducting meaningful research limited and difficult. It is no surprise, then, that we now find ourselves in this state of confusion as to whether marijuana is a medicine or just a recreational drug. In a recent article, I sought to succinctly summarize one small area of the knowledge base: the use of medicinal marijuana in posttraumatic stress disorder (PTSD).

With the increasing number of persons, particularly veterans, diagnosed with PTSD and the rampant rates of suicide within this population, it is not surprising that people are looking to what some consider to be nontraditional forms of treatment. Although federal agencies have not approved its use, medicinal marijuana is now an approved treatment for PTSD in some US states. Registry data from 2011 showed that, in a state that allowed the use of medicinal marijuana, PTSD was the primary indication for which people used it. Why? Well, it appears that it may help. One study suggested that medicinal marijuana resulted in a 75% decrease in clinical symptoms of PTSD, especially traumatic intrusions, hyperarousal, and overall anxiety. Another study found a significant relationship between PTSD symptom severity and coping-motivated use of marijuana.

How is medicinal marijuana thought to work? Cannabinoid receptors are widespread in the brain. According to the Peters and Mechoulam chapter in the bookProfessional Perspectives On Addiction Medicine: Beyond Medical Marijuana, the areas of the brain with the highest number of cannabinoid receptors are those involved in memory formation (hippocampus), motor coordination (cerebellum), and emotionality (prefrontal cortex). Perhaps unsurprisingly, this distribution correlates with a number of known side effects of marijuana. Combinations of animal and human research have begun to shed light on possible mechanisms to explain the reported improvement of PTSD symptoms with marijuana. To name a few, potential correlations exist between cannabinoid receptors in the amygdala, an area known for modulating “fight or flight,” and decreased hyperarousal, hypervigilance, and anxiety, and cannabinoids may also play a role in so-called extinction response, the forgetting of traumatic memories.

While this research sounds promising, nothing conclusive can be said at this time. Most of the evidence has come from either animal or observational studies rather than from large-scale, randomized, controlled studies, which are considered the gold standard of science. Also, marijuana has potential problems such as pulmonary issues from smoking, sleep disturbances from chronic use, and possible development of cannabis use disorder. While not an exhaustive list of potential concerns, it does emphasize that medicinal marijuana is not without risks. Patients and clinicians need to be aware of these and other risks, as well as of the limitations of the evidence for efficacy, prior to undertaking marijuana treatment for PTSD.

Financial disclosure:Dr Yarnell had no relevant personal financial relationships to report.​

Category: PTSD , Substance Use Disorder , Veteran
Link to this post: https://www.psychiatrist.com/blog/strongveterans-com-blogdoes-medicinal-marijuana-help-people-with-ptsd/
Related to Does Medicinal Marijuana Help People With PTSD?

4 thoughts on “StrongVeterans.com BlogDoes Medicinal Marijuana Help People With PTSD?

  1. As a counterpoint to your review, consider the recent article: “Marijuana Use Is Associated With Worse Outcomes in Symptom Severity and Violent Behavior in Patients With Posttraumatic Stress Disorder”. It was just published in the Journal of Clinical Psychiatry (76-9:1174–1180), & concludes: “Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment.”
  2. Thank you for the comment. As this was only recently published, it could not have been included in the review. (This blog entry too was written prior to that publication, though only now being posted.) New information on both sides is becoming available almost daily and continues to expand our knowledge on this evolving topic. I am not sure anyone has the full picture at this time.

    While I believe there are some methodological issues with the article you suggested, I continue to have the utmost respect for Dr. Wilkinson and have actually co-authored a piece in the Annal Review of Medicine on marijuana with him.

  3. I would add another article you may have missed. While you are correct that the research on marijuana is limited if we consider the research on association with psychosis and effects on intellectual function, effects on anxiety disorders in general etc it seems to be injudicious to emphasize the value of marijuana. If there is some value in some of the active substances included in marijuana then it seems sensible to research them in refined form rather than in an unregulated delivery system which includes exposure to a number of chemicals with known risks and no specific benefit. We don’t let people smoke cigarettes in public because we know smoke is harmful.
    You might also want to return to a little basic psychology. Extinction and forgetting are very different processes.

    Posttraumatic Stress Disorder and Cannabis Use
    Characteristics among Military Veterans with
    Cannabis Dependence
    Matthew Tyler Boden, PhD,1 Kimberly A. Babson, PhD,1,2 Anka A. Vujanovic, PhD,3
    Nicole A. Short, BA,1 Marcel O. Bonn‐Miller, PhD1,4,5
    The American Journal on Addictions, 22: 277–284, 2013
    Copyright © American Academy of Addiction Psychiatry
    ISSN: 1055-0496 print / 1521-0391 online
    DOI: 10.1111/j.1521-0391.2012.12018.x

  4. There have been numerous studies on the medicinal properties of marijuana. The downside to this is excessive usage – anything that is used abusively would certainly take a toll in the long run. It is best to consult with a doctor specializing in this field rather than to take self medication.

    Regards,
    Rom of https://www.gomainstem.com/

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