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Post-traumatic stress disorder, most common in war veterans, involves uncontrollable anxiety and flashbacks following a traumatic experience. Studies have shown cannabis is effective at lessening the emotional impact of traumatic events and can help patients experience less anxiety and fear and improve their sleep.
Overview of PTSD
Post-traumatic stress disorder (PTSD) is a mental condition that develops after experiencing or witnessing a traumatic event. Those suffering from PTSD experience flashbacks, severe anxiety, nightmares, and uncontrollable thoughts about the event, according to Mayo Clinic. They often feel stressed and in danger when no real threat exists. According to the National Institute of Mental Health, other symptoms of PTSD include staying away from places or events that are reminders of the traumatic experience, feeling numbness or guilt, losing interest in former enjoyable activities, being easily startled, feeling tense, having problems sleeping and experiencing angry outbursts.
PTSD is prevalent in military veterans, but can develop following any type of traumatic event, such as a mugging, kidnapping, car accident, plane crash, physical attack or natural disaster.
Currently, PTSD is commonly treated with psychotherapy efforts that include exposure therapy, which exposes patients to trauma they experienced but in a safe way, cognitive restructuring, which helps patients make sense of the bad memories, and stress inoculation training, which teaches patients how to reduce their anxiety. Antidepressant medications are often prescribed to help curtail feelings of sadness, anger, worry and numbness. These medications can sometimes have side effects like headache, nausea, sleeplessness or drowsiness, agitation and sexual problems.
Findings: Effects of Cannabis on PTSD
Cannabis has been found to help PTSD patients manage their symptoms19. Two major cannabinoids found in marijuana, tetrahydrocannabinol (THC) and cannabidiol (CBD), influence the body’s endocannabinoid system, which plays an essential role in maintaining emotional homeostasis and in regulating memory consolidation, retrieval and extension. Cannabinoids found in cannabis activate the cannabinoid receptors (CB1 and CB2) of the endocannabinoid system, which in turn modulates the release of neurotransmitter and produces a wide range of effects on the central nervous system, including an increase in pleasure and the alternation of memory processes2. The cannabinoids block the continuous retrieval of the traumatic event, thus enhancing its extension and reducing its associated anxiety1,9,18.
These effects help PTSD patients manage the three core symptoms of the condition, which include re-experiencing, avoidance and numbing, and hyperarousal. PTSD patients saw a 75% reduction in PTSD symptoms, as measured by the Clinical Administered Post-traumatic Scale, when they were using cannabis compared to when they were not8.
Military veterans use cannabis for coping purposes, especially those whose condition causes difficulties in emotional regulation or stress tolerance15. An improvement in sleep patterns in those who suffering from insomnia or nightmares is another primary motivating factor for cannabis use in PTSD patients2,5,13. The more severe the PTSD symptoms, the more that military veterans desire to use cannabis to cope4,5,6. Preclinical evidence supports CBD as having considerable potential as a treatment for PTSD when it’s administered acutely as symptoms arise rather than chronically3.
There’s evidence to suggest, however, that the benefits of cannabis for PTSD patients go beyond temporary. Findings support that cannabis has the potential to dampen the strength and emotional impact of traumatic memories13. In addition, administering cannabinoids shortly after the exposure to an intensely stressful event can help prevent the development of PTSD-like symptoms7.
States That Have Approved Medical Marijuana for PTSD
Currently, 23 states have approved medical marijuana specifically for the treatment of PTSD. These states include: Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Michigan, Minnesota, Montana, Nevada, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia.
A number of other states will consider allowing medical marijuana to be used for the treatment of other conditions, including PTSD, with the recommendation by a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), and Massachusetts (other conditions as determined in writing by a qualifying patient’s physician).
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Recent Studies on Cannabis’ effect on PTSD
- Akirav, I. (2013). Targeting the endocannabinoid system to treat haunting traumatic memories. Frontiers in Behavioral Neuroscience, 7, 124. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776936/.
- Betthauser, K., Pilz, J., and Vollmer, L.E. (2015, August). Use and effects of cannabinoids in military veterans with posttraumatic stress disorder. American Journal of Health-System Pharmacy, 72(15), 1279-84. Retrieved from http://www.ajhp.org/content/72/15/1279.long.
- Blessing E.M., Steenkamp, M.M., Manzanares, J., and Marmar, C.R. (2015, September 4). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neuotherapeutics, Epub ahead of print. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/.
- Boden, M.T., Babson, K.A., Vujanovic, A.A., Short, N.A., and Bonn-Miller, M.O. (2013, May-June). Post-traumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence. The American Journal on Addictions, 22(3), 277-84. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1521-0391.2012.12018.x/full.
- Bonn-Miller, M.O., Babson, K.A., and Vandrey, R. (2014, March 1). Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug and Alcohol Dependence, 136, 162-5. Retrieved from http://www.sciencedirect.com/science/article/pii/S0376871613005243.
- Bonn-Miller, M.O., Vujanovic, A.A., and Drescher, K.D. (2011, September). Cannabis use among military veterans after residential treatment for posttraumatic stress disorder. Psychology of Addictive Behavior, 25(3), 485-91. Retrieved from http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2011-01110-001.
- Campos, A.C., Ferreira, F.R., and Guimaraes, F.S. (2012, November). Cannabidiol blocks long-lasting behavioral consequences of predator threat stress: possible involvement of 5Ht1A receptors. Journal of Psychiatric Research, 46(11), 1501-10. Retrieved from http://www.journalofpsychiatricresearch.com/article/S0022-3956(12)00245-2/fulltext.
- Greer, G.R., Grob, C.S., and Halberstadt, A.L. (2014, January-March). PTSD symptom reports of patients evaluated for the New Mexico Medical Cannabis Program. Journal of Psychoactive Drugs, 46(1), 73-7. Retrieved from http://www.tandfonline.com/doi/full/10.1080/02791072.2013.873843?needAccess=true.
- Heimendahl, Jenny von (2012): Changes of endocannabinoid plasma levels following type I trauma: A prospective pilot study. Dissertation, LMU München: Faculty of Medicin. Retrieved from https://edoc.ub.uni-muenchen.de/15106/1/Heimendahl_Jenny_von.pdf.
- Korem, N., and Akirav, I. (2014). Cannabinoids Prevent the Effects of a Footshock Followed by Situational Reminders on Emotional Processing. Neuropsychopharmacology, 39(12), 2709–2722. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200492/.
- Lu, A.T., Ogdie, M.N., Järvelin, M.R., Moilanen, I.K., Loo, S.K., McCracken, J.T., McGough, J.J., Yang, M.H., Peltonen, L., Nelson, S.F., Cantor, R.M., and Smalley, S.L. (2008). Association of the Cannabinoid Receptor Gene (CNR1) With ADHD and Post-Traumatic Stress Disorder. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics : The Official Publication of the International Society of Psychiatric Genetics, 147B(8), 1488–1494. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685476/.
- Neumeister, A., Normandin, M.D., Pietrzak, R.H., Piomelli, D., Zheng, M.Q., Gujarro-Anton, A., Potenza, M.N., Bailey, C.R., Lin, S.F., Najafzadeh, S., Ropchan, J., Henry, S., Corsi-Travali, S., Carson, R.E., and Huang, Y. (2013). Elevated Brain Cannabinoid CB1 Receptor Availability in Posttraumatic Stress Disorder: A Positron Emission Tomography Study. Molecular Psychiatry, 18(9), 1034–1040. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752332/.
- Passie, T., Emrich, H.M., Karst, M., Brandt, S.D., and Halpern, J.H. (2012, July-August). Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence. Drug Testing and Analysis, 4(7-8), 649-59. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/dta.1377/full.
- Post-traumatic stress disorder (PTSD). (2014, April 15). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540.
- Potter, C.M., Vujanovic, A.A., Marshall-Verenz, E.C., Bernstein, A., and Bonn-Miller, M.O. (2011, April). Posttraumatic stress and marijuana use coping motives: the mediating role of distress tolerance. Journal of Anxiety Disorders, 25(3), 437-43. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101637/.
- Roitman, P., Mechoulam, R., Cooper-Kazaz, R., and Shalev, A. (2014, August). Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post-traumatic stress disorder. Clinical Drug Investigation, 34(8), 587-591. Retrieved from http://link.springer.com/article/10.1007%2Fs40261-014-0212-3.
- Stern, C.A.J., Gazarini, L., Takahashi, R.N., Guimarães, F.S., and Bertoglio, L.J. (2012). On Disruption of Fear Memory by Reconsolidation Blockade: Evidence from Cannabidiol Treatment. Neuropsychopharmacology, 37(9), 2132–2142. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398715/.
- Trezza, V., and Campolongo, P. (2013, August 9). The endocannabinoid system as a possible target to treat both the cognitive and emotional features of post-traumatic stress disorder (PTSD). Frontiers in Behavioral Neuroscience, 7, 100. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739026/.
- Walsh, Z., Gonzalez, R., Crosby, K., S Thiessmen, M., Carroll, C., and Bonn-Miller, M.O. (2016, October 12). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review, 51, 15-29. Retrieved from http://www.sciencedirect.com/science/article/pii/S0272735816300939.
- What is Post-traumatic Stress Disorder (PTSD)? (n.d.). National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml.
- Wilker, S., Pfeiffer, A., Elbert, T., Ovuga, E., Karabatsiakis, A., Krumbholz, A., Thieme, D., Schelling, G., and Kolassa, I.T. (2016, May). Endocannabinoid concentrations in hair are associated with PTSD symptom severity. Psychoneuroendocrinology, 67, 198-206. Retrieved from http://www.psyneuen-journal.com/article/S0306-4530(16)30040-3/fulltext.
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