StrongVeterans.com BlogDoes Medicinal Marijuana Help People With PTSD?

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.​