This story was updated with new reporting and data on October 8, 2019.
Post-traumatic stress disorder, or PTSD, is an increasingly common condition among Americans. According to the U.S. Department of Veterans Affairs (VA), around 8 million adults experience PTSD each year. It tends to affect women more than men — 10 percent of women go through PTSD at some point in their lives, compared with 4 percent of men.
PTSD can be triggered by a wide variety of causes. Sometimes, it’s the result of a direct experience: Suffering a severe accident or physical abuse, living through a war, or witnessing a death. Sexual abuse is now widely acknowledged as a cause of PTSD, as well. But it’s not always necessary for a person to have a first-hand negative experience to develop PTSD, as sometimes the shock of an event (like a terrorist attack in one’s city) can be enough to trigger symptoms in certain people.
Given the prevalence of PTSD in contemporary American society — and the difficulty in treating it — it’s little surprise that scientists, doctors, and patients are on the lookout for new ways to manage it. Cannabis has emerged as an intriguing option for many, and today many states with medical cannabis programs include PTSD as a qualifying condition. But while there’s an abundance of anecdotal reports of people self-medicating with cannabis, this method of treatment hasn’t been extensively studied.
Still, this hasn’t stopped a growing number of Americans from turning to cannabis to manage their PTSD symptoms. Many military vets, in particular, have sought safer access to medical cannabis as a substitute for the pharmaceutical medications that have traditionally been prescribed, which often come with the risk of addiction and other severe side effects.
The symptoms of PTSD are complex, and vary widely from person to person. The Anxiety and Depression Association of America (ADAA) groups them into three main categories: Re-experiencing the trauma (which can include nightmares, flashbacks, and painful memories); emotional numbness (which can lead people to avoid any person, place, or thing that they connect with the trauma); and heightened sensitivity (which can manifest in jumpiness, an inability to concentrate, and sudden mood swings).
Psychotherapy and drugs like selective serotonin reuptake inhibitors (SSRIs) are commonly used to manage these symptoms. While they’re effective for some people, others still struggle to find relief.
This has led researchers to investigate whether cannabis could be a viable alternative treatment, and while studies are still limited, some of the early results have been promising.
Cannabis can impair memory — and that’s positive for people with PTSD.
For example, in 2013 a team of researchers from NYU Langone Medical Center found that the brains of people with PTSD have more CB1 receptors than those who don’t have PTSD, which is a response to the brain’s lack of a chemical called anandamide. Since THC, the most prominent compound in cannabis, has a nearly identical chemical structure to anandamide, using cannabis could help restore balance — and in the process impair memories, which could help alleviate the suffering of people with PTSD.
As Dr. Alexander Neumeister, the study’s lead researcher, told Science Direct, “There’s a consensus among clinicians that existing pharmaceutical treatments such as [antidepressants simply] do not work. In fact, we know very well that people with PTSD who use marijuana — a potent cannabinoid — often experience more relief from their symptoms than they do from antidepressants and other psychiatric medications.”
Cannabis could help reduce anxiety as well.
Scientists are also beginning to explore cannabis’ effectiveness for treating common PTSD symptoms like anxiety. Some of the plant’s most prominent compounds like CBD have been shown to help with anxiety, and recent studies have suggested that even obscure ones like the terpene limonene could have anti-anxiety and antidepressant properties.
Dr. Jordan Tischler, an instructor at Harvard Medical School and a cannabisMD medical advisor, believes that the ability of these cannabis compounds to reduce anxiety could make them well-suited to treating PTSD as well. As he told The Guardian, “PTSD and generalized anxiety disorder have a lot in common). At the same time, he’s wary about people with PTSD self-medicating with the plant — especially veterans, whose lack of access to medical cannabis means they often rely more on advice from friends than doctors.
Cannabis could also help relieve insomnia.
Another frequent issue for people with PTSD is insomnia — many patients report experiencing nightmares and traumatic memories when they try to sleep. Since an inability to sleep can exacerbate other health issues, finding a safe and effective sleep aid is a priority for many patients.
Cannabis could potentially prove useful in this regard. The reason? Its ability to affect REM sleep — also known as rapid-eye movement, this is the stage of the sleep cycle when we experience dreams. A 1975 study in the journal Clinical Pharmacology and Therapeutics showed THC can reduce the amount of time people spend in this stage, leading to less vivid dreams (or no dreams at all).
According to Dr. Michael Breus, a prominent physician known as “The Sleep Doctor,” this could make cannabis a useful a useful treatment for people with PTSD. “Because of this diminished time in REM, THC reduces dreaming,” he writes on his website. “That can be helpful to people who have conditions such as PTSD that involve frequent, disturbing dreams and nightmares”.
Despite anecdotal reports and the preliminary studies, there’s still no scientific consensus on cannabis as a potential treatment for PTSD. And while the U.S. federal government’s newfound openness to cannabis research could one day help scientists get a clearer picture of its risks and benefits when it comes to PTSD, many experts are urging caution for the time being.
Some research shows cannabis can worsen PTSD symptoms.
A number of experts, like Dr. Samuel T. Wilkinson of the Yale University School of Medicine, believe that cannabis could actually worsen the symptoms of PTSD. He was the lead author of a 2014 study that examined over 2,000 veterans and found that cannabis use led to more severe symptoms and increased violent behavior.
While he was open about the limitations of the study, he pulled no punches when describing its findings. “This wasn’t a randomized controlled trial. But at least in this study, we found that marijuana is not associated with improvement in PTSD and that initiating marijuana was associated with worsening outcomes in a number of measures,” he told the medical website Medscape.
PTSD patients who self-medicate with cannabis could be at risk.
The VA has also voiced concerns about veterans self-medicating with cannabis, which seems to have been on the rise in recent years. According to the agency’s data, in 2002 around 13 percent of veterans with PTSD had a “co-occurring marijuana addiction,” a number that rose to 22.7 percent by 2014. The VA also reports that cannabis use disorder has been the most-diagnosed substance abuse issue among veterans since 2009.
A number of mental health organizations have expressed their reservations about cannabis as a potential treatment for PTSD, as well, citing the risks of anxiety, depression, and psychosis in people predisposed to those issues. The American Addiction Centers (AAC) recommends methods like Cognitive Behavioral Therapy (CBT) as safer alternatives, and states that, “If the drug is legalized on the federal level for mental health treatment in the future, as many groups are pushing for, it is important to understand that it should be used like other psychiatric medications: for short-term relief of symptoms, so the individual can focus on therapy to treat their mental health.”
More research is needed before cannabis becomes a viable PTSD treatment.
While it’s obvious that new ways of managing PTSD symptoms are needed, many doctors believe it’s too soon to embrace cannabis as a go-to option. According to Dr. Michael Bloomfield, a researcher at the UCL Psychiatry and Traumatic Stress Clinic and the senior author of a 2019 study on cannabis and PTSD, “Based on the evidence, we cannot yet make any clinical recommendations about using cannabinoids to treat PTSD,” he told Science Daily.
However, despite the limitations of the available research, there’s reason to be intrigued about the future of cannabis as a PTSD treatment. As Bloomfield said, “Current prescribing of cannabinoids for PTSD is not backed up by high quality evidence, but the findings certainly highlight the need for more research, particularly long-term clinical trials”.