There are about 19 million veterans in the US and as many as a third of them may have PTSD. Flashbacks and nightmares, along with stress and anxiety, frequently plague people who have been exposed to violence, natural disasters, or other traumatic events. The resulting post-traumatic stress disorder (PTSD) can linger for years or even a lifetime without psychotherapy and complementary treatments. While the incidence of PTSD in the general population is between 6% and 10%, it's 13% to 31% for US military veterans. And about 30% of people with PTSD aren't helped by pharmaceuticals.
Veterans Affairs lists psychotherapy as the first line of treatment and prescription anti-anxiety and anti-depression medication as the second. But many veterans resist counseling or therapy sessions and the majority of those who do attend don't find relief. Medication isn't much more effective and many veterans reject it as only treating the symptoms. Since veterans with PTSD have an increased risk of suicide, finding an effective treatment is paramount.
Anecdotal evidence abounds of desperate vets using legal and unregulated cannabis to treat their symptoms. But what other support is there for this method of treatment?
Going over the available recent research on cannabis as a treatment for PTSD, it's clear that more (and more rigorous) study is needed. Research on the medicinal benefits of cannabis has been hampered by many things, including its prohibition at the federal level. Narrowing trials to a specific dose has also been difficult since cannabinoid and terpene content can vary greatly even within the same strains of cannabis.
While it's relatively simple to compare different doses of standard pharmaceutical compounds, the nearly boundless possibilities of cannabinoid and terpene concentrations and ratios across multiple consumption possibilities significantly muddies the water for testing the medical efficacy of cannabis. As more researchers venture into studies of cannabis medicine for PTSD and other mental health issues, details about effective THC and CBD amounts and ratios, as well as efficient consumption methods, should come into focus.
For now, however, the research is mostly promising.
In 2020, the journal BMC Psychiatry published a review of existing studies which concluded that THC could help PTSD sufferers more easily forget traumatic memories. It also found that low doses of THC (10 mg or less) or THC combined with CBD could also lower anxiety and reduce the rate of unpleasant side effects.
A small study on ten veterans with PTSD was conducted in the Netherlands and the results were published in the journal European Neuropsychopharmacology in 2020. The focus group participants reported reduced anger and irritability as well as improved sleep quality and fewer nightmares. The participants were all being treated for PTSD by the Dutch military's mental health services and had been prescribed medical cannabis because they didn't respond to conventional pharmacological treatment. No adverse effects were reported and participants all said the medical cannabis was more effective than other medications they had tried.
A study published in the journal Cannabis and Cannabinoid Research in late 2020 looked at cannabis use in a group of 150 men and women diagnosed with PTSD. One group consumed cannabis obtained from a licensed dispensary and the other didn't. At the end of the year in which the study took place, the cannabis consumers were nearly three times more likely to no longer meet the diagnostic criteria for PTSD.
Psychopharmacology, the official journal of the European Behavioural Pharmacology Society, published the results of a study on THC and PTSD in 2021. The study's authors concluded that THC helped participants experience less fear and anxiety in exercises designed to provoke those feelings. The cannabinoid, administered in 7.5-milligram (mg) doses as the FDA-approved drug dronabinol, was shown to both reduce reactions to threats and increase emotional and behavioral control.
After nearly 20 years in the military, including Special Forces deployments, Adam Smith found himself back home but struggling to leave battlefield anxiety behind. He was always on alert, not sleeping, and eventually contemplated suicide, according to an article in Forbes. Smith eventually tried cannabis and found that it improved his physical pain, allowed him to sleep, and soothed the constant feeling of being on alert. He even started a Kentucky-based CBD business that caters to veterans.
Another PTSD patient, Elvis Alonzo, was profiled in a 2018 article published in Scientific American. A former Marine and Glendale, Arizona, police officer, Alonzo battled severe PTSD that his medications were unable to treat. After starting a regimen of cannabis, Alonzo noticed monumental improvements to his wellbeing. He shared, “It's been a godsend. It curbs my anxiety, and it makes me sleep fantastic for at least four hours. It needs to be studied.”
Many medical experts concur with Alonzo. Medical marijuana needs to be studied as a real treatment option for PTSD.
What experts say
Dr. Alexander Neumeister, the lead author of the NYU study and director of the molecular imaging program in the Departments of Psychiatry and Radiology at NYU School of Medicine, perceives a pressing need for alternative PTSD treatments, including cannabis therapy.
“There's not a single pharmacological treatment out there that has been developed specifically for PTSD. That's a problem,” Neumeister said. “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. Clearly, there's a very urgent need to develop novel evidence-based treatments for PTSD.”
Experts also recognize the need to distinguish between THC and CBD, and which of these natural compounds could be better suited to treat PTSD. According to Marcel Bonn-Miller, a psychology and psychiatry professor at the University of Pennsylvania's Perelman School of Medicine in Philadelphia in the same Scientific American article that profiled Alonzo, the Marine-turned-police officer: “Think of CBD as a shotgun. It hits so many receptors that people are still trying to understand it. If you want to actually treat PTSD, most of the evidence is pointing toward CBD. But most people with PTSD are gravitating toward [marijuana] products with high THC levels, which may help in the short-term but are likely to worsen their symptoms over time.”
Bonn-Miller's opinion aligns with the findings of some recent studies, such as a 2018 case series published in the Journal of Alternative and Complementary Medicine. Clinicians found that oral CBD, in concert with psychiatric care, resulted in a reduction of PTSD symptoms.
Cannabinoids could be the alternative medicine that PTSD sufferers have been desperately needing, but more rigorous clinical studies are needed to convince the skeptics and identify appropriate dosing for consistent treatment of depression, anxiety, and other PTSD symptoms for our veterans and others.