Can Cannabis Help PTSD?

This article was Medically reviewed by Roni Sharon, MD and originally published by The Cannigma.

Medical cannabis is an approved treatment for PTSD (Post-Traumatic Stress Disorder) in an increasing number of countries and US states, and there is a growing body of research into how it can help those living with the condition. 

While research into cannabis as a treatment for PTSD is still sparse, large numbers of PTSD patients themselves report that it helps with both the primary symptoms of the condition and secondary side effects including anxiety and sleep disturbances. Furthermore, because cannabis triggers body receptors that regulate memory, some researchers are looking at ways medical cannabis could help the brain “overwrite” traumatic memories.

How cannabis works on PTSD

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the ECS can also be modulated and activated by cannabinoids found in the cannabis plant. 

Endocannabinoids are molecules produced by the human body that are very similar to some of the active chemicals in cannabis, and act as messengers, sending signals to cannabinoid receptors. Because the ECS plays a role in regulating both stress response and memory building — two major factors in PTSD — there is reason to believe that marijuana could be particularly helpful for people suffering from the condition. In addition, researchers have found that impaired endocannabinoid functioning after a stress-inducing event may be a factor in patients developing anxiety disorders and PTSD.

Marijuana is also known for being especially effective in helping users get a good night’s sleep — no small thing for people suffering from the trauma and distress of PTSD.

Medical studies on cannabis and PTSD

Legal prohibitions against cannabis have inhibited research, but there is nonetheless a growing body of work that suggests how medical marijuana can help people with PTSD, as well as a host of other conditions and diseases. 

• A 2015 meta review stated that “the evaluated evidence indicates that substantial numbers of military veterans with PTSD use cannabis or derivative products to control PTSD symptoms, with some patients reporting benefits in terms of reduced anxiety and insomnia and improved coping ability.” 
• A 2017 article stated that the regions of the brain that are involved in stress-induced behavioral consequences “are modulated by endocannabinoids and, therefore, are also potential therapeutic targets for cannabinoid drugs.” 
• A 2016 article stated that “the end result of the current clinical and preclinical data is that cannabinoid agents may offer therapeutic benefits for PTSD.”
• A 2014 study performed in New Mexico (the first state to list PTSD as an approved condition for medical cannabis) found that “cannabis is associated with reductions in PTSD symptoms in some patients.” The study found a greater than 75% reduction in CAPS (Clinician Administered Posttraumatic Scale) symptom scores when patients were using cannabis.
• A 2014 study found that cannabis use led to statistically significant improvements in global symptom severity, sleep quality, frequency of nightmares, and PTSD hyperarousal symptoms.

It is prudent to note that cannabis is also known to potentially cause anxiety and paranoia in some users, though research has shown that this is linked to the amount and strength of the marijuana that is consumed. This is by no means universal — the same type and amount of marijuana given may have a relaxing effect in one patient, and spur anxiety and/or paranoia in another. 

There have also been observational studies on PTSD patients that showed negative effects from cannabis treatment. One study also looked at veterans with PTSD who enrolled in a four-month treatment program found that initiating cannabis use after treatment was associated with worse PTSD symptoms such as more violent behavior, and alcohol use. These authors warn that cannabis may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Of course, it is important to note here that alcohol use is independently associated with violent behavior, and may be contributing to the violence observed in this study since alcohol use was also statistically correlated with cannabis use. It is also known that cannabis may be associated with psychosis in some people, so caution must be used in patients that have a history of hallucinations or delusions.

CBD and PTSD

Cannabidiol (CBD) is one of the 146 identified cannabinoids, and because it does not have the psychotropic effects of THC, it is often widely-available in places where medical marijuana has not been legalized. This also means that CBD is often more readily available for research. 

• A 2019 article stated that “oral CBD, when given in addition to routine outpatient psychiatric care, may have a beneficial effect for patients with PTSD.”
• A 2018 article stated that “human and animal studies suggest that CBD may offer therapeutic benefits for disorders related to inappropriate responses to traumatic memories. The effects of CBD on the different stages of aversive memory processing make this compound a candidate pharmacological adjunct to psychological therapies for PTSD. CBD also shows an action profile with fewer side effects than the pharmacological therapy currently used to treat this type of disorder. In addition, even at high doses, CBD does not show the anxiety-inducing profile of compounds that directly activate eCB transmission.

A 2015 article stated that preclinical evidence conclusively showed CBD’s efficacy in reducing anxiety behaviors relevant to PTSD and a variety of other disorders including GAD (Generalized Anxiety Disorder), PD (panic disorder), OCD (obsessive compulsive disorder), and SAD (social anxiety disorder), and had a “a notable lack of anxiogenic effects.”

Side effects

Cannabis is far safer than many other legal forms of medication, but it is not without its side effects. Most notably, the psychotropic qualities of THC can cause problematic cognitive effects that can interfere with work and make operating heavy machinery or driving more difficult than otherwise. 

And while the reaction is different for each user, THC has been known to trigger anxiety and paranoia in some users, potentially aggravating the symptoms of PTSD. 

These side effects are not a concern when taking hemp-derived CBD products, which do not have psychotropic qualities. 

Also, smoking cannabis exposes users to the same cardiopulmonary risks of tobacco smoking, and while vaping is considered a safer option, it is still a relatively new practice, so further time is needed to gauge the long-term effects. 

Marijuana can also be habit forming. 

It is important to note, there have been no verified cases of death caused by cannabis.

When considering the use of cannabis for anxiety, or any other medical condition, it is important to consult with your doctor before initiating therapy.