Post-Traumatic Stress Disorder – or PTSD – is a common anxiety disorder which develops as a response to stressful or traumatic events. While the condition was first identified in soldiers (in the past, PTSD has also been called shell shock), it is associated with a wide range of traumatic experiences, including abuse, car accidents, and childbirth. It is estimated that around 1 in 5 people who experience a traumatic event will later develop some form of PTSD.
Treatment for PTSD can be varied and include both medication and therapy. However, antidepressants such as paroxetine and sertraline are routinely prescribed to patients experiencing PTSD. In recent years, there has been a clear increase in the number of patients experiencing PTSD who are interested in alternative therapies – perhaps the most popular being medical cannabis.
Cannabis use has been reported among PTSD patients – who claim it has helped with various symptoms, including nightmares, panic attacks, anxiety, and depression – for decades. In fact, the prevalence of cannabis use reportedly increased to over 20% in US veterans aged 18-44 in 2019-2020. This rise is part of a wider trend as more jurisdictions around the world continue to improve the accessibility of medical cannabis for a wide range of indications.
But is there any evidence to support the use of medical cannabis for PTSD?
Cannabis and PTSD
The use of psychoactive drugs has been common among patients experiencing PTSD likely throughout the whole of history. For example, the use of alcohol and other drugs is common in this population as patients seek ways to escape their experiences; however, evidence shows that such coping tactics can intensify symptoms in the long run, potentially leading to drug relapse and other harmful outcomes. The potential of addiction to some psychoactive drugs can also represent further dangers to patients.
On the other hand, a growing body of evidence suggests that some psychoactive drugs, including cannabis and psychedelics, may actually be useful for the management of some PTSD symptoms.
Despite people with PTSD long reporting the benefits experienced through medicinal cannabis use, little clinical research was carried out in the 20th century. However, over the last 30 years, scientific and medical interest in the therapeutic potential of cannabis in this setting has gradually increased.
One such study was published in the journal Expert Review of Neurotherapeutics in 2022 and focused on UK patients who had been prescribed medical cannabis for PTSD. The data, collected by the UK Medical Cannabis Registry, represented 162 patients who reported changes in health-related quality of life at 1, 3, and 6 months after the initiation of medical cannabis treatment.
Various questionnaires and measures, including a sleep quality survey, anxiety evaluation, and a questionnaire designed to measure how distressing post-trauma difficulties had been in the past week, were used to determine quality of life scores. The researchers concluded that medical cannabis treatment was associated with significant improvements in PTSD symptoms, sleep, and anxiety across all follow-ups.
Another study, published in 2020, aimed to compare the effects of THC on responses to threat in non-trauma-exposed healthy control participants, trauma-exposed adults without PTSD, and trauma-exposed adults with PTSD. Participants completed a well-established threat processing paradigm during functional magnetic resonance imaging. Among patients with PTSD, THC was observed to lower threat-related amygdala reactivity, which indicates a measurable sign of reduced fear and anxiety.
Participants exposed to THC also demonstrated an increase mPFC activation during threat and increase mPFC-amygdala functional coupling. The researchers concluded that these results may indicate “that THC modulates threat-related processing in trauma-exposed individuals with PTSD” and these potential benefits may recommend THC as “a pharmacological approach to treating stress- and trauma-related psychopathology.”
Finally, a US-based prospective study assessed PTSD patients every three months throughout a one-year study period. The researchers compared PTSD symptom severity in patients who used cannabis and those who did not. Over the course of the year, “cannabis users reported a greater decrease in PTSD symptom severity over time compared to controls.” In fact, the researchers concluded that PTSD patients who used cannabis were 2.57 times more likely to no longer meet DSM-5 criteria for PTSD at the end of the study observation period.
Other non-PTSD-specific trials have assessed the potential of medical cannabis for other indications such as anxiety and sleep disturbances – both of which are also common symptoms among PTSD patients.
Can medical cannabis be prescribed for PTSD in the UK?
Medical cannabis was legalised in the UK in November 2018 when the government announced the rescheduling of the drug. This law change means that cannabis-based medicines can now be prescribed by a specialist doctor for a number of conditions.
While the National Institute for Health and Care Excellence (NICE) currently only recommends the use of medical cannabis in a limited number of indications, private clinics routinely prescribe unlicensed medications for many more conditions, including PTSD. As there is some evidence for the potential of medical cannabis in this setting, patients may receive a medical cannabis prescription in cases where conventional therapies have failed to achieve satisfactory relief of symptoms. Many clinics have access schemes for patients who are on low incomes, with Mamedica offering a specific support scheme for military veterans who are experiencing post-service PTSD.
To find out more, take a look at leafie’s guide: ‘How to get a medical cannabis prescription in the UK’.