Review and Comment by Cheryl Rose, RPh for Verilife

Post-traumatic stress disorder (PTSD) has gone by many names and carried decades of stigma with it throughout the years. As we learn more about this disease, some patients are turning to medical cannabis to relieve some of their symptoms. In fact, today nearly every state that offers medical cannabis includes PTSD as one of the program’s qualifying conditions. In this article, we’ll discuss medical cannabis for those suffering from PTSD and what a potential cannabinoid regimen would look like.

PTSD is a mental health condition that occurs after someone has experienced or witnessed a disturbing, shocking, or dangerous event. Patients with post-traumatic stress disorder may experience debilitating symptoms such as flashbacks to the traumatic event; night terrors and nightmares; disturbing thoughts and feelings; ongoing guilt, shame, or anger; as well as many others. 

According to the U.S. Department of Veterans Affairs, PTSD is common among veterans, with as many as 30% receiving the diagnosis at some point in their lifetime. While we often associate PTSD with military service, this disorder can affect anyone who has experienced or witnessed a traumatic event at some point in their lives. The Anxiety and Depression Association of America estimates that around eight million people in the United States suffer from PTSD at any given time.

“I work with a wide range of patients with PTSD who have experienced traumatic events, ranging from military service to childhood abuse,” stated Cheryl Rose, a registered pharmacist and cannabis expert at Verilife. “Many of these patients are looking for relief from recurring thoughts, irritability, and sleep issues, as well as overwhelming anxiety.”

As with most cannabis research, studies on the topic are limited. However, there continues to be anecdotal evidence from PTSD patients that marijuana can reduce symptoms.

Rose typically recommends a combination of THC and CBD to her patients. This minimizes the possibility of paranoia that can be associated with THC, which can actually mimic the symptoms of PTSD. 

“Since the timing of a flashback episode or startling event cannot generally be predicted, my patients find using an oral product  that combines THC and CBD to be the most effective. The gradual onset and longer-acting effect provide a low baseline level of cannabinoids to reduce the stress of such unforeseen incidents,” says Rose. “I also request that my patients keep a medication diary so we can monitor their progress. This can help to avoid rapid dose escalation and adverse effects.”  

Rose’s PTSD patients typically find the most success with the following regimen:

• Take once or twice daily to cover waking hours: oral capsules or chewable tablets 
  • Either high in CBD or a 1:1 ratio of THC and CBD
• As-needed additions for stressful situations: chewable gummies in a 1:4 THC:CBD ratio

While a higher CBD ratio is essential for counteracting some THC-related side effects, says Rose, at least one study indicated that the inclusion of minor phytocannabinoids and cannabis terpenes could provide greatest relief, rather than selecting the highest percentage of THC. That’s why she suggests edibles made from whole flower rather than edibles made with THC distillate.

When it comes to other products like vaporizers or inhaled flower, Rose does not feel that these are beneficial for PTSD patients. “Pure cannabis flower typically has such a short-acting effect, and the immediate “high” could mask symptoms that may rebound when the cannabis wears off,” stated Rose.

“Since studies show the relief provided by marijuana for PTSD is temporary, it is important to continue treatment under your physician’s supervision,” said Rose. “Marijuana is not a substitute for trauma-focused psychotherapy, cognitive behavioral therapy, or other first-line support therapies.” 

As with any medical condition, be sure to consult with your primary care practitioner if you are considering medical marijuana for PTSD.