Cannabis and Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is typically triggered
by exposure to an extreme traumatic stress, involving direct experience of
death or serious harm, actual or threatened. The response to this stress
usually involves an intense experience of terror or helplessness. The classic
symptoms of PTSD include repetitive and intense recollections of the original
event, often from flashbacks or nightmares. PTSD often leads to emotional
distancing, avoidance, and intense arousal or rage. Some of the traumatic
experiences that can lead to PTSD symptoms include combat, living in a war
zone, natural disasters, sexual, verbal, and physical abuse, traffic accidents,
or violent crime.
History
Cristobal Acosta, a Portuguese doctor and botanist, traveled
to India as a soldier in the 16th century. He studied the use of
medicinal plants in India and first noted the use of cannabis in the form of
the traditional Indian preparation, bhang, for “battle fatigue” in his text,
“On the Drugs and Medicines for the East Indies.” Acosta noted that soldiers
used cannabis for different symptoms of PTSD: “Some to forget their worries and
sleep without thoughts; others to enjoy their sleep in a variety of dreams and
delusions; others to become drunk and act like clowns.” This account is
extraordinary in its anecdotal appraisal of the efficacy of cannabis for PTSD
nearly 500 years ago.
During the Vietnam War, U.S. soldiers often smoked Southeast
Asian cannabis to deal with the horrors of combat. After returning home from
the war, many veterans continued to use cannabis to deal with the
post-traumatic stress of their experience. Preclinical research underscores a
connection between the endocannabinoid system and how the brain processes
traumatic memories, showing significant potential for cannabinoid-based treatment
therapies for PTSD.
How Cannabis Helps
Recent reviews cite convincing evidence for the use of
cannabis to help PTSD, finding improvements with difficult to treat symptoms of
PTSD, including sleep disturbance, anxiety, frustration, intolerance and issues
with anger, and a reduction in incidence of flashbacks, avoidance, and
hyperarousal.
One of the most interesting targets for cannabinoids in PTSD is
the endocannabinoid system’s regulation of the creation, consolidation, and
extinguishing of traumatic emotional memories.
The goal of cannabis treatment is extinction of the fear
memory from it’s associated memory of the traumatic event so that a “trigger”
can be experienced without the associated terror response. https://www.ncbi.nlm.nih.gov/pubmed/25225304
There is evidence
that both endocannabinoids and cannabinoids reduce this acute response to
stress, as well as the aberrant response to perceived threats, while supporting
the extinction of fears associated with PTSD.
In a 2017 review of studies related to cannabis and fear
memories, researchers found that: “CBD produces an enduring reduction in
learned fear expression when given in conjunction with fear memory
reconsolidation or extinction by disrupting the former and facilitating the
latter. This makes CBD a potential candidate for testing as a pharmacological
adjunct to psychological therapies of behavioral interventions used in treating
PTSD and phobias.
These effects of CBD are mediated at least in part by 5-HT1A
receptors and indirectly via endocannabinoid-mediated action on cannabinoid receptors,
although these contrasting effects of CBD on fear extinction and memory
reconsolidation both result in a lasting reduction of learned fear expression.
CBD was also able to disrupt the reconsolidation of both newer and older fear
memories. The subsequent reduction of learned fear expression lasted for over
21 days and was not reinstated by later shock presentation, indicating that the
effects of CBD were due to disrupted memory reconsolidation and not enhanced
extinction.
Endocannabinoid signaling has been proven to be key to the
body’s adaptation to stress and its recovery after a stressful event. CBD is
extremely effective in animal and human models for reducing stress-related
anxiety and anxiety after a stressful event. The effectiveness of the use of
CBD to reduce stress-related anxiety is exhibited in its support of
neurogenesis within the hippocampus (the production of new nerves), a process
linked to plasticity.
A study of Isreali veterans who were given 100 gm of
government-grown cannabis per month also showed a reduction in Clinician
Administered Post-traumatic Scale (CAPS) scores on repeated evaluations over
the course of a year. Symptoms that patients have reported as improved with
medical cannabis include hyperarousal, anxiety, insomnia, and flashbacks.
It is not realistic to expect cannabis to cure PTSD. It is
believed that cognitive behavioral therapy (CBT) with progressive exposure (PE)
may possibly cure PTSD – even then, it is hard to predict who will respond
well.
PTSD changes the structure and function of the amygdala (the
small almond-shaped portion of the brain associated with emotional memory and
fear conditioning).
The endocannabinoid system is associated with the
extinction of aversive memories, such as those associated with the amygdala, found in this '02 research study.
Endocannabinoid CB1 receptors are densely concentrated in
the anatomic areas of the fear network – the amygdala, hippocampus, and
ventromedial prefrontal cortex.
PTSD patients have changes in their
endocannabinoid signaling system compared to healthy controls, with lower
anandamide endocannabinoid levels and abnormal CB1 receptor densities.
CBD,
which is not a direct CB1 agonist, has also been shown to extinguish fear
memories, facilitate disruption of contextual memories, and reduce anxiety in
rats.
Dosing
Taking cannabinoids orally requires some patience or
planning to achieve even relief over time, as swallowed medicine typically take
45 minutes to 1 hour to be felt. Inhaled forms are felt immediately and
sublingual oils or sprays both take about 20 minutes to be felt.
THC is effective for anxiety at 1-5 mg when taken
sublingually (or swallowed for a more potent effect) and CBD cannabis is
effective orally and sublingually at 5-10 mg.
Sublingual and swallowed THC cannabis are effective for
anxiety. Light doses of THC (2.5 mg), taken sublingually, has relatively clear
effects and has proven helpful to shift or elevate mood and relieve anxiety.
This dose can be increased to 5 mg, if needed.
Special caution should be taken with successive doses of
oral THC cannabis to avoid an additive overdose, as this can be
anxiety-provoking. If this happens, it is best to sit or lay down and take some
deep breaths. It is best to stick to smaller doses of THC. Combined THC and CBD
medications also help advert the anxiety, and “high” effect.
CBD can be used without intoxicating effect, if taken in a
spray or sublingually in a ratio of CBD:THC of 10:1 or higher (5:1, 1:1), in
doses of 5 – 10 mg CBD in the morning and again mid-afternoon. It can also be
used throughout the day, as needed, but it is advised that the last dose of the
day occur before 5 p.m., as CBD may be wake-promoting.
THC taken orally is recommended for sleep: 5 mg THC,
swallowed one hour before bed. Swallowing THC increases its soporific and
analgesic effects and extends the period of action.
Methods of Ingestion
Oral infused cannabis products containing THC are excellent
for reducing nightmares that plague some PTSD sufferers. Oral products also
have longer lasting effects and are better for analgesia and sleep.
Vaporizing and smoking are the most common delivery methods
preferred by PTSD patients. Although sublingual or oral-mucosal delivery may be
better for daytime use due to increased clarity, PTSD patients tend to
gravitate toward the inhaled delivery. Inhaled cannabis is short acting and
most users increase doses until they experience psychoactive effects. Lower
doses, 2.5 – 7.5 mg, may have a positive impact on the functioning of the
endocannabinoid signaling system, to help control an overactive amygdala and
counter flashbacks or nightmares, as well as helping the user to avoid
developing a tolerance.
Chemotypes and
Varieties
Cultivars that contain the terpene, Pinene, should be
avoided if an inhaled or sublingual method of administration is chosen, as
pinene may be anxiety-provoking, its memory-enhancing effects may make the
extinguishing of aversive memories difficult, and it is contraindicated for
those with suicidal ideation. Varieties with linalool or limonene are
preferred.
Cannatonic, ACDC, Suzt Q (CBD dominant cultivars) may be
helpful for anxiety, while broad-leafleted cultivars, such as one of the
“Purples” or Bubba Kush may be calming. Linalool and myrcene have known
anxiolytic and analgesic effects, so look for these terpenes when choosing
cannabis medicine.
Information for this article was gathered from the amazing
book, we highly recommend!
Cannabis Pharmacy:
The Practical Guide to Medical Marijuana by: Michael Backes, Andrew Weil, M.D., and Jack D. McCue, M.D.
You can find this amazing book, written by doctors, backed
by research, all about Cannabis Medicine ~ here...
Other Resources for Veterans
You can find local dispensaries, places to find specific strains, and doctors for prescriptions available through Leafly.com and Marijuanadoctors.com as well as more recent research and information about cannabis.
Some amazing supportive groups for veterans healing with cannabis:"Veterans for Natural Rights builds communities where veterans can heal, find their voice, and change the world. We are a social welfare and political action organization with deep roots in the veteran population, specializing in helping those with war trauma regain their lives, their purpose, and their sense of community."
http://veteransfornaturalrights.org/
"Innate Path is a national organization providing cannabis and ketamine assisted psychotherapy and psychedelic therapy training to clinicians. We are validating the use of these medicines in mental health through our research program with Johns Hopkins School of Medicine researcher Alan Davis and our recently completed combat veteran pilot study."
https://innatepath.org/
"The Veterans Cannabis Project is dedicated to improving US military veterans’ quality of life through the opportunity of cannabis. We empower veterans to live healthy, fulfilling lives, while advocating on their behalf for unrestricted and supported access to medical cannabis through the VA just like any other medicine."
Americans for Safe Access: https://www.safeaccessnow.org/veterans-cannabis
Santa Cruz Veterans Alliance: https://scveteransalliance.com/
Veterans for Cannabis: http://www.vfcusa.com/
Veterans Deserve Cannabis, Here is how you can help:https://www.leafly.com/news/lifestyle/help-veterans-get-medical-marijuana-access
As laws continue to change, so will the VA's stand on cannabis medicine for Veterans. As of this date here is what they are saying about veterans and cannabis:
Some things Veteran need to know about marijuana and the VA:
- Veterans will not be denied VA benefits because of marijuana use.
- Veterans are encouraged to discuss marijuana use with their VA providers.
- VA health care providers will record marijuana use in the Veteran's VA medical record in order to have the information available in treatment planning. As with all clinical information, this is part of the confidential medical record and protected under patient privacy and confidentiality laws and regulations.
- VA clinicians may not recommend medical marijuana.
- VA clinicians may only prescribe medications that have been approved by the U.S. Food and Drug Administration (FDA) for medical use. At present most products containing tetrahydrocannabinol (THC), cannabidiol (CBD), or other cannabinoids are not approved for this purpose by the FDA.
- VA clinicians may not complete paperwork/forms required for Veteran patients to participate in state-approved marijuana programs.
- VA pharmacies may not fill prescriptions for medical marijuana.
- VA will not pay for medical marijuana prescriptions from any source.
- VA scientists may conduct research on marijuana benefits and risks, and potential for abuse, under regulatory approval.
- The use or possession of marijuana is prohibited at all VA medical centers, locations and grounds. When you are on VA grounds it is federal law that is in force, not the laws of the state.
- Veterans who are VA employees are subject to drug testing under the terms of employment. https://www.publichealth.va.gov/marijuana.asp
