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for PTSD conducted in 2019 included 12 studies (10). I found an
additional five studies to add to this review (19–23). As empha-
sized by the systematic reviewers, these dozen and a half stud-
ies are quite varied in methodology and generally low-powered.
That being said, these studies generally show that cannabis
improves symptoms associated with PTSD, including stress, anx-
iety, depression, nightmares, sleep, and fear extinction.
Concerns Regarding Cannabis and PTSD
Researchers of cannabis use for PTSD expressed a couple of con-
cerns: First, higher doses of THC may provoke anxiety or psycho-
sis in cannabis users. And second, high coincidences of cannabis
use disorder are found in people who suffer from PTSD.
Anxiogenic and Propsychotic Potential of THC
It is well-known that low doses of THC generally reduce anxiety,
while higher doses may very well promote either anxiety or psy-
chosis (6,10). For a population of individuals who already suffer
from anxiety, any risk of exacerbating this sensation is not
welcome. Researchers do point out, however, that CBD has gar-
nered interest as potentially reducing anxiety, where CBD may
be used either on its own or in tandem with THC to mitigate any
anxiety-promoting risks of THC (6).
PTSD and Addiction
There's a high prevalence of cannabis use in people who suffer
from PTSD. There is also a high prevalence of substance use
disorders (SUD) in PTSD sufferers, involving either cannabis, al-
cohol, or other drugs. Orsolini and colleagues note, "It has been
estimated that individuals with PTSD are 2–4 times more likely
to have a SUD compared to individuals without PTSD" (10,13).
Researchers recognize that people who suffer from PTSD
are likely to use cannabis or other substances to self-medi-
cate. In fact, surveys of PTSD sufferers who use cannabis spe-
cifically indicate they do so because it helps relieve their
symptoms (10,22,23).
At the same time, Orsolini and colleagues make the inter-
esting observation that the malfunctions in circuitry that
cause PTSD are the same malfunctions involved with develop-
ment of addiction. In other words, rather than SUDs being the
result of PTSD victims' attempts to self-medicate, victims may
be predisposed to addiction for the very same reasons they
were vulnerable to PTSD (10).
In Sum
PTSD is a disorder in which an individual's threat response fails
to adequately disengage after he or she has experienced a
traumatic event. The areas of the brain responsible for engaging
and then disengaging our threat responses have been shown
to be high in ECS activity in healthy individuals, while being
much less active in people who suffer from PTSD. It follows that
cannabis would be expected to help address symptoms of PTSD.
Much preclinical work has, indeed, established this potential. To
date, clinical evidence supporting the efficacy of cannabis for
PTSD has been positive in nature but weak in power; hopefully
stronger clinical evidence will be forthcoming.
References
(1) Posttraumatic Stress Disorder. (2013) American Psychiatric
Association. Retrieved from www.psychiatry.org/File%20Library/
Psychiatrists/Practice/DSM/APA_DSM-5-PTSD.pdf
(2) G. Fraser,. (2009). The Use of a Synthetic Cannabinoid in the Management
of Treatment-Resistant Nightmares in Posttraumatic Stress Disorder
(PTSD). CNS Neuroscience & Therapeutics. Retrieved from www.
ncbi.nlm.nih.gov/pmc/articles/PMC6494011/pdf/CNS-15-84.pdf
(3) V. Trezza and P. Campolongo, (2013). The endocannabinoid system
as a possible target to treat both the cognitive and emotional
features of post-traumatic stress disorder (PTSD). Front Behav
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(5) S. Maren. and A. Holmes, (2016). Stress and Fear
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(7) L. Elms, et al (2019). Cannabidiol in the Treatment of Post-Traumatic
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(8) T. Passie, et al (2012). Mitigation of post-traumatic stress symptoms by
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