The session reports within RYAH Data indicate patients are frequently using cannabis for mental health issues. Anxiety, stress, and depression are the top conditions treated, as reported by every single demographic.
Another mental health concern reported within RYAH is Post Traumatic Stress Disorder (PTSD). A disorder frequently encompassing anxiety, stress, and depression, among many other psychological issues, it\’s at the top of mind come Veterans Day.
With so much focus these days on plant-based medicines for the treatment of PTSD, cannabis as a treatment option is no longer a fringe opinion. PTSD is already an approved, qualifying condition for medical cannabis in at least 16 states (as of 2017). There is significant support for medical marijuana research among most veterans organizations, including the Disabled American Veterans (DAV), the American Legion, and Veterans of Foreign Wars. Much of the focus is on researching cannabis for the treatment of PTSD.
The Landscape for Veterans With PTSD
Among US veterans who have served overseas, between 11 to 20 percent experience symptoms of PTSD during any given year. The number is higher for veterans of the Vietnam War, with approximately 30 percent experiencing PTSD in their lifetime.
Recently, reports have surfaced indicating that the Vet Centers designed to serve the needs of America\’s veterans are failing them. With suicide and suicidal ideation rates much higher among veterans than within the general population, and rates even higher among those diagnosed with PTSD, there is an urgent need to expand care for vets.
According to a poll of legion members, approximately 20 percent of veterans already rely on cannabis for the treatment of their health conditions, often including chronic pain and mental health concerns. Yet, only 40 percent live in states with legal access. In total, 92 percent of respondents supported medical cannabis research, and 81 percent supported federally-regulated cannabis treatment options.
As a veteran, it\’s not always feasible to access medical cannabis via approved channels. The Veterans Administration (VA) does not support medical cannabis use, even for those members living in legalized states. Thankfully, members are now allowed to access medical cannabis programs outside of the VA, and speak with their VA physician about the plant, but must access these services outside of the framework of the VA itself.
Early Days for Research into Cannabis for PTSD
Over the last few decades, the scientific understanding of PTSD has grown exponentially. From this growing understanding has come a new wave of therapies, medications, and other approaches to treatment. Unfortunately, despite the advances, \”there are limitations to the effectiveness, tolerability, and acceptability of available first-line interventions,\” as the authors of \”Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review\” explained.
PTSD is a condition long associated with a return from military combat, and as such, a significant portion of the research is dedicated to PTSD among veterans. But, there is growing awareness that PTSD is not strictly a condition stemming from combat. As a condition triggered by trauma, all demographics are susceptible to it.
In their lifetime, between 7 to 8 percent of Americans will experience PTSD. According to the US Department of Veterans Affairs and the National Center for PTSD, in any given year, 8 million Americans show signs of this challenging mental health condition. With such prevalence among veterans as well as within the general population, finding an effective and acceptable treatment is paramount.
Researchers have long known about the relationship between cannabis use and the alleviation of PTSD symptoms, although this relationship is still poorly understood. Veterans and others with PTSD often report the positive effects of cannabis on their challenging symptoms, but these reported benefits have not been confirmed with clinical trials (yet).
Preliminary research indicates cannabis could help with the frequency and severity of nightmares, insomnia, stress, and fear conditioning. Interestingly, data analysts have also demonstrated that cannabis use increases following major disasters, seeming to indicate widespread use of the plant as a conscious or unconscious stress reliever following trauma.
The Relationship Between Cannabis Use and PTSD
Unfortunately, the correlation between cannabis use, trauma, and PTSD is not straightforward. As one example, there is a higher rate of cannabis use among trauma patients. There is also a high rate of Cannabis Use Disorder (CUD) among those with PTSD. Very clearly, there is much more to learn about the nature of the relationship between cannabis use and trauma.
To date, only one Food and Drug Administration (FDA) approved trial looking at cannabis use for PTSD among veterans has been completed. The trial, sponsored largely by the Multidisciplinary Association for Psychedelic Studies (MAPS), wrapped up in early 2019, and the team has not yet published the results.
Beyond this single controlled trial, there have been several small studies examining the possible applications of cannabinoids for the treatment of PTSD. Of the five human trials reviewed by the previously mentioned publication, \”Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review,\” one looked at unregulated cannabis, one at THC, and three at a synthetic cannabinoid called Nabilone.
The only study with whole-plant cannabis relied on self-reported data from 80 veterans reporting to a medical cannabis clinic in New Mexico. The study, published in 2009, tasked participants to rate the severity of their PTSD symptoms when using cannabis, versus without cannabis.
The report concluded that 75 percent of participants experienced a measurable decrease in their symptoms. Regrettably, due to the nature of this uncontrolled and self-reported survey, the results only lead to more questions, not answers.
In Israel, researchers published another small, uncontrolled study in 2014. This study looked at ten patients with PTSD, each given a 5 mg dose of THC twice daily for three weeks. The authors noted the cannabinoid was \”safe and generally well-tolerated\” among the participants, with no serious adverse reactions. Most importantly, \”patients reported statistically significant improvement in self-reported nightmares and sleep quality as well as interviewer-assessed arousal.\”
Finally, there have been three studies on cannabinoids for PTSD using neither whole-plant nor extracted cannabinoids. These studies used Nabilone, a synthetic cannabinoid initially developed to reduce chemotherapy-related nausea and vomiting.
In one such study, patients with PTSD received a small dose (under 6 mg) of Nabilone an hour before bedtime. Almost three-quarters of the study participants reported \”either cessation of nightmares or a significant reduction in nightmare intensity, and reported subjective improvements in sleep.\”
Unfortunately, Nabilone seems to have a higher risk of adverse side effects than whole-plant cannabis. The two other studies of Nabilone also reported a positive reduction in symptoms, but with a high risk of adverse reactions.
A Call to Support Research and Veterans’ Mental Health
With a growing demand among veterans for mental health services, there is an increasing burden on the already overburdened VA to provide these services. Veterans are turning to medical cannabis in record numbers, even if that means they have to pay for their medicine out of pocket, and outside the scope of conventional VA healthcare.
It is more important than ever before to fund robust clinical studies into medical cannabis for the treatment of mental illness, especially among the nation\’s veterans. If the VA is at capacity, veterans are seeking solutions elsewhere.
With all national veterans organizations supporting research, and a majority of veterans supporting federally-regulated cannabis treatment, it\’s time for the US Department of Veterans Affairs to respond to this growing demand.