Many people use cannabis for PTSD as a natural form of treatment. Amidst the limited research on its efficacy, most patients claim it brings them relief.
As a medical practitioner, you may have concerns about using cannabis in PTSD treatment. Is it safe? Is it legal? What if the patient becomes addicted?
There are more than three million people with PTSD in Australia.¹ In 2022, approved medicinal cannabis prescriptions reached over 250,000. An increase of almost threefold in one year indicates a demand for this form of therapy.
Clinical guidelines for healthcare professionals can help address some of your unanswered questions. This information aims to aid you in giving your patients the best medical care.
In this article, you’ll learn more about the guidelines and the efficacy of cannabis for PTSD.
Understanding PTSD and its impact
Post-traumatic stress disorder (PTSD) is a condition that can result from a very traumatic and unexpected experience. Events like a natural disaster, emotional distress, or physical violence can trigger this condition.
Some people develop PTSD after witnessing trauma continuously. These include soldiers in war or police officers who are involved in numerous cases of child and women abuse. PTSD sets in when negative feelings develop and remain for extended time.
When making a diagnosis, the patient needs to display the following PTSD symptoms.²
- Avoidance: One identifying symptom is avoiding places, people, or events that could trigger the trauma.
- Cognitive and mood: PTSD can negatively affect a patient’s thoughts and mood. They lose interest in what they previously enjoyed and resort to social isolation.
- Re-experiencing: Reliving the event or encounter is another symptom. This indicator can lead to an increased heart rate and sweating.
- Arousal and reactivity: A PTSD patient may engage in self-destructive behaviour. They feel angry and irritable all the time, lashing out at others for no reason.
What is the resulting impact of PTSD?
The patient’s daily life becomes disrupted. They find no enjoyment in any of their usual day-to-day activities. It then negatively affects their relationships. When left untreated, it can lead to severe depression.
It’s not uncommon for other mental illnesses, including suicidal thoughts, to set in. Some victims may even develop a drug or alcohol addiction.
The most popular medical treatment is psychotherapy coupled with medication. Many have also experienced relief from including cannabis in PTSD treatments.³
The neurobiological basis of cannabis in PTSD treatment
The endocannabinoid system (ECS) plays an important role in the human body.⁴ It regulates multiple physiological processes.
- Mood
- Appetite
- Memory
- Pain
- Liver function
- Learning and memory
- Stress
Cannabinoids like CBD and THC resemble the body’s internal molecules. When consumed, they bind to CB1 and CB2 receptors and impact certain processes.
Current evidence for cannabis in PTSD treatment revealed a decrease in symptoms.⁵ The result is that patients enjoy an enhanced quality of life.
Some research also shows that cannabis’ interaction with the ECS may potentially improve PTSD symptoms.⁶ It could also enhance sleep and reduce anxiety.
Cannabinoid compounds and their therapeutic potential
The cannabis plant contains a wide range of compounds known as cannabinoids. Let’s look at the primary ones.
THC (tetrahydrocannabinol)
THC is a psychoactive compound that creates a high. It interacts with the ECS and can bind to both CB1 and CB2 receptors.
It affects the body and mind in various ways. It may reduce the fear response, so THC in PTSD treatment may benefit patients struggling with triggers.
CBD (cannabidiol)
Unlike THC, CBD is non-psychoactive. It binds to the CB2 receptors. The way it functions in the human body is still somewhat unclear. Studies have shown that without THC, CBD can ease anxiety and reduce fear.
While it doesn’t directly help with the production of serotonin and dopamine, it does assist with it. This action indicates that CBD benefits PTSD symptoms.
CBG (cannabigerol)
CBG is predominantly present in hemp. There’s very little found in the cannabis plant. It has no psychoactive effects.
CBG’s role in PTSD therapy is that it may ease PTSD symptoms through its neuroprotective properties. Anecdotal evidence also indicates that it acts as an anti-inflammatory agent.
The entourage effect and its impact on treatment outcomes
While each compound has its own benefits, they can be advantageous when used together. THC, CBD, CBG and other minor cannabinoids combined can create an entourage effect.⁷
The individual compound effect may differ from one person to another. The same applies to the full spectrum of cannabinoids. Patients should consult their medical practitioner for a formula that will suit them.
Guidelines for prescribing cannabis in PTSD treatment
In Australia, medicinal cannabis has been legal since 2016.
Health practitioners can prescribe medical cannabis with approval from the TGA (Therapeutic Goods Administration).⁸ This governing body regulates all medicines, making it possible for doctors to prescribe cannabis products for their patients.
Patient assessment and eligibility criteria
Assess the patient’s condition to confirm their eligibility for cannabis for PTSD.⁹ They must have this chronic ailment for more than three months to qualify. You also need to evaluate the patient’s current treatment plan.
Have they been unresponsive to the therapy received? Are they experiencing side effects from the meds? Has their condition remained unchanged after lifestyle and dietary changes? These are some important questions to ask.
Investigate the candidate’s medical history. It’s important to ensure there’s no record of drug dependence or substance abuse.
Prescribing cannabis for PTSD isn’t unusual in Australia. It’s one of the most common conditions considered for this form of treatment.
Some patients diagnosed with PTSD struggle to maintain their daily activities. In severe cases, it may continue for a prolonged period. They may find it difficult to work, to have relationships, or any form of social interaction.
In children or teenagers, you may come across the following symptoms:
- Unusually clings to parents or adults
- Acting out with erratic behaviour
- Unable to speak
- Small kids may wet their bed
Dosage consideration and titration for individualised treatment
A prescribed cannabis dosage varies from one patient to another. A practice that’s universally maintained is “start low, go slow,” known as titration.¹⁰
Closely monitor the effectiveness of the dosage based on the patient’s biodiversity. This is how each person’s body absorbs the cannabinoids, and experiences may differ.
The method of consumption influences how fast and effective a dosage may work. The different ways of consuming cannabis include:
- Inhalation (smoking or vaping)
- Oral (sublingually)
- Ingestion (edibles)
The various cannabinoids also affect the effectiveness and determine the symptoms. The effects are either a result of a particular compound or a combination. With titration, you can explore the most suitable combination.
The patient’s tolerance levels also influence effectiveness. First-time users need to start with low dosages and gradually increase it. Someone who regularly consumes cannabis can start with a higher dosage.
Each person’s ECS also reacts differently. Finding the right dose sometimes depends on trial and error. In consultation with your patient, you can find an individualised dosage for PTSD treatment.
Monitoring and adjusting treatment plans based on patient response
The patient needs to monitor their body responses to each dose. Keeping you informed of this will help you both identify the ideal dose. The reaction will indicate if the dosage needs adjustment.
- It’s important to stick to the treatment plan to build up the effect of cannabis.
- Always start low and go slow. Less is more. Maintaining a low dosage for a long period is better than starting with a high dosage.
- Have regular follow-ups with your patient to monitor the progress. These checkups also enable you to detect any adverse reactions.
Addressing potential concerns and considerations
Addressing concerns in cannabis therapy is one way to ensure the patient’s well-being.
During the early stages of treatment, there may be some side effects or adverse reactions.¹¹ The most common ones are nausea, vertigo, fever, and vomiting. The patient may also experience fatigue, sedation, and an increase in appetite.
When following the titration process, it’s easier to identify these reactions. Other side effects to consider is the interaction with other medication. It’s important that patients declare this information during the initial consultation to avoid any unwanted effects.
When prescribing a particular cannabis product, pay attention to the THC content, as it may increase anxiety and sensory impairment.
Only prescribe THC to children or adolescents when the benefits outweigh the risks. CBD has minor side effects, even in high doses, but it could cause a reaction when taken with other medications.
Encourage the patient to practise responsible use of cannabis in PTSD treatment. There’s always a risk of cannabis addiction.
THC triggers the brain’s reward system, releasing dopamine. When ingested regularly, the tolerance for THC increases. The result can become addictive as the need to experience the same sensation grows.
Patients with a history of substance abuse run a higher risk of succumbing to this habit. They should report any signs of cannabis addiction. This includes cravings and withdrawal symptoms.
The following factors can promote a healthy relationship between the patient and medical cannabis:¹²
- Have regular consultations with the patients using cannabis for PTSD.
- Explain all the potential risks and the interactions with other medications.
- Discuss what strategies to use to reduce the risks of any addiction.
- Discuss an exit strategy in the event the treatment goals aren’t met.
Collaborative care and multidisciplinary approach
Collaboration between healthcare professionals and regulators is vital.¹³ It keeps everyone updated on developments in the cannabis industry.
The regulatory system can keep doctors up to date with any current cannabis news. In the same way, health professionals can keep regulators informed about their patients. Relay any concerns regarding treatment.
This collaborative care in cannabis therapy can protect the patient. It’s also important to include other professionals, such as psychotherapists and psychiatrists.
Cannabis for PTSD or anti-depressants are treatments that shouldn’t occur in isolation. While it may alleviate the symptoms, some patients may need cognitive therapy as well.
This multidisciplinary approach to PTSD treatment ensures that the patient finds holistic healing. All these role players may have their own functions. Integrating them can add value to cannabis therapy.
Legal and ethical considerations in cannabis prescriptions
Medical cannabis has been legal in Australia for almost a decade. This legalisation doesn’t mean rules don’t govern it.
You still need to observe the legal considerations for cannabis prescriptions. Practitioners with the relevant qualifications in PTSD can prescribe a medicinal cannabis product.
You need to request permission to issue a prescription. The request must meet the legal and TGA requirements before approval.
The rules in the country differ from region to region. Authorities have only authorised certain cannabis products for sale in Australia.
Apply the same care with medicinal cannabis as you would with any other medications.¹⁴ It’s important to ensure a favourable benefit to risk ratio.
Another vital aspect is the principle of beneficence and non-maleficence. This is an ethical rule to ensure that the patient’s care always comes first.
Base your recommended treatment on well-established evidence. With cannabis for PTSD, this principle isn’t always easy, as there’s not much evidence.
Remain well-informed of any developments in the legal guidelines for cannabis. Tap into relevant sources that can help you remain up to date.
One entity is the Therapeutic Goods Administration. They regulate the manufacturing, supply, import, and export of all therapeutic products.
Case studies and success stories
Most of the evidence supporting the benefits of cannabis for PTSD is anecdotal.
- In one example of real-life cannabis cases, military veterans at a focus group discussion shared their experience with medical cannabis.¹⁵ They used various strains and doses of cannabis to treat PTSD. Their experience included improved sleep.
- A study conducted in 2015 reported 50% of participants experienced relief with cannabinoids.¹⁶
- Further research conducted in 2018 also had positive outcomes.¹⁷ 91% of patients experienced improvement in their symptoms. These benefits included a decrease in nightmares.
Besides these cannabis success stories in PTSD treatment, there are more. An increase in research can afford more patients the benefits of medical cannabis.
Light at the end of the tunnel for PTSD patients
PTSD is a serious condition. While doctors usually prescribe antidepressants, some patients want a more natural approach.
There’s been growing support for medical cannabis. A lack of research and clinical evidence supporting its efficacy deters many doctors.
Anecdotal evidence and successful studies encourage PTSD patients to trust the product. There’s light at the end of the tunnel for practitioners.
The guidelines for cannabis in PTSD treatment help make treating patients easier. You can also educate yourself by engaging in multidisciplinary discussions.
Continuing education for medical practitioners is crucial to improving your cannabis knowledge. Why not journey into the world of cannabis with Planted? Sign up for a course that suits you today.
References
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- Orsolini L, Chiappini S, Volpe U, Berardis DD, Latini R, Papanti GD, et al. Use of Medicinal Cannabis and Synthetic Cannabinoids in Post-Traumatic Stress Disorder (PTSD): A Systematic Review. Medicina [Internet]. 2019 Aug 23;55(9):525. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780141/
- What is the Entourage Effect? | Alternaleaf [Internet]. www.alternaleaf.com.au. [cited 2024 Feb 28]. Available from: https://www.alternaleaf.com.au/post/what-is-the-entourage-effect
- Goods T. Guidance for the use of medicinal cannabis in Australia: Patient information [Internet]. Therapeutic Goods Administration (TGA). 2023. Available from: https://www.tga.gov.au/resources/resource/guidance/guidance-use-medicinal-cannabis-australia-patient-information#:~:text=Medicinal%20cannabis%20can%20only%20be
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