Post-traumatic stress disorder (PTSD) is a mental health condition that some people may develop after witnessing or experiencing a traumatic or disturbing event. Symptoms include flashbacks, hypervigilance, avoiding reminders of the event, and negative feelings when remembering the event or experience.
There are treatments available for PTSD, including talk therapy and medication, among others. Not every treatment will work for everyone, however, and PTSD can be difficult to treat.
Many people with PTSD use cannabis to help cope with their symptoms. Recent research has investigated whether cannabis can help treat the symptoms of PTSD. The evidence is mixed, with some studies showing robust benefits and others showing no effect. There is also significant evidence showing that cannabis may worsen symptoms of PTSD, and associated outcomes.
When it comes to PTSD, not all cannabis-based medicine is the same. CBD-only or CBD-focused treatments appear to offer many benefits and relatively few risks for people with PTSD. Recently, several lines of evidence have emerged suggesting CBD may help with PTSD.
Despite the confusing state of cannabis and PTSD research, CBD shines through as a safe and effective alternative to THC for the treatment and management of PTSD.
No Clear Answers About THC-Based Cannabis and PTSD
When it comes to cannabis as a treatment for PTSD, there is conflicting evidence. Some studies suggest a robust link between cannabis use and improved PTSD symptoms, while others suggest there is no effect. Still, others suggest potential negative effects of cannabis use on people with PTSD.
The confusion likely stems from the way the studies are designed. Most cannabis and PTSD studies are retrospective and typically rely on self-report. Such studies tend to recruit people who already use cannabis, rather than running a randomized, double-blind, placebo-controlled trial.
A clinical trial of cannabis for people with PTSD is currently underway, and the results should help clarify the nature of the relationship.
Some studies use biased samples, which may reduce the validity of the data. For example, a 2017 study found no effect of cannabis use on the symptoms of PTSD or the severity of substance abuse. However, the study examined people with co-occurring PTSD and substance use disorder, which may indicate that the participants had more severe PTSD in the first place.
The different results may also reflect differences in the composition of different cannabis strains people used.
Evidence Supporting the Use of Cannabis for PTSD
Several recent studies and reviews suggest that cannabis may benefit people living with PTSD.
A 2019 study analyzed data from the 2012 Canadian Community Health Survey – Mental Health, which was administered to a representative sample of Canadians over 15 years old.
1.7% reported a diagnosis of PTSD, 28.2% of those used cannabis while only 11.2% of people without PTSD did.
PTSD was significantly associated with a recent episode of major depression, as well as suicidal ideation, but only among those who did not use cannabis. Among people with PTSD who did use cannabis, there was no such association.
The researchers concluded that the data suggest cannabis may reduce the association between PTSD and depressive episodes and suicidal ideation.
Another recent 2019 review concluded that cannabis shows promise for the treatment of PTSD:
“Present data show that cannabis and synthetic cannabinoids, both acting on the endocannabinoid system, may have potential therapeutic use for improving PTSD symptoms, e.g., reducing anxiety, modulating memory-related processes, and improving sleep.”
A 2009 study found that the synthetic cannabinoid Nabilone significantly reduced nightmares in 72% of participants with PTSD.
Risks of Cannabis for People with PTSD
As with any medication or treatment, there are risks associated with cannabis use. In particular, the use of THC-containing cannabis carries with it mental health risks, like paranoia, anxiety, and in rare cases, psychosis. People with PTSD in particular “might be at greater risk for serious consequences if they have any adverse effects,” according to a 2017 review on cannabis and PTSD.
In addition to these general risks, there is also evidence suggesting cannabis may harm, rather than help, people with PTSD.
A 2015 study followed veterans seeking treatment for PTSD, evaluating them at intake and four months after discharge. The researchers classified the patients into four groups: those who had never used cannabis (“never users”), those who used cannabis when admitted but not upon discharge (“stoppers”), those who used cannabis both at admission and discharge (“continuing users”), and those who started using cannabis during the time between admission and discharge (“starters”).
The study found that cannabis use was associated with worse outcomes: increased symptom severity, violent behavior, and increased drug and alcohol use. Compared to starters and continuing users, stoppers and never users had significantly lower levels of PTSD symptoms.
However, these results may simply indicate that people who were worse off to begin with, or who were experiencing worse symptoms at the time, were more likely to use cannabis, rather than that the cannabis caused the negative outcomes.
CBD Offers a Safer Alternative
There is mounting evidence suggesting that CBD can help treat PTSD. CBD may offer an effective alternative to THC in a population that is vulnerable to mental health risks. THC is psychoactive, and is known to carry a number of mental health risks, like anxiety and paranoia. CBD is non-intoxicating and does not carry these same risks.
Researchers are working to uncover the mechanisms behind how CBD may work to treat PTSD. A 2013 study found that CBD enhanced the process of fear memory extinction, which may help people forget their negative memories.
A 2019 study of PTSD patients found that CBD helped reduce the symptoms of PTSD when administered over an 8-week period, in addition to routine psychiatric care.
The study is limited because it only had 11 participants, and no control group. Of the 11 PTSD patients, 10 (91%) experienced a decrease in symptom severity.
Overall, CBD was well-tolerated, with no major side effects. The researchers noted that CBD worked particularly well for people suffering from nightmares.
A 2016 case report found that CBD reduced PTSD symptomatology in a child. The authors concluded that CBD oil was a safe and effective treatment.
Looking Toward the Future
Current research on cannabis and PTSD is mixed, with some studies suggesting a benefit, some suggesting potential harm, and still others suggesting no effect. This is likely due to methodological challenges when studying the subject, as well as differences in the types of cannabis people use.
Regardless, there is good reason to be cautious when considering THC-containing cannabis medicine for people with PTSD, because of the potential mental health side effects.
CBD has shown promise as an effective, safer treatment for people with PTSD. It does not carry the same mental health risks as THC, yet it appears to improve the symptoms of PTSD.
Future research may reveal whether different combinations of THC and CBD could better treat the symptoms of PTSD than either one alone.