Medical Marijuana for Post-Traumatic Stress Disorder? No Way!

Summary and Comment |
October 23, 2015

Medical Marijuana for Post-Traumatic Stress Disorder? No Way!

  1. Peter Roy-Byrne, MD

Outcomes are worse in patients continuing or initiating marijuana use after finishing a PTSD treatment program, compared with those not using or those who stopped use.

  1. Peter Roy-Byrne, MD

At least nine U.S. states consider post-traumatic stress disorder (PTSD) an indication for medical marijuana, based largely on preclinical data linking cannabidiol with enhanced fear extinction and anecdotal reports of improvement in PTSD with marijuana use. Researchers used Veterans Affairs (VA) data to examine effects of marijuana use in 2276 patients in PTSD treatment programs with no recent history of alcohol or drug use.

Patients reported marijuana use at program entry and 4 months after program discharge. Continuing users (n=296) and “starters” — those starting use after the program (n=831) — had worse PTSD symptoms and drug abuse problems, compared with never users (n=850) and those stopping after the program (n=299). “Starters” had more violent behavior and alcohol problems at follow-up than patients in the other three subgroups.

Comment

Findings from this observational study are consistent with those from smaller observational studies from VA inpatient PTSD programs suggesting that marijuana may worsen rather than improve PTSD. As the authors note, “starters” might be more severely ill patients who began use because the PTSD treatment they received was ineffective. Alternatively, use might have provided transient relief, but withdrawal worsened symptoms and overall outcome. Nonetheless, this analysis, the largest of its kind, does not indicate that marijuana use improves PTSD symptoms. Clinicians treating PTSD patients would be wise to share this information with them and to discourage their use of marijuana.

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / Research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (President)

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