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Cannabis Column | June 21, 2022

Dr. Jan Roberts on cannabis and PTSD

Can cannabis help with trauma recovery?


My clinical specialty is trauma. While I will only discuss one case here, I have treated many clients who have successfully used cannabis to reduce their trauma symptoms.

If you’ve read my articles before, you are aware that I try to provide a balanced view of cannabis. I don’t buy into the belief that cannabis is a harmful drug, nor do I buy into the belief that it is harmless. It’s all about dosing, cannabinoids used, and self-regulation - which includes awareness, balance, and not using cannabis to avoid life. These factors are the hallmark of purposeful consumption.

It's important to note that the success of recovery is often the result of purposeful cannabis consumption. In other words, paying attention to the proper dose, using cannabinoids that maintain a reduction of symptoms (like CBD and THC), and being mindful that cannabis doesn’t become a way to avoid emotions.

In this article, I will explain how purposeful cannabis consumption has positively impacted my patients who have experienced trauma.

A clinician’s perspective on trauma

Around 70% of the population will experience some form of trauma that results in neurobiological and structural changes in the brain. While not all people who experience trauma will develop PTSD or trauma-related adjustment disorders, a significant portion of people will experience both physical and mental symptoms of trauma.

Trauma is a mind and body response to a frightful event where one’s life or the life of a significant loved one is in danger- it can result from rape or sexual abuse, the unexpected death of a loved one through suicide or a horrific accident, or a natural disaster. Sometimes people have a delayed reaction to trauma, but nonetheless trauma results in negative changes to mood and cognition, distressing memories, flashbacks, nightmares, and changes in arousal and reactivity (called hypervigilance). Hypervigilance can manifest as being on edge, having a substantial startle reflex, or even war veterans being triggered by fireworks.

It is common for people who have experienced trauma to have difficulties in interpersonal relationships and even co-morbid conditions like substance use disorders, depression, eating disorders, and chronic pain.

My clinical experience with cannabis and PTSD

In my clinical practice, several of my patients have successfully used cannabinoids for the treatment of PTSD and other trauma-related conditions. 

One of my patients, who I will call Mike, began using cannabis after finding his partner following their suicide. For his PTSD, Mike, a middle-aged veteran, was prescribed antidepressants, benzodiazepines (a class of drugs including Klonopin, Ativan, and Xanax used to reduce anxiety, which have a high risk of physical dependency and can result in death from overdose), and a sleep medication called Ambien.

Mike did not like how the medications affected him. He said that they muted his experiences and that he didn’t feel like himself when taking them. Mike had PTSD symptoms including continual flashbacks of finding his partner, nightmares, insomnia, increased depression, increased anxiety, and hypervigilance. He was also struggling with his own suicidal thoughts and had begun to severely isolate from family and friends. 

Mike and I discussed the possibility of using cannabinoids to treat his PTSD symptoms. I advocated for Mike to use the legal cannabis dispensaries in his state instead of buying cannabis illicitly. As a clinician, I believe firmly in using safe and tested cannabis products. Legal dispensaries (due to testing requirements) should have cannabis free from pesticides and mold. In addition, legal dispensaries also provide chemical analyses of products, so you know which products are best suited for your needs. 

For his cannabis regimen, Mike used CBD during the day to minimize intoxicating effects and to reduce his anxiety and startle reflex. CBD has demonstrated anxiolytic effects in animal studies and has been shown to reduce cortisol. This is remarkable because hypervigilance and anxiety are related to cortisol production - which is greatly increased after trauma.

At night, since he did not like the drugged effect that Ambien gave him, Mike used a high THC product to help him sleep. In animal studies, THC has been demonstrated to have antidepressant-like effects. Mike began experimenting with products to see what worked best for him.

Cannabis had a phenomenal impact on Mike’s PTSD. Clinically speaking, I saw a significant transition for Mike: he went from being a traumatized, haunted, scared, and sad man to feeling more like himself, engaging in activities and friendships as he had before his partner’s suicide. 

From his use of specific cannabinoids, Mike was able to sleep through the night. He saw a significant reduction in flashbacks and nightmares and started finding motivation to spend time with family and friends again. He even noticed that his drinking, which had increased after the suicide, greatly reduced after he began using cannabis purposefully. 

But Mike’s results were not exclusively due to cannabis. Clinically speaking, we were able to work through the impact of the trauma, and specifically his memories of the traumatic event, because cannabis helped him manage his symptoms without overwhelming side effects. It is my clinical opinion that cannabis allowed my patient to begin the process of healing from this unimaginable trauma.

Why does cannabis help trauma?

But why does cannabis work for trauma? Both the endocannabinoid system (ECS) and cannabinoids seem to be implicated in trauma and healing from trauma. For example, the ECS has been linked to hypervigilance and negative emotionality.

Mice without CB1 receptors are unable to forget traumatic stimuli. Researchers have postulated that a healthy ECS allows “extinction of aversive memories.” Evidently, the ECS plays a role in the symptoms of trauma.

We also know that stress negatively impacts ECS function. One study on 9/11 first responders to the World Trade Center (WTC) found that first responders with PTSD had significant alterations in their ECS compared to first responders without PTSD. Researchers found reduced levels of the endocannabinoid 2-AG, but normal levels of cortisol and AEA, another endocannabinoid.

Further research on WTC first responders demonstrated that increasing 2-AG can assist in resilience from trauma-related disorders. These findings suggest that stimulating the ECS could be useful in the treatment of PTSD.

But when it comes to the use of cannabinoids in treating trauma, we must understand what the science says. In a qualitative study of veterans with PTSD who use medical cannabis, a wide range of therapeutic effects were reported. Most frequently, cannabis was cited as having a beneficial impact on veterans’ sleep quality and nightmares.

According to another study, cannabis provides temporary relief from PTSD-related symptoms. However, cannabis may not be an effective long-term remedy for PTSD as baseline symptoms were maintained over time, and the dose used for anxiety increased over time, which is indicative of development of tolerance. However, this study used cannabis with high THC and low or no CBD. THC, while it helps with motivation and memory extinction, can increase anxiety. CBD has been implicated in reducing hypervigilance and anxiety. Most studies do not account for the fact that different cannabinoids have different effects.

Final thoughts on using cannabis for trauma recovery

In trauma therapy, whether its talk therapy, EMDR, or other modalities, best practice involves the active processing of trauma.

I have witnessed patients use cannabis to process their emotions and memories of the trauma, to develop new insights, and even to create a wider “window of tolerance” for distress. Cannabis is one of many tools to process trauma. To get the best results, it is vital to work with a trained clinician who understands the role that purposeful cannabis can play in the reduction of trauma symptoms.

Written by Dr. Jan Roberts

Dr. Jan Roberts, LCSW, is an internationally-recognized psychotherapist and educator whose approach merges neurobiology, cognitive processing, EMDR, and mindfulness-based strategies in her clinical practice. Dr. Roberts focuses on integrative mental health and wellness, using tools like nutrition and plant medicine to help her patients improve their mental health. She has a private practice in Manhattan. Additionally, Dr. Roberts is a professor at NYU, the founder of The Cannabinoid Institute, and serves as the faculty advisor to NYU's Cannahealth Student Group and NYU's Student Association for Psychedelic Studies (SAPS). Dr. Roberts serves as a Jointly advisor, focusing on helping cannabis consumers leverage science to improve their well-being.

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