Does cannabis help veterans with PTSD?

You see them on the streets, curled up against a wall with a cardboard sign alerting you to the presence of someone who served your country, now collecting coins on the sidewalk (91% are men). Many live with alcohol or opioid addiction and chronic pain. The U.S. Department of Veterans Affairs estimates there are about 40,000 homeless veterans.

Many live with chronic pain, physical and emotional, and the V.A.'s legal solution is the 'combat cocktail', a combination of antidepressants and opioids. Others prefer the over-the-counter medication at the corner liquor store.

A (not so) new way to treat veteran PTSD

One of the more promising applications for medical cannabis is treatment for mental illness, and especially Post-Traumatic Stress Disorder (PTSD). According to the Veterans Administration's National Center for PTSD, between 10%-20% of veterans of wars fought in the last sixty years suffer from it, with estimates as high as 30% for Vietnam veterans. A different study found that two-thirds of Iraq & Afghanistan homeless veterans had PTSD, significantly higher than Vietnam veterans.

In addition, military-related PTSD also comes in the form of Military Sexual Trauma (MST). Twenty-three percent of female personnel reported sexual assault while serving. The numbers for sexual harassment are higher, with 55% of women and 38% of men reporting it.

Cannabis has been the go-to for American military personnel since Vietnam, when soldiers smoked the local varieties to deal with the daily stresses and horrors of combat and they brought the seeds home. They believed cannabis relieved their anxiety and helped with the chronic pain that was their new constant companion.

Sourcing cannabis, of course, has always been a challenge, since today it remains a Schedule 1 drug on the U.S.'s FDA list. Despite the brisk adoption of medical cannabis laws by many states beginning with California in 1996, the Department of Veterans Affairs refuses to prescribe it, citing the lack of scientific evidence to support the contention that cannabis relieves the symptoms of PTSD. The government argument is a bit circular because cannabis research in the U.S. is largely prohibited by the immense bureaucracy involved to get the proper authorization to conduct it.

This includes three agency approvals and a complex maze of requirements and a plethora of rules for prospective researchers, only to encounter the infamously poor-quality research samples produced by the only federal government-approved cannabis source: The University of Mississippi, where the samples are old, often contaminated by mold, full of stems and leaves, and unrepresentative of the much more potent strains on the cannabis market, legally and illegally, today.

Cannabis's widespread reputation for helping veterans cope with PTSD, then, is largely anecdotal with minor boosts from observational studies and case reports.

The FDA-approved solution for veteran PTSD is to prescribe selective serotonin reuptake inhibitors (SSRIs) which modulate the neurotransmitters in the brain associated with sleep, mood, anxiety, appetite and other functions, all of which are disrupted by PTSD. SSRIs result in a 60% response rate, but only 20-30% of veterans experience complete remission.

Cannabis, however, may go one step further than traditional antidepressants by helping veterans process traumatic memories.

How is medical cannabis different from traditional antidepressants?

According to the National Center for Biotechnology Information, stimulation of the cannabinoid receptors in the brain increases stress-coping behaviors. The brain's endocannabinoid system may also function to relieve PTSD. THC and CBD impact the ECS in different ways by changing how the brain processes memories including those at the source of PTSD. Some evidence shows that cannabis also reduces anxiety and nightmares.

Patients with PTSD have been found to have increased availability and decreased agonism of the CB-1 receptors in the ECS which is where THC locks itself. When those receptors are activated in the amygdala, cannabis can potentially relieve fear and anxiety and reduce unpleasant memories.

Medical professionals caution that the potential risks of cannabis are not yet fully understood, including the risk of psychosis and addiction. Meanwhile, veterans with PTSD remain at high risk from themselves, either through accidents or suicide.

The high cost of inadequate treatment

In 2019, of the more than 45,000 Americans who committed suicide that year, 13.5% were military veterans with the largest number coming from the Vietnam generation in the 55-74 year old range. A study last year in the American Journal of Preventive Medicine found that the mortality rate for veterans was 5% higher than for the general U.S. population of the same age and sex. Veterans were also twice as likely to die from viral hepatitis (which they may have contracted through intravenous drugs and/or unprotected sex) and they experienced an elevated risk of accidental death through poisonings and auto accidents.

One former addiction psychiatrist and U.S. veteran moved to Colorado specifically to access medical cannabis to treat his PTSD and chronic pain. He claims a year or so later he was off traditional pharmaceuticals. The state had not yet added PTSD to the list of treatable conditions when he moved there so he took advantage of the recreational cannabis market to get the medication he wanted.

He says today, many veterans continue to source their cannabis from this market as they're afraid the V.A. will penalize them for getting on the medical cannabis registry by stopping their benefits.

His story and others' contribute to the debate and confusion surrounding the issue of veterans and medical cannabis:

Regardless of which side stakeholders in the medical cannabis debate are on, almost everyone agrees more research is needed to learn how medical cannabis may do more than relieve PTSD symptoms; that it may in fact address the source of the psychological pain.

It's not just veterans who could benefit, but civilians as well suffering from non-combat-related PTSD.

I'm a freelance writer and sales/business developer who's passionate about mental health issues and the promise formerly verboten drugs like cannabis, MDMA, and psychedelics are showing to address mental disorders, particularly anxiety, depression, and PTSD. Please feel free to reach out to me here on LinkedIn if you'd like me to help you with content creation or to generate new business.