Patients and Healthcare Providers Tend to Disagree About Cannabis and PTSD—Why?

Written by BlackbirdGo October 16, 2018
The History

Disclaimer: Keep out of reach of children. For use only by adults 21 years of age and older.

The idea that symptoms of post-traumatic stress disorder can be reliably managed by cannabis consumption is likely one that has long been quietly circulated throughout social circles where significant trauma—and a fairly liberal view of drug usage—are prevalent. Now that cannabis is rapidly going “mainstream” in the United States, a once “open secret” about how some individuals have turned to self-medication has become, for many, a form of conventional wisdom. The idea is that because “weed is no more addictive than coffee”, as a popular YouTube personality with a large following of fans who enjoy her play-through of horror video games said while describing her own struggle with anxiety and chronic pain, its benefits must outweigh any risks—which must be negligible.

On its face, the idea that any potential benefits of cannabis consumption must outweigh possible risks or other problems seems perfectly reasonable. Certainly, in a country where access to health care remains limited and where care specialists like psychiatrists or pain management professionals can both be difficult to reach and expensive, it isn’t hard to imagine why individuals might turn to an increasingly available substance for which a longer-term supply might cost less than, say, a weekly $50-plus co-pay. Access to psychiatric treatment is, unfortunately, not a privilege that all people have.

With a wave of decriminalization and legalization for both medical and recreational use of cannabis products spreading across the country, legal risks seem minimal—particularly in the eyes of the vast majority of millennial and centennial-aged people who assume that because cannabis is known to be far less dangerous than various banned drugs (and legal alcohol) that it must be harmless. But, in a number of cases, this is simply not so. Cannabis is still capable of impacting the neurological development of youths, is still a risk factor for pulmonary complications if smoked over a sustained period of time, and can, in fact, impair one’s ability to drive or operate heavy machinery despite the popular myth that it doesn’t. Plus, while the research is limited for a number of reasons, there is evidence that the presence of either tetrahydrocannabinol (THC) or cannabidiol (CBD) in the body may produce drug interactions that health care professionals haven’t identified—not because they don’t exist but because the research hasn’t been done and, in many cases, has been blocked or underfunded due to cannabis’s federal illegality.

What this means for people living with post-traumatic stress disorder or certain other chronic mental health conditions is that there may, in fact, be a need to consult with a physician before choosing to consume these products as a method for symptom management. While it can be easy to presume that healthcare providers simply wish to make money and feel threatened by the miracle of cannabis, many practitioners simply want to see better outcomes for their patients and worry that self-medication may ultimately intensify the challenges faced by those living with PTSD in the long run.

Kumiko Nixon, a psychiatric nurse living in Reno, Nevada, points out that PTSD is usually a multifaceted ailment that can require multifactorial treatment to produce positive outcomes for patients. Those using cannabis to “cure” their PTSD may be achieving the opposite effect.

“As a psych nurse, the thing we emphasized the most was behavioral therapy partnered with medication management. One isn’t really effective without the other,” Nixon explains. “[Cannabis] is classified as a depressant. The chemical effects it has on the brain—a brain that is already struggling to keep normal levels of dopamine and serotonin—can be detrimental to someone coping in a positive manner. If anything, I’ve seen that cannabis helps ‘numb’ the pain, therefore masking the problem but not dealing with it.”

Nixon’s view is one that is fairly common among medical professionals treating PTSD who face increasing pressure from a number of demographics (particularly veterans’ groups) to look more closely at cannabis and to think about what role it might play in patient recovery.

While there is some reticence about cannabis’s long-term therapeutic capabilities among medical professionals, doors are gradually opening where research is concerned. It was reported in May 2018 that Dr. Sue Sisley would conduct the first FDA-approved trial for testing the merits of incorporating cannabis into multifactorial psychiatric treatment for PTSD patients.

Results from this research remain fairly distant for people presently struggling with their symptoms, and, where the commercial cannabis industry is concerned, there is sometimes little interest in waiting for the “go ahead” from medical professionals to make claims about the “life-changing” properties of CBD and THC products. That these claims are often framed in loosely scientific terms or paired with imagery and language that emphasizes the “natural” healing properties of marijuana or hemp make them especially appealing to consumers who want to feel better and either don’t have access to or fear potential side effects of other treatments.

While medical professionals may not be able to stem the proliferation of claims made by some commercial vendors or stop their patients from experimenting with options that may offer them at least some temporary relief, they remain committed to letting people living with post-traumatic stress disorder know that there are effective long-term treatment options available. Among them is “Eye Movement Desensitization and Reprocessing” or EMDR therapy—a once-controversial treatment in which clinicians work with patients to “reorganize” memories, prying them carefully away from the powerfully negative emotions gained through trauma and storing them “elsewhere” in the mind where the “moved” memory can be experienced without PTSD’s unpleasant symptoms.

An outpatient medical program that features EMDR or other behavioral treatments, paired with medication managed by a psychiatrist, is presently believed to be the most effective method for healing individuals living with PTSD.

“You’re essentially trying to identify and desensitize yourself from the things you find trigger you through self-awareness and treating symptoms such as insomnia or anxiety with medication,” explains Nixon, who believes that recovering from PTSD must involve addressing the root issue and not just the symptoms. “Many people find that they’ll eventually be able to stop medication or don’t get as stimulated to triggers over time with treatment.”

As for cannabis? It’s possible, based on patient testimony and broadening horizons for health care professionals, that it could someday play a role in the managed outpatient treatment programs that are already recommended. This could open up new doors for patients in need of significant, immediate relief who feel they do not need or want to use pharmaceutical prescriptions—and who would prefer to work with their doctors to heal in a way that is less intimidating and more accessible to them. Right now, it’s too early to responsibly say, but answers are indeed on the horizon.