Medical Marijuana and Posttraumatic Stress Disorder

Medical marijuana (MM), also known as medical cannabis and Indian hemp, is used for a wide variety of medical and mental ailments caused in part by stress and anxiety generally. In places where it is legal, MM is prescribed as one of many methods of relief. Hundreds of treatments to manage stress have emerged during the past 30 years with limited success. Posttraumatic stress disorder (PTSD) is no different. Many of the classic signs of PTSD, including elevations in heart and respiration rate, are associated with the inability to calm oneself. MM is one means by which such calming is achieved. Unfortunately, because cannabis is illegal, there has been very little research on both the costs and benefits of regular use. Nevertheless, because this substance has been used extensively throughout the world for centuries and there is no evidence of the substance doing significant harm or having lasting negative effects, it would have been irresponsible not to include an entry on this topic. What follows represents an effort to cite the most important findings in the literature and to discuss that research and its practical implications in the context of a rational, nonpolitical, science-based narrative.

The phrase medical marijuana refers to the legal use of the naturally occurring parts of the cannabis herb or weed for the purpose of relieving anxiety associated with PTSD and other anxiety-based [Page 372]symptoms such as depression and panic attacks. MM appears to be emerging as the substance of choice because initial therapeutic effects in treating PTSD appear promising.

Most pharmaceutical treatments for PTSD have negative side effects including drowsiness and deficits in problem-solving skills and other decision-making tasks over extended periods. Moreover, these substances often interact when more than one is prescribed. Their dangerous side effects can lead to driving accidents and other emergency events. Yet although driving under the influence of most prescription medications is legal, driving under the influence of medical marijuana is not. This is partly because of the lack of evidence of its safety, which has not been researched. The U.S. federal government considers MM as a type of narcotic, dating back to the 1937 Marihuana Tax Act. Yet Lester Grinspoon and James B. Bakalar, in a widely noted article published in the Journal of the American Medical Association, conclude that MM is far less dangerous than either tobacco or alcohol.

Despite the lack of evidence of harm, cannabis use disorder (CUD) has emerged as a way of categorizing based on use, rather than on dysfunction. CUD is described in the American Psychiatric Association's compendium of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM), as a kind of mental disorder. Psychological treatments may solve the primary cause of the traumatic stress reaction, but there are few qualified practitioners and treatment is often too expensive for working-class patients. Even if they are able to get an appointment, the effect of the sessions is often to increase stress reactions before it decreases them. Also, desensitizing the traumatized using one of many cognitive-behavioral, exposure-based treatments of PTSD requires considerable time investment. These iatrogenic effects can reduce treatment success and compliance rates.

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