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Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder.

Does marijuana treat PTSD?

Samuel T. Wilkinson, MD, Elina Stefanovics, PhD, and Robert A. Rosenheck, MD

J Clin Psychiatry 2015;76(9):1174-1180

The August 29, 2016 issue of TIME magazine reported on military veterans using marijuana for posttraumatic stress disorder (PTSD). The Multidisciplinary Association for Psychedelic Studies has been granted approval to embark upon the first ever randomized, blind and placebo-controlled trial, using marijuana plant, for the treatment of PTSD.

Anecdotally, some report positive effects of marijuana use for chronic pain related to war injuries and easing anxiety, depression, and insomnia related to PTSD. To date, there are no scientific studies to support this claim. The 2015 observational study showed potentially worse PTSD symptoms, violent behavior, and alcohol use among veterans.

The Northeast Program Evaluation Center of the Veterans Health Administration used data from the health record. Patient records were selected if they had a diagnosis of PTSD between 1992-2011, had entered a PTSD program, and other inclusion criteria to compare 4 different groups. Over 2000 patients met inclusion criteria and assigned one of the following groups. 1) those with no marijuana use reported at all (“never users”), 2) those that had used marijuana at admission but not at 4 months after discharge (“stoppers”), 3) those using marijuana at admission and after discharge (“continuing users”), and 4) those with no use of marijuana at admission but reporting use at 4 months after discharge (“starters”). Outcomes included 4-month follow-up of PTSD symptom severity, employment status, violent behavior and measures of alcohol and drug use.

The analysis showed “starters” and “continuing users” to have a statistically significant higher PTSD severity at follow-up. The differences in scores ranged from 36-39. While these have a statistical significance it is unclear how much a 3-point difference makes for clinical outcomes. “Starters” had significantly higher measures of violent behavior at follow-up, as assessed by self-report using a 4-item self-report questionnaire. Higher use of alcohol and other drugs was seen in “starters” and “continuing users”.

While there are some statistical findings, this research is not definitive to prove that marijuana is the cause of worsening PTSD or violent behavior. Some of the statistical findings may not correlate to a much different clinical course. In addition, many of the measured outcomes are self-reported, which has potential for under reporting. More research is needed to prove the use of marijuana is beneficial in patients who have PTSD.