Introduction: Given the increasing availability and use of cannabis among individuals with post-traumatic stress disorder (PTSD) and the addition of PTSD as an eligible diagnosis in several U.S. medical cannabis programs, the efficacy of dispensary-obtained cannabis needs to be thoroughly examined.
Materials and Methods: This prospective study assessed PTSD symptoms and functioning every 3 months over the course of a year in two samples of participants diagnosed with PTSD: (1) those with PTSD using dispensary-obtained cannabis (cannabis users) and (2) those with PTSD, who do not use cannabis (controls). Linear mixed-effects models and generalized estimating equations tested whether trajectories of symptoms differed between the two subsamples.
Results: A total of 150 participants (mean [standard deviation] age, 50.67 [15.26] years; 73% male) were enrolled in the study. Over the course of 1 year, the cannabis users reported a greater decrease in PTSD symptom severity over time compared to controls [group×time interaction=−0.32 (95% confidence interval [CI]=−0.59 to −0.05, R2=0.13; t=−2.35, p=0.02). Participants who used cannabis were 2.57 times more likely to no longer meet DSM-5 criteria for PTSD at the end of the study observation period compared to participants who did not use cannabis (95% CI=1.12–6.07; p=0.03).
Conclusions: This study provides evidence that the types of cannabis available in recreational and medical cannabis dispensaries might hold promise as an alternative treatment for PTSD. Randomized placebo-controlled trials are needed to assess safety and determine how different preparations of cannabis impact PTSD and functioning.
dtmc on December 20th, 2020 at 00:47 UTC »
A few notes, based solely on the abstract because I can't get full access yet for some reason even with institutional subscriptions.
First and foremost, its always nice to have some clinical evidence to support what clinicians are hearing (that smoking helps reduce symptoms). However, this result isn't shocking given the comparison the study makes (those using vs. those who didn't use). It seems to be saying something like those who do something are better than those who don't do anything, which undercuts the support somewhat. The R-squared is also low at .13 (the model accounts for 13% of the variance :\ ), and if that un-anchored statistic of "interaction term" is a standardized coefficient, 0.3 is also low, meaning the differences weren't that large. It also doesn't indicate how many didn't meet criteria. If it's 8 vs. 3 controls out of 150, that's a lot less impressive than like 80 vs. 30.
Second, the study doesn't say whether or not the individuals were able to maintain benefits when the cannabis use decreased, which is an important distinction. I'd much rather have people not suffer from PTSD full stop, and on the other hand the frontline interventions/treatments for PTSD provide benefit up to a year or two after treatment has ended for most people, and there's evidence that those interventions don't work as well in individuals who use cannabis in that time. There are a lot of chronic diseases, including some mental disorders, that require long-term treatment and/or medication, but thankfully for the majority of individuals with PTSD, that isn't the case. This also leaves me with a few important questions I don't see in the abstract and am hoping are in the full manuscript. Was this a treatment-seeking population, or something a bit more convenience-y?; what were the effects of engagement with mental health services?; and how was frequency and amount used accounted for?
Third, the phrase "users reported" makes me wary, as retrospective self-report has a lot of limitations vs. something like a blinded, clinician-administered assessment (which comes with its own limitations but has the benefit of standardization and better reliability). Ideally, they have both and the correlations are strong, but I don't see measures specified in the abstract. If it truly is only self-report the last sentence in the results section is fairly misleading, as no clinician should make a diagnosis via a self-report measure a good conversation contextualizing those answers, and their strongest point is much less power.
Lastly, the widely accepted theory of PTSD notes that the disorder is maintained by two things - maladaptive thoughts and avoidance. For a lot of individuals with mental health issues, substance use is big way to avoid quickly and easily, and can often be problematic. The comorbidity of PTSD and SUD is something like 60+% if my memory serves. And comorbid PTSD and substance use at problematic levels is challenging enough that that has warranted the development of specific treatment protocols.
EDIT - typos
GaugeFOREVER on December 19th, 2020 at 21:29 UTC »
Would be nice if they could test CBD vs full fledged cannabis to see if it's one portion of it or the whole thing. This isn't to try to restrict soldiers from using cannabis as a medication, more to see if there is an option for soldiers who don't like being high. I went to Iraq and I don't particularly like being high anymore, but if the CBD yields most of the benefits that would be nice to know.
Helloitsme1010 on December 19th, 2020 at 20:36 UTC »
Decreases frequency of nightmares for sure, and dreams in general