Medical and mental health issues have been linked to cannabis usage. Marijuana usage, especially heavy, persistent use initiated during formative years, may contribute to these issues. Nonetheless, it’s possible that the personalities of heavy cannabis users contribute to these issues. Chronic bronchitis (8), aberrant brain development in early adolescent initiators (9), and deficits in short-term memory, motor coordination, and the capacity to do complicated psychomotor activities like driving are all medical concerns (10). Psychosis (which is particularly common in genetically sensitive groups; (11), depression, and suicidality (6), and impairment in cognitive capacity are all examples of psychiatric issues. Regular cannabis usage has been linked to worse life quality in the future due to issues including stress and anxiety over money and social isolation (12). Dependence on cannabis is also possible with long-term usage, and there is evidence of a clinically substantial withdrawal symptoms associated with stopping use (13).
Formulation and Administration
Delta-9-tetrahydrocannabinol (THC) is the main psychoactive component of the cannabis plant, among several other components (cannabinoids, terpenes). There is a wide range in the strength of cannabis strains, measured by the amount of THC they contain. Indica and sativa strains may produce cannabis with THC concentrations as low as 1% and as high as 30%, respectively. There has been as much as a 10-fold rise in the THC content of cannabis over the previous 40 years, making the drug more powerful than ever (14,15). Cannabis includes a wide variety of cannabinoids, including the well-known tetrahydrocannabinol (THC), as well as cannabidiol (CBD), cannabinol (CBN), and cannabigerol (CBG). Cannabinoid concentration (such as THC %) and cannabinoid ratio (the amount of one cannabinoid to another) seem to have a role in the range of possible cannabis effects (e.g., the intensity of the high, anxiety levels, and the ability to sleep) (such as the ratio of THC to CBD).
Wax, tinctures, and oils are just some of the cannabis extract products that have entered the market in recent years in addition to whole plant cannabis. These products may contain as much as 90% THC. As a result, a person might unwittingly absorb a very high amount of THC in a single delivery, greatly raising the probability of experiencing a negative response (such as dizziness, anxiety or tachycardia).
Flower, hash, oil, wax, edibles, and tinctures are just some of the cannabis products that may be smoked, vaped, or applied topically, among other ways to consume the drug. Although the effects of smoking or vaporizing cannabis are same, the effects of swallowing the same amount are delayed in onset and last longer (16). (17). The delayed impact generated by ingestion might lead some cannabis users to consume more than they planned, leading to a more intense high.
Finally, medications derived from cannabis have been developed and tested in clinical trials. These include Sativex® (nabiximols) and Epidiolex® (CBD extract). Differences exist between these and commercially available cannabis products such as entire plants or extracts. Research on the effects of cannabis-based medicines cannot be extrapolated to consumption of whole plant cannabis or other cannabis products due to the drugs’ concentrations of certain cannabinoids.
The human endocannabinoid system has been shown repeatedly in neurobiological studies to have a crucial role in post-traumatic stress disorder (PTSD). Cannabinoid type 1 (CB1) receptor availability is higher in those with PTSD than in those who have been traumatized or in healthy controls (18,19). Therefore, those with PTSD who use cannabis may get temporary relief from their symptoms. Evidence suggests that chronic cannabis usage by people with PTSD may have detrimental effects such as tolerance (caused by a decrease in CB1 receptor density and/or efficiency) and dependency (20). Individuals with post-traumatic stress disorder (PTSD) may have special difficulty stopping marijuana, as mentioned below, despite new research showing that CB1 receptors may reappear after periods of abstinence (21). (22).
The Potential of Cannabis to Treat Post-Traumatic Stress Disorder
Anecdotal evidence from people with PTSD who say cannabis eases their symptoms or improves their quality of life and functioning is the primary source for the notion that cannabis may be used to treat PTSD. To determine the safety and effectiveness of using whole plant cannabis to treat PTSD, further research is required. Specifically, randomized controlled trials (RCTs) are the “gold standard” for such studies. One randomized controlled trial comparing whole-plant cannabis to a placebo for PTSD treatment is all that exists at this time (23). This test was conducted in two parts. In the first part of the study, the effects of three different active cannabis formulations (high THC, high5 CBD, balanced THC+CBD) and a placebo were compared on PTSD symptoms in eighty U.S. service Veterans. None of the active cannabis formulations compared well to the placebo in terms of alleviating symptoms of post-traumatic stress disorder. Seventy-four war veterans were re-randomized in the second phase to receive one of three different forms of active cannabis. However, since there was no placebo group in this phase, we cannot make any inferences regarding the effectiveness of cannabis for treating PTSD from these data.
Finally, there is conflicting data on whether or not long-term cannabis usage is associated with an increase in post-traumatic stress disorder (PTSD) symptoms. Cannabis users reported better improvements in PTSD symptoms when examined over the course of a year, compared to non-user controls, in a new research. However, the participants in this research were chosen from among those who admitted previously using cannabis to alleviate symptoms of post-traumatic stress disorder. It is rather interesting that these people’s PTSD symptoms improved at the start of the trial rather than earlier in the course of their cannabis usage, given that they were not starting cannabis as a new therapy. Individuals who reported better symptom improvement in relation to cannabis usage may have been more likely to be those who felt cannabis to be effective for their PTSD. Additionally, there was a significant risk of bias since the research did not account for other factors that could account for variations in symptom improvement across the groups (24). Another research indicated that medical cannabis users who also reported suffering from PTSD got temporary alleviation from their symptoms while taking the drug but no lasting effects, indicating that cannabis may not be a viable treatment for PTSD (25). Additionally, several studies have shown that long-term cannabis usage may exacerbate trauma-related symptoms (26).
Preliminary research suggests that CBD oil used orally may reduce anxiety in both persons with and without clinical anxiety (27). As a result of these efforts, CBD therapies for social anxiety (28) and post-traumatic stress disorder (PTSD) are now being tested (29).
Consequences of Cannabis Abuse for the Management of Posttraumatic Stress Disorder
Veterans who use cannabis on a chronic or troublesome basis may not benefit as much from currently available therapies for post-traumatic stress disorder. There is evidence to show that having a diagnosis of CUD predicts poorer symptom reduction after residential PTSD treatment (30), and there is evidence to suggest that using cannabis after PTSD treatment has been connected to increased PTSD symptoms (31). While some research has identified a correlation between pre-treatment cannabis usage and reduced PTSD symptoms, other studies have not found such a link (32,33). As opposed to a neurobiological effect, cannabis-related functional issues may influence the efficacy of PTSD therapy. A recent research indicated that cannabis users had a more than twofold increased risk of dropping out of cognitive-behavioral and pharmaceutical treatments for PTSD, as well as poor adherence to trauma-focused psychotherapy, compared to non-users (33).