Cannabis in the management of PTSD: a systematic review

Abstract

Introduction Existing reviews exploring cannabis effectiveness have numerous limitations including narrow search strategies. We systematically explored cannabis effects on PTSD symptoms, quality of life (QOL), and return to work (RTW). We also investigated harm outcomes such as adverse effects and dropouts due to adverse effects, inefficacy, and all-cause dropout rates. Methods Our search in MEDLINE, EMBASE, PsycInfo, CINAHL, Web of Science, CENTRAL, and PubMed databases, yielded 1 eligible RCT and 10 observational studies (n = 4672). Risk of bias (RoB) was assessed with the Cochrane risk of bias tool and ROBINS-I. Results Evidence from the included studies was mainly based on non-randomized studies with no comparators. Results from unpooled, high RoB studies showed that cannabis was associated with a reduction in overall PTSD symptoms and improved QOL. Dry mouth, headaches, and psychoactive effects such as agitation and euphoria were the commonly reported adverse effects. In most studies, cannabis was well tolerated, but small proportions of patients experienced a worsening of PTSD symptoms. Conclusion Evidence in the current study primarily stems from low quality and high RoB observational studies. Further RCTs investigating cannabis effects on PTSD treatment should be conducted with larger sample sizes and explore a broader range of patient-important outcomes.

“The Two Sides of the Same Coin”—Medical Cannabis, Cannabinoids and Immunity: Pros and Cons Explained

“…In a sharp difference to opioid-based drugs, nabiximols were shown to be well tolerated in clinical trials with very mild side effects, such as dizziness or disorientation with no significant adverse effects on cognition [28][29][30]. Although mostly based on non-randomized studies with no comparators, a recent systematic review also shows that using cannabis by patients with post-traumatic stress disorder (PTSD) improves pain and sleep and is associated with reduced overall PTSD symptoms and reports of a better quality of life [31,32]. Likewise, cannabis provides a beneficial intervention for reducing inflammation-related morbidity in acquired immunodeficiency syndrome (AIDS) patients [33], also improving muscle and nerve pain, and may also assist with depression [34][35][36].…”

Medical cannabis for treatment-resistant combat PTSD

“…Literature reviews from the past two years that have examined the effectiveness of cannabis on PTSD symptoms count a small number of heterogeneous studies (open-label, longitudinal, and retrospective studies) with methodological problems and many limitations ( 28 , 29 ). To date, there were only two randomized, controlled clinical trials for PTSD patients.…”

“…The first used the synthetic cannabinoid nabilone ( 30 ), and the second used smoked cannabis but for only three weeks and was underpowered to detect significant differentiation from placebo ( 31 ). The conclusions of the few systematic reviews examining the effectiveness of cannabis on PTSD symptoms are that cannabis and synthetic cannabinoids may have a role in the treatment of PTSD, but there is currently limited evidence regarding their safety and efficacy ( 28 , 29 ). Therefore, additional research is needed to better understand the effectiveness and safety of cannabis in the treatment of PTSD.…”

La Cannabis terapeutica nel trattamento del Disturbo Post Traumatico da Stress: Protocollo per una Scoping Review

“…A third review delves into the effectiveness of cannabis on PTSD symptoms, the quality of life of patients undergoing this therapy and reintegration into the world of work, probing the various side effects of the therapy (8). Finally, the latest review found has set itself the goal of determining the clinical and therapeutic potential of cannabis and synthetic cannabinoids for PTSD.…”