Healing wounds of war: Cannabis, PTSD, and the war in Ukraine

[Joolz]

Following the recent legalisation of medical cannabis in Ukraine, Adam Kavalier PhD, explores what we know about its potential in the treatment of PTSD. 

Ukrainian President Volodymyr Zelensky recently signed into law reforms on medical Cannabis to provide relief to victims of trauma, resulting from the ongoing conflict with Russia.

The law permits the use of medical Cannabis for patients suffering from serious health conditions, including PTSD. The Ukrainian Ministry of Health estimates that over six million people are living with PTSD and other mental health related issues, with a significant number also experiencing chronic pain.

PTSD Background

PTSD affects roughly one in three people who experience severe trauma, and is characterised by acute anxiety, flashbacks, and nightmares. It particularly burdens those who have served in military combat, with its high prevalence among war veterans. Conventional treatments such as antipsychotics and antidepressants often fall short in efficacy and are associated with adverse effects. Consequently, medical Cannabis has garnered attention as an alternative treatment for PTSD, promising fewer side effects and potential improvements in symptom management.

Medical Cannabis and Evidence

There is a growing body of evidence supporting that medical Cannabis is an effective low risk high reward therapy for patients suffering from a variety of conditions. PTSD is a good example of a disorder that has shown to be relieved by Cannabis treatment, but the evidence remains limited to observational studies and as with most Cannabis research, there is a critical need for more advanced studies. There has been only one controlled clinical study, but several observational studies and laboratory analysis have displayed promise for Cannabis treatment of PTSD.

 

A 2021 metareview in AIMS Neuroscience assessed 11 studies where medical Cannabis was used to treat PTSD, many reported reductions in symptoms and improvements in quality of life, although most were single-arm observational studies [2].

Further evidence comes from a cross-sectional study published last year in Clinical Therapeutics, which surveyed 510 U.S. veterans on their use of Cannabis for conditions including chronic pain, PTSD, and associated comorbidities such as anxiety and depression. In this study 91% of Cannabis users noted an enhanced quality of life, and 21% reduced their dependency on opioid painkillers. This self-reported survey also highlighted Cannabis as a more effective alternative to other available treatment options [3]. 

 

In a separate longitudinal study involving 150 participants tracked over a year, substantial decreases in PTSD symptom severity were observed with Cannabis use. Remarkably, participants who acquired Cannabis from dispensaries had more than double the likelihood of no longer meeting PTSD criteria by the end of the study. This indicates a potential use of Cannabis in trauma recovery beyond initial symptom management. Furthermore, the study highlights that the success of PTSD treatment may depend on the type and source of Cannabis used [4].

 

Laboratory research corroborates clinical findings by demonstrating the role of the endocannabinoid system in PTSD. Evidence shows that PTSD is linked to increased availability of cannabinoid type 1 (CB1) receptors [5]. Furthermore, THC has been observed to diminish activity in the amygdala, the brain region that governs fear responses. These insights bolster the theory that THC could regulate threat-related processing in individuals with PTSD, providing a potential pharmacological route for treating stress- and trauma-related disorders [6]. 

 

By contrast, an FDA-approved clinical study conducted in 2021 found no significant benefits of Cannabis use for symptoms of PTSD [7]. The study faced criticism for using poor quality drug material, unrepresentative of the Cannabis patients obtain from dispensaries and pharmacies. The recent expansion of DEA sanctioned research cultivation licenses and the potential rescheduling of Cannabis in the US offer hope for more robust FDA-approved studies in the future. For the time being, observational studies remain vital for guiding policy and medical application.

A Critical Opportunity

The effectiveness of a new program is reliant on thorough doctor education and integration of research programs. The Ukrainian Association of Medical Cannabis and The Ukrainian Medical Cannabis Association were formed to develop the industry and spearhead educational and research endeavors.

 

Hanna Hlushchenko, a Ukrainian-born Cannabis expert has played an important role by contributing to drafting of the law, and is orchestrating educational initiatives. Additionally, Hlushchenko has facilitated collaboration between Ukrainian Health Minister Viktor Liashko and his German counterpart Karl Lauterbach, visiting German medical Cannabis companies to garner support and gain insights from a successful and mature medical program.

 

We can find examples of valuable resources from more developed markets such as the Medical Cannabis Clinicians Society (MCCS) and the Society of Cannabis Clinicians (SCC), which offer educational platforms, and are supported by Key Opinion Leaders (KOLs). Research programs, such as the UK’s T21 project and the Quality of Life Evaluation Study (QUEST), can provide evidence for effective decision-making as programs evolve.

 

Development of similar initiatives can bring greater success to Ukraine’s program, and these initiatives can also contribute to a more global understanding of medical Cannabis’ impact, particularly for veterans who often lack access and financial support for Cannabis therapy despite its potential to enhance their quality of life.

 

This new legislation has provided a unique opportunity to offer potentially life-changing treatments for severe war-related conditions on a broad scale and amidst an ongoing war.

 

A continued proactive approach will render it appealing for developed markets to participate, not only in offering products but also in providing essential support for education and research programs. Such efforts could bolster the establishment of a robust program, extend critical aid to a nation in distress, and showcase to the world the potential impact of medical Cannabis treatment to heal the traumatic wounds of war.

 

References:

1. Sinclair, S., President Zelensky Signs Bill Legalizing Medical Cannabis In Ukraine. Forbes, 2024. 
2. Rehman, Y., et al., Cannabis in the management of PTSD: a systematic review. AIMS Neurosci, 2021.
3. McNabb, M., et al., Self-reported Medicinal Cannabis Use as an Alternative to Prescription and Over-the-counter Medication Use Among US Military Veterans. Clinical Therapeutics, 2023.
4. Bonn-Miller, M.O., et al., The Long-Term, Prospective, Therapeutic Impact of Cannabis on Post-Traumatic Stress Disorder. Cannabis and Cannabinoid Research, 2020.
5. Grotenhermen, F., Pharmacokinetics and Pharmacodynamics of Cannabinoids. Clinical Pharmacokinetics, 2003.
6. Rabinak, C.A., et al., Cannabinoid modulation of corticolimbic activation to threat in trauma-exposed adults: a preliminary study. Psychopharmacology (Berl), 2020. 
7. Bonn-Miller, M.O., et al., The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: A randomized cross-over clinical trial. PLoS One, 2021.

 

 

https://cannabishealthnews.co.uk/2024/03/28/healing-wounds-of-war-cannabis-ptsd-and-the-war-in-ukraine/

[j.o.i.n.t]

18 hours ago, Joolz said:

Rehman, Y., et al., Cannabis in the management of PTSD: a systematic review. AIMS Neurosci, 2021.

 

https://pubmed.ncbi.nlm.nih.gov/34183989/

 

"Conclusion: Evidence in the current study primarily stems from low quality and high RoB observational studies"

 

But whatever, eh, when there's money to be made.