Challenges and considerations for treating PTSD with medicinal cannabis: the Australian clinician’s perspective

ABSTRACT

Introduction

Preclinical and experimental research have provided promising evidence that medicinal cannabis may be efficacious in the treatment of posttraumatic stress disorder (PTSD). However, implementation of medicinal cannabis into routine clinical therapies may not be straightforward.

Areas covered

In this review, we describe some of the clinical, practical, and safety challenges that must be addressed for cannabis-based treatment of PTSD to be feasible in a real-world setting. These issues are especially prevalent if medicinal cannabis is to be combined with trauma-focused psychotherapy.

Expert opinion

Future consideration of the clinical and practical considerations of cannabis use in PTSD therapy will be essential to both the efficacy and safety of the treatment protocols that are being developed. These issues include dose timing and titration, potential for addiction, product formulation, windows of intervention, and route of administration. In particular, exposure therapy for PTSD involves recall of intense emotions, and the interaction between cannabis use and reliving of trauma memories must be explored in terms of patient safety and impact on therapeutic outcomes.

KEYWORDS:

• Cannabis
• clinical medicine
• exposure therapy
• posttraumatic stress disorder
• psychiatry

Article highlights

• Medicinal cannabis is a possible effective treatment option for posttraumatic stress disorder (PTSD)

• However, pragmatic issues of treatment have not been addressed and this approach to treatment may be difficult to implement clinically

• Issues including dose timing, dose titration, addiction potential, product formulation, and route of administration relative to therapy are yet to be explored

• Likelihood and severity of potential risk associated with combination of cannabis with exposure therapy also need to be identified

• Despite decades of promising preclinical research, feasibility clinical trials are needed to determine whether this therapy combination can be used in humans

Declaration of interest

MN Hill consults for Lundbeck Pharmaceuticals and Jazz Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Conflicts of interest

M.N.H. consults for Lundbeck Pharmaceuticals and Jazz Pharmaceuticals. None of the other authors have any conflicts of interest to declare.

Additional information

Funding

This paper was not funded.