Cannabis use and trauma

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Trauma contributed to promoting the use and potential abuse of cannabis. [1] Conversely, cannabis use has been associated with the intensity of trauma and PTSD symptoms. [2] [3] While evidence of efficacious use of cannabis is growing in novelty, it is not currently recommended. [4] [5]

Contents

Frequency and intensity of symptoms

Individuals who have traumatic experiences have been found to have increased overall cannabis use and higher instances of cannabis use disorder (CUD), suggestive of problematic cannabis use. [6]  For example, veterans who identify as medicinal users have been shown to have a higher association with combat exposure, trauma related symptoms, and arousal when cued to situations, as well as overall cannabis use. [7]

Despite increased cannabis use in those with PTSD symptoms, a National Epidemiological Study with thousands of  participants based in the United States indicated lifetime PTSD was a weak predictor of lifetime cannabis use. [8] [9] [10] However, this study affirmed that for individuals who endorse cannabis use and trauma exposure, they are likely to have concurrent PTSD and CUD symptoms. [8] [9] [11] The strength of the association between heavy PTSD symptoms and CUD was stronger than that of CUD and other psychological disorders, namely depression, general and social anxiety, panic disorder, alcohol dependence, and personality disorders. [8] It is worth noting that this was done with older DSM-IV criteria, rather than the most current DSM-V, suggestive of possible shifts in diagnostic criteria used to gauge psychological and substance-related disorders.

Trauma as a motive

High use of cannabis has been associated with coping motives in medicinal cannabis users with PTSD symptoms. [2] In a longitudinal study of American female twins, trauma and psychological symptoms were significant predictors for cannabis initiation and cannabis use disorder (CUD). [12] [13] Individuals with higher levels of life-threatening events, injury, or experiences of death were also more likely to initiate cannabis use during the emerging adulthood phase, with sexual abuse predicting cannabis use initiation before the age of 15 in African American women. [13] In European-American women, sexual and physical abuse, as well as major depressive disorder (MDD) predicted age of cannabis initiation, with development of a CUD being predicting more specifically by MDD and physical abuse. [13] Those with sexual trauma who initiate cannabis use prior to the age of 16, are also more likely to develop psychosis. [14]

In women military veterans, a higher proportion of cannabis users who had experienced childhood and adult sexual trauma, had higher levels Post-Traumatic Stress Disorder (PTSD) diagnosis when compared to those with no drug use. [15]    When controlling for PTSD symptoms and demographic factors, regular cannabis use was still significantly related to sexual trauma. [15] For sexual minority women, have indicated higher cannabis use, coping motives, and post-traumatic stress symptoms than heterosexual women. [16] [17] This may suggest that for women, trauma symptoms may be more severe for those who belong to a minority status, and the necessity to cope is often met by increasing cannabis use. These findings corroborate the idea that increased cannabis use can also be driven by minority stress, which has also been related to increased trauma. [18] [19]

Viability and use of cannabis as treatment

Emotion regulation and anxiety symptoms

Tetrahydrocannabinol (THC)

The psychoactive component of cannabis, tetrahydrocannabinol (THC) is not effective in treating emotion-regulation and anxiety-related symptoms. [20] Conversely, THC has been empirically related to an increase anxiety symptoms through impacts on neurological areas impacting serotonin, noradrenalin, GABA and glutamate. [20] [21] [22] [23]

Cannabidiol (CBD)

When using cannabidiol (CBD) results have indicated a weakened emotional response to traumatic memories. [24] This effect is attributed to the presence of endocannabinoid receptors in the limbic system, including the amygdala, and the hypothalamus that CBD may impact. [24] [25] [26] [27] These components' effect likely leads to the reduction of neuroendocrine and behavioral stress responses. [24] [28] Altogether, a cumulation of research indicates cannabinoids can help with fear extinction and combating depression. [24] However, further studies are needed to validate the therapeutic potential of cannabinoids for emotion dysregulation and anxiety symptoms associated with trauma. [24]

Sleep

Tetrahydrocannabinol (THC)

While the psychoactive component THC, has been shown to reduce time to get to sleep, studies indicate disrupted circadian rhythms when using THC. [29] [30] Furthermore, THC is shown to have a quicker development of tolerance to sleep-inducing effects. [31] It is worth noting that synthetic THC has also shown the same effects of developed tolerance to sleep latency effects. [32]

However, individuals diagnosed with high PTSD scores have endorsed the use of medical cannabis for sleeping. [33] [34] Studies have found some evidence for using Naboline, a synthetic version of THC, has proven effective for decreasing the frequency of PTSD related nightmares without developing long-term tolerance. [35] [36] [37] [38]

Cannabinol (CBD)

Novel research into cannabis suggests potential therapeutic effects of cannabinoids, specifically with higher doses of CBD, as opposed to lower doses, which can have an energizing effect. [30] [39] [40] In laboratory studies with rats, CBD has been shown to reduce sleep latency due to anxiety in REM sleep, with no negative changes to other aspects of sleep. [41] [42]

Related Research Articles

<span class="mw-page-title-main">Tetrahydrocannabinol</span> Psychoactive component of cannabis

Tetrahydrocannabinol (THC) is a cannabinoid found in cannabis. It is the principal psychoactive constituent of cannabis and one of at least 113 total cannabinoids identified on the plant. Although the chemical formula for THC (C21H30O2) describes multiple isomers, the term THC usually refers to the delta-9-THC isomer with chemical name (−)-trans-Δ9-tetrahydrocannabinol. It is a colorless oil.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Effects of cannabis</span>

The short-termeffects of cannabis are caused by many chemical compounds in the cannabis plant, including 113 different cannabinoids, such as tetrahydrocannabinol (THC), and 120 terpenes, which allow its drug to have various psychological and physiological effects on the human body. Different plants of the genus Cannabis contain different and often unpredictable concentrations of THC and other cannabinoids and hundreds of other molecules that have a pharmacological effect, so the final net effect cannot reliably be foreseen. Acute effects while under the influence can sometimes include euphoria or anxiety. Although some assert that cannabidiol (CBD), another cannabinoid found in cannabis in varying amounts, may alleviate the adverse effects of THC that some users experience, little is known about CBD's effects on humans. Cannabinoid receptor antagonists have previously been tested as antidotes for cannabis intoxication with success, reducing or eliminating the physiological and psychological effects of intoxication. Some of these products are currently in development as cannabis antidotes.

<span class="mw-page-title-main">Medical cannabis</span> Cannabis sativa L. (Marijuana; Hemp) used medicinally

Medical cannabis, medicinal cannabis or medical marijuana (MMJ), refers to cannabis products and cannabinoid molecules that are prescribed by physicians for their patients. The use of cannabis as medicine has a long history, but has not been as rigorously tested as other medicinal plants due to legal and governmental restrictions, resulting in limited clinical research to define the safety and efficacy of using cannabis to treat diseases.

<span class="mw-page-title-main">Cannabinoid</span> Compounds found in cannabis

Cannabinoids are several structural classes of compounds found in the cannabis plant primarily and most animal organisms or as synthetic compounds. The most notable cannabinoid is the phytocannabinoid tetrahydrocannabinol (THC) (delta-9-THC), the primary psychoactive compound in cannabis. Cannabidiol (CBD) is also a major constituent of temperate cannabis plants and a minor constituent in tropical varieties. At least 113 distinct phytocannabinoids have been isolated from cannabis, although only four have been demonstrated to have a biogenetic origin. It was reported in 2020 that phytocannabinoids can be found in other plants such as rhododendron, licorice and liverwort, and earlier in Echinacea.

<span class="mw-page-title-main">Cannabidiol</span> Phytocannabinoid discovered in 1940

Cannabidiol (CBD) is a phytocannabinoid, one of 113 identified cannabinoids in cannabis plants, along with tetrahydrocannabinol (THC), and accounts for up to 40% of the plant's extract. It was discovered in 1940 and as of 2022, clinical research on CBD included studies related to the treatment of anxiety, addiction, psychosis, movement disorders, and pain, but there is insufficient high-quality evidence that CBD is effective for these conditions. CBD is sold as a herbal dietary supplement and promoted with yet unproven claims of particular therapeutic effects.

<span class="mw-page-title-main">Parahexyl</span> Synthetic homologue of THC

Parahexyl is a synthetic homologue of THC which was invented in 1941 during attempts to elucidate the structure of Δ9-THC, one of the active components of cannabis.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

<i>N</i>-Acylethanolamine Class of chemical compounds

An N-acylethanolamine (NAE) is a type of fatty acid amide where one of several types of acyl groups is linked to the nitrogen atom of ethanolamine, and highly metabolic formed by intake of essential fatty acids through diet by 20:4, n-6 and 22:6, n-3 fatty acids, and when the body is physically and psychologically active,. The endocannabinoid signaling system (ECS) is the major pathway by which NAEs exerts its physiological effects in animal cells with similarities in plants, and the metabolism of NAEs is an integral part of the ECS, a very ancient signaling system, being clearly present from the divergence of the protostomian/deuterostomian, and even further back in time, to the very beginning of bacteria, the oldest organisms on Earth known to express phosphatidylethanolamine, the precursor to endocannabinoids, in their cytoplasmic membranes. Fatty acid metabolites with affinity for CB receptors are produced by cyanobacteria, which diverged from eukaryotes at least 2000 Million years ago (MYA), by brown algae which diverged about 1500 MYA, by sponges, which diverged from eumetazoans about 930 MYA, and a lineages that predate the evolution of CB receptors, as CB1 – CB2 duplication event may have occurred prior to the lophotrochozoan-deuterostome divergence 590 MYA. Fatty acid amide hydrolase (FAAH) evolved relatively recently, either after the evolution of fish 400 MYA, or after the appearance of mammals 300 MYA, but after the appearance of vertebrates. Linking FAAH, vanilloid receptors (VR1) and anandamide implies a coupling among the remaining ‘‘older’’ parts of the endocannabinoid system, monoglyceride lipase (MGL), CB receptors, that evolved prior to the metazoan–bilaterian divergence, but were secondarily lost in the Ecdysozoa, and 2-Arachidonoylglycerol (2-AG).

<span class="mw-page-title-main">Dronabinol</span> Generic name of Δ9-THC in medicine

Dronabinol, sold under the brand names Marinol and Syndros, is the generic name for the molecule of delta-9-tetrahydrocannabinol (THC) in the pharmaceutical context. It has indications as an appetite stimulant, antiemetic, and sleep apnea reliever and is approved by the U.S. FDA as safe and effective for HIV/AIDS-induced anorexia and chemotherapy-induced nausea and vomiting.

<span class="mw-page-title-main">Long-term effects of cannabis</span>

The long-term effects of cannabis have been the subject of ongoing debate. Given that the use of cannabis is illegal in most countries, clinical research presents a challenge and there is limited evidence from which to draw conclusions. In 2017, the U.S. National Academies of Sciences, Engineering, and Medicine issued a report summarizing much of the published literature on health effects of cannabis, into categories regarded as conclusive, substantial, moderate, limited and of no or insufficient evidence to support an association with a particular outcome.

<span class="mw-page-title-main">Cannabis use disorder</span> Continued use of cannabis despite clinically significant impairment

Cannabis use disorder (CUD), also known as cannabis addiction or marijuana addiction, is a psychiatric disorder defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and ICD-10 as the continued use of cannabis despite clinically significant impairment.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

<span class="mw-page-title-main">Post-traumatic stress disorder and substance use disorders</span> Association of PTSD and substance dependencies

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

PTSD treatment In South Africa arose to treat the victims of physical violence and sexual abuse, who often display symptoms of post-traumatic stress disorder (PTSD).

<span class="mw-page-title-main">8,9-Dihydrocannabidiol</span> Chemical compound

8,9-Dihydrocannabidiol is a synthetic cannabinoid that is closely related to cannabidiol (CBD) itself. that was first synthesized by Alexander R. Todd in 1940 derived from the catalytic hydrogenation of cannabidiol.

<span class="mw-page-title-main">Δ-8-Tetrahydrocannabinol</span> Isomer of tetrahydrocannabinol

Δ-8-tetrahydrocannabinol is a psychoactive cannabinoid found in the Cannabis plant. It is an isomer of delta-9-tetrahydrocannabinol, the compound commonly known as THC, with which it co-occurs in hemp; natural quantities of ∆8-THC found in hemp are low. Psychoactive effects are similar to that of Δ9-THC, with central effects occurring by binding to cannabinoid receptors found in various regions of the brain.

Psychedelic treatments for trauma-related disorders are the use of psychedelic substances, either alone or used in conjunction with psychotherapy, to treat trauma-related disorders. Trauma-related disorders, such as post-traumatic stress disorder (PTSD), have a lifetime prevalence of around 8% in the US population. However, even though trauma-related disorders can hinder the everyday life of individuals with them, less than 50% of patients who meet criteria for PTSD diagnosis receive proper treatment. Psychotherapy is an effective treatment for trauma-related disorders. A meta-analysis of treatment outcomes has shown that 67% of patients who completed treatment for PTSD no longer met diagnostic criteria for PTSD. For those seeking evidence-based psychotherapy treatment, it is estimated that 22-24% will drop out of their treatment. In addition to psychotherapy, pharmacotherapy (medication) is an option for treating PTSD; however, research has found that pharmacotherapy is only effective for about 59% of patients. Although both forms of treatment are effective for many patients, high dropout rates of psychotherapy and treatment-resistant forms of PTSD have led to increased research in other possible forms of treatment. One such form is the use of psychedelics.

Cannabinoids are compounds found in the cannabis plant or synthetic compounds that can interact with the endocannabinoid system. The most notable cannabinoid is the phytocannabinoid tetrahydrocannabinol (THC) (Delta-9-THC), the primary intoxicating compound in cannabis. Cannabidiol (CBD) is another major constituent of some cannabis plants. Conversion of CBD to THC can occur when CBD is heated to temperatures between 250–300 °C, potentially leading to its partial transformation into THC.

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