Posted on 12/19/2014 4:39:22 PM PST by steve86
AVENTURA, Fl; Although a growing number of states have approved post-traumatic stress disorder (PTSD) as a qualifying condition for medical marijuana use, new research shows that the drug may actually worsen symptoms and increase violent behavior.
A large observational study of more 2000 participants who were admitted to specialized Veterans Administration treatment programs for PTSD showed that those who never used marijuana had significantly lower symptom severity 4 months later than those who continued or started use after treatment. Veterans who were using marijuana at treatment admission but quit after discharge ("stoppers") also had significantly lower levels of PTSD symptoms at follow-up.
On the other hand, the highest levels of violent behavior were found in the so-called "starters," those who were not using the substance at admission but who started use after discharge.
At the American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting, lead author Samuel T. Wilkinson, MD, from the Yale University School of Medicine, in New Haven, Connecticut, told conference delegates that the findings suggest marijuana nullifies the benefits of intensive PTSD treatment.
"This wasn't a randomized controlled trial. But at least in this study, we found that marijuana is not associated with improvement in PTSD and that initiating marijuana was associated with worsening outcomes in a number of measures," said Dr Wilkinson.
Little Substantive Evidence
Despite the fact that a number of states have approved the use of medical marijuana for PTSD, there's little evidence to support its use for treatment of the disorder.
"There have been a few longitudinal assessments, but no randomized controlled trials showing efficacy and safety," added Dr Wilkinson.
The investigators evaluated data from the Northeast Program Evaluation Center for veterans who were admitted across the United States between 1991 and 2011 into specialized intensive PTSD treatment programs lasting a mean of 42.5 days.
A total of 2276 representative veterans were included in this analysis. They were split into four groups: in addition to the marijuana starters (n = 831), those with no use at treatment admission or after discharge were placed in the "never used" group (n = 850); those using at admission and after discharge were placed in the "continuing use" group (n = 296); and those who quit using after treatment were in the "stoppers" group (n = 299).
All were evaluated at admission and at a follow-up 4 months after discharge. Measures used included the short version of the Mississippi Scale (MISS) to assess PTSD symptom severity, the drug and alcohol subscales of the Addiction Severity Index (ASI), and reports of violent behavior.
Results showed that use of marijuana was significantly associated with higher PTSD symptom severity, as well as higher levels of violent behavior and alcohol and drug use.
Scores on the MISS showed that all groups except the starters had at least some improvement. However, the lowest levels of PTSD symptoms at the 4-month follow-up were in the marijuana stoppers, with a score decrease of 7.9% (P < .0001 vs the continuing users and the starters), and in the never users, with a score decrease of 5.5% (P < .0001 vs the starters).
Surprise Finding
Although there were changes in violence scores in all three groups, improvement was significantly less in the starters than in the other 3 groups (P < .0001 for all three comparisons). "This was a surprise because generally, marijuana is not thought to be associated with violence. There's been a little bit of literature investigating this, but this was interesting," said Dr Wilkinson.
The starters also had greater severity in scores on both the ASI drug use and alcohol use subscales vs the other three groups (P < .0001 for all).
On the other hand, the stoppers had significantly lower severity scores on the drug use subscale (P < .0001 vs the other 3 groups) and lower alcohol subscale scores (P < .0001 vs continuing users; P < .001 vs never users).
"This showed that those who started marijuana did turn to other drugs to cope with residual PTSD symptoms, which is to be expected," Dr Wilkinson said. "However, there was no evidence that those who stop cannabis use turn to other drugs or alcohol."
During the Q&A session after his presentation, an audience member pointed out that there was no implication that cannabis drove PTSD severity and asked whether it could just be that the patients with more severe symptoms use more cannabis.
"There wasn't a sense of that from these data," replied Dr Wilkinson. However, he added that they found only an association and not causation, because the study was not prospective or randomized.
"When we looked at a different analysis, there was a dose response. Those who used more marijuana or who had greater change in marijuana use had worse PTSD symptoms," he said.
When another attendee mentioned that she had seen violent behavior in some veterans who use marijuana and have traumatic brain injuries (TBIs), Dr Wilkinson noted that the investigators did not evaluate whether any of the study participants specifically had a TBI.
A Band-Aid Solution?
Session moderator Carla Marienfeld, MD, told Medscape Medical News that public perception has been that marijuana soothes those with PTSD.
"Addiction psychiatrists struggle a lot with how to communicate with our patients about this. People assume that there aren't a lot of risks, but there are some papers starting to show that there really are," she said.
"Most people assume things based on their own experience. So when you talk to patients, they often say, 'it's the only thing that helps me sleep' or 'it's the only thing that calms me down.' But when you actually start looking into the symptoms of whether or not they get better with marijuana use, I don't think studies, at least with these initial data, are going to bear that out."
Although Dr Marienfeld, like Dr Wilkinson, is from the Yale University School of Medicine, she was not involved with this research. She noted that it could be that cannabis is acting as a Band-Aid instead of being a long-term solution.
"Marijuana use may make patients feel better for the short term, and we need to look at that. Does it make things better for a few hours and then it gets worse the next day? That would be an important study to understand," she said.
She added that because Dr Wilkinson presented an association study, "there's not really a take-away for clinicians yet. But I think it's important for them to bear this in mind and watch for this kind of data."
Dr Wilkinson reports having received a past grant from the American Psychiatric Foundation/Janssen through Yale University for a project involving electroconvulsive and cognitive-behavioral therapies.
American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting: Paper presentation 5, presented December 6, 2014.
Paranoia would make PTSD worse.
Why is this news?
Basically people who want to smoke pot do so to get high. The medical excuse is just a lie, imo.
Hey! I look like that guy! Who’s Dave?
This study shows only an "association", which is rather difficult to contradict.
But in the case of seemingly contradictory studies, the discrepancies are part of the scientific method and are immensely useful. The contradictions eventually lead to a determination of what independent variable(s) account for the effects (like marijuana variety, or pre-existing severity of symptoms in the subject population).
Though it almost pains me to say it, by the fact this is VA research, it is suspect. Were it research conducted for the Israeli army, who have been using marijuana to treat PTSD in soldiers for at least a decade, it would have much greater credibility.
Well, then I'm a liar because I'm going to purchase an edible Indica variety for pain. Parenthetically, this happens to be what the just-retired Director of the Washington State Liquor Control Board did a few weeks ago as well. I guess she's a liar, also.
Probably because we already know alcohol is not a good thing. Ever hear of MADD and other such nonsense, blah blah blah? Well pot is even worse! That’s why! Don’t kid yourself.
You would of needed to grow up in the '60's to know.
It was part of an old comedy sketch from Cheech & Chong.
I heard it can actually cause a form of insanity called “madness”. Or something like that.
The study is from the Yale University School of Medicine, not Reuters or Medscape.
See #31
Giving hallucinogenic drugs to people with PTSD.
What could go wrong?
If the VA paid for the research, and the schools know the VA is opposed to pot for PTSD, the study starts off tainted. Its exactly like when the government pays a university for global warming research. Report back that there is no human caused warming and guess what,,,, no more research grants come your way.
Well.... Some things are bad for people. Who the hell cares?
Grown adults should be able to freely choose whether or not to do such things without legal ramifications, as long as they aren’t harming other people. The BIGGEST problem with illegal drugs is the fact that they’re illegal. It forces them onto the black market, and drives the prices WAY up, which introduces the criminal element.
I don’t use any drugs myself, and I never have(aside from a single curiosity when I was a teen that resulted in me being sick), but I have no problem at all with those that might choose to do so.
Notice I posted the word “smoke”.
I’m aware marijuana is in pill form and it wasn’t what I was giving an opinion on.
And perhaps struggle to communicate with addicts about anything. Addiction is so difficult, I believe that only a cleaned up, sober, non-using addict/counselor can communicate effectively with other addicts.
As for marijuana stoking the flames of PTSD, why wouldn't it? It's a psychoactive substance that torques the psyche around. Even normal people can have "bad trips." Perhaps it brings the visions, the emotions of the trauma back to mind in these severely effected soldiers, many who have seen bodies blowing apart in all directions.
“...marijuana does cause paranoia in a fair number of people”
Has anyone here noticed just how threatening the weather seems to be, lately?
It i a little unclear but it appears the study might have been funded by the American Psychiatric Foundation/Janssen through Yale University.
Well you know ...I’d just like to add that.. um... what are we talking about?
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