- Veterans with PTSD commonly use marijuana to help manage symptoms like insomnia, anxiety, and depression. Studies show marijuana use is associated with reduced severity of PTSD symptoms and improved sleep and mood. - The endocannabinoid system, including the CB1 receptor in the hippocampus and amygdala, may explain why marijuana provides relief from PTSD symptoms. However, more research is still needed on the long term effects and potential risks of marijuana use for treating PTSD. - While preliminary evidence supports exploring marijuana as a treatment for PTSD, more extensive clinical trials are required before it can be recommended or prescribed as a standard treatment option. Research barriers around federal laws and stigma need to be addressed first.

1. RUNNINGHEAD: PTSD ANDMARIJUANA USAGE
PTSD and the use of Marijuana in Veteran Populations
Susan DeRosa
Dr. Kristina Hallett
PSY 662 H1
January 21, 2015

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Susan DeRosa | PSY662H1 BAY PATH UNIVERSITY COUNSELING THEORY & PRACTICE
The first recorded use of Cannabis was found in China dating around 4000 BC, and has been used
in ancient cultures to treat a variety of ailments. (Hi, 1974). The medicinal benefits of marijuana had
grown in popularity until the Harrison Act of 1914, which grouped marijuana together with illicit drugs
such as cocaine and heroin. This resulted in a reduced interest in the marketing and use of marijuana
derived products. With the decline in pharmaceutical marketing interests, a paradoxical rise in
recreational usage ensued until the Marijuana Tax Act of 1937 outlawed the use, possession, or
distribution of marijuana and other cannabis products (Musto, 1972).
Illegal, recreational use of marijuana has exponentially increased; beginning in the 1960’s and
70’s and continues to increase today. According to Drug abuse trends among youth (Banken, 2004)
approximately 50% of the US population reported having tried cannabis at least once.
Due to the longstanding resistance to marijuana as an acceptable medical option, there are few
scientific studies to support the medical benefits of marijuana use prior to 1960. However; the
psychoactive compound, THC was discovered in 1964, sparking renewed interest in the cannabinoid
field. In 1988, the first cannabinoid receptor (CB1) was isolated, and cloned, leading to an increased
interest in marijuana changing the trajectory of its therapeutic applications.
At the present time there are 2 synthetic cannabinoids approved by the FDA in the United States,
Cesamet® (nabilone/Meda Pharmaceuticals) indicated for the treatment of the nausea and vomiting
associated with cancer chemotherapy in patients who have failed to respond adequately to conventional
antiemetic treatments (Cesamet® Package insert 2011) ; and Marinol ® (dronabinol/Par Pharmaceuticals)
indicated for anorexia associated with weight loss in patients with AIDS, and nausea and vomiting
associated with cancer chemotherapy in patients who have failed to respond adequately to conventional
antiemetic treatments (Marinol® Package insert 2014).

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Susan DeRosa | PSY662H1 BAY PATH UNIVERSITY COUNSELING THEORY & PRACTICE
There is a growing body of evidence supporting the use of medical marijuana to alleviate adverse
medical symptoms beyond chemotherapy, nausea and anorexia. The acceptance of medical marijuana
legislation is spreading throughout the United States. According to the National Council of State
Legislators, as of January 12 2015, 23 states and the District of Columbia have enacted laws and 10 more
states have bills in progress which reduce criminal penalties on the use, possession and cultivation of the
cannabis plant for those who have received prescriptions from their physician. Patients now have the
ability to obtain marijuana for a wide range of medical purposes through statewide programs and
marijuana dispensaries.
By way of example, in May 2012 in the state of Connecticut, Governor Dannel P Malloy signed
into Law, (House Bill 5389), approving medical marijuana for:
"Cancer, glaucoma,positive statusforhuman immunodeficiency virusor acquired
immune deficiency syndrome [HIV/AIDS],Parkinson's disease, multiple sclerosis,damage to the
nervoustissue of the spinal cord with objective neurological indication of intractable spasticity,
epilepsy, cachexia,wasting syndrome, Crohn's disease, posttraumatic stress disorder, or... any
medical condition,medical treatment or disease approved by the Department of Consumer
Protection..."
Posttraumatic stress disorder (PTSD),which is caused by an extremely stressful event, can
develop after military combat and exposure to threat of death or serious injury. Mental health experts
estimate that the intensity of warfare in Iraq and Afghanistan caused more than 30% of service members
returning from this conflicts to develop PTSD (Hogue et al, 2004) but less than half sought mental health
care. This further substantiates the likelihood of veterans to self-medicate.
Symptoms of PTSD can be debilitating and include insomnia; intense anxiety; and difficulty
coping with work, social, and family relationships (Clancy et al, 2006). Posttraumatic Stress Disorder has
been associated with a high prevalence of marijuana use, specifically in combat veterans (Brenner et al

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Susan DeRosa | PSY662H1 BAY PATH UNIVERSITY COUNSELING THEORY & PRACTICE
1996, Calhoun et al 2000, Rosen et al 2008). Studies provide evidence that many individuals with PTSD
use marijuana to reduce negative effects and other unpleasant internal experiences, associated with PTSD
and those methods of avoidance correlated with increased marijuana use (Bordieri, 2014). Research on
this topic includes self-reported questionnaires, retrospective chart analysis, psychological assessments
and clinical trials; unfortunately, the majority of these studies are limited in sample size and typically
focused on a unique population: combat-exposed veterans.
Left untreated PTSD can also lead to severe depression, and suicide. Symptoms may appear
within months of the traumatic event or be delayed for years. While there is no cure for PTSD,mental
health experts believe early identification and treatment of PTSD symptoms may lessen their severity and
improve the overall quality of life for individuals with this disorder.
The utility of medical marijuana in mental health conditions is expanding. Research on the
neuroanatomical and electrophysiology of the cannabinoid Receptor (CB1) has proven that this receptor
acts to inhibit the release of classical neurotransmitters. This research shows that the role of cannabinoid
signaling to different regions of the limbic and nervous systems affect movement, memory, anxiety, pain
and smooth muscle contractility. (Elphik and Egertova, 2001), thereby paving the way for further studies
on Multiple diseases. CB1 affected insomnia nightmares, chronic pain, anxiety, harm reduction and other
indications (Cameron, 2014).
Neuroimaging studies have demonstrated significant neurobiological changes in patients
suffering from PTSD. The amygdala appears to be hyper-reactive to trauma-related stimuli, presenting as
an exaggerated startle response. Flashbacks are believed to be related to a failure of higher brain regions,
(the hippocampus and the medial frontal cortex), from dampening the exaggerated symptoms of arousal
and distress that are mediated through the amygdala in response to remainders of the

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Susan DeRosa | PSY662H1 BAY PATH UNIVERSITY COUNSELING THEORY & PRACTICE
The CB1 receptor has been shown to activate in the hippocampus and the amygdala and may
explain the relationship between PTSD symptomology and marijuana use among veteran populations
(Neumeister et.al. 2013, Bonn-Miller 2007 Bonn-Miller 2011).
The specific symptom relief for insomnia, restlessness,anxiety, and depression have been
reported by marijuana users (Farris, 2014; Bonn-Miller 2007; Bonn-Miller 2011; Chaite, 1990, Hsaio et
al. 2012; Numberg et al. 2011). These studies support the belief that individuals who have been exposed
to trauma and related PTSD symptoms benefit from the use of marijuana in reducing unpleasant
experiences. Marijuana usage has been shown to positively correlate to relief of intrusion and arousal
experiences (Earlywine and Bolles, 2014), reduced depressive symptoms, particularly cognitive-affective
symptom features,(Farris, 2014), and less sleep disturbances for military veterans with PTSD diagnoses.
Some studies associated the use of marijuana as an avoidant function to the trauma. (Bonn-Miller 2007;
Bonn-Miller 2011, Bordieri 2014, Cougle 2011)
Combat-exposed veterans with PTSD who reported poor quality of sleep and sleep disturbances
had an increased use of marijuana and increased symptom relief. Veterans who use marijuana appear to
use more as the magnitude of PTSD symptoms increase. Additionally, as their expectations of marijuana-
induced symptom relief increases,so does their usage. Some research indicated that the expectation of
symptom relief could prove useful in explaining links among symptoms and anticipated effects.
When compared to Military veteran control subjects without PTSD,those with PTSD reported
significant increases in the use of marijuana to cope. They also reported a higher severity of withdrawal
from marijuana, and increased craving for marijuana. The severity of PTSD symptoms were positively
associated with reduced coping skills, heightened cravings for marijuana, marijuana relapse and a return
of symptoms of nervousness and anxiety (Bonn-Miller 2011). These results emphasize the importance
of keeping PTSD treatments and potential negative effects of marijuana to a minimum.

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Susan DeRosa | PSY662H1 BAY PATH UNIVERSITY COUNSELING THEORY & PRACTICE
There is abundant scientific literature supporting the association between PTSD and substance
use. Individuals diagnosed with significant PTSD symptoms had a higher incidence of substance use
including prescription sedatives, opioids, and cocaine when compared to other patients seeking marijuana
for the first time (Bohenert et al., 2014). Although veterans with PTSD symptoms have been shown to
benefit with marijuana usage, more research is necessary to better understand the relationship between
marijuana use and PTSD longitudinally.
Research has supported exploration of the use of marijuana as treatment for psychiatric disorders
such as PTSD,OCD,and anxiety (Neumeister, 2013) but more research is needed before healthcare
professionals will safely prescribe this type of medication. The marijuana plant itself has been studied in a
limited number of clinical trials (Hazekamp, 2010), and need additional future research before being used
as a first line therapeutic option. In order to enroll participants in large clinical trials barriers to large
clinical trials such as the failure of federalacceptance of marijuana, lack of anonymity, and the fear of
being released from military service if diagnosed with PTSD have to be ameliorated. Furthermore,
additional research investigating the correlation and mechanism of the CB1 Receptor and PTSD
symptomology is warranted.

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Susan DeRosa | PSY662H1 BAY PATH UNIVERSITY COUNSELING THEORY & PRACTICE
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