Psy-Q: Should behavioral and mental health clinicians be concerned about cannabis use in patients with PTSD, and, if so, what is the best way to counsel patients about marijuana use? Aaron Weiner PhD, ABPP, answers.

Aaron Weiner, PhD, ABPP

Answer­: Yes, there is cause for concern, according to Aaron Weiner, PhD, ABPP. “From a therapeutic standpoint, there is a tremendous amount of confusion regarding what THC is good for, what it’s not good for, and what we actually have no evidence for,” Dr. Weiner explains.

He points out that PTSD is “one of the most misunderstood conditions from a public and policy perspective, as it’s included on the list of qualifying conditions for medical marijuana in many states.” Yet marijuana can actually make things worse for people PTSD. “By using marijuana to cope with symptoms, people are opening the door to becoming addicted on a substance that isn’t actually solving the problem,” he adds.

Therefore, Dr. Weiner recommends that clinicians give patients “accurate information about the nature of PTSD, and then a full picture of what different paths forward look like.” Such approaches may include, for instance, Cognitive Processing Therapy, Prolonged Exposure Therapy, or Eye-Desensitization Movement and Reprocessing. “These therapies can actually solve the root cause of the problems that are fueling the PTSD symptoms, as opposed to just treating the symptoms and not getting at the core issue.”

If a patient with PTSD is using cannabis recreationally, Dr. Weiner suggests that clinicians “examine whether or not their use is actually occasional, recreational, and social, or more like daily or near-daily self-medication. If it’s the latter, it could interfere with psychological treatments that could actually resolve the symptoms of PTSD in a more permanent way,” he explains. (Truly occasional use, not for treating PTSD, is less concerning, he adds.)

“If a patient asks for authorization to use marijuana for PTSD, I recommend physicians redirect the patient towards different treatment options that are supported by science.  Marijuana may numb PTSD symptoms in the short-term while intoxicated, but it only creates more problems for the patient in the long run,” Dr. Weiner stresses.

He also points out that when meeting with a patient for the first time, clinicians should always complete a thorough assessment that includes behavioral health considerations such as active (or historical) substance use.  “Particularly for PTSD, where experiential avoidance is part of the pathology, asking questions about use patterns for all addictive and intoxicating substances is important,” he adds.

He encourages clinicians to stay up-to-date on what symptoms medical marijuana has been shown to effectively treat, and recommends these resources:

“It’s also helpful to acquaint yourself with medications that react poorly to THC in the body, as your patient may not have disclosed his or her THC use to his medical care team, which could affect their prescribing choices,” he adds.

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Last Updated: Apr 9, 2021