Using marijuana for PTSD is the newest controversial topic in the media and as a psychiatrist I wanted to discuss why I disagree with using marijuana for PTSD or any psychiatric condition for that matter.  I spoke to other psychiatrists who agree thatusing marijuana for PTSD is absolutely the wrong way to proceed at this point.  As a physician I would be thrilled to have another option in my armamentarium that helped my patients, however I have to be convinced it is completely safe and has no chance of causing any harm to my patient.

Given the intense media coverage of ptsd and the suffering it causes our soldiers and their families it is understandable why people want a better solution but using marijuana for PTSD is not it.   The problem is that a “quick fix” like smoking marijuana means people will more likely ignore other well studied and more safe treatments such as cognitive behavioral therapy, psychodynamic therapy and FDA approved medications.  Although having less evidence than CBT and medications, EMDR is also an option with evidence for its efficacy and is completely safe. Due to the fact some of these treatments often take months to work, people will make the choice to use marijuana for PTSD and not even consider these great options.  I am by no means saying that these treatments work for everyone, and I agree we as a field need more effective options that work more quickly but from a physicians view, these options have to be well studied and safe.  Unfortunately given the legal nature of marijuana and smoking as a delivery system, studies are less likely to happen.  Smoking marijuana for PTSD unfortunately brings the risks of increasing chance of lung cancer and disease as well as erratic delivery of the marijuana depending on each persons anatomy and tecnique. As a physician, this means I am unable to know or control the effective dose a patient is taking. The potency of the marijuana also varies largely from plant to plant and source to source;adding further variability to the situation of smoking marijuana for PTSD.

Another concer regarding using marijuana for PTSD involes the effects it has physiologically and psychiatrically.  First off, one of the potent chemicals in marijuana is THC (tetrahydrocannabinol) which exerts potent physiological effects on multiple aspects of the brain.  There have been hundreds of studies to evaluate the effects of marijuana on individuals and consistently the studies show that marijuana causes symptoms that are virtually indistinguishable from many symptoms of schizophrenia.  Schizophrenia is largely known as a disorder of extreme hallucinations, delusions and paranoia-the “positive symptoms”.  However an equally debilitating part of schizophrenia include the “negative symptoms” which includes extreme apathy (complete lack of emotion or caring), low motivation, fatigue, cognitive slowing and dulling (similar to what happens in dementia) and it is these symptoms that tend to be much more debilitating than the positive symptoms of schizophrenia.

Now why I am talking about schizophrenia? Well in short-smoking marijuana for PTSD or any other reason often will give someone almost the same symptoms as someone suffering from schizophrenia! Yet people are asking physicians and psychiatrists to prescribe this to people?  Now imagine our young soldiers returning from battle and having their whole life ahead of them, families to love and support and their health intact.  The last thing these people or any person needs is to be transformed into a “zombie” which is exactly what marijuana will do.  Sure “numbing” emotions technically “helps” the symptoms of PTSD or any other psychiatric disorder in terms of no longer feeling emotional pain.  However is sentencing someone to go through life as an apathetic, unmotivated, fatigued and cognitive slowed person the right thing for a psychiatrist to do?

The other concern if marijuana for PTSD is embraced is where the line ends? If someone is depressed do we give them medical marijuana to smoke?  Sure,some drugs work well for psychiatric disorders in the very short term: cocaine and meth treat depression VERY effectively for a few hours, so do we start to use cocaine for depression?  This is the road we go down if we start to implement drugs such as marijuana for PTSD or other psychiatric disorders.

Until there is more evidence for both efficacy and safety, more consistent regulation of potency and ingredients in each source of marijuana as well as a safer delivery system such as a metered dose inhaler rather than having to smoke a cigarette, psychiatrists are unlikely to embrace using marijuana for ptsd or any other psychiatric disorder.

Michael Yasinski M.D