Medical Cannabis for the Management of PTSD-associated Nightmares

Medical Cannabis for the Management of PTSD-associated Nightmares

Post-Traumatic Stress Disorder (PTSD) is a psychological condition that is thought to affect up to 3.5% of the US population every year according to the American Psychiatric Association. PTSD may occur in people who have experienced or witnessed a traumatic event.

Those who suffer from PTSD may experience vivid flashbacks and nightmares, intense negative emotions, and strong reactions to everyday noises long after the traumatic experience is over. Managing these symptoms can be difficult and is often attempted with a combination of medication – such as antidepressants – and talking therapies.

Medical cannabis has also been implicated as a potential therapeutic option for the management of PTSD. The synthetic cannabinoid, Nabilone, originally marketed as an antiemetic, has been assessed for its potential to aid nightmare suppression.

Nabilone has been used for PTSD nightmares at the Canadian Forces Operational Trauma and Stress Support Centre (OTSSC) in Ottawa for over a decade. However, there are limited published reports of the ongoing experiences of patients who have been prescribed Nabilone for PTSD nightmare suppression.

To address this gap in the literature around cannabinoids and PTSD nightmares, a recently published study aimed to gather data from PTSD patients who had continued on Nabilone.

What were the methods?

Researchers aimed to understand the ongoing effects of nabilone in patients who continued with the treatment. The research aims included gauging what happened to doses, the therapeutic effects, and the side effects of nabilone over an extended period. This data was collected through anonymous online surveys completed by active military members who had been diagnosed with PTSD and experienced chronic nightmares.

The survey consisted of 22 multiple-choice questions along with an open-ended question about the participants’ personal experiences while taking nabilone. Participants were not obliged to complete all questions – this resulted in a variable number of responses.

Results of the Study

From an estimated 150 patients who were prescribed nabilone at the Ottawa OTSSC, 60 patients completed the survey. All of the participants were receiving evidence-based treatment for PTSD, psychotropic medications, and psychotherapy. Of the 60 patients, 53 were still using nabilone.

Treatment duration varied from less than six months to more than two years, with half of the patients having taken nabilone for over a year and the other half for less than a year. Researchers noted that dosages tended to be higher among patients who had been on treatment for longer.

Efficacy of Nabilone for Nightmare Suppression

Respondents reported an overall improvement in the prevalence of nightmares, with no patients reporting that their symptoms were unchanged or worsened since the start of treatment. The majority (73%) reported a significant improvement in symptoms, with complete, or near-complete, remission of all symptoms. Of the remaining patients, the majority reported a moderate improvement while a small number experienced minimal or slight improvement.

Some respondents (52) also reported additional benefits to nabilone treatment. This included 40 patients who reported fewer or no night sweats; 33 reported better sleep; and 19 reported fewer or no flashbacks. Better mood was reported by 13 respondents and 8 individuals were able to decrease or stop other medications. In addition, a small number of respondents reported better pain control (6) and reduced anxiety (3).

Side Effects Associated with Nabilone Treatment

This particular study found that the majority of patients were not concerned about nabilone’s association with cannabis’ recreational use. In addition, when asked if their use of nabilone had affected their ability to drive, the majority of respondents answered “no”. None of the respondents who reported a driving impairment were required to end their treatment.

Discontinuing Nabilone Treatment

Seven patients completed the survey despite ending their treatment with nabilone. In addition, 13 patients had stopped treatment to determine whether they still needed it. Twelve of the 13 patients that ceased nabilone treatment reported that they experienced a period of success before the recurrence of nightmares. On average, nightmares recurred seven days following cessation of treatment.

When patients restarted treatment, they were able to achieve nightmare suppression with similar dosages as prior to cessation. These findings suggest that continued nabilone treatment may be needed for effective suppression of nightmares associated with PTSD. The recurrence of nightmares following cessation of treatment may suggest that nightmares are chronic and require a longer treatment duration or other therapeutics. However, as not all patients experienced the recurrence of nightmares, reduction or cessation of nabilone may be possible.

Limitations of the Findings

The authors of this study acknowledge a number of limitations to their findings, including the small patient sample and the survey format. This survey was focused on active military personnel and it is unclear whether these findings can be generalised to the civilian population treated for PTSD nightmares.

It is also noted that some respondents had continued to engage in additional traditional therapies. These included medications and psychotherapies which may have had some effect on nightmare reduction. However, the findings of this study offer promising preliminary evidence for the efficacy of nabilone as a treatment for PTSD nightmares.