Biology:Cannabis use and trauma

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Short description: Contribution trauma plays in promoting use and abuse of cannabis


Cannabis use and trauma is the contribution that trauma plays in promoting the use and potential abuse of cannabis.[1] Conversely, cannabis use has been associated with the intensity of trauma and PTSD symptoms.[2][3] While evidence of efficacious use of cannabis is growing in novelty, it is not currently recommended.[4][5]

Frequency and intensity of symptoms

Individuals who have traumatic experiences have been found to have increased overall cannabis use and higher instances of cannabis use disorder (CUD), suggestive of problematic cannabis use.[6]  For example, veterans who identify as medicinal users have been shown to have a higher association with combat exposure, trauma related symptoms, and arousal when cued to situations, as well as overall cannabis use.[7]

Despite increased cannabis use in those with PTSD symptoms, a National Epidemiological Study with thousands of  participants based in the United States indicated lifetime PTSD was a weak predictor of lifetime cannabis use.[8][9][10] However, this study affirmed that for individuals who endorse cannabis use and trauma exposure, they are likely to have concurrent PTSD and CUD symptoms.[8][9][11] The strength of the association between heavy PTSD symptoms and CUD was stronger than that of CUD and other psychological disorders, namely depression, general and social anxiety, panic disorder, alcohol dependence, and personality disorders.[8] It is worth noting that this was done with older DSM-IV criteria, rather than the most current DSM-V, suggestive of possible shifts in diagnostic criteria used to gauge psychological and substance-related disorders.

Trauma as a motive

High use of cannabis has been associated with coping motives in medicinal cannabis users with PTSD symptoms.[2] In a longitudinal study of American female twins, trauma and psychological symptoms were significant predictors for cannabis initiation and cannabis use disorder (CUD).[12][13] Individuals with higher levels of life-threatening events, injury, or experiences of death were also more likely to initiate cannabis use during the emerging adulthood phase, with sexual abuse predicting cannabis use initiation before the age of 15 in African American women.[13] In European-American women, sexual and physical abuse, as well as major depressive disorder (MDD) predicted age of cannabis initiation, with development of a CUD being predicting more specifically by MDD and physical abuse.[13] Those with sexual trauma who initiate cannabis use prior to the age of 16, are also more likely to develop psychosis.[14]

In women military veterans, a higher proportion of cannabis users who had experienced childhood and adult sexual trauma, had higher levels Post-Traumatic Stress Disorder (PTSD) diagnosis when compared to those with no drug use.[15]   When controlling for PTSD symptoms and demographic factors, regular cannabis use was still significantly related to sexual trauma.[15] For sexual minority women, have indicated higher cannabis use, coping motives, and post-traumatic stress symptoms than heterosexual women.[16][17] This may suggest that for women, trauma symptoms may be more severe for those who belong to a minority status, and the necessity to cope is often met by increasing cannabis use. These findings corroborate the idea that increased cannabis use can also be driven by minority stress, which has also been related to increased trauma.[18][19]

Viability and use of cannabis as treatment

Emotion regulation and anxiety symptoms

Tetrahydrocannabinol (THC)

Post-traumatic stress symptoms are related to coping-related motives of cannabis use, especially for emotional regulation.[2] However, studies indicate that with regular cannabis using veterans, problems with emotion regulation can trigger panic symptoms, especially when trying to quit use.[20] Currently, it is indicated that psychoactive components of cannabis, tetrahydrocannabinol (THC) is not effective in treating emotion-regulation and anxiety-related symptoms.[21] Conversely, THC has been empirically related to an increase anxiety symptoms through impacts on neurological areas impacting serotonin, noradrenalin, GABA and glutamate.[21][22][23][24]

Cannabidiol (CBD)

When using cannabidiol (CBD) results have indicated a weakened emotional response to traumatic memories.[25] This effect is attributed to the presence of endocannabinoid receptors in the limbic system, including the amygdala, and the hypothalamus that CBD may impact.[25][26][27][28] These components' effect likely leads to the reduction of neuroendocrine and behavioral stress responses.[25][29] Altogether, a cumulation of research indicates cannabinoids can help with fear extinction and combating depression.[25] However, further studies are needed to validate the therapeutic potential of cannabinoids for emotion dysregulation and anxiety symptoms associated with trauma.[25]

Sleep

Tetrahydrocannabinol (THC)

While the psychoactive component THC, has been shown to reduce time to get to sleep, studies indicate disrupted circadian rhythms when using THC.[30][31] Furthermore, THC is shown to have a quicker development of tolerance to sleep-inducing effects.[32] It is worth noting that synthetic THC has also shown the same effects of developed tolerance to sleep latency effects.[33]

However, individuals diagnosed with high PTSD scores have endorsed the use of medical cannabis for sleeping.[34][35] Studies have found some evidence for using Naboline, a synthetic version of THC, has proven effective for decreasing the frequency of PTSD related nightmares without developing long-term tolerance.[36][37][38][39]

Cannabinol (CBD)

Novel research into cannabis suggests potential therapeutic effects of cannabinoids, specifically with higher doses of CBD, as opposed to lower doses, which can have an energizing effect.[31][40][41] In laboratory studies with rats, CBD has been shown to reduce sleep latency due to anxiety in REM sleep, with no negative changes to other aspects of sleep.[42][43]

References

  1. ↑ "Stress-related factors in cannabis use and misuse: implications for prevention and treatment". Journal of Substance Abuse Treatment 36 (4): 400–13. June 2009. doi:10.1016/j.jsat.2008.08.005. PMID 19004601. 
  2. ↑ 2.0 2.1 2.2 "Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event-exposed marijuana users". Journal of Traumatic Stress 20 (4): 577–86. August 2007. doi:10.1002/jts.20243. PMID 17721963. 
  3. ↑ "Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample". Psychology of Addictive Behaviors 29 (3): 633–8. September 2015. doi:10.1037/adb0000110. PMID 26415060. 
  4. ↑ "Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis". The Lancet. Psychiatry 6 (12): 995–1010. December 2019. doi:10.1016/s2215-0366(19)30401-8. PMID 31672337. 
  5. ↑ "Cannabis and Complex Posttraumatic Stress Disorder: A Narrative Review With Considerations of Benefits and Harms". The Journal of Nervous and Mental Disease 208 (8): 619–627. August 2020. doi:10.1097/nmd.0000000000001172. PMID 32433200. 
  6. ↑ "Regular past year cannabis use in women veterans and associations with sexual trauma". Addictive Behaviors 84: 144–150. September 2018. doi:10.1016/j.addbeh.2018.04.007. PMID 29684763. 
  7. ↑ "Medicinal versus recreational cannabis use: Patterns of cannabis use, alcohol use, and cued-arousal among veterans who screen positive for PTSD". Addictive Behaviors 68: 18–23. May 2017. doi:10.1016/j.addbeh.2017.01.008. PMID 28088054. 
  8. ↑ 8.0 8.1 8.2 "Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample". Psychology of Addictive Behaviors 29 (3): 633–8. September 2015. doi:10.1037/adb0000110. PMID 26415060. 
  9. ↑ 9.0 9.1 "Cannabis-related impairment and social anxiety: the roles of gender and cannabis use motives". Addictive Behaviors 37 (11): 1294–7. November 2012. doi:10.1016/j.addbeh.2012.06.013. PMID 22766487. 
  10. ↑ "Marijuana effect expectancies: relations to social anxiety and marijuana use problems". Addictive Behaviors 33 (11): 1477–1483. November 2008. doi:10.1016/j.addbeh.2008.06.017. PMID 18694625. 
  11. ↑ Zvolensky, Michael J.; Bonn-Miller, Marcel O.; Leyro, Teresa M.; Johnson, Kirsten A.; Bernstein, Amit (2010). Marijuana: An Overview of the Empirical Literature. New York, NY: Springer New York. pp. 445–461. ISBN 978-1-4419-0337-2. 
  12. ↑ Diagnostic and statistical manual of mental disorders : DSM-5.. American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. (Fifth ed.). Arlington, VA. 2013. ISBN 978-0-89042-559-6. OCLC 847226928. https://www.worldcat.org/oclc/847226928. 
  13. ↑ 13.0 13.1 13.2 "The association of specific traumatic experiences with cannabis initiation and transition to problem use: Differences between African-American and European-American women". Drug and Alcohol Dependence 162: 162–9. May 2016. doi:10.1016/j.drugalcdep.2016.03.003. PMID 27012434. 
  14. ↑ "Cannabis use and psychosis: re-visiting the role of childhood trauma". Psychological Medicine 41 (11): 2339–48. November 2011. doi:10.1017/S0033291711000559. PMID 21557896. 
  15. ↑ 15.0 15.1 "Regular past year cannabis use in women veterans and associations with sexual trauma". Addictive Behaviors 84: 144–150. September 2018. doi:10.1016/j.addbeh.2018.04.007. PMID 29684763. 
  16. ↑ "Sexual minority women and Cannabis use: The serial impact of PTSD symptom severity and coping motives". Addictive Behaviors 92: 1–5. May 2019. doi:10.1016/j.addbeh.2018.12.012. PMID 30553032. 
  17. ↑ "Daily-level associations between PTSD and cannabis use among young sexual minority women". Addictive Behaviors 74: 118–121. November 2017. doi:10.1016/j.addbeh.2017.06.007. PMID 28618391. 
  18. ↑ "Demographic Characteristics, Components of Sexuality and Gender, and Minority Stress and Their Associations to Excessive Alcohol, Cannabis, and Illicit (Noncannabis) Drug Use Among a Large Sample of Transgender People in the United States". The Journal of Primary Prevention 38 (4): 419–445. August 2017. doi:10.1007/s10935-017-0469-4. PMID 28405831. 
  19. ↑ "The application of minority stress theory to marijuana use among sexual minority adolescents". Substance Use & Misuse 50 (3): 366–75. February 2015. doi:10.3109/10826084.2014.980958. PMID 25493644. 
  20. ↑ "Difficulties in emotion regulation are associated with panic symptom severity following a quit attempt among cannabis dependent veterans". Anxiety, Stress, and Coping 28 (2): 192–204. 2014-07-18. doi:10.1080/10615806.2014.934228. PMID 25034429. 
  21. ↑ 21.0 21.1 "Cannabis and anxiety: a critical review of the evidence". Human Psychopharmacology 24 (7): 515–23. October 2009. doi:10.1002/hup.1048. PMID 19693792. 
  22. ↑ "5-HT1A receptors are involved in the anxiolytic effect of Delta9-tetrahydrocannabinol and AM 404, the anandamide transport inhibitor, in Sprague-Dawley rats". European Journal of Pharmacology 555 (2–3): 156–63. January 2007. doi:10.1016/j.ejphar.2006.10.038. PMID 17116299. 
  23. ↑ "Exploring the association between cannabis use and depression". Addiction 98 (11): 1493–504. November 2003. doi:10.1046/j.1360-0443.2003.00437.x. PMID 14616175. 
  24. ↑ "The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin". British Journal of Pharmacology 153 (2): 199–215. January 2008. doi:10.1038/sj.bjp.0707442. PMID 17828291. 
  25. ↑ 25.0 25.1 25.2 25.3 25.4 "Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence". Drug Testing and Analysis 4 (7–8): 649–59. 2012-06-26. doi:10.1002/dta.1377. PMID 22736575. 
  26. ↑ "Distribution of CB1 cannabinoid receptors in the amygdala and their role in the control of GABAergic transmission". The Journal of Neuroscience 21 (23): 9506–18. December 2001. doi:10.1523/jneurosci.21-23-09506.2001. PMID 11717385. 
  27. ↑ "Cannabinoid analgesia". Pharmacology & Therapeutics 95 (2): 127–135. 2002. doi:10.1016/S0163-7258(02)00252-8. PMID 12182960. 
  28. ↑ "Structural MRI findings in long-term cannabis users: what do we know?". Substance Use & Misuse 45 (11): 1787–808. September 2010. doi:10.3109/10826084.2010.482443. PMID 20590400. 
  29. ↑ "The role of the hippocampus in feedback regulation of the hypothalamic-pituitary-adrenocortical axis". Endocrine Reviews 12 (2): 118–34. May 1991. doi:10.1210/edrv-12-2-118. PMID 2070776. 
  30. ↑ "Delta9 -tetrahydrocannabinol increases brain temperature and inverts circadian rhythms". NeuroReport 12 (17): 3791–4. December 2001. doi:10.1097/00001756-200112040-00038. PMID 11726796. 
  31. ↑ 31.0 31.1 "Cannabis, Cannabinoids, and Sleep: a Review of the Literature". Current Psychiatry Reports 19 (4): 23. April 2017. doi:10.1007/s11920-017-0775-9. PMID 28349316. 
  32. ↑ "Response to Intervention for Middle School Students With Reading Difficulties: Effects of a Primary and Secondary Intervention". School Psychology Review 39 (1): 3–21. 2010-03-01. doi:10.1080/02796015.2010.12087786. PMID 21479079. 
  33. ↑ "Tolerance to effects of high-dose oral δ9-tetrahydrocannabinol and plasma cannabinoid concentrations in male daily cannabis smokers". Journal of Analytical Toxicology 37 (1): 11–6. 2013-01-01. doi:10.1093/jat/bks081. PMID 23074216. 
  34. ↑ "Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users". The American Journal of Drug and Alcohol Abuse 40 (1): 23–30. January 2014. doi:10.3109/00952990.2013.821477. PMID 24205805. 
  35. ↑ "The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD". Psychology of Addictive Behaviors 30 (7): 743–754. November 2016. doi:10.1037/adb0000210. PMID 27786514. 
  36. ↑ "Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation". Journal of Clinical Psychopharmacology 34 (5): 559–64. October 2014. doi:10.1097/jcp.0000000000000180. PMID 24987795. 
  37. ↑ "The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (PTSD)". CNS Neuroscience & Therapeutics 15 (1): 84–8. 2009. doi:10.1111/j.1755-5949.2008.00071.x. PMID 19228182. 
  38. ↑ "The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study". Psychoneuroendocrinology 51: 585–8. January 2015. doi:10.1016/j.psyneuen.2014.11.002. PMID 25467221. 
  39. ↑ "Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post-traumatic stress disorder". Clinical Drug Investigation 34 (8): 587–91. August 2014. doi:10.1007/s40261-014-0212-3. PMID 24935052. 
  40. ↑ "Hypnotic and antiepileptic effects of cannabidiol". Journal of Clinical Pharmacology 21 (S1): 417S–427S. 1981-08-09. doi:10.1002/j.1552-4604.1981.tb02622.x. PMID 7028792. 
  41. ↑ "Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults". Journal of Clinical Psychopharmacology 24 (3): 305–13. June 2004. doi:10.1097/01.jcp.0000125688.05091.8f. PMID 15118485. 
  42. ↑ "Effect of cannabidiol on sleep disruption induced by the repeated combination tests consisting of open field and elevated plus-maze in rats". Neuropharmacology. Anxiety and Depression 62 (1): 373–84. January 2012. doi:10.1016/j.neuropharm.2011.08.013. PMID 21867717. http://ntur.lib.ntu.edu.tw/bitstream/246246/245704/-1/index.html. 
  43. ↑ "Effects of acute systemic administration of cannabidiol on sleep-wake cycle in rats". Journal of Psychopharmacology 27 (3): 312–6. March 2013. doi:10.1177/0269881112474524. PMID 23343597. 



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