Clinical Outcomes and Changes in Concomitant Medication Use Following Initiation of Medical Cannabis Treatment in Patients with Post-Traumatic Stress Disorder: A Six-Month Prospective Cohort Study

Lihi Bar-Lev Schleider, PhD
Tikun Olam

Co-authors: Lihi Bar-Lev Schleider¹, Ilya Reznik², Ben Amit³˒⁴, Vered Hermush⁵˒⁶
¹Tikun Olam, ²MaReNa Diagnostic and Consulting Center, ³Tel Aviv University, ⁴Tel Aviv Sourasky Medical Center, ⁵Laniado Hospital, ⁶Technion School of Medicine

Background: Post-traumatic stress disorder (PTSD) is a chronic psychiatric condition frequently accompanied by pain, impaired quality of life, and extensive use of psychotropic medications. Although medical cannabis is increasingly used by patients with PTSD, prospective data describing its clinical outcomes, safety, and impact on concomitant medication use remain limited.

Objective: To evaluate six-month changes in PTSD-related symptoms, pain intensity, quality of life, concomitant medication use, and safety following initiation of medical cannabis treatment in patients with PTSD.

Methods: This prospective observational cohort study included patients initiating medical cannabis treatment for PTSD. Participants completed standardized questionnaires before treatment initiation and after six months of treatment. Outcome analyses included patients who completed the relevant six-month follow-up questionnaire, with denominators varying according to outcome-specific data availability. Outcomes included PTSD-related symptoms, pain intensity, quality of life, changes in concomitant medication use, and adverse events.

Results: A total of 870 patients initiated medical cannabis treatment. Outcome analyses included patients who completed the relevant six-month follow-up questionnaire (up to n=595, depending on outcome-specific data availability). The proportion of patients reporting intrusive memories on a daily or frequent basis decreased from 63.2% at baseline to 41.7% after six months, while rage attacks on a daily or frequent basis declined from 58.2% to 22.1%. Mean pain intensity (VAS 0–10) decreased significantly (p<0.001), accompanied by a significant improvement in patient- reported quality of life (5-point Likert scale, p<0.001). Dose reduction or treatment discontinuation was most frequently observed for opioid analgesics (58.7%), hypnotics and sedatives (48.9%), anxiolytics (44.7%), and antidepressants (42.2%). Overall, 29.0% of patients reported at least one adverse event. The most commonly reported adverse events were increased appetite (6.5%), dry mouth (6.2%), and dizziness (3.6%).

Conclusions: Medical cannabis treatment was associated with clinically meaningful improvements in PTSD-related symptoms, pain intensity, and quality of life over six months, accompanied by reductions in the use of several classes of concomitant medications. These findings suggest a potential role of medical cannabis as part of acomprehensive treatment approach for PTSD and warrant further studies to confirm these observations.