Medical Cannabis for Chronic Posttraumatic Stress Disorder in Dutch Veterans: A Health Care Evaluation

Abstract

Introduction: Medical cannabis has emerged as a promising treatment for Posttraumatic Stress Disorder (PTSD), particularly among veterans. Given the high prevalence of PTSD in this population and the limited availability of effective therapeutic options, medical cannabis has garnered increased interest. However, evidence remains scarce endorsing its efficacy and patients' experiences with this treatment. Method: To gain more insight into patients' experiences with medical cannabis, we interviewed 18 Dutch veterans diagnosed with chronic PTSD who were prescribed off-label medical cannabis for symptom relief at an outpatient clinic in the Dutch Military Mental Health Service. The interviews were recorded and transcribed verbatim, followed by a framework analysis with thematic coding. Results: A group of 18 patients turned to medical cannabis as an alternative to traditional treatments due to persistent symptoms iof PTSD. Of these, 15 continued using the Bediol strain, primarily before bedtime to aid sleep. They reported significant improvements, including increased peace of mind and reduced irritability. Although patients expressed satisfaction, they often asked assistance in dosage and reimbursement. Despite initial reservations from some family members, there was notable support, signaling a changing perception of medical cannabis through increased education. However, a few patients still faced lingering stigma. Through the analysis, five overarching themes were identified: (1) assessment phase, (2) intervention phase, (3) termination phase, (4) access and availability, and (5) social support. Conclusion: Based on the data collected, we advocate for the continued prescription of medical cannabis, as most of the interviewed patients reported positive effects, including alleviation of core symptoms like sleep disturbances, irritability, and hyperarousal. Secondly, we recommend the continued reimbursement of medical cannabis due to its positive impacts, as many patients expressed potential financial hardship if this reimbursement were halted. Furthermore, we propose the appointment of a cannabis coach to provide patient-centered care. Reliable information on cannabis use is often challenging for patients to access, and proper use, including dosage, strain, cannabidiol (CBD) to Tetrahydrocannabinol (THC) ratio, and timing of administration, is essential to ensure optimal benefits and minimize risks. Lastly, we emphasize the necessity for further research, including longitudinal studies and randomized controlled trials, to explore individualized treatment approaches that work best under specific conditions. Greater clarity on dosages and product selection is also essential to minimize confusion and potential over- or under-consumption risks. Overall, these recommendations can guide the advancement of medical cannabis treatment for chronic PTSD in veterans, enhancing patient outcomes and paving the way for evidence-based practices.