300 people are being sought from across Australia in what will be a 12-month study investigating the role of medicinal cannabis on people suffering Post-Traumatic Stress Disorder (PTSD). 

Healthcare professionals along with public and private organisations are constantly exploring new and better ways of managing the condition, especially following recent media reports on the impact of returned servicemen and servicewomen from our armed forces. Medicinal pharmaceutical-grade cannabis is being accepted as one such option.
 
PTSD is the second most common mental health disorder after depression.1  About 12% of Australians will experience PTSD2 in their lifetime with as many as 800,000 Australians suffering from the condition at any given time, often going undiagnosed in children and teenagers.1 Single or repeated exposure to traumatic events can cause the development of PTSD.2 It is thought these events cause the amygdala, the part of the brain responsible for emotional processes, to become overactive and hence maintaining the condition.3
 
“Any traumatic event has the potential to cause PTSD, with a lot of people not realising that serious car accidents are actually the leading cause of PTSD in Australia” says Michelle New, CEO of Australian Resource Centre for Post Traumatic Stress Disorder. “It is important that people exposed to trauma, especially repeated trauma, seek help.” Other Traumatic events include4:

• Sexual or physical abuse
• threat of death
• serious injury, including car accidents which are the leading cause of PTSD in Australia1
• viewing or handling human remains
• seeing someone badly injured or killed
• interpersonal violence such as being mugged or sexually assaulted
• being unable to respond to a threatening situation
• witnessing human suffering on a large scale

 
Some occupations, such Australian Defence Forces (ADF), have higher exposure to traumatic events. The ADF reports about 90% of ADF members have experienced at least one potentially traumatic event at some time in their life, compared to 73% of people of a similar age and employment in the general Australian community.5 Approximately 8.3% of ADF members will have experienced PTSD in the last 12 months which is 3.1% higher than the general Australian community (5.2%). Also, ADF males have higher rates of PTSD compared with the general community (8.1% versus 4.6%), with research indicating that PTSD occurs at the same rate for those deployed and not deployed.  
 
Each person with PTSD will respond differently.4, 6 Symptoms can range from subtle changes in day-to-day life, withdrawal and numbness to distressing flashbacks or physical symptoms.4,6 The onset of the symptoms can appear soon after the event or appear years later.6 Some symptoms of PTSD include:4, 6

• Re-experiencing the trauma through ‘flashbacks’, nightmares or reminders of the trauma
• Avoidance, including avoiding reminders, staying away from places or people that trigger memories, feeling numb
• Negative moods and thoughts including depression, feeling hopeless, anxiety, intense worrying, anger or guilt, emotional detachment, no longer finding joy or enjoyment
• Increased arousal which can result in disrupted sleep or insomnia, poor concentration, being easily startled
• Agitation and negative changes in behaviour

 
80% of people with long standing PTSD develop anxiety disorders, depression and/or substance abuse which can lead to serious addictions.4 Other effects of long-term PTSD can include:4, 6

• Social and occupational impairment
• Physical morbidity
• Health and economic burden
• Suicide

 
A range of psychological and pharmacological interventions are currently used in the treatment of people with PTSD.6 However, a large proportion of patients fail to respond to these medications.7,8 Combat PTSD is currently regarded as less responsive to standard treatments than single-event civilian trauma-associated PTSD.7 According to research there is also a gap in treatment options available to treat the maladaptive cognitive features of PTSD and/or to prevent its development.8
 
Emerging evidence indicates medicinal cannabis may be suitable for PTSD, by possibly simultaneously treating the emotional and cognitive symptoms.8 Medicinal cannabis may reduce the strength of traumatic memories, “calming” the amygdala and making it easier for individuals with PTSD to sleep and causing them to feel less anxious when experiencing flashback memories.9,10
 
One non-psychoactive constituent of medicinal cannabis, CBD, is gathering momentum in its role for mental health conditions, including PTSD. In one study researchers note “that CBD may offer therapeutic benefits for disorders related to inappropriate responses to traumatic memories”3 As CBD effects different stages of aversive memory processing it holds potential as a pharmacological adjunct to psychological therapies for PTSD.3
 
This study, which aims to examine the effects of a specific medicinal cannabis extract (ECs315) in PTSD patients with inadequate response to conventional treatments, has been approved by the National Human Research Ethics Committee. Applied Cannabis Research, an Australian Contract Research Organisation currently undertaking a range of studies in the medicinal cannabis field, will conduct the study. Dr John Barlow, principal researcher at Applied Cannabis Research commented “Through the TGA, Australia has a stringent medical compliance framework for medicinal cannabis that requires precise dosing and monitoring of patients, making it an ideal location for this type of research. We hope to add to the increasing body of knowledge about medicinal cannabis and the potential for benefit to patients suffering from the effects of traumatic experiences”. 
 
Patients will be treated exclusively through Cannabis Access Clinics  with centres across Australia through a shared-care medical model. For eligible patients in remote or regional areas there will be the opportunity to use “Tele-Health” to participate.
 
Dr. Nijhawan, Medical Director for Cannabis Access Clinics, is the key investigator for the study. “We have first-hand experience treating symptoms of PTSD and seeing the positive effects that medicinal cannabis can have on patient outcomes, he said. “This study will provide valuable insight into how medicinal cannabis is being used and its effect on patient outcomes. It will help build on existing evidence, and to support further research and clinical applications. CBD has fewer side effects than the pharmacological therapy currently used, even at high doses.”
 
A high CBD medicinal cannabis, MediCablis 5% CBD ECs315, by Australian company BOD AUSTRALIA will be used in the study.  The pharmaceutical-graded MediCabils 5% CBD ECs315 is produced to strict pharmaceutical standards ensuring the highest quality, and phytochemical consistency and reliability.
 
MediCabilis 5% CBD ECs315 oil contains a unique full-spectrum Cannabis sativa extract named ECs315, cultivated to provide high CBD and other cannabinoids but low THC. Each mL of oil provides 50mg CBD and less than 2mg THC. ECs315 is also organically grown and GMO-free.
 
Bod Australia CEO Jo Patterson has welcomed this important study. “Post-Traumatic Stress Disorder is widespread and debilitating on a global scale. This study will provide valuable insight into how medicinal cannabis is being used and its effects on patient outcomes.”
 
The study is open to all sufferers of PTSD including those working in careers where PTSD is a serious concern including but not limited to armed forces, law enforcement and emergency services.  Patients will bear standard treatment costs for participating in the study, although they will be eligible for rebates through Medicare and, in some cases, private insurers.
 
The Australian Resource Centre for Post Traumatic Stress Disorder provides information for both sufferers and their support network on PTSD and its management. The Annual PTSD Awareness Walk on 29th June 2019 in the Gold Coast aims to help raise awareness and demonstrate support.
 
PTSD sufferers can register their interest online at www.bodaustralia.com.au. 
                                                
References:

1. Brown, M. Post-Traumatic Stress Disorder affects 800,000 Australians, new research suggests. ABC News. 27 Aug 2013. abc.net.au
2. SANE Australia. Post-traumatic stress disorder (PTSD). sane.org
3. Bitecourt R, Takahashi R. Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials, Front Neuroscience, 2018; 12:502 ncbi.nlm.nih.gov
4. Health Direct. Symptoms of PTSD. healthdirect.gov.au
5. Australian Government Department of Defence. Post-Traumatic Stress Disorder. defence.gov.au
6. Australian Government. NHMRC. Australian Centre for Posttraumatic Mental Health. Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. secasa.com.au
7. Koek. R. Treatment-resistant PTSD. 2017. psychiatrictimes.com
8. Trezza V, Campolongo P. The endocannabinoid system as a possible target to treat both the cognitive and emotional features of post-traumatic stress disorder (PTSD). Front Behav Neurosci. 2013;7:100. Published 2013 Aug
9. Passie T, Emrich HM, Karst M, Brandt SD, Halpern J. H. Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence. Drug Test. 2012; Anal. 4: 649–659 onlinelibrary.wiley.com
10. Neumeister A. The endocannabinoid system provides an avenue for evidence-based treatment development for PTSD. Depress. Anxiety 2013. 30 93–96. 10.1002/da.22031