Veterans & PTSD(Post Traumatic Stress Disorder): Medical Cannabis, Top 3 Terpenes, Indica vs Sativa. Compare Smoking vs Ingesting. Role of CBD and THC.

Dr. Jagmeet Sethi, MD, explains how to choose the best cannabis strains, Indica vs Sativa, for veterans with PTSD(Post Traumatic Stress Disorder). Selecting the best terpenes that will relieve PTSD symptoms. Comparing Smoking vs Vaping vs Ingesting cannabis for PTSD symptom relief. Role of CBD, Cannabidiol oils in PTSD.

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This blog is on PTSD and veterans and how PTSD is treated with cannabis, medical cannabis and the veteran population. This information is based on the thousands of patients I've seen in the last seven years. and it doesn't apply to all patients with PTSD because there's so much individual variability.

The first part I'm going to talk about is selecting strains that will work better for PTSD symptoms.

The second part of this blog is about smoking versus ingesting cannabis for PTSD symptoms and how it differs.

The last part will be more about CBD and how CBD, Cannabidiol, plays a role in PTSD patients.

 

Selecting cannabis strains for PTSD symptoms in veterans.

Cannabis does help PTSD symptoms significantly with sleep and nightmares. But it also helps patients during the day deal with their anxiety and the symptoms related to PTSD.

The symptoms vary among individuals, but overall, the benefits of cannabis are quite substantial in this patient population, especially in the veteran patient population. The most common way cannabis is used in this population is by smoking. I'm going to discuss specific strains related to smoking, not ingesting cannabis. When choosing strains for smoking cannabis, it's best to choose strains with more THC (Tetrahydrocannabinol) in them because THC seems to help with PTSD symptoms.

Most patients already know high THC cannabis strains work best to relieve PTSD symptoms related to anxiety, sleep, irritability, and anger.  Most patients will select indica strains because Indica strains are more calming and help sleep and other symptoms of PTSD.

Sativa strains, on the other hand, are stimulating and can make anxiety symptoms worse. And hybrids strains are in between Sativa and Indica. Some people like the hybrid strains. It just depends on the symptoms. Some PTSD patients do better with sativa strains, which is counterintuitive. But there is, I would say, about 10 to 20% of PTSD patients in the veteran population that like Sativa strains more, but 80% will like Indica strains. A few like hybrid strains, but it seems more polarized between more Indica than Sativa for PTSD symptoms.

Strain selection, other than Indica, Sativa, or Hybrid, also depends on the THC amount. Most of the time, the THC amount is 25 to 30%, and CBD is less than 1%.

Terpenes are important in cannabis strain selection for PTSD symptoms. Terpenes are the taste and smell of cannabis. In the cannabis plant, terpenes attract insects or defend again predators.

The top 2 terpenes in cannabis for PTSD are Myrcene and Limonene.

Myrcene is the most found terpene in cannabis strains in Canada. Myrcene is sedating, calming terpene. Myrcene is a terpene in cannabis that is calming, helps sleep, reduces anger and helps pain.

Limonene is an uplifting terpene found in oranges and other citrus fruits. It improves mood.

A combination of terpenes gives different results to mood and the level of sedation or uplifting experience. For example, a combination of Myrcene and Limonene in a cannabis strain will have calming effects from Myrcene but also uplifting effects from limonene.

Another terpene that isn't found that often in the cannabis in this combination is Pinene.

Pinene is an important terpene for mood as well. If you find a cannabis strain with a combination of terpenes: Myrcene, Limonene and Pinene, that would be great.

Another commonly found terpene is Caryophyllene, a more anti-inflammatory terpene, and that's more for patients with arthritis or pain symptoms and not so much for PTSD symptoms.

I think selecting the terpenes is important in treating PTSD symptoms in veterans. One way to figure out what terpenes are best for PTSD is to record the terpenes in the cannabis strains you're already taking. Once you record the terpenes in the cannabis during your taking and you journal it, you'll find out which strains work better for you.

If specific terpene combinations work better for you,  then you can choose terpenes based on what works for you best individually rather than what works for everybody else.

2. The second part of this blog is about inhaling cannabis for PTSD in veterans.

Most patients will smoke cannabis for PTSD symptoms in the veteran population because that works best for them. Vaping cannabis flower, meaning grinding up the flower and putting it in a vaporizer, is the lowest risk option because you don’t have products of combustion like in smoking. But unfortunately, vaping flower doesn't work as well for PTSD populations and veterans. And smoking works better in terms of symptom relief. This is pretty clear now after talking to so many thousands of patients. And then the last option, of course, is to vape distillates or extracts/oils/vape pens. Vaping oils is the riskiest option because we don't know what the long term risks to the lungs are with that option. Also, vaping oils are 80% THC, so these are very high amounts of THC.

And once you get used to those high amounts of THC, it's hard to go back to smoking the flower, which is like 20 or 25% THC. Most PTSD patients will tell you if they've been vaping oils for a few years, that it's hard for them now to take the flower because it just doesn't work as well. The risk of overuse also lies in vaping these oils over time, but there are some PTSD patients for whom the flower is not enough, or they're using large amounts of flower in the day, and vaping the oils makes more sense for them.

It's not a one-size-fits-all category. There are some PTSD patients in the veteran population where vaping the oils is the only way they can function, and that's fine because you have to get through the day. It makes sense for them.

So those are the categories. And it is not all black and white. this is a very special population with PTSD and veterans. I'm just referring to this specific population, not  PTSD in the general population.

Ingesting cannabis (oils, capsules, edibles) in PTSD in veterans.

Ingesting oils or edibles doesn't seem to work in PTSD as well as inhaling cannabis for some reason.

Ingesting helps symptoms in about 10 to 20% of the population in PTSD in veterans. Some veterans with PTSD do ingest cannabis and edibles or oils, and it does help them somewhat. There is a synergy of ingesting with inhaling to reduce the amount inhaled. It's a harm reduction strategy. Most of the cannabis strains ingested are higher in THC, not CBD (Cannabidiol).

3. What is the role of CBD or Cannabidiol in PTSD in veterans?

Unfortunately, CBD does not work very well in the PTSD in veterans population. Again, this doesn't apply to everybody. I mean, for 80% of the PTSD patients in the veterans population, CBD does not help them.

Maybe 10% to 20% of PTSD patients will benefit from CBD. They will take CBD oil during the day or CBD: THC oil in a 1:1 ratio.

I hope that helps understand PTSD in the veterans’ population and symptom control. And I'll do another blog on how cannabis is covered for veterans. in Canada. Veteran Affairs covers cannabis in some cases and will pay for cannabis for up to 3 grams a day.

Dr. Jagmeet Sethi MD, Medical Cannabis Treatment

Dr. Jagmeet Sethi MD

Sethi Cannabis Clinic

Website: sclinic.ca

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