Twenty-three states and Washington, D.C., have new laws that allow the use of cannabis for medicinal purposes, thus spurring an increase in the use of the drug for a variety of medical conditions, including chronic pain, post-traumatic stress disorder (PTSD), epilepsy, sleep problems, nausea during cancer treatment, and more.
But the new policies have come before the proof: While anecdotes abound from patients attesting that marijuana provides some amount of relief for these types of conditions, there is little scientific data that speaks to whether, among whom, and how it may work.
Marcel Bonn-Miller, PhD, an adjunct assistant professor of Psychology in the department of Psychiatry, has been studying the effects of cannabis for 10 years and is one of many researchers looking to change that.
Marijuana for Sleep Problems
He recently published the first study, in the journal Addictive Behaviors, to examine what strains of cannabis and at what concentration patients prefer most for the management of sleep problems.
Marijuana comes in different strains, or species, the most common of which include the buds and leaves of the Cannabis sativa or Cannabis indica plants, or hybrids of both strains. The plant contains more than 500 chemicals, including delta-9-tetrahydrocannabinol (THC), the chemical responsible for most of marijuana's psychological effects. Some strains of cannabis can have as little as 0.3 percent THC by weight. Others contain up to 30 percent. The less THC the marijuana contains, the more the user must consume to produce the desired effects.
Of the 163 patients in the sleep study, many reported using cannabis for nightmares and insomnia. On average, they reported using the drug nearly twice a day over the previous month.
Smoking—via a rolled joint, glass pipe or water pipe (bong)—remains the most common way of ingesting marijuana for medicinal purposes in the U.S. It is one of the fastest and most efficient ways to deliver an optimum dose of the drug into the system. “Vaping” is also increasingly common. This is a process in which the cannabinoids are released in gas form through the application of heat and collected and inhaled. In addition, cannabis leaves can also be “baked in” to cookies, candies, power bars, popcorn and more. Ingestion of the drug in this way takes longer for it to reach its full effect.
Those who used sleep medications at a lower frequency used cannabis with higher concentrations of THC, a surprising finding since higher concentrations of THC have been shown to have a stimulating effect that can lead to poor sleep. The researchers surmised that perhaps some refrained from using this strain in the evening. There was no species preference found among those who used the drug for insomnia.
In contrast, those individuals using cannabis to reduce nightmares were more likely to use cannabis of the sativa species, which often contains lower levels of THC.
Marijuana as Treatment for PTSD
Bonn-Miller is also embarking on two additional studies to look at the drug as a solution for patients with PTSD. He recently received two grants totaling over $3.3 million from the Colorado Board of Health to begin this work.
“What this money has made possible is amazing,” Bonn-Miller said. “Most studies on the drug to this point in time have focused on its negative effects. All of the money Colorado has doled out has been for studies looking at whether the drug is helpful to patients,” Bonn-Miller said.
Colorado was the second state to officially legalize cannabis in 2012, behind the state of Washington. Tax records from Colorado reveal that the new law has sparked big business: Retailers sold $386 million worth of medical marijuana in the state and $313 million worth of the drug for recreational purposes in 2014.
Bonn-Miller’s first study will enroll 76 veterans with severe PTSD who will each receive two of four different strains of marijuana over the course of the study, at a quantity equivalent to two joints per day to smoke for symptom relief. Each participant then will submit daily observations and confirm that he or she followed protocols. The results will be compared by strain.
The second, larger study includes 150 participants in the Denver area with PTSD, half of whom have a history of marijuana use and are already using and purchasing the drug on their own. Each of these participants will be matched with a non-user with similar demographics and trauma histories. These two groups will be compared in terms of PTSD symptoms over the course of a year, with special attention paid to the impact of initiation (among initial non-users) and discontinuation (among users) during this period, as well as cannabis preference among users reporting symptom alleviation.
“We hope that this research will reveal some clues as to why and how the drug works in order to make a more informed decision about the medicinal use of cannabis for the treatment of PTSD,” Bonn-Miller said. “We are working to determine viable treatment options for those suffering from the disorder.”