Minnesota is mistaken in authorizing marijuana use for PTSD

As a staff psychiatrist working at the Minneapolis VA Medical Center, I was alarmed to hear that the Minnesota Department of Health (MDH) is adding post-traumatic stress disorder (PTSD) as a qualifying condition for medical marijuana use starting in August 2017.

During a press event on Dec. 1, Dr. Ed Ehlinger, commissioner of MDH, was quoted as saying, "PTSD presented the strongest case for potential benefits and a … lack of treatment alternatives."

I strongly disagree.

At the American Society of Addiction meeting in April 2016, addiction medicine specialists from across the country specifically stated that marijuana use is not associated with improvement in PTSD. On the contrary, initiating marijuana is associated with worse outcomes in PTSD symptom severity, measures of violent behavior, and alcohol problems

In a study by Sam Wilkinson, Yale School of Medicine, published in the September 2015 issue of the Journal of Clinical Psychology, he writes: "Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Cessation or prevention of use may be an important goal of treatment."

The Wilkinson study included 2,276 veterans admitted to U.S. Department of Veterans Affairs treatment programs for PTSD. They were almost all male and, on average, older than 50 and primarily white.

The study "can't prove causation but it definitely strongly suggests that marijuana use can be associated with worse outcomes," he said.

Dr. Ehlinger suggested there is a "lack of treatment alternatives" for PTSD, which is untrue. There are many high-quality research studies that demonstrate that psychotropic medications, prolonged exposure therapy (PE), cognitive processing therapy (CPT), and mindfulness-based stress reduction are all effective treatment options for PTSD. In the August 2015 issue of the Journal of the American Medical Association (JAMA), a review of randomized clinical trials studying psychotherapy for military-related PTSD by Maria Steenkamp and colleagues demonstrated that "trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD."

In the same JAMA issue, a study by Minneapolis VA psychologist Melissa Polusny and her colleagues showed that mindfulness-based stress reduction therapy significantly decreased PTSD symptom severity.

There is substantially more research backing the efficacy of the aforementioned PTSD treatments, as compared to marijuana. Colorado recently voted against adding PTSD to the medical conditions eligible for treatment under the state's medical marijuana program because scientific evidence does not support it.

Marijuana use can cause irreversible psychosis (auditory hallucinations, visual hallucinations, paranoia) in genetically susceptible individuals. Marijuana use can also lead to cognitive impairment, memory problems, psychomotor slowing, impaired driving, birth defects, and mood changes.

Our state's veterans are receiving mixed messages about the utility of marijuana, which makes my job as a physician even more challenging. I urge the Minnesota Department of Health to reconsider its decision.

Patricia Dickmann is a staff psychiatrist in the VA Health Care System in Minneapolis.