CBD for Veterans: Can CBD Cannabinoid Help with Anxiety & PTSD In Veterans?

Almost 1 in 10 Americans is a Veteran, but the number of physical and mental health complaints that follow time in service is poorly addressed by most governments worldwide. Can CBD be an alternative for opioids for military veterans with PTSD, related depressive symptoms and pain?
Written by 
Dr Shane McKeown, Acute Internal Medicine (AIM).
|Last Updated:
CBD for veterans

Common complaints include PTSD, anxiety and pain, conditions that usually require strong antipsychotics, painkillers and all the side effects that come with taking those medications.

CBD offers a real chance for veterans to not only get on top of these debilitating symptoms but to also reduce dependency on more risky, ‘mainstream’ medicine. This clear benefit has been noted by a number of veterans groups, who now offer substantial discounts on CBD to their veteran members.

How CBD affects the mind and body

CBD, a derivative of cannabis and hemp plants has been in the military news fairly frequently in recent years. Active service members were also investigating it for the same reason as veterans, but in the early days of CBD were struggling to find a pure strain.

CBD is a non-psychoactive drug, yet as we know the cannabis plant when smoked or ingested can make you high. This effect comes from a compound known as THC. The overwhelming majority of CBD is sold with nil to minimal THC content. This means you won’t get any of the ‘drug’ effect at all – just make sure to double check the bottle.

CBD may not give you any feeling but it does have a number of therapeutic effects throughout the human body. CBD plugs into the body’s pre-existing endo-cannabinoid system.

Receptors called CB1 and CB2 detect the presence of CBD molecules which causes a cascade of effects throughout the body and brain which are only now just being understood.

Read more on how CBD works

Human CBD receptors chart

CBD and PTSD

Post Traumatic Stress Disorder is the ‘classic’ mental health concern found within the military population. Although any extreme or distressing event can lead to PTSD, repeated exposure to war time activities can leave soldiers with persistent symptoms.

These include but are not limited to heightened stress and anxiety throughout the day, flashbacks, nightmares alongside an increased risk of substance abuse and dependency.

While many veterans engage in talking therapies and take anti depressants such as SSRIs, these interventions are not completely successful. Veterans often find that the side effects from the SSRIs that they are prescribed can leave them with worsened insomnia, erectile dysfunction and brain fog amongst other ill effects.

There is mounting evidence that CBD can help specifically with the signs and symptoms of trauma. In the brain, it seems the molecule can promote the weakening of connections to painful memories. This reduces the negative emotions that are associated with a particular memory, whilst also making the likelihood of experiencing a flashback much less.

Similar in the way to how Cognitive Behavioural Therapy (CBT – a talking therapy) works, CBD seems to give users the ability to ‘unlearn’ their damaging thoughts and behaviours that have come about as a reaction to the trauma they have suffered.

CBD and Anxiety & Depression

Cannabidiol has long shown promise in alleviating depressive and anxious feelings. While PTSD is a specific response to trauma, both anxiety and depression can occur in a person months or years later, with no clear link to historical stressors.

A review of veterans over the last decade showed that around 40% of those who suffered from PTSD also had an anxiety disorder as well. This is unsurprising due to the continuously pressured work that soldiers have to carry out.

While PTSD may develop in response to a particular event or collection of events, depression and anxiety can develop due to the overall buildup of perceived negative events and consequences over time.

These mental health concerns also exacerbate other physical symptoms as well. When two people experience the same level of pain, if one is also depressed or anxious they will report a higher level of pain than the mentally well person. Clearly there is a lot of benefit in reducing these symptoms as much as possible.

There are a handful of randomized, controlled trials looking at CBD and anxiety – although dosing varied wildly from 6-400mg per dose the researchers found that CBD has a promising role in the management of anxiety disorders with it generally being a very well tolerated medication with minimal adverse effects.

It is thought that CBD’s action on the CB1 receptor alongside it’s activity on serotonin receptors is the mechanism by which it exerts its anti-anxiety effects.

CBD and pain

Of all the medical conditions that CBD has shown promise for, it is perhaps most widely used for the management of pain, both acute and chronic. The opioid epidemic in America has shown the dangers of pushing strong painkillers into the public domain without checks and balances to prevent them from becoming addicted.

The problem is even more acutely present in the veteran population, who are much more likely at all ages to be suffering from all levels of pain severity. Often living with complex wounds and disabilities, veterans are in need of pain relief that does not get less effective and more addictive over time.

Fortunately CBD has a number of positive benefits which come together to treat pain as effectively as opioids. Researchers have found that not only can it reduce the level of pain felt, it also exerts an anti-inflammatory effect and stabilizes mood.

The consequence of this is that it reduces one of the causes of pain, reduces perception of remaining pain and keeps negative thoughts and feelings at bay so that the user is better mentally equipped to cope with any remaining discomfort.

The Military View

The Military is mixed both in the US and around the world. In July of 2020, the US House of Representative approved an amendment to the National Defense Authorization bill. This amendment technically allows members of the military to consume CBD or use CBD containing topical products like creams and lotions.

The definition of CBD (for the US military at least) is an oil containing CBD and less than 0.3% THC. The Military Times also noted its positive benefits in treating common veteran ailments such as ‘depression, anxiety….and all common characteristics of post traumatic stress disorder or traumatic brain injury’.

The main issue, and one repeatedly expressed by the Navy, is that many CBD products have yet to come under proper regulation. Purchasing cheap or unregulated CBD means that there is a chance that there is more than 0.3% THC present in the product.

While it is unlikely that there will be enough in any product to produce a psychoactive effect, there is always the risk that they could trigger a drug testing kit, such as a urine dip (known as urinalysis).

Whilst this may not be of too much concern to Veterans who are retired, anyone who is still in employment may find themselves pulled up for failing their work drugs test.

Certain companies, like Veterans CBD Oil in the US, and Tier One CBD in the UK, go to extra lengths to ensure that the CBDthey sell is pure and unlikely to be contaminated by THC. Veterans CBD for example derives their cannabidiol from 100% natural non-GMO industrial grown hemp.

Their compounds and tinctures are also Full Spectrum rather than isolate which means they include other cannabinoids and terpenes. It is thought that these other compounds have an ‘entourage’ effect and allow CBD to work even more effectively whilst also remaining non-psychoactive.

Conclusion

For Veterans worldwide CBD offers real hope and promise when it comes to addressing some of the most debilitating conditions, both physical and mental, that come from life in the military.

Whilst we are still awaiting large, long term trials to see the exact benefits of CBD, there is already some evidence to suggest that there can be great benefit from trialing its use now. One of the biggest benefits is its ability to reduce dependency on opioids, which treat pain but put users at risk of addiction when they are already likely to be struggling with anxiety or PTSD.

While the industry is still in its infancy some care is required to ensure that you are ingesting CBD only containing products. However research is evolving along with government and public interest, meaning there is a bright future ahead for Veterans looking to manage their health with CBD supplementation.

References

  1. Weathers FW, Bovin MJ, Lee DJ, Sloan DM, Schnurr PP, Kaloupek DG, Keane TM, Marx BP. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018 Mar;30(3):383-395. doi: 10.1037/pas0000486. Epub 2017 May 11. PMID: 28493729; PMCID: PMC5805662.
  2. Johnson JR, Lossignol D, Burnell-Nugent M, Fallon MT. An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manage. 2013 Aug;46(2):207-18. doi: 10.1016/j.jpainsymman.2012.07.014. Epub 2012 Nov 8. PMID: 23141881.
  3. Di Marzo V, Piscitelli F. The Endocannabinoid System and its Modulation by Phytocannabinoids. Neurotherapeutics. 2015 Oct;12(4):692-8. doi: 10.1007/s13311-015-0374-6. PMID: 26271952; PMCID: PMC4604172.
  4. Armenta RF, Walter KH, Geronimo-Hara TR, Porter B, Stander VA, LeardMann CA; Millennium Cohort Study Team. Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans. BMC Psychiatry. 2019 Dec 13;19(1):396. doi: 10.1186/s12888-019-2375-1. PMID: 31836015; PMCID: PMC6911296.
  5. Cipriani A, La Ferla T, Furukawa TA, Signoretti A, Nakagawa A, Churchill R, McGuire H, Barbui C. Sertraline versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD006117. doi: 10.1002/14651858.CD006117.pub4. PMID: 20393946; PMCID: PMC4163971.
  6. Milanak ME, Gros DF, Magruder KM, Brawman-Mintzer O, Frueh BC. Prevalence and features of generalized anxiety disorder in Department of Veteran Affairs primary care settings. Psychiatry Research. 2013;209(2):173-179.
  7. Skelley JW, Deas CM, Curren Z, Ennis J. Use of cannabidiol in anxiety and anxiety-related disorders. Journal of the American Pharmacists Association. 2020;60(1):253-261.
  8. Papagianni EP, Stevenson CW. Cannabinoid Regulation of Fear and Anxiety: an Update. Curr Psychiatry Rep. 2019 Apr 27;21(6):38. doi: 10.1007/s11920-019-1026-z. PMID: 31030284; PMCID: PMC6486906.
  9. Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018 Mar 7;3(3):CD012182. doi: 10.1002/14651858.CD012182.pub2. PMID: 29513392; PMCID: PMC6494210.
  10. Simkins JD. From combat to marijuana processing — veteran corners the CBD market. Military Times. https://www.militarytimes.com/news/your-air-force/2018/08/06/from-combat-to-marijuana-processing-veteran-corners-the-cbd-market/ Accessed March 2020
  11. Simkins JD. Navy ramps up its regulation of CBD products. Navy Times. https://www.navytimes.com/off-duty/military-culture/2020/09/09/navy-ramps-up-its-regulation-of-cbd-products/ Accessed March 202
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Dr Shane McKeown
Dr Shane McKeown
Acute Internal Medicine (AIM)
Dr Shane McKeown is a UK clinician with experience in both Medicine and Surgery. With a strong background in education, he currently teaches all grades of doctor and sits as examiner for foreign medical staff looking to work in the United Kingdom. Working within rehabilitation and therapy, he utilizes complementary treatments like CBD to provide holistic care where it is most effective. His expertise with CBD continues to be called upon by numerous brands to optimise their product offerings.

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