Medical Cannabis for Chronic Posttraumatic Stress Disorder in Dutch Veterans: A Health Care Evaluation

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Eric Vermetten Julia de Wit


Introduction: Medical cannabis has emerged as a promising treatment for Posttraumatic Stress Disorder (PTSD), particularly among veterans. Given the high prevalence of PTSD in this population and the limited availability of effective therapeutic options, medical cannabis has garnered increased interest. However, evidence remains scarce endorsing its efficacy and patients' experiences with this treatment.

Method: To gain more insight into patients' experiences with medical cannabis, we interviewed 18 Dutch veterans diagnosed with chronic PTSD who were prescribed off-label medical cannabis for symptom relief at an outpatient clinic in the Dutch Military Mental Health Service. The interviews were recorded and transcribed verbatim, followed by a framework analysis with thematic coding.

Results: A group of 18 patients turned to medical cannabis as an alternative to traditional treatments due to persistent symptoms iof PTSD. Of these, 15 continued using the Bediol strain, primarily before bedtime to aid sleep. They reported significant improvements, including increased peace of mind and reduced irritability. Although patients expressed satisfaction, they often asked assistance in dosage and reimbursement. Despite initial reservations from some family members, there was notable support, signaling a changing perception of medical cannabis through increased education. However, a few patients still faced lingering stigma. Through the analysis, five overarching themes were identified: (1) assessment phase, (2) intervention phase, (3) termination phase, (4) access and availability, and (5) social support.

Conclusion: Based on the data collected, we advocate for the continued prescription of medical cannabis, as most of the interviewed patients reported positive effects, including alleviation of core symptoms like sleep disturbances, irritability, and hyperarousal. Secondly, we recommend the continued reimbursement of medical cannabis due to its positive impacts, as many patients expressed potential financial hardship if this reimbursement were halted. Furthermore, we propose the appointment of a cannabis coach to provide patient-centered care. Reliable information on cannabis use is often challenging for patients to access, and proper use, including dosage, strain, cannabidiol (CBD) to Tetrahydrocannabinol (THC) ratio, and timing of administration, is essential to ensure optimal benefits and minimize risks. Lastly, we emphasize the necessity for further research, including longitudinal studies and randomized controlled trials, to explore individualized treatment approaches that work best under specific conditions. Greater clarity on dosages and product selection is also essential to minimize confusion and potential over- or under-consumption risks. Overall, these recommendations can guide the advancement of medical cannabis treatment for chronic PTSD in veterans, enhancing patient outcomes and paving the way for evidence-based practices.  

Keywords: PTSD, Cannabis, Veterans, Health Care Evaluation

Article Details

How to Cite
VERMETTEN, Eric; DE WIT, Julia. Medical Cannabis for Chronic Posttraumatic Stress Disorder in Dutch Veterans: A Health Care Evaluation. Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 23 apr. 2024. doi:
Research Articles


1. Burback, L., Brémault-Phillips, S., Nijdam, M. J., McFarlane, A., & Vermetten, E. (2023). Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr. Neuropharmacol.
2. Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. The American Journal of Psychiatry. 2005; 162(6): 1171-8.
3. Xue C, Ge Y, Tang B, et al. A Meta-Analysis of Risk Factors for Combat-Related PTSD among Military Personnel and Veterans. PLoS One. 2015; 10(3).
4. Lyk-Jensen SV, Weatherall CD, Jepsen PW. The effect of military deployment on mental health. Economics and Human Biology. 2016; 23: 193-208.
5. American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. [Internet]. Avail-able from: [Accessed 13 August 2023].
6. Kitchiner NJ, Lewis C, Roberts NP, et al. Active duty and ex-serving military personnel with post-traumatic stress disorder treated with psy-chological therapies: systematic review and meta-analysis. European Journal of Psychotraumatology. 2019; 10(1)
7. Steenkamp MM, Litz BT, Hoge CW, et al. Psy-chotherapy for Military-Related PTSD, A Re-view of Randomized Clinical Trials. Journal of the American Medical Association. 2015; 314(5): 489-500.
DOI: 10.1001/jama.2015.8370
8. Bradley R, Greene J, Russ E, et al. A multidimen¬sional meta-analysis of psychotherapy for PTSD. The American Journal of Psychiatry. 2005; 162(2): 214-227
9. Cipriani A, Williams T, Nikolakopoulou A, et al. Comparative efficacy and acceptability of pharmacological treatments for post-traumatic stress disorder in adults: a network meta-anal-ysis. Psychological Medicine. 2018; 48(12): 1975 – 1984.
10. Hoskins MD, Bridges J, Sinnerton R, et al. Phar-macological therapy for post-traumatic stress disorder: a systematic review and meta-analy-sis of monotherapy, augmentation, and head-to-head approaches. European Journal of Psy-chotraumatology. 2021; 12(1).
11. Hoskins M, Pearce J, Bethell A, et al. Pharma-cotherapy for post-traumatic stress disorder: Systematic review and meta-analysis. The Brit-ish Journal of Psychiatry. 2015; 206(2): 93-100.
Doi: 10.1192/bjp.bp.114.148551
12. Ney LJ, Matthew A, Bruno R, et al. Cannabinoid interventions for PTSD: Where to next? Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2019; 93: 124-140.
13. Hill MN, Campolongo P, Yehuda R, et al. Inte-grating Endocannabinoid Signaling and Can-nabinoids into the Biology and Treatment of Posttraumatic Stress Disorder. Neuropsycho-pharmacology. 2018; 43(1): 80-102. DOI: 10.1038/npp.2017.162
14. Bedrocan. Over Bedrocan – Onze methode. [In¬ternet]. Available from: [Accessed 20 October 2021].
15. Greer GR, Grob CS, Hakberstadt AL. PTSD Symptom Reports of Patients Evaluated for the New Mexico Medical Cannabis Program. Jour¬nal of Psychoactive Drugs. 2014; 46(1): 73-77.
16. Passie T, Emrich HM, Karts M, et al. Mitigation of post-traumatic stress symptoms by Cannabis resin: A review of the clinical and neurobiolog-ical evidence. 2012; 4(7-8): 649-59.
17. Reznik I. P.4.a.011 Post-traumatic stress disor-der and medical cannabis use: a naturalistic ob¬servational study. Drug testing and analysis. 2012; 22(2): 363-364.
18. Black N, Stockings E, Campbell G, et al. Can-nabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The Lancet Psychia¬try. 2019; 6(12): 995-1010.
19. Steenkamp MM, Blessing EM, Galatzer-Levy IR, et al. Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review. Depression and Anxiety. 2017; 34(3): 207-216.
20. Jetly R, Heber A, Fraser G, et al. The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, pla-cebo-controlled cross-over design study. Psy-choneuroendocrinology. 2015; 51: 585-588.
21. Government of Canada. Cannabis for Medical Purposes. [Internet]. Available from: [Accessed 27 January 2022]
22. Krediet E, Jansen DGA, Heerdink ER, et al. Ex-periences with medical cannabis in the treat-ment of veterans with PTSD: Results from a focus group discussion. European Neuropsychophar¬macology. 2020; 36: 244-254.
23. Forsythe ML, Boileau AJ. Use of cannabinoids for the treatment of patients with post-trau-matic stress disorder. Journal of Basic and Clin¬ical Physiology and Pharmacology. 2021.
24. Orsolini L, Chiappini S, Volpe U, et al. Use of Medicinal Cannabis and Synthetic Canna-binoids in Post-Traumatic Stress Disorder (PTSD): A Systematic Review. Medicina. 2019; 55(9): 525.
25. Browne K, Leyva Y, Malte CA, Lapham GT, Tiet QQ (2022). Prevalence of medical and non¬medical cannabis use among veterans in pri¬mary care. Psychology of Addictive Behaviors, 36(2), 121–130.
26. Metrik J, Bassett SS, Aston ER, Jackson KM, Bor¬sari B. Medicinal versus recreational cannabis use among returning veterans. Transl Issues Psy¬chol Sci. 2018 Mar;4(1):6-20. doi: 10.1037/tps0000133.
27. Turna J, MacKillop J. Cannabis use among mili¬tary veterans: A great deal to gain or lose? Clin Psychol Rev. 2021 Jan 11;84:101958. doi: 10.1016/j.cpr.2021.101958
28. Wolfgang AS, Hoge CW. Cannabis and Can-nabinoids for Pain and Posttraumatic Stress Dis¬order in Military Personnel and Veterans. JAMA Psychiatry. 2023 Sep 1;80(9):869-870.
doi: 10.1001/jamapsychiatry.2023.1685.
29. Mallinson DJ, Puello F. Veterans and Medical Cannabis: A Perfect Federalism Storm. Public Administration Quarterly. 2023;47(3): 347-373
30. Metrik, J., Stevens, A. K., Gunn, R. L., Borsari, B., & Jackson, K. M. (2022). Cannabis use and posttraumatic stress disorder: prospective evi-dence from a longitudinal study of veterans. Psychological medicine, 52(3), 446-456.
31. Walsh, Z., Mitchell, I., Crosby, K., St Pierre, M., DeClerck, D., Ong, K., & Lucas, P. (2023). A small clinical trial of vaporized cannabis for PTSD: suggestive results and directions for fu-ture study. Trials, 24(1), 1-4.
32. Bonn-Miller, M. O., Brunstetter, M., Simonian, A., Loflin, M. J., Vandrey, R., Babson, K. A., & Wort¬zel, H. (2022). The long-term, prospective, therapeutic impact of cannabis on post-traumatic stress disorder. Cannabis and cannabinoid research, 7(2), 214-223.
33. Coelho, M. P., Duarte, P., Calado, M., Almeida, A. J., Reis, C. P., & Gaspar, M. M. (2023). The current role of cannabis and cannabinoids in health: A comprehensive review of their therapeutic potential. Life Sciences, 121838.