Cannabis use disorder (CUD) is a significant and expanding health problem, and no FDA
approved treatments are currently available. Persons with posttraumatic stress disorder
(PTSD) may use cannabis to help control symptoms. Relief from PTSD insomnia, nightmares,
anxiety, and preoccupying thoughts have been reported as troublesome symptoms targeted by
cannabis users. Risks from cannabis use by individuals with PTSD have been reported. Chronic
use of cannabis can lead to tolerance, requiring increased use for symptom relief, and
withdrawal symptoms upon stopping. CUD is more frequent and severe in those with PTSD than
those without. Many symptoms of cannabis withdrawal overlap with troubling symptoms of PTSD
and thus may be interpreted as a relapse of PTSD symptoms. Those attempting to reduce or stop
cannabis use may experience cannabis withdrawal symptoms including insomnia and distressing
dreams, anxiety, irritability, and/or excessive sweating that they may misattribute to
re-emerging or untreated PTSD symptoms.
Excessive brain adrenaline activity is arguably the best-described neurobiological
contribution to the pathophysiology of PTSD. Prazosin, a drug that blocks the negative
effects of brain adrenaline, has demonstrated effectiveness in robustly reducing PTSD-related
nightmares and sleep disturbance in active duty Servicemembers and recently discharged combat
Veterans in most, but not all, clinical trials, as well as in civilians with non-combat
trauma. Clinically, the investigators have observed that several patients with PTSD using
cannabis to treat insomnia and/or trauma-related nightmares and wanting to reduce their
cannabis use were able to achieve reduction or cessation of cannabis use once they were
treated with an effective dose of prazosin. Therefore, we have wondered if prazosin may
provide sufficient treatment of PTSD symptoms otherwise targeted by cannabis, supporting
those individuals' efforts to reduce cannabis use.
This open-label pilot study aims to study the feasibility of prazosin as a treatment for CUD
in individuals with or without comorbid PTSD, and to evaluate if additional research on a
larger scale is warranted.