Cannabis and PTSD: What I Know and What I Don't

Two in the morning, February 2015, and I'm standing in my kitchen in Sheridan eating cold leftover spaghetti because trazodone sleep is not real sleep. Trazodone sleep is a chemical blackout that spits you back out at 0200 with a dry mouth and a heart rate that says you've been running. You don't remember the dream. Your body remembers everything.

That was the routine. Fifty milligrams of trazodone at 2100. Unconscious by 2130. Awake at 0200 with my T-shirt soaked through and my wife pretending she was still asleep because she'd learned that talking to me during an episode made it worse. I'd eat whatever was in the fridge. I'd sit on the porch until my hands stopped shaking. I'd go back to bed around 0400 and get maybe ninety minutes of something that resembled rest. Then I'd drive to the sheriff's office and dispatch calls for twelve hours.

That went on for six years.

I'm telling you this because there's a version of the cannabis-and-PTSD conversation that sounds like a commercial, and I'm not going to give you that version. I'm going to tell you what happened to me. Some of it is good. Some of it I still don't understand.

August 2016, my buddy Travis Wendt handed me half a gummy in his apartment in Missoula. Ten milligrams of THC. I'd had two beers in four hours. He said take it an hour before bed. I did. I slept six hours. Not trazodone blackout. Sleep. I woke up and knew where I was. I knew what day it was. My hands were steady.

That first night felt like proof. It wasn't.

Here's what I know after almost ten years of using cannabis for PTSD: it helps me sleep. Not every night. Maybe five nights out of seven. The nightmares come less often. Used to be four, five times a week. Now it's maybe once a week, sometimes less. When they come, they're not as loud. I can't explain that any better than that.

I know that 5 to 10 milligrams of THC in an edible, taken about an hour before bed, is the range that works for me. I know that above 15 milligrams I get paranoid and my heart rate spikes and I am worse off than if I'd taken nothing. I know that the CBD tincture I use during the day takes the edge off my back and knees enough that I don't reach for ibuprofen by noon.

That's what I know.

Here's what I don't know: why it works some nights and not others. Whether it's doing something to the nightmares or just knocking me deep enough that I don't remember them. Whether ten years from now I'll find out I traded one dependency for another. I don't know that. Nobody does. Anybody who tells you they do is selling something.

Here's what cannabis does not do. It does not stop the hypervigilance. I still can't sit with my back to a door. I still clear the house when I come home, every time, even though the rational part of my brain knows there is nobody in my house except my wife and two kids. I still flinch when a car backfires. I flinched yesterday. Jack noticed. He's ten. He doesn't say anything anymore.

Cannabis didn't fix that. Therapy fixed some of it. Specifically, a counselor at the Sheridan VA named Dave who spent two years doing cognitive processing therapy with me. I didn't want to go. Sarah made it a condition. She was right. Dave gave me tools that cannabis never could. Cannabis gave me enough sleep to actually use those tools. That's the honest version.

I talked to a guy at the VFW in Billings last year. Iraq, 2007, Diyala Province. He'd heard cannabis helped with PTSD and wanted to know if he should try it. I told him what I'm telling you: it might help you sleep. It might reduce the nightmares. It is not going to process your trauma. It is not going to replace the work. If you use it as a reason to skip therapy, you're making a mistake. If you use it alongside therapy, alongside the hard conversations, alongside the stuff that actually changes the wiring — it might give you enough rest to keep going.

That's the best I've got. I don't have a clinical study. I've got ten years of my own data. Five to ten milligrams. An hour before bed. Not every night works. The ones that do are worth it.

If you're reading this at 2 AM with your heart going and your shirt soaked through, I know what that's like. I don't know if cannabis will help you specifically. But I know you deserve an honest answer from someone who's been there, and I know the honest answer is: it's a tool. Not a cure. A tool.

What I still can't figure out is why nobody told me that part first.