Sexual violence—which includes rape and any other unwanted sexual experience—is a significant problem in the United States. About one in three American women, and one in six American men, have experienced sexual violence at some point in their lives. Intimate partner violence is a scourge in the US as well. In 2015, the Center for Disease Control reported that one in four women, and one in ten men, experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime. (It should be noted that the term “intimate partner violence” includes psychological aggression as well, such as name calling, insulting, or humiliating.)
Dr. Dustin Sulak
I’m a survivor of intimate partner violence and sexual violence, and I’ve been consuming cannabis for almost eight years. Ironically, my physically, sexually, and emotionally abusive ex-boyfriend was the first person I ever consumed cannabis with. Now, the plant helps me manage the PTSD symptoms his violence created.
For most of my twenties I lived in prohibition states, where trustworthy budtenders and access to legal, budget-friendly, and high-quality cannabis simply wasn’t a reality. But now that I live in California—where buying cannabis is a legal, safe, and socially acceptable errand—I’m doing everything in my power to shine a light on all the ways cannabis can help trauma survivors live their best lives.
And I’m not alone.
I recently spoke with the following people on the topic:
- Ashley Manta, creator of CannaSexual, sex and cannabis coach, and a multiple sexual assault survivor.
- Caitlin Flynn, a Seattle-based writer and rape survivor.
- Dr. Carrie Cuttler, an Assistant Professor of Psychology at Washington State University.
- Dr. Dustin Sulak, the founder of Integr8 Health, a medical practice in Maine that follows over 8,000 patients using medical cannabis; Healer.com, a medical cannabis patient education resource; and Cannabis Expertise, a continuing medical education curriculum.
How Trauma Changes the Brain
“Sexual abuse and other types of intense trauma can change the body’s communication pathway between the brain and the adrenal glands,” Dr. Sulak says. “This usually results in overactive adrenal function, producing excessive levels of the stress hormone cortisol, which can result in increased blood pressure and blood sugar and increased adrenaline,” Dr. Sulak says these changes can also impair the immune system’s ability to respond to acute and chronic infections, and have a negative impact on digestion, sleep, focus, learning, and more.
“After long periods of overactive adrenal function, the glands can also start to malfunction, resulting in adrenal fatigue—a primary component of chronic fatigue syndrome and sexual dysfunction,” Dr. Sulak says. He adds that trauma survivors have been found to have problems with neurotransmitter signaling as well, especially when it comes to the neurotransmitters serotonin and glutamate, both of which correlate with hyperarousal (excessive fight-or-flight response) and re-experiencing traumatic memories (two of the three domains of PTSD symptoms—the third is avoidance).
Dr. Sulak says excessive glutamate signaling can also reinforce the neural pathways that are most problematic for survivors. “When we practice a new skill, like knitting for example, and get so good at it that we can do it with little thought, that type of learning is accompanied by structural connections in the brain’s neurons that create something like a knitting superhighway,” Dr. Sulak says.
In trauma survivors, this can happen with the pathways that cause feelings and behaviors related to anxiety and panic. “We don’t want those pathways to be superhighways that are used every day,we want them to be there only for emergency use.”
How Cannabis Can Help
Dr. Sulak relayed that cannabis often works by suppressing excessive activity in the body. “If the fight-or-flight branch of the nervous system is too activated, cannabis can help bring this back to normal. If the neural pathways related to trauma are being overused, cannabis can turn them down or turn them off. And it does this best in areas of the brain related to memories and emotional responses, because those areas have very high levels of cannabinoid receptors.”
Cannabinoid receptors are located throughout the body. They’re part of the endocannabinoid system, which is involved in a variety of physiological processes including appetite, pain-sensation, mood, and memory. Even without using cannabis, our bodies are already using cannabinoids to help manage some of the health problems that plague survivors the most.
“Our brains produce endocannabinoids, which function like THC to correct many of the alterations in brain and body function associated with trauma,” Dr. Sulak says. He adds that a recent study discovered that people who have mutations in the genes that code for components of the endocannabinoid system have a higher likelihood of developing anxiety disorders, of which PTSD is one.
THC and CBD can help a trauma survivor change their response to stimuli that would have previously triggered symptoms like anxiety, panic, and flashbacks.
“Conventional pharmacologic treatments for PTSD and other trauma-related symptoms leave a lot to be desired. Cannabis, on the other hand, is one medicine that, when used correctly, can achieve all these goals: improve mood, reduce anxiety, promote restorative sleep, and suppress nightmares,” Dr. Sulak says. “It’s truly a holistic treatment … In my nine years of treating thousands of patients with cannabis, I’ve seen the most consistent, satisfactory response for reducing or eliminating trauma-related nightmares, and restorative sleep is essential for healing.”
Beyond symptom relief, Dr. Sulak says cannabis can actually promote the long-term healing process after trauma. Studies on human subjects have shown that the compounds in cannabis, both THC and CBD, can enhance our capacity for “fear extinction,” a scientific term for what happens in the brain when therapy (or just everyday life in a safe and loving environment) helps a trauma survivor change their response to stimuli that would have previously triggered symptoms like anxiety, panic, and flashbacks. “The cannabinoids literally promote the kind of brain changes needed to release limiting patterns of thought and behavior,” he explains.
The Research on Cannabis and PTSD
“I’m not a trauma expert by any stretch of the imagination,” Dr. Cuttler tells me. “What I can say is that cannabis has demonstrated some beneficial effects in the treatment of PTSD. Cannabis helps to improve sleep and reduce nightmares in people with PTSD, and it also seems to facilitate memory extinction—so helping survivors extinguish those traumatic memories,” she says.
Research in Dr. Cuttler’s Health and Cognition Lab focuses on illuminating the potentially beneficial and detrimental effects of chronic cannabis use and acute cannabis intoxication. Her current and recent work focuses on examining links between cannabis use and mental health, physical health, stress, and cognition.
In 2018, Dr. Cuttler and her team conducted one of the first official studies to track the self-reported effects of different cannabis strains and doses on cannabis consumers. The study found that consuming cannabis made people less anxious, stressed, and depressed.
But there’s still much to learn. Statistics show that women actually have double the rate of PTSD than men, yet the bulk of existing trauma research focuses on male combat veterans. Moreover, a study on Gulf War veterans found that sexual assault is more likely to lead to PTSD than combat.
“Clinical trials give us our best evidence and there really haven’t been very many, or very good, clinical trials looking at the use of cannabis for mental health purposes, and we just need far more of those,” Dr. Cuttler says. “The scheduling of cannabis as a Schedule I drug in the US makes it very difficult to research legally, which has really stalled the progress of our research.”
Best Practices for Daily Cannabis Consumption
Dr. Sulak recommends consuming a combination of CBD and THC each morning and afternoon as a baseline treatment. He adds that survivors should be mindful of how their doses make them feel—the goal is to reduce symptoms without causing impairment, decreased motivation, or increased avoidance behaviors. “The CBD:THC ratio of this baseline treatment can vary, but 1:1 is a fine place to start.” Dr. Sulak says if that ratio is too impairing, consumers should try switching to a higher CBD ratio. “Inhaled cannabis can then be used during the day, at the lowest effective dose, to control breakthrough symptoms.”
Regarding inhalation, Dr. Sulak says the best method is using an herbal vaporizer that heats up your cannabis flower without burning it. “This allows users to try several varieties of cannabis and find what works best for them.”
Dr. Sulak recommends not using inhalation as the only delivery method though, due to its rapid onset and short duration of action. “Patients who do this often end up chasing their symptoms around (waiting until the anxiety recurs before a subsequent dose) instead of preventing the symptoms. Remember, it’s important to avoid using those trauma pathways so that they stop acting like a superhighway and become more of an old country road with grass growing through the blacktop.”
Survivors on Their Relationship With Cannabis
Ashley Manta is a multiple sexual assault survivor whose first assailant was a cannabis consumer. “I was 13 and the person who assaulted me was using cannabis at the time,” Manta shares. She was strictly anti-cannabis for nearly a decade afterward. “I associated cannabis with getting assaulted. Even smelling it would set me off.” Manta says she didn’t want to be around weed—and had a lot of bias and judgement toward people who used it—until she had her first consensual cannabis experience at age 23.
“All of my cohorts in my philosophy program were stoners, because of course. I picked a group of them and I was like, okay, these are people that I respect and they’re amazing and my professors even smoke weed. What am I missing?”
That experience changed Manta’s mind about cannabis, but it wasn’t until she moved from Pennsylvania to California in 2014 that she was able to experiment with all the healing properties the plant has to offer. “When I found Foria, the THC-infused oil, that was the first time I was ever able to have penetrative sex without pain since my assault. So that was a big game-changer for me.”
When Manta named her rapist on the internet in 2015, she says cannabis was one of the few things that helped her keep it together. “My PTSD was so horrifically triggered by that experience that I was having panic attacks. I couldn’t work. I couldn’t even think about sex. Cannabis was actually the thing that allowed me to get through the panic attacks, that let me sleep at night and helped me start to feel comfortable in my body again.”
These days, she incorporates cannabis flower into her sex life as well. “My boyfriend and I just had marathon sex all day yesterday and we stopped at various points to smoke a little bit of Galactic Jack. He really likes that,” she says.
Manta used to take antidepressants and Xanax, but she says safe and legal access to cannabis has enabled her to take care of herself without having to rely on pharmaceuticals. “If I get panicky, I have things that I reach for that are cannabis derived. I have tinctures, I have pens, and as my tolerance has grown, I dab more. But even just a couple of puffs of something that’s really heavy and grounding can be enough to take the edge off of my pretty constant anxiety.”
Manta consumes cannabis daily, and she believes anyone who might be suffering from PTSD, regardless of the cause, should have safe and legal access to the plant. “Whatever it is that has caused you trauma, I think cannabis is beneficial and I think people should have access to it as easily as they have access to any other kind of medication that helps you function.”
Flynn, who first began experiencing symptoms of PTSD and an eating disorder when she was in middle school, couldn’t agree more. “I think it should absolutely be made accessible to survivors and anyone who would benefit from it, whether it’s physically, mentally, or both,” she says.
The Soothing Effects of Cannabis on Multiple Symptoms
Flynn was hospitalized for an eating disorder seven times between the ages of 13 and 24, then experienced early-age corporate burnout in 2015. “I moved from NYC to Seattle for a fresh start, but I was raped the next summer, so that triggered a lot of really severe anxiety and some of my eating disorder symptoms started to come back,” Flynn shares.
“I was only sleeping two or three hours per night and I was really struggling to just keep my head above water.” Flynn’s psychiatrist kept increasing her dose of Valium just so Flynn could function, but she was really worried about its long-term effects on Flynn’s brain. “She made it clear that it was a temporary solution until we could find a long-term treatment plan to address the underlying issues. I have an addictive personality, and addiction runs in my family, so that was also a concern.”
Although she’d tried cannabis in high school and college, Flynn says she wasn’t a fan of the plant before moving to Seattle. “I have asthma and I’m a now-retired dancer, so I don’t like to smoke—and it just never really did much for me or my mood when my friends were passing around a joint.” Even after moving to Seattle, she never went looking for weed until she was asked to cover the opening of a high-end cannabis dispensary. “While I was speaking with their budtenders my interest was piqued,” she told me.
“They gave me some samples to try based on what I told them, and I couldn’t believe how much it helped with my anxiety, PTSD, and insomnia. I talked to my psychiatrist about it and she said that it would be a better long-term solution than Valium.”
Flynn says moderation is key for her, so she consumes cannabis infused edibles only on an as needed basis. “When I’m going through a rough patch, I definitely rely on it more, but I’ll also sometimes go a week or two without feeling like I need to use cannabis,” Flynn says.
A Note on Cannabis and Consent
As a survivor and someone who studied sexual violence prevention for a long time, Manta said she had a lot of concerns when she first started consuming cannabis on a regular basis. “Because the hard line among sexual violence educators is that you don’t mix substances and sex regardless, ever, ever, ever—no alcohol, no weed, no pills, nothing. With cannabis, there’s room for nuance. So what I’ve come up with is to negotiate before you medicate.”
Manta said it’s important to have a conversation with your partner about why you want to get elevated before getting intimate, and what kinds of products you’re using if it’s a product that’s going to get you high. “If you’re using CBD only or topicals or things like that, then it doesn’t impact consent. But if you’re going to be doing something that has a high feeling associated with it, it’s something that you want to have a conversation with your partner about in advance,” Manta advised. “Don’t get stoned at a party and hookup with somebody you just met. Get their phone number and text them the next day and then make plans.”