Abstract Objectives: Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health problem. There has been a recent surge of interest regarding the use of cannabinoids in the treatment of PTSD. We therefore sought to systematically review and assess the quality of the clinical evidence of the effectiveness of cannabinoids for the treatment of PTSD. Method: We included all studies published until December 2018 where a patient has had PTSD diagnosed and had been prescribed or were using a cannabinoid for the purpose of reducing PTSD symptoms. Our primary outcome measure was the reduction in PTSD symptoms using a validated instrument. In the absence of randomized controlled trials, we included the next best available levels of evidence including observational and retrospective studies and case reports. We assessed risk of bias and quality using validated tools appropriate for the study design. Results: We included 10 studies in this review, of which only one study was a pilot randomized, double-blind, placebo-controlled, crossover clinical trial. Every identified study had medium to high risk of bias and was of low quality. We found that cannabinoids may decrease PTSD symptomology, in particular sleep disturbances and nightmares. Conclusions: Most studies to date are small and of low quality, with significant limitations to the study designs precluding any clinical recommendations about its use in routine clinical practice. Evidence that cannabinoids may help reduce global PTSD symptoms, sleep disturbances, and nightmares indicates that future well-controlled, randomized, double-blind clinical trials are highly warranted. PROSPERO registration number: 121646

中文翻译：

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大麻素治疗创伤后应激障碍 (PTSD) 的有效性：系统评价

摘要目的：创伤后应激障碍（PTSD）是一种潜在的使人衰弱的心理健康问题。最近人们对使用大麻素治疗 PTSD 的兴趣激增。因此，我们试图系统地审查和评估大麻素治疗 PTSD 有效性的临床证据的质量。方法：我们纳入了截至 2018 年 12 月发表的所有研究，其中患者被诊断出患有 PTSD 并且已经开具处方或正在使用大麻素以减轻 PTSD 症状。我们的主要结果测量是使用经过验证的仪器减少 PTSD 症状。在没有随机对照试验的情况下，我们纳入了下一个可用的最佳证据水平，包括观察性和回顾性研究以及病例报告。我们使用适合研究设计的经过验证的工具评估了偏倚风险和质量。结果：我们在本综述中纳入了 10 项研究，其中只有一项研究是一项试验性随机、双盲、安慰剂对照、交叉临床试验。每个确定的研究都有中到高的偏倚风险，并且质量很低。我们发现大麻素可能会减少 PTSD 症状，尤其是睡眠障碍和噩梦。结论：迄今为止，大多数研究规模小且质量低，研究设计存在重大局限性，因此无法就其在常规临床实践中的使用提出任何临床建议。大麻素可能有助于减少整体 PTSD 症状、睡眠障碍和噩梦的证据表明，未来控制良好的、随机的、双盲的临床试验是非常有必要的。