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Cannabinoids in the Context of the Russian-Ukrainian War: Could Cannabis Improve the Mental State of Ukrainians in the Face of a Full-Blown Invasion?

  • 14 August 2025
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Intro

In the context of the ongoing war and growing mental health challenges in Ukraine, the issue of finding new ways to support people who have experienced traumatic events among veterans and those who did not participate in hostilities is particularly acute. The evidence base of preclinical and initial clinical studies shows the significant therapeutic potential of cannabinoids in reducing the symptoms of PTSD, anxiety, and sleep disorders, which are the problems that Ukrainians are facing on a large scale during the full-scale Russian aggression. So can cannabis, at least in part, become a tool for preserving the mental health of people affected by the war? In this article, I will try to give the most comprehensive answer to this painful, yet relevant question.

What is the endocannabinoid system?

Botanical Sciences. (n.d.). Understanding the endocannabinoid system: A primer. Botanical Sciences.
Endocannabinoid system (ECS) is an extensive neuromodulatory network involved in both the development of the central nervous system (CNS) and the regulation of many cognitive and physiological processes in the mature brain. It is composed of endogenous cannabinoids (endocannabinoids), cannabinoid receptors (primarily CB1 and CB2), and enzymes responsible for the synthesis and degradation of endocannabinoids (Lu & Mackie, 2021).
During embryonic and postnatal development, the ECS plays a key role in the formation of neuronal circuits, regulation of neuronal proliferation, migration, differentiation, and synapse formation. In the mature brain, it acts as a regulator of neuronal activity and synaptic plasticity, affecting the functioning of neural networks (Lu & Mackie, 2021).
It should be borne in mind that most components of the ECS are multifunctional, i.e., involved in several physiological processes simultaneously (Lu & Mackie, 2021). For example, CB1 receptors, which are predominantly localized in the brain, play a key role in the regulation of neuronal excitability. At the same time, these receptors are the main target of D9-tetrahydrocannabinol (THC), the main psychoactive component of cannabis (Lu & Mackie, 2021). It is through the interaction of THC with CB1 receptors that most of the psychoactive effects of cannabis are realized.
At the cellular level, endocannabinoids modulate synaptic transmission through the mechanism of inhibition of inhibition (DSI) or excitation (DSE), two forms of short-term synaptic plasticity that allow flexible regulation of neuronal circuit activity (Wilson & Nicoll, 2002). These mechanisms are key to processes related to memory formation, emotions, and adaptation to new environments.

Further studies indicate that ECS is not limited to short-term changes - it is also involved in longer-term forms of synaptic plasticity, such as long-term potentiation (LTP) and depression (LTD), in many brain regions, including the hippocampus, amygdala, and prefrontal cortex. These changes underlie learning, emotional regulation, and memory (Maldonado et al., 2006; Di Marzo, 2009; Sidhpura & Parsons, 2011; Bitencourt & Takahashi, 2018).

Thus, the endocannabinoid system appears to be a powerful module for regulating brain neurophysiology, from the stages of its development to the finest settings of emotional experience and memory.

Exogenous phytocannabinoids: CBD and THC

Cannabis contains several biologically active compounds, among which the most famous are Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD).THC — is the main psychoactive component of cannabis that causes a state of euphoria or "high", At the same time, we see that it has analgesic, anti-inflammatory, anticonvulsant, antiemetic properties, as well as the ability to stimulate appetite (Chayasirisobhon, 2020; Harbich, Michalak, & Michalak, 2024). Its main mechanism of action is the activation of CB1 receptors - the main cannabinoid receptors in the central nervous system (Wright, Di Ciano, & Brands, 2020).
CBD, unlike THC, is not psychoactive and demonstrates a different pharmacological profile (Chayasirisobhon, 2020). Its effects are associated with therapeutic potential in a number of neuropsychiatric diseases, including epilepsy, anxiety disorders, psychosis, Parkinson's disease and inflammatory bowel disease (Wright, Di Ciano, & Brands, 2020). For example, the drug Epidiolex (99% CBD, 0.1% THC) is already approved for the treatment of some forms of epilepsy in children, and clinical studies support the effectiveness of CBD in childhood-onset epilepsy(Wright, Di Ciano, & Brands, 2020).
Mazzetti, C., Ferri, E., Pozzi, M. et al. Quantification of the content of cannabidiol in commercially available e-liquids and studies on their thermal and photo-stability. Sci Rep 10, 3697 (2020).
CBD is well tolerated even in high doses - up to 1500 mg/day - and does not affect psychomotor functions, appetite, or physiological parameters. It does not cause cataplexy or psychotic reactions(Wright, Di Ciano, & Brands, 2020). The drug shows anxiolytic effects in social anxiety, reduces stress reactions, demonstrates positive results in preliminary studies of schizophrenia and Parkinson's disease, and has the potential to treat pain, alcoholism, tumors, depression, diabetes, Alzheimer's disease and arthritis(Wright, Di Ciano, & Brands, 2020).
At the molecular level, CBD binds only weakly to the CB1 and CB2 cannabinoid receptors (Pertwee, 2008), but can enhance the effects of endogenous cannabinoids, such as anandamide (AEA), by inhibiting its uptake and hydrolysis by the FAAH enzyme.(Bisogno et al., 2001; De Petrocellis et al., 2011; Leweke et al., 2012; Elmes et al., 2015). It indirectly activates CB1 receptors, which has been shown in animal studies to reduce the severity of fear and negative memories(Chhatwal et al., 2005; Pamplona et al., 2006, 2008; Bitencourt et al., 2008; Bitencourt & Takahashi, 2018).
In addition, CBD actively interacts with serotonin receptors, primarily 5-HT1A. It acts as an agonist of this receptor, stimulating serotonergic neurotransmission, which is associated with its anxiolytic effect, reduction of stress reactions, and inhibition of conditioned fear formation.(Russo et al., 2005; Campos & Guimarães, 2008; Gomes et al., 2011, 2012; Campos et al., 2012a, 2012b; Resstel et al., 2009).
So, although both THC and CBD come from the same plant, cannabis, their effects, mechanisms of action, and therapeutic potential are significantly different, opening up prospects for differentiated medical applications of each of these compounds.

Modern forms of use

Although inhaled and smoked forms of cannabis are often used by patients, they are not standardized as pharmaceutical products due to significant dose variations, complex regulatory restrictions, and safety concerns(Stella et al., 2021).

The only FDA-approved plant cannabinoid is Epidiolex — an oral CBD solution designed to treat epileptic syndromes(Stella et al., 2021). Synthetic analogs of THC - dronabinol and nabilone - are available in the form of oral capsules(Stella et al., 2021).

Nabiximol (Sativex®), oro-mucosal spray with a combination of THC and CBD, approved in several countries (not in the United States) for spasticity in multiple sclerosis, neuropathic pain, and certain types of cancer pain(Stella et al., 2021).

For the convenience of patients and to avoid significant liver metabolism, oropharyngeal CBD tablets are being developed that disperse rapidly in the oral cavity. Furthermore, transdermal gels, dermal sprays, and nanospheric systems are in clinical trials, providing controlled release of cannabinoids without oral or inhalation routes of administration.(Stella et al., 2021).

Traditional topical (liniments) and galenic forms - gels, oils, creams, ointments - often contain CBD, THC or other cannabinoids (e.g. CBG) in combination with excipients that improve skin permeability and stability of the product(Kaczorová et al., 2023).

Cannabinoids and anxiety

Anxiety disorders are the most common mental illnesses in the world, creating a significant social cost and economic burden. They are accompanied by panic attacks, avoidant behaviors, and reduced overall well-being, leading to poorer interpersonal relationships, higher unemployment, and increased risk of suicide.(Wright, Di Ciano, & Brands, 2020).
Neuropsychiatric anxiety disorders include generalized anxiety disorder (GAD), social anxiety disorder (SAD, also known as social phobia), specific phobias, panic disorder, and agoraphobia. Today, the main pharmacological approaches are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, partial 5-HT1A receptor agonists, and benzodiazepines.. However, these medications are often accompanied by side effects and demonstrate relatively low effectiveness - only about 40-60% of patients achieve a noticeable improvement, and most do not receive a complete cure(Wright, Di Ciano, & Brands, 2020).
Improving our knowledge of the anxiolytic properties of CBD began with preclinical animal studies, where various behavioral models of anxiety were widely used. One of the first tests was the "elevated cross maze" (EPM), which Guimarães et al. used to plot a dose-response graph in rats: a single systemic administration of CBD created a "bell-shaped" curve, indicating an anxiolytic effect at medium doses and no effect at high and low doses (Wright, Di Ciano, & Brands, 2020).
Bertoglio, Leandro & Carobrez, Antonio. (2016). Animal Tests for Anxiety. Animal models as tools in ethical biomedical research. 271-284. 10.1007/978-3-319-11578-8_18.
Subsequent preclinical studies have confirmed these observations in other models of innate fear and anxiety behavior using the EPM, open-field test, dark-light box, and predator exposure test(Wright, Di Ciano, & Brands, 2020). Additional techniques such as the Vogal test, classical conditioning, marble ball burying, chronic unpredictable stress, fear and predator interaction tests, and social interaction have demonstrated a variety of CBD effects: anxiolytic (anti-anxiety), stress-reducing, anticompulsive, and panic-inhibiting.(Blessing et al., 2015; Lee et al., 2017; Papagianni & Stevenson, 2019).

The first clinical trials back in the 1980s showed that CBD can reduce the anxiogenic and psychoactive effects of THC in healthy volunteers (Wright, Di Ciano, & Brands, 2020).

Neuroimaging studies of acute CBD administration have found modifications in cerebral blood flow in key structures associated with anxiety: the amygdala, hypothalamus, hippocampus, and cingulate cortex (Wright, Di Ciano, & Brands, 2020).

Thus, from preclinical models to the first clinical and neuroimaging data, the accumulating evidence clearly points to the multifaceted anxiolytic potential of CBD, which is dose-dependent, context-dependent, and targeted neuronal networks.

Cannabinoids and PTSD

Post-traumatic stress disorder (PTSD) — is a chronic condition that can develop after experiencing a traumatic event and is manifested by sleep disturbances, cognitive changes (e.g., intrusive recall of the event), mood disturbances, emotional instability, and reduced social skills(Bitencourt & Takahashi, 2018). Currently, anxiolytics and antidepressants are used to treat PTSD, but their effectiveness is limited and their side effects are significant(Berger et al., 2009; Shin et al., 2014; Bernardy & Friedman, 2015; Bitencourt & Takahashi, 2018).
UK Trauma Council. (n.d.). Post-traumatic stress disorder (PTSD) and complex PTSD. Retrieved August 6, 2025
An important discovery was the results of Marsicano et al. (2002), who showed that genetic deletion or blockade of the CB1 receptor significantly disrupts the process of extinction of conditioned (acquired) fear (Bitencourt & Takahashi, 2018). This suggests a key role for the endocannabinoid system (ECS) in learning and suppression of malignant memories(Quirk & Mueller, 2008). The bioavailability of exogenous cannabinoids, in particular CBD, can correct the disruption of the process of extinction of negative memories characteristic of PTSD, which is not covered by classical antidepressants and anxiolytics (Singewald et al., 2015).
Preclinical research indicates that CBD acts on all stages of traumatic memory processing, from acquisition (Levin et al., 2012) and recovery (Lemos et al., 2010) to blocking reconsolidation (Stern et al., 2012) and stimulating extinction(Bitencourt et al., 2008; Do Monte et al., 2013) (Bitencourt & Takahashi, 2018). In animal models, CBD also reduces cardiovascular and other somatic stress responses. (Resstel et al., 2006, 2009; Gomes et al., 2011; Campos et al., 2012a, 2013).
In addition, in human studies, CBD reduced amygdala activity during exposure to anxiety stimuli (Fusar-Poli et al., 2010) and decreased c-fos protein expression in the amygdala of mice (Todd & Arnold, 2016), which may partially explain its therapeutic effect in PTSD(Passie et al., 2012). Chronic use of CBD also promotes neurogenesis in the hippocampus, a structure that is affected in PTSD (Wolf et al., 2010; Campos et al., 2013), and studies show its benefits in normalizing sleep architecture and reducing anxiety after sleep disorders (Monti, 1977; Hsiao et al., 2012; Chagas et al., 2013) (Bitencourt & Takahashi, 2018).
Thus, although available pharmacotherapies for PTSD largely fail to address key mechanisms of traumatic memory processing (Singewald et al., 2015), experimental evidence demonstrates that CBD can modulate both neurobiological and behavioral aspects of PTSD, making it a promising addition to existing approaches.

Limitations faced by scientists and doctors

While CBD is generally considered well tolerated, a recent meta-analysis of 1-14 week studies showed that the most common adverse effects (AEs) were sedation, decreased appetite, diarrhea, and drowsiness, with more severe AEs more commonly observed at high doses and in patients with epilepsy - a possible contribution to this being drug-drug interactions with antiepileptic drugs(Chesney et al., 2020; Gaston et al., 2017; Geffrey et al., 2015; Morrison et al., 2019). In studies of other indications, where CBD was used in healthy volunteers, difference from placebo was found only in terms of diarrhea(Chesney et al., 2020).
Most clinical studies on CBD compare only one dose in patients (300-600 mg), while several dose levels (300, 600, 900 mg) have been investigated in healthy volunteers. This creates gaps in understanding the dose-dependence of effects in specific groups of patients, including those with social anxiety disorder.(Fliegel & Lichenstein, 2022).
The risk of bias assessment showed that almost all studies have a low risk in the areas of randomization, deviations from the intended interventions, lack of data, and outcome measurement. However, two papers - Masataka (2019), where three volunteers dropped out due to the unpleasant taste of the solution, and Arndt and de Wit (2017), where the one-week washout period was insufficient to allow the study participants to wean themselves off the tests, resulting in a high probability that the results are biased. These papers received a high risk of bias in their respective domains(Fliegel & Lichenstein, 2022).
In terms of chronic use, only one study by Masataka (2019) administered 300 mg of CBD daily for a month to patients with social anxiety and obtained a significant reduction in symptoms compared to placebo with no significant side effects. In addition, participants in the CBD group were more likely to seek follow-up care (medication and CBT), suggesting the potential of CBD to reduce barriers to additional interventions (Masataka, 2019).
Despite the impressive preclinical data on PTSD symptoms, their translation to humans needs to be confirmed (Bitencourt & Takahashi, 2018). Higher traumatic experiences are associated with higher cannabis consumption (Kevorkian et al., 2015), which may indicate the importance of the "accompaniment effect" of the plant's components: cannabis components work better in a natural combination rather than in isolation. However, this hypothesis requires further testing (Zer-aviv et al., 2016).
In addition, a systematic analysis of the molecular pharmacology of CBD has shown about 65 specific targets (receptors, enzymes, ion channels, vectors), and although CBD was previously thought to inhibit FAAH, the results are contradictory, and inhibition is only detectable at high concentrations, questionable to achieve in the living body(Ibeas Bih et al., 2015; Massi et al., 2008).

The issue of serotonin mechanisms remains controversial: Rock et al. (2012) did not confirm a direct agonistic effect of CBD on 5-HT1A, suggesting allosteric or intracellular modifications; there is no experimental confirmation of these mechanisms in living organisms (Ibeas Bih et al., 2015).

Therefore, further research should not only expand the clinical range of CBD doses and administration regimens, but also elucidate its molecular targets and accompanying effects to fully assess its therapeutic potential in various neuropsychiatric conditions.

Mental challenges during the war: stress, anxiety, depression

Stress — is a normal body reaction to external threats, but in the context of a full-scale invasion, its level in the population of Ukraine averaged 7.55 out of 16 possible points six months after the start of hostilities (Kurapov et al., 2023).
Reactions to traumatic events can be acute or chronic. Acute stress is manifested by intense emotional outbursts during the first month after the trauma (Kurapov et al., 2023). However, for some people, this condition does not go away - prolonged exposure to stressors leads to more serious disorders, including PTSD, as constant exposure to danger and loss of family members significantly increase the risk of long-term mental health problems (Kurapov et al., 2023).
The war seriously increases the risk of psychological disorders among civilians: about 68% of Ukrainians surveyed six months after the invasion experienced moderate stress, and 15% experienced high stress (Kurapov et al., 2023). At the same time, almost a third (32.9%) of non-displaced persons, 39.4% of internally displaced persons, and 47.2% of refugees had PTSD levels that exceeded the clinical threshold(Lushchak et al., 2024). Those who experienced severe suffering or came under fire were the worst off: their anxiety and PTSD were 6-10% higher than in groups with less acute experiences.(Kurapov et al., 2023).
Kurapov, A., Kalaitzaki, A., Keller, V., Danyliuk, I., & Kowatsch, T. (2023). The mental health impact of the ongoing Russian-Ukrainian war 6 months after the Russian invasion of Ukraine. Frontiers in Psychiatry, 14, 1134780.
In a large study of more than 14,000 respondents, there was a 2.2% increase in the likelihood of suicidal thoughts and a 4.9% increase in feelings of helplessness in areas with severe damage compared to less affected areas. Men were more likely to feel suicidal and women more likely to feel helplessness(An et al., 2025)
An, J., Wang, T., Chen, B., Oleksiyenko, A., & Lin, C. (2025). Mental health of residents of Ukraine exposed to the Russia-Ukraine conflict. JAMA Network Open, 8(2), e2459318.
Thus, while many people demonstrate remarkable resilience (the average psychological resilience score in the survey is 2.85 out of 5), war poses long-term mental health challenges. The figures show that assistance needs to be targeted: internally displaced persons and refugees require special attention, and creating a safe environment and employment opportunities can greatly facilitate recovery from conflict (Kurapov et al., 2023; An et al., 2025).

Experience of other countries

In the United States, the use of cannabis for the treatment of PTSD among veterans has been studied most thoroughly. It was found that approximately 44% of veterans with mild traumatic brain injuries use cannabis on a monthly basis, five times more than the general population (8.6%) (Utter et al., 2023). Among those who seek help, the percentage of cannabis users for medical or recreational purposes reaches 40-45% (Betthauser et al., 2015; Metrik, J. et al, 2018). Although the first placebo-controlled study conducted by MAPS did not show any benefit of smoking cannabis over placebo (Bonn-Miller et al., 2021), more recent data show that veterans who used prescription cannabis were 2.5 times more likely to no longer meet the criteria for a PTSD diagnosis (VFW, 2021). At the same time, VA policy prohibits the prescription of medical cannabis due to its federal Schedule I classification, and veterans are forced to seek it out on their own in state programs or on the illegal market (Politico, 2021). It was only in late 2024 that the FDA authorized a new placebo-controlled study, MJP2, involving 320 veterans to study cannabis with high THC concentrations in real-world settings (Stars and Stripes, 2024; The Psychiatrist, 2024).

Israel has the most developed clinical platform for patients with combat trauma: about 20,000 people with PTSD (15% of all medical cannabis users) get access only after two medication and two psychotherapy courses have failed (Yakinevich et al., 2023; Globes, 2025). A large-scale follow-up study at Soroka University Medical Center covered 8,500 patients and showed that 90.8% of them achieved "therapeutic success" within six months: opioid use decreased by 52%, antipsychotics by 36.9%, and antiepileptics by 35.7% (Clinical Trial, 2022). Israel is also investing in innovation - for example, the SyqeAir inhaler provides 60 precise doses of pharmaceutical cannabis and has been approved in Canada and the EU after three clinical trials (NoCamels, 2023; Syqe Medical, 2025).
Canada offers the most comprehensive system of access for veterans: since 2008, VAC has reimbursed up to 3 grams of dry cannabis per day, and the program budget in fiscal year 2021-2022 exceeded $153 million, with an increase in the number of recipients from 37 to 18,288 (Veterans Affairs Canada, 2025; Wang et al., 2023). Today, 45% of CAF members and veterans report using cannabis, and the average rating of its effectiveness on a 10-point scale is 8.4 for PTSD, 8.2 for insomnia, 8.1 for anxiety, 8.0 for depression, and 7.6 for chronic pain (Walsh et al., 2023; Valikhanova et al., 2023). The pronounced need for reliable medical recommendations encourages Canadian organizations (Atlas Institute, MHCC) to promote research and clinical guidelines (Mental Health Commission of Canada, 2023).
Valikhanova, G., Kato, Y., Fitzcharles, M. A., Ware, M., Da Costa, D., Lowensteyn, I., Cheung, H. S., & Grover, S. (2023). Medical Cannabis Use Among Canadian Veterans and Non-Veterans: A National Survey. Integrative medicine reports, 2(1), 120–128.

At the same time, the problem of access to cannabis remains open for Ukrainian citizens affected by the war. Medical cannabis was legalized in August 2024, but PTSD was excluded from the final list of diseases, although the Ministry of Health estimates the potential target audience at 6 million people (Business Insider, 2023; Le Monde, 2024; Cannabis Health News, 2024). The Cannabis with Ukraine campaign seeks to distribute therapies to the wounded and children of the dead, but there are no clear mechanisms to ensure access for civilians (Soft Secrets, 2025).

Finally, while countries demonstrate different levels of political support and scientific basis, the overall challenge remains balancing accessibility, evidence of efficacy, and long-term safety of cannabinoid therapies for veterans and civilians affected by combat.

Legal and medical status of cannabis in Ukraine

On February 16, 2024, President of Ukraine Volodymyr Zelenskyy signed the Law of Ukraine No. 3528-IX "On Amendments to Certain Laws of Ukraine on State Regulation of the Turnover of Plants of the Cannabis Genus". The law came into force on August 16, 2024, marking a historic moment for medical practice in Ukraine (Cabinet of Ministers of Ukraine, 2023; Suspilne, 2025; Ukrinform, 2024).

Draft law No. 7457, as it was known at the stage of consideration, was adopted by the Verkhovna Rada on December 21, 2023, in the second reading and in general, with the support of 248 deputies. The document regulates the circulation of cannabis exclusively for medical, industrial, scientific, and scientific and technical purposes, leaving recreational use under the ban (Rada, 2025; BBC Ukraine, 2023).

The Ministry of Health of Ukraine has approved the list of diseases and conditions for which medical cannabis will be prescribed by Order No. 1586 of September 13, 2024. The list is based on the most up-to-date research and evidence of efficacy and will be reviewed periodically (МЗ, 2024; ТСН, 2024).

The approved list includes:

Chronic or neuropathic pain and/or spasticity caused by:
  • Malignant neoplasms(C00-C97)
  • Diabetic neuropathy(E10.4-E14.4)
  • Multiple sclerosis (G35)
  • Lesions of the trigeminal and facial nerves (G50, G51)
  • Neuralgia due to shingles (G53.0)
  • Spinal cord injuries and intracranial injuries
  • Cerebral palsy and other paralytic syndromes

Other indications include:

  • Nausea and vomiting due to chemotherapy
  • Parkinson's disease and de la Tourette syndrome
  • Refractory epilepsy
  • Pediatric convulsive syndromes (Lennox-Gastaut, Dravet, tuberous sclerosis)
  • Weight loss in HIV infection
  • Other diseases with the conclusion of the medical advisory commission
    • (MOH, 2024; MedPlatforma, 2024).

Medical cannabis-based medicines can be obtained exclusively with an electronic prescription from a primary or specialized healthcare provider. Data on prescriptions are entered into the electronic healthcare system (EHR), which ensures full transparency of the process (MoH, 2024; Hromadske Radio, 2025).

There are special restrictions for children: the ratio of cannabidiol to tetrahydrocannabinol should be more than 20:1, and the maximum daily dose should not exceed 25 mg/kg body weight. The drug is not prescribed to pregnant women, women while breastfeeding, or patients with a tendency to psychotic disorders (The Village, 2025).

In January 2025, the first medicines based on medical cannabis were officially registered in Ukraine - oral drops from the Spanish brand Kuralif. This was an important milestone after many years of struggle by patient organizations for access to treatment (Gvara Media, 2025; LB.ua, 2025).

Stigmatization and social and legal barriers

The biggest problem is people's misunderstanding and ignorance of the differences between medical and recreational cannabis. According to representatives of patient organizations, there is a persistent stigma in society when the concepts of medical and recreational cannabis are deliberately mixed, which creates misunderstandings about the safety and effectiveness of medicines (Ukr.radio, 2024).

A 2020 study among Ukrainian pharmacy students found that almost half of respondents were not sufficiently informed about the therapeutic properties of cannabis, although more than 90% believed that materials on the medical properties of cannabis should be included in the curriculum (Kovalenko et al., 2020).

Awareness of Ukrainian pharmacy students about the therapeutic properties of cannabis and cannabinoids in the treatment of certain diseases
Kovalenko, A., Pakhomov, I., Horoshko, O., Kalinichenko, V., & Bezditko, P. (2020). Perspectives on formation of medical cannabis market in Ukraine based on holistic approach. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC7819340/
The Ministry of Health estimates that about 6 million patients need medical cannabis-based medicines, a significant increase from the pre-war 2 million, due to the large number of military and civilians with PTSD and other mental disorders as a result of the war (Suspilne, 2024; Gvara Media, 2025).
A critical obstacle is the lack of detailed clinical treatment protocols. Although the Ministry of Health has approved a list of diseases, there are still no specific protocols for dosages and treatment regimens. According to the Deputy Minister of Health, it will take another six months to a year to develop clinical protocols and register drugs (UNIAN, 2023).

Patient organizations insist on including PTSD in the official list of indications. Currently, this condition can be treated with medical cannabis only with the conclusion of a medical advisory committee in hospitals with a scientific base, which limits access for many veterans(LB.ua, 2025).

The lack of proper training for medical professionals creates additional obstacles. Charitable organizations, together with the NHSU Academy, are preparing online training for Ukrainian doctors so that they can adopt modern treatment regimens from their foreign colleagues(LB.ua, 2025).

Risks and ethical considerations

In recent years, cannabis has become one of the most commonly used psychoactive drugs in the United States: a large national survey estimates that 52.4 million people aged 12 and older used it last year, which is 18.7% of this age group.(Le Foll et al., n.d.). At the same time, 16.3 million people (5.8% of the same age groups) met the clinical criteria for a "cannabis use disorder". (CUD) (Le Foll et al., n.d.).

CUD occurs in all age groups, but is especially common among young people. Thus, among those aged 18 to 25, the percentage of people with CUD last year was 14.4%, while among adolescents (12-17 years old) it was 4.8%, and among adults over 26 years old - 4.6%.(Le Foll et al., n.d.).

These facts can be explained by factors that influence the development of addiction. First, the earlier a person starts using cannabis, the faster their habit can progress to chronic use and eventually to CUD (Le Foll et al., n.d.). Second, although CUD incidents are more common in men across all age groups, some evidence suggests that women may develop dependence more quickly after their first use of cannabis(Le Foll et al., n.d.).

Epidemiological studies show that cannabis use significantly increases the risk of developing psychotic disorders. Thus, a meta-analysis of prospective studies showed that those who had ever tried cannabis were 2.58 times more likely to develop a psychotic disorder than those who had not.(Moore et al., 2007).

Young people are particularly vulnerable to this effect, as the brain is still actively forming in adolescence. It is during this period that cannabis use can disrupt the endocannabinoid system, leading to changes in synaptic "tuning", white matter development, and binding to CB1 receptors. The main role in the occurrence of such effects is attributed to Δ9-tetrahydrocannabinol (THC), which is responsible for most of the psychoactive properties of cannabis (Lubman, Cheetham, & Yücel, 2015).
The most recent data confirms this vulnerability. A large cohort study of adolescents (12-19 years old) found that cannabis users had an approximately elevenfold increased risk of psychotic disorder compared to non-users. However, no such association was found among young adults (20-33 years old)(McDonald et al., 2024).

These results emphasize:

  • Cannabis is a risk factor for psychosis. Even single use increases the risk several times.
  • Adolescents are the most vulnerable group. The development of the brain makes them particularly sensitive to the psychotogenic effects of THC.
  • Preventive measures are needed. Delaying the start of use and informing about the risks should be a priority in working with young people.

Cannabis and Ukraine - instead of a conclusion

For Ukraine to be able to effectively and safely use cannabis in the treatment of mental (and other) diseases, we need a comprehensive research program: from preclinical testing of pharmacological properties to large-scale clinical trials involving the military and civilians. At the same time, it is necessary to create clear legal rules and standards - who can receive cannabis-based medicines and for what indications, how the quality of the drugs will be controlled and how abuse will be prevented. Without a broad public education campaign, it is impossible to achieve public trust: it is important to explain to citizens that therapeutic cannabis is not a "free drug" but a carefully regulated medicine with proven efficacy and safety.

Physicians should become agents of change before prescribing therapy to a patient; they should understand the mechanisms of action of cannabinoids and be able to assess the feasibility and risks for each individual. Psychologists will help integrate cannabinoid therapy with psychotherapeutic techniques, enhancing the effect of both approaches. Scientists - pharmacologists, clinical researchers, epidemiologists - should work on continuous data collection and improvement of treatment protocols. The joint work of these specialists will result in a reliable, evidence-based algorithm that will minimize risks and maximize patient benefit.

Veterans and civilians who have experienced the trauma of war are often overlooked by traditional healthcare systems. Medical cannabis can be an important tool in reducing post-traumatic anxiety, improving sleep and overall well-being. The creation of specialized support centers where veterans and affected civilians can receive medical, psychological and social assistance with the possibility of cannabinoid therapy can give a new impetus to the recovery of both individuals and entire communities. Such a model of combining evidence-based medicine and social rehabilitation will show an example of an integrated approach that can make a real difference in the lives of those who have sacrificed their health for our safety.

Cannabinoids are not a universal remedy for all mental suffering, but they open up new opportunities to support survivors of war and other traumas as an additional tool in the hands of doctors and psychotherapists. At the same time, it is necessary to find a golden mean between strict scientific control of each stage of research and a humanistic desire to respond to the common pain and suffering of citizens, not limited to protocols and numbers. At a time when the war is accelerating the revision of our understanding of mental health and prompting us to look for atypical ways to help, it is the combination of evidence-based medicine and a humane approach that can become a real catalyst for changes in society's attitude to psychoactive substances and care for the patient's mental health.

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