Pre-Trauma THC Use Is Associated With a Positive Posttraumatic Adjustment Scale Screening

Abstract

Background

Cannabis use has increased in recent years, often perceived as therapeutic for psychiatric symptoms including those of posttraumatic stress disorder (PTSD). However, the relationship between pre-trauma tetrahydrocannabinol (THC) use and development of PTSD symptoms after injury remains poorly defined. The purpose of this study was to determine the association between THC use and positive screening for posttraumatic stress symptoms using the Posttraumatic Adjustment Scale (PAS) in trauma patients.

Methods

This retrospective cohort study used data from a Level 1 trauma center between January 2023 and December 2024. Adult trauma patients who completed inpatient PAS screening were included. Patients were stratified into PAS-positive and PAS-negative groups. THC use was identified via urine drug screen on admission. Multivariable logistic regression was used to evaluate independent predictors of a positive PAS screen, adjusting for age, sex, injury severity, assault mechanism, polysubstance use, ICU admission, and in-hospital complications.

Results

Among 1960 patients, 437 (22.3%) screened positive on PAS. Tetrahydrocannabinol use was more common in PAS-positive patients (19.6% vs 13.2%, P = 0.001) and remained independently associated with a positive PAS screen after adjustment (OR 1.66, 95% CI 1.23-2.24, P = 0.001). Other independent predictors included polysubstance use, younger age, assault-related injury, and longer hospital stay. Male sex was associated with lower odds of a positive PAS screen.

Conclusions

Recent THC use is independently associated with positive PAS screening in trauma patients, suggesting that baseline cannabis use may signal heightened vulnerability to psychological distress following trauma. These findings raise concern about the role of THC as self-medication and highlight the need for targeted screening and intervention.