Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Sunday, July 5, 2015

Examining pot's potential for treatment of veterans' PTSD problems

This recent lengthy article about marijuana research struck me as especially worth highlighting as we close out a weekend of patriotic celebrations.  The piece is headlined "PTSD And Cannabis -- Can Researchers Cut Through The Politics To Find Out Whether Weed Works?" and here are excerpts:

After steadily accumulating anecdotes about how veterans use cannabis to treat their war wounds that understanding might finally be on the way.  Following years of bureaucratic hurdles, the first Food and Drug Administration (FDA)-approved, randomized controlled trial on cannabis and PTSD is set to begin this summer.  Many believe the study will spur increased acceptance of veterans using marijuana, a political shift that’s already led more and more states to add PTSD to their lists of conditions that qualify for medical marijuana.

But that key study still faces roadblocks, the latest being a VA hospital’s refusal to let one of the trial’s researchers recruit patients at its facility.  It’s just one more example of the political and scientific obstacles that remain before cannabis is embraced as a viable option for soldiers.  While the idea of veterans becoming medical marijuana patients has proven to be a powerful political leveraging tool, the concept gives some people pause.  Amid reports of skyrocketing substance abuse among veterans, overworked VA doctors and increasingly potent marijuana offerings, some worry that exposing the nation’s wounded warriors to cannabis might in some instances do more harm than good -- and in extreme cases, lead to even more violence and tragedy.

More than for any other potential medical use for marijuana, the clock is ticking to nail down the science behind cannabis and PTSD.  According to a 2014 report by the RAND Corporation’s Center for Military Health Policy Research, approximately 300,000 of the 1.64 million service members who deployed to Iraq or Afghanistan as of October 2007 were suffering from PTSD or major depression.  Only about half of that number had sought treatment in the previous year, and of those who did, just over half received a "minimally adequate treatment."  And with hundreds, if not thousands, of these struggling veterans killing themselves each year, advocates argue that if marijuana can help reduce the death toll there’s not a minute to lose....

But while veterans helped jumpstart recognition of cannabis’ potential medical benefits, many of them have limited access to medical marijuana themselves.  Because cannabis is still illegal under federal law, federal employees such as VA doctors can’t recommend the substance as treatment....

In some cases, veterans say their VA physicians wouldn’t just avoid talking about medical marijuana, but actively penalized them for using it.  Jack Stiegelman, founder of the Florida-based organization Vets For Cannabis, says a 2004 deployment in Afghanistan left him with a serious back injury for which he was prescribed daunting amounts of morphine and muscle relaxants.  There was also the PTSD that led him to wake up screaming in the middle of the night, threatening his squad leader with physical violence. “I said I was going to put my foot through his teeth,” says Stiegelman. “I felt it was their fault for not taking care of me.”...

VA spokeswoman Ndidi Mojay notes that federal law prohibits VA physicians from prescribing medical marijuana and from completing forms and paperwork necessary for patients to enroll in state marijuana programs.  However, “VA does not administratively prohibit VA services to those veterans who participate in state marijuana programs," she says.  "In some cases, participation in state marijuana programs may be inconsistent with treatment goals and therefore VA clinicians may modify treatment plans for the health of the patient.”

A major stumbling block is that there’s still little scientific research related to marijuana’s medical benefits, particularly when it comes to one of the signature injuries of modern veterans: PTSD.  Arguments for using cannabis to treat PTSD got a boost last year when New Mexico psychiatrist George Greer published in the Journal of Psychoactive Drugs the results of a chart review of 80 veterans he worked with who had PTSD and used marijuana.  He found that on average, patients using cannabis reported a 75 percent reduction in several of the main symptoms of PTSD, including hyperarousal and re-experiencing traumatic episodes. “This is a watershed,” says Greer. “You think of people being stoned on marijuana, you don’t think of them being more functional. It has to be a historical thing for marijuana to be found at least in anecdotal reports to be helpful for people for psychiatric conditions.”

But like all existing research on cannabis and PTSD, Greer’s study was based on anecdotal evidence, not the gold standard of scientific research: a randomized clinical trial. “We are at the point where self-report data is overwhelming and generally positive regarding medical marijuana and PTSD,” says Mitch Earleywine, a professor at SUNY Albany and chair of the National Organization for the Reform of Marijuana Laws (NORML)’s board of directors. “Unfortunately, there has never been a randomized clinical trial or anything like that.”...

Political momentum for linking PTSD and medical marijuana is growing. Of the 23 states that now allow for medical marijuana, nine include PTSD as a qualifying condition for the drug, and in three others doctors have broad discretion to recommend medical cannabis for PTSD or other ailments. In 2010, the VA published a directive stating veterans shouldn’t be punished for using medical marijuana in those states that allow it, but reiterated that its doctors can’t help veterans obtain the treatment. Now, even that restriction could be lifted. In May, a Senate committee passed a bipartisan amendment to a military spending bill that would allow VA doctors to recommend and fill out paperwork for medical marijuana in states where it’s legal; the final bill will be negotiated later this year.

But in many jurisdictions, PTSD and marijuana remains a political sticking point. In Colorado, which has some of the most liberal cannabis laws in the world, PTSD still doesn’t count as a qualifying condition for obtaining medical marijuana. And while PTSD is the No. 1 reason for which people obtain medical marijuana cards in New Mexico, there have been multiple initiatives to remove it from the state’s list of qualifying conditions.

Part of the problem is that PTSD is unique among medical marijuana conditions, since it is a psychiatric disorder, not a physical ailment. “One of the issues with PTSD with medical marijuana is it is the first mental condition to be considered,” says John Evans, founder of the organization Vets 4 Freedoms. He helped add PTSD to Michigan’s list of medical marijuana-approved conditions in 2014 and petitioned to add the condition to Colorado’s list earlier this year. The Colorado Board of Health will hold a hearing on the issue on July 15. “It bothers a lot of people in the psychiatric community and the prescription-drug world,” says Evans.

“It’s a catch-22,” says Dan Riffle, director of federal policies for the Marijuana Policy Project. “People want to have hard data on how medical marijuana works for PTSD. But you can’t say that and then actively block the research. And that’s what’s happening on a federal level.”

http://lawprofessors.typepad.com/marijuana_law/2015/07/examining-pots-potential-for-treatment-of-veterans-ptsd-problems.html

Medical community perspectives, Medical Marijuana Data and Research, Who decides | Permalink

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