Medical marijuana may have a host of advantages over other treatments
for traumatized vets, but the VA won't even study its efficacy.
"There's a lot of things I'm passionate about, but getting a prescription for my marijuana from the VA is probably at the top of my list. I'd be like a kid waiting up for Santa if I thought he might be bringing me one of those. Haha!"
On top of a 100 percent disability rating with PTSD, "Charlie" -- who asked that his real name not be used -- came home from Afghanistan with a traumatic brain injury, a back injury and gastrointestinal problems. The VA pulled every magic trick out of its bag to treat him. But nothing worked.
What did work was marijuana.
Shirak-e-Mazar, the milk of Mazar, is what got Charlie through his deployment in Afghanistan. Shirak-e-Mazar is what Afghanis call the paper-thin sheets of hashish that sell for about $1.50 an ounce. It's a 5000-year-old recipe, perfected in the Mazar-e-Sharif region, for preparing the compressed resin glands of the marijuana plant, and unless things have changed since Charlie left Afghanistan in 2004, it's available, well, just about everywhere.
So was alcohol, but according to Charlie, it didn't provide the same kind of relief: "You get some drinks in you, you get nice and loose; you drop your inhibitions and think you're invincible. But you haven't dealt with the stress; you've just kind of blocked it; you don't really understand the possible outcomes of what you're about to do - or you don't care.
"Smoking though ... you can appreciate the stresses and understand everything that's going on, but you're still relaxed enough to do what you have to do, and do it well."
Since he got home, he says he is "smoking about one and a half grams a day, depending on how I'm doing. I go through an ounce in three to four weeks. I'm medicating for PTSD, but also a back injury and gastrointestinal problems, so if I had to do things like shovel the walk ... I would have to smoke a little more."
Unfortunately, Charlie does not live in one of the 13 states that have authorized the use of medical marijuana. In the rest of the states, federal law still applies, and according to the United States Department of Agriculture (USDA) marijuana is still classified as a Schedule I drug. Schedule I drugs are those deemed most dangerous, more so than cocaine, oxycodone and methamphetamines, all of which are Schedule II.
"Me and the rest of my veterans' group talk about it all the time," he says. "Most of them also medicate with marijuana. If you asked any of us what, out of everything, was most effective in PTSD treatment, we would tell you marijuana." But the VA is a federal agency, so even in the 13 states where doctors are at liberty to suggest that patients try marijuana, they are prohibited from dispensing it.
The first two years after he got home, Charlie and his wife were still active duty. Marijuana was too risky, so he drank. A lot. So much that he almost killed himself and his wife. "Alcohol seemed to exaggerate all the negative feelings, the anger, the rage, the depression, the desperation."
Since Charlie was discharged in 2006, the VA has pulled an astonishing variety of medications out of its magic bag. Charlie's list is an impressive one that many, perhaps most, vets who have gone to the VA for help with post-combat stress and pain issues will recognize.
"I've been on six different antidepressants, lorazepam for anxiety; two sleep aids, Ambien and something else; three medications for my stomach problems, including omeprazole; and Topomax and amyltriptomine for migraines.
"Even if the sleeping pills got me to sleep, I'd still wake up in the middle of the night from nightmares. The only difference is that WITH the pills I'd wake up dizzy and disoriented. The disorientation made for a smooth transition into flashbacks, and if you want to see a vet have a bad episode, make sure he/she is completely disoriented and wake them suddenly in the dark. (Don't try this at home -- danger, danger!)
"The lorazepam was prescribed for the anxiety caused by the antidepressants, but it turned me into some kind of shuffling Ozzie Osborne zombie. I didn't have the physical energy to do anything but lay on the couch. Topomax and amyltriptomine turned me into a sloppy, silly bedlamite, groggy like I'd had too much to drink and babbling like a face-painted Anna Nicole Smith. Oh, and the Topomax had me hurling up last year's Christmas dinner.
"I've gone through pain management more times than I can count on my hands, and I've had over twelve series of epidermal steroid injections done to my lower back. None of them ever did anything for me. Except of course make my stomach problems much worse. I started smoking [marijuana] again three years ago, and it's been the best pain management I've found. I can pick up my thirty-pound daughter for a while now, which might not seem like a big deal, but it is. Oh, as for helping with hypervigilance, it does, but given the current legal status of my medication of choice in this state, I am hypervigilant for the police."
And not without cause.
Even in states where medical marijuana has been approved, conflicting state and federal laws have provided law enforcement agencies with an excuse to prosecute according to personal prejudice.
Recently, the Obama Department of Justice instructed prosecutors to leave legitimate growers of medical marijuana alone. That is a step in the right direction, but there are at least 10 reasons why they should be encouraged to continue moving toward saner and clearer policies.
1) Until proven otherwise, marijuana is the safest thing they've got in their pharmacopoeia.
Marijuana has been used worldwide to treat pain, stress and any number of other ailments since the third millennium BCE.
It has been outlawed in the United States since 1937, but since 1970, with passage of the Controlled Substances Act, marijuana has been classified as a Schedule I drug, with a "high potential for abuse," "no currently accepted medical use" and a "lack of accepted safety" for use of any kind.
The Schedule I classification has meant that for the better part of 40 years, claims could be made that marijuana would turn you into a serial psycho-killer, a spotted owl or a socialist, and nobody could prove them wrong.
Daunting layers of federal permits discouraged serious study of the substance's efficacy, and strictly controlled access to the only legally grown supply have meant that grants were awarded only to those folks who weren't looking for anything nice to say about pot.
Schedule I drugs can't even be the subject of research or study.
But this November, the young guard at the American Medical Association (AMA) gleefully hip-checked the doomy, gloomy straight-laced old guard out of the way and voted to revisit marijuana's Schedule I classification.
After reviewing all the reliable information available, their conclusion was this (PDF): "Adverse reactions observed in short-term randomized, placebo controlled trials of smoked cannabis to date are mostly mild without substantial impairment. Physicians who comply with their ethical obligations to 'first do no harm' and to 'relieve pain and suffering' should be protected in their endeavors, including advising and counseling their patients on the use of cannabis for therapeutic purposes."
In taking that position, the AMA joined the American College of Physicians, the country's second largest physician group, which in February 2008, had adopted a similar resolution.
As former Surgeon General Dr. Jocelyn Elders wrote in AlterNet in 2008, it's time "to put science ahead of politics."
2) Reduce our dependence on foreign opioids.
Chronic pain is the leading indication for medical marijuana use, accounting for 90 percent of the patients in Oregon's medical marijuana program.
Recently, research done both in Canada and the United States has demonstrated a synergistic interaction between cannabis and opioids. Patients who smoked a little weed along with their meds found they could decrease their opioid dose by between 60-100 percent.
So consider that if the entrenched drug warriors were finally outflanked, VA doctors would be allowed to prescribe marijuana and our vets could reduce their consumption of opioids.
3) Restore the reputation of the VA among veterans.
After all the criticism of the VA for limiting access, shredding claims, misdiagnosing illnesses as a cost-saving trick and using soldiers as uninformed guinea pigs to test pharmaceutical drugs linked to suicide and other violent side effects, veterans invited by the VA to knowingly participate in a marijuana study might be inclined to allow the euphorogenic qualities associated with cannabis to blur their outrage, even to the point of forgiveness.
4) Israeli rats have less stress than American soldiers.
In an article published in the September issue of the Journal of Neuroscience, Israeli scientists revealed that injecting synthetic marijuana into the brains of rats allowed them to recover faster from trauma. In fact, it "cancelled out the symptoms of stress."
The researchers predicted that marijuana may help patients overcome life stresses that worsen reawakened trauma and other symptoms of post-traumatic stress disorder.
5) And then there is Sativex.
Savitex is an oromucosal spray, developed by the British firm GW Pharmaceuticals, that has been called "liquid marijuana" because it is derived from the entire botanical cannabis plant. In 2005, the Canadian government approved its use for relief of neuropathic pain and the FDA has agreed to trials in the U.S. prior to an approval application.
It will be challenging to persuade patients that Sativex, which will surely cost more than what can be grown in your backyard, is the better choice. No pharmaceutical preparation, synthetic or natural, has yet proven as effective as the smoked plant. In fact, the only proven advantage of such medications is that they are legal.
Those FDA trials, by the way, were supposed to be completed by the end of 2009.
6) We gave Big Pharma 40 years of government handouts and they came up with zilch.
Instead of paying extortionist rates, imagine if the VA could say, "Sorry, Bayer, but you're going to have to make it cheap and make it good, or they'll just grow their own."
It's a piece of cake to go around Big Pharma on this one. All you need is a little sun, soil and TLC, or a grow-lamp in your basement. And the good fortune to get to your crop before the cops, the local kids or the deer.
How easy? Since 2006, entrepreneurial Americans have grown enough marijuana to displace corn as the leading cash crop in America.
7) The growing process is itself demonstrably therapeutic.
A recent study out of the Naval Postgraduate School and Stanford University predicts that as many as 35 percent of returning soldiers could have PTSD. The number of veterans who have already served in Iraq and Afghanistan has reached 1.8 million.
Another study, courtesy of the Pentagon, estimates that as many as 360,000, or 20 percent of the veterans of these current wars have suffered traumatic brain injuries.
That's a lot of new fists that will be banging on the doors of an already overwhelmed VA asking for help. How serendipitous then, that a promising treatment option being offered to traumatized veterans across the country is gardening.
8. We could fill some budget gaps.
Imagine the savings for states like Washington that are currently facing huge financial deficits. Washington announced this month that a bill to legalize marijuana altogether will be on the ballot in 2010.
The circularity is sweet; the logic hopefully irresistible. Traumatized veterans could be hired by the state to garden, which relieves their post-combat stress symptoms and also affords them an income and the self-respect that comes with employment. The crop they grow will medicate their own psychic distress and that of other veterans, while at the same time replenish the state coffers when sold in state-run liquor stores.
Rep. Mary Lou Dickerson, a Seattle Democrat who is sponsoring the legalization bill, said she expected legal sale of marijuana could bring in as much money as alcohol; more than $300 million a year.
It will also challenge legislators in other cash-strapped municipalities to consider the billions of dollars worth of marijuana that is currently going untaxed, and whether they want to stand on principle or on solvency.
9) Suicide prevention.
The National Center for Posttraumatic Stress Disorder acknowledges that there is "disagreement whether pharmacotherapy should be considered a first-line treatment for PTSD."
As illustration, their manual, "Treatment of the Returning Iraq War Veteran," states: "We recommend SSRIs as first-line medications for PTSD pharmacotherapy in men and women with military-related PTSD."
The Journal of Clinical Psychiatry reports that 89 percent of veterans with PTSD are prescribed antidepressants and 34 percent antipsychotics by the VA.
Of the specific medications identified as potentially useful, all but two come with black box warnings of suicide or increased risk of death.
In October, VA Secretary Eric K. Shinseki announced that, "(m)ore Veterans have committed suicide since 2001 than we have lost on the battlefields of Iraq and Afghanistan - each one a tragedy."
Soldier suicides are at an all-time high and so are prescriptions for all kinds of new and dangerous drugs. Nobody can say for sure if there is a connection between those two facts, and I would never suggest that marijuana could or should take the place of SSRIs or any other drugs proven to be effective in managing PTSD. Or that marijuana could prevent soldier suicides. But the vast majority of drugs the VA prescribes for PTSD are known to worsen depression, increase suicidal thinking or increase risk of death in enough people to warrant the warning.
The same is not true of marijuana.
10) It would bring some coherence to our nation's drug policies.
It is just possible that Tim Leary was right when he said that "(p)sychedelic drugs cause paranoia, confusion, and total loss of reality in politicians that have never taken them."
Daniel Robelo of the Drug Policy Alliance says, "The federal government has a duty to help veterans receive the most effective treatment available for their combat-related conditions, and for PTSD and chronic pain, marijuana is often that treatment. All veterans (and non-veterans) who might benefit should have unfettered access to this effective medicine, which is well within the margin of safety for any drug, and in fact, much less dangerous than most drugs commonly used to treat PTSD and pain."