A New Hope for Veterans with PTSD

Two million Americans have served in Iraq and Afghanistan, and it is estimated that 30 percent of them have returned with PTSD 1. That means the Veterans Health Administration (VA) has been overwhelmed with more than 600,000 PTSD patients, and in response, they are over-prescribing opiates. Despite treatment, an average of 22 veterans commit suicide each day.

While it is normal to experience stress after a trauma, PTSD sufferers seem caught in an endless loop of reliving the trauma and overreacting to similar, yet ordinary events in daily life. The simplest and most innocent event can trigger nightmares, violent reactions, or even a full-blown flashback. For those suffering from PTSD, it is not uncommon for them to avoid any situation that might trigger them, often withdrawing from friendships, relationships, and life in general. Suicide is an all too common outcome for these returning heroes with wounds that can’t be seen.

The current treatments include therapy and prescription opiates. For this reason, veterans get addicted to prescription drugs at a much higher rate than civilians. NIDA reports that prescriptions for opioids written by military physicians quadrupled between 2001 and 2009, with devastating effects. On average, 2,500 veterans commit suicide each year. But many are turning to Cannabis as an effective treatment for their PTSD.

Because Cannabis is still illegal at the Federal level, the VA refuses to prescribe it. On their website, the VA claims that marijuana is actually harmful to individuals with PTSD 2, and veterans found to be using Cannabis will lose their benefits 3. In fact, VA doctors are not even allowed to discuss the topic of medical marijuana with patients 4.

A New Hope

Dr. Raphael Mechoulam is one of the most respected neuroscientists in Israel. In the 1960’s, he identified THC as the psychoactive compound in marijuana, and in 1971 he successfully synthesized it 5. Decades later, in the 1980’s, he demonstrated that cannabis was a safe and effective treatment for epilepsy in humans 6, then in the 1990’s, he identified endogenous cannabinoids produced within the body which regulate a wide range of psychological and physiological functions. For more than 50 years, Mechoulam has been studying the Cannabis plant and the way its compounds interact with the human body. He seems to think Cannabis would be an effective treatment for PTSD and has applied to conduct research on this topic. In 2011, Mechoulam published a study that claimed cannabinoids appear to be a “magic-bullet” in treating traumatic brain injury 7.

The endocannabinoid system, or ECS, is a network of cannabinoid receptors found throughout every vertebrate’s brain and body. It turns out that the ECS is integrally related to memory, specifically memory extinction. Memory extinction is the normal, healthy process of removing associations from stimuli. Some researchers, such as Dr. Robert Melamede, believe that endogenous cannabinoids found in mother’s milk help babies forget and recover from the trauma of childbirth.

This has profound implications for patients with PTSD, who have trouble forgetting traumatic events. Dr. Mechoulam explained experiments conducted on mice which were given an electric shock combined with a certain noise. Like Pavlov’s dogs, the mice are conditioned to react to the noise as if they have been shocked even when the noise is played by itself. After a few days of hearing just the noise without the shock, the mice eventually remove that association naturally. However, mice bred with a deficient ECS simply never forget – they continue to cringe at the noise indefinitely, whether they receive an electric shock or not 8,9.

Conversely, mice administered phytocannabinoids (from the Cannabis plant) show a much-improved ability to “decouple” the memory of the sound with the trauma of the electric shock.

Killer Painkillers

“The United States is in the midst of an opioid addiction crisis,” says Dr. Dustin Sulak.
Prescription opioid abuse and addiction is actually a much bigger problem than heroin addiction in the US. In 2014 there were 11,000 overdose deaths from heroin, however, there were 19,000 overdose deaths from prescription opiates – nearly twice as many.

What’s worse, nearly 80 percent of heroin users in the US reported that they began on prescription painkillers before progressing to heroin use, and 45 percent of heroin users are currently addicted to prescription painkillers. “So this problem is largely starting in the doctor’s office,” says Dr. Sulak.

According to a recent Army study in the Journal of the American Medical Association, nearly half of all troops who have come home from Afghanistan and Iraq are coping with chronic pain 10. Veterans with PTSD are more likely to be prescribed more than one opioid, and to receive the highest dose 11. This only compounds the problems for veterans who suffer from both chronic pain and PTSD. They are prescribed one type of opioid for their pain and another type of opioid for their PTSD. Your body builds a tolerance to opioids, and so over time, you need to be prescribed more and more. This is the downward spiral that ensnares far too many of our veterans today.

Cannabis, Opioid Addiction, and PTSD – A Magic Bullet?

According to reports from Doctors and researchers like Dr. Sulak, Cannabis is an effective treatment for chronic pain in and of itself. Administering Cannabis and opioids together results in a “greater-than-additive anti-pain effect” 12. As if that weren’t enough, Cannabis also prevents the body from building a tolerance to the opioids resulting in dose escalation, and it helps treat the symptoms of opioid withdrawal. Simply legalizing medical marijuana is enough to reduce opioid overdose deaths dramatically. In fact, according to the Journal of the American Medical Association, States that had legalized medical Cannabis showed a 25 percent reduction in opioid overdose deaths compared with states where Cannabis is still illegal 13.

Just like Dr. Mechoulam’s traumatized mice, traumatized veterans have shown significant improvements in their symptoms of PTSD after consuming Cannabis. Some veterans report that marijuana helps them manage anxiety, insomnia, and nightmares 14. Mike Whiter, a former Marine who switched from prescription drugs to medical marijuana, told CBS, “I went from being an anxious mess to numbing myself with the pills they were giving me. Cannabis helped me get out of the hole I was in. I started to talk to people and get over my social anxiety.” 15

Cannabis provides all of these benefits without any of the seeming side effects. “Cannabis? The worst it’s ever made me do is be happy,” says one veteran in the Vice series Weediquette16 There has never been a recorded death caused by Cannabis, ever. There is no known toxic dose for any cannabinoid, and therefore it is impossible to overdose on Cannabis.

“Those pills, they take your soul away,” says veteran Ryan Begin, in reference to prescription opioids. “They are murdering veterans every day by giving them those cocktails of pills. [Cannabis] is a solution to that problem. It is safe as shit! People don’t kill themselves, people don’t kill other people, people don’t kill their families. This is love in this little joint right here. Love.”

Despite mounting evidence and countless vocal examples like veteran Ryan Begin, Cannabis remains illegal Federally, and therefore unavailable to veterans through the VA. We hear politicians try to demonize this medicine in statements and press conferences, and the DEA has near free reign to write their own rules and prosecute citizens and veterans alike for saving their own lives. But there is hope on the horizon.

The First Clinical Trial

2017 saw the start of the first placebo-controlled, triple-blind, randomized crossover study on the effects of smoked marijuana on veterans with chronic, treatment-resistant PTSD 17,18. We don’t need to wait for the results of this study before we take action to help our veterans.

If you support our troops, don’t forget to support them even after they’ve finished serving. Real change will only come when everyday citizens like you and I begin to educate ourselves and speak up. Check the facts stated in this article and prove to yourself whether or not this is true. Then take action! Share this article with a friend, write a letter to Congress, or contact your local representative.

Don’t wait until another 22 veterans take their own lives tomorrow.

References:

1.
Veterans Face Dangerous Combination of Painkillers and PTSD – Partnership for Drug-Free Kids. Partnership for Drug-Free Kids. http://drugfree.org/learn/drug-and-alcohol-news/veterans-face-dangerous-combination-of-painkillers-and-ptsd/. Published November 11, 2013. Accessed March 11, 2017.
2.
Veterans A. Marijuana Use and PTSD among Veterans – PTSD: National Center for PTSD. U.S. Department of Veterans Affairs. http://www.ptsd.va.gov/professional/co-occurring/marijuana_use_ptsd_veterans.asp. Accessed March 10, 2017.
3.
Will My Fellow Vet Lose His Veterans Administration Benefits if He Uses Medical Marijuana to Help His PTSD? Drug Policy Alliance. http://www.drugpolicy.org/blog/will-my-fellow-vet-lose-his-veterans-administration-benefits-if-he-uses-medical-marijuana-help-. Accessed March 10, 2017.
4.
Veterans Still Can’t Discuss Medical Marijuana With Their VA Doctors. The Huffington Post. http://www.huffingtonpost.com/2014/05/01/veterans-medical-marijuana_n_5244565.html. Published May 1, 2014. Accessed March 10, 2017.
5.
Ben-Zvi Z, Mechoulam R, Edery H, Porath G. 6 -hydroxy-  1 -tetrahydrocannabinol synthesis and biological activity. Science. 1971;174(4012):951-952. [PubMed]
6.
Cunha J, Carlini E, Pereira A, et al. Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology. 1980;21(3):175-185. [PubMed]
7.
Shohami E, Cohen-Yeshurun A, Magid L, Algali M, Mechoulam R. Endocannabinoids and traumatic brain injury. British Journal of Pharmacology. 2011;163(7):1402-1410. doi: 10.1111/j.1476-5381.2011.01343.x
8.
General use of cannabis for PTSD Symptoms | VMCA . Veterans for Medical Cannabis Access. http://veteransformedicalmarijuana.org/content/general-use-cannabis-ptsd-symptoms. Accessed March 11, 2017.
9.
Bouton ME. Context and ambiguity in the extinction of emotional learning: Implications for exposure therapy. Behaviour Research and Therapy. 1988;26(2):137-149. doi: 10.1016/0005-7967(88)90113-1 [Source]
10.
VA, NIH seek alternatives to addictive opioids . U.S. Department of Veterans Affairs. https://www.research.va.gov/pubs/varqu/fall2014/fall14-3.cfm. Published 2014. Accessed March 11, 2017.
11.
Toblin RL, Quartana PJ, Riviere LA, Walper KC, Hoge CW. Chronic Pain and Opioid Use in US Soldiers After Combat Deployment. JAMA Intern Med. 2014;174(8):1400. doi: 10.1001/jamainternmed.2014.2726
12.
Dr. Dustin Sulak on America’s Opiate Addiction Crisis and How Medical Cannabis Can Help. Project CBD. https://www.projectcbd.org/article/americas-opiate-crisis-how-medical-cannabis-can-help. Published July 25, 2016. Accessed March 11, 2017.
13.
Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668. doi: 10.1001/jamainternmed.2014.4005
14.
AP Eastern U.S. on Twitter. Twitter. https://twitter.com/APEastRegion/status/712276895258247169. Published March 22, 2016. Accessed March 11, 2017.
15.
More veterans using marijuana for PTSD. CBS News. http://www.cbsnews.com/news/more-veterans-using-marijuana-for-ptsd/. Published March 22, 2016. Accessed March 11, 2017.
16.
Stoned Vets – Weediquette – VICELAND. VICELAND. https://www.viceland.com/en_us/video/stoned-vets/56cdd0654e3a0a6d5eaa13c3. Published March 8, 2016. Accessed March 11, 2017.
17.
Times A. Clinical trial using marijuana to treat PTSD in veterans gets underway. Army Times. https://www.armytimes.com/articles/clinical-trial-using-marijuana-to-treat-ptsd-in-veterans-gets-underway. Published February 7, 2017. Accessed March 11, 2017.
18.
MAPS – Marijuana for Symptoms of PTSD in U.S. Veterans. MAPS. http://www.maps.org/research/mmj/marijuana-us. Accessed March 11, 2017.
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