2699. Legalize Marijuana: The Case of a Wounded Veteran

By Thomas James Brennen, The New York Times, September 1, 2017

The explosion that wounded me during a Taliban ambush in Afghanistan in 2010 left me with a traumatic brain injury and post-traumatic stress. In 2012 I was medically retired from the Marine Corps because of debilitating migraines, vertigo, and crippling depression. After a nine-year career, I sought care from the Department of Veterans Affairs.

At first, I didn’t object to the pills that arrived by mail: antidepressants, sedatives, amphetamines and mood stabilizers. Stuff to wake me up. Stuff to put me down. Stuff to keep me calm. Stuff to rile me up. Stuff to numb me from the effects of my wars as an infantryman in Iraq and Afghanistan. Stuff to numb me from the world all around.

The T.B.I. brings on almost daily migraines, and when they come, it’s as if the blast wave from the explosion in Afghanistan is still reverberating through my brain, shooting fresh bolts of pain through my skull, once again leaving me incapacitated. Initially, the prescriptions helped — as they do for many veterans. But when I continued to feel bad, the answers from my doctors were always the same: more pills. And higher dosages. And more pills to counteract the side effects of those higher dosages. Yet none of them quite worked.One thing did. In 2013, a friend rolled a joint and handed it to me, urging me to smoke it later. It will relieve your symptoms, he promised. That night I anxiously paced around my empty house. I hesitated to light it up because I’d always bought into the theory of weed as a “gateway drug.” But after a few tokes, I stretched out and fell asleep. I slept 10 hours instead of my usual five or six. I woke up feeling energized and well rested. I didn’t have nightmares or remember tossing or turning throughout the night, as I usually did. I was, as the comedian Katt Williams puts it, “hungry, happy, sleepy.”

With the help of my civilian psychiatrist, I began trading my pill bottles for pipes and papers. I also began to feel less numb. I started to smile more often. I thought I had found a miracle drug. There was just one problem: That drug was illegal.

In 21 states, including North Carolina, where I live, any use of marijuana is forbidden under state law. The current punishments for those who possess or cultivate cannabis — even for medical purposes — may include a felony conviction and imprisonment, loss of child custody and permanent damage to their livelihood. The V.A. encourages veterans to discuss their cannabis use with their doctors, but because cannabis is also prohibited under federal law, the V.A. cannot prescribe it in any form — thereby denying countless veterans relief to many mental health symptoms and other service-connected disabilities.

The medical benefits of marijuana for the more than 360,000 post-Sept. 11 veterans who have brain injuries are not universally recognized. (As many as one in five veterans are thought to have post-traumatic stress.) But medical experts like Dr. Frank Ochberg, a psychiatrist and former associate director of the National Institute of Mental Health, believe that “medical marijuana absolutely belongs in the pharmacy for post-traumatic stress and brain injury treatment.” The V.A., Dr. Ochberg said, “is failing veterans by not making cannabis a treatment option.”

In recent years, the V.A. has worked to reduce the number of opioids prescribed to veterans and increase the promotion of alternative therapies such as yoga and mindfulness, and it has made significant improvements in access to health care. Dr. David Shulkin, the V.A. secretary, has publicly supported the evaluation of emerging cannabis research, acknowledging that patients may benefit from marijuana use. But the department is prohibited from prescribing medical cannabis for veterans even in states where it is legal. (In those states, veterans can get prescriptions from private doctors, but at their own expense.)

Most of the major veterans groups, including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans, support regulated research into the medical uses of cannabis. But the research is slow in coming: Since 1968, the University of Mississippi has been home to the only licensed facility to produce cannabis for clinical research. In March it was reported that the university’s cannabis was contaminated with lead, yeast and mold — substances that jeopardize research efficacy and patient safety.

What I know is that it works for me. If I hadn’t begun self-medicating with it, I would have killed myself. The relief isn’t immediate. It doesn’t make the pain disappear. But it’s the only thing that takes the sharpest edges off my symptoms. Because of cannabis, I’m more hopeful, less woeful. My relationship with my wife is improving. My daughter and I are growing closer. My past is easier to remember and talk about. My mind is less clouded. More than anything, it feels good to feel again. My migraines and depression don’t control my life. Neither do pills.

But I live in fear that I will be arrested purchasing an illegal drug. I want safe, regulated medical cannabis to be a treatment option. Just like the sedatives and amphetamines the V.A. used to send me by mail. And the opioids they still send to my friends.

Thomas James Brennan, a former sergeant in the Marine Corps, is the founder of The War Horse, a veterans’ news site, and a co-author of “Shooting Ghosts : A U.S. Marine, a Combat Photographer, and Their Journey Back from War.”

1780. Seeking the Facts on Medical Marijuana

By Claudia Dreifus, The New York times, March 23, 2015

Twenty-three states and the District of Columbia have legalized medical marijuana, but scientific research into its appropriate uses has lagged. Dr. Mark Ware would like to change that.

Dr. Ware, 50, is the director of the Canadian Consortium for the Investigation of Cannabinoids and the director of clinical research of the Alan Edwards Pain Management Unit of McGill University Health Center. Medical marijuana has been legal in Canada for 16 years, and Dr. Ware, a practicing physician, studies how his patients take the drug and under what conditions it is effective.

We spoke for two hours at the recent meeting of the American Association for the Advancement of Science and later by telephone. Our interviews have been condensed and edited for space.

Q. How did you become interested in the medical possibilities of cannabis?

A. In the late 1990s, I was working in Kingston, Jamaica, at a clinic treating people with sickle cell anemia. My British father and Guyanese mother had raised me in Jamaica, and I’d attended medical school there.

One day, an elderly Rastafarian came for his annual checkup. I asked him, “What are your choices of medicines?” He leaned over the table and said, “You must study the herb.”

That night, I went back to my office and looked up “cannabis and pain.” What I found were countless anecdotes from patients who’d obtained marijuana either legally or not and who claimed good effect with a variety of pain-related conditions.

There were also the eye-opening studies showing that the nervous system had specific receptors for cannabinoids and that these receptors were located in areas related to pain. Everything ended with, “More studies are needed.”

So I thought, “This is what I should be doing; let’s go!”

Was getting started that easy?

Actually, not.

That summer, I went to England and considered working with a British pharmaceutical concern researching cannabinoids. But just then, a Canadian court took up the case of an epileptic who’d been arrested when he used cannabis for his seizures. The court essentially legalized medical marijuana throughout Canada.

When I heard that, it seemed like Canada was the place I should be going to. I packed up my young family and moved to Montreal. What I proposed to McGill was a clinic where we might evaluate the claims of patients about medical marijuana.

So much of what we knew about the drug was anecdotal. Some of it was folkloric. My idea was to listen to the patients’ stories and put them to a clinical evaluation.

When you first moved to Canada in 1999, what was known about medical marijuana?

We certainly knew that cannabinoids were analgesic in animal models. There were case reports floating around of people with multiple sclerosis who’d been helped.

In California, people with H.I.V. were using it for appetite stimulation, nausea and pain. Cancer patients sometimes used it to curb nausea from chemotherapy.

Since then, there have been at least 15 good-quality trials around the world. Cannabinoids are reported to help with H.I.V.-associated neuropathy, traumatic neuropathy, multiple sclerosis, pain from diabetes. There have also been a few small studies on fibromyalgia and PTSD.

When you talk about translational medicine, a drug usually moves from “bench to clinic.” But cannabis has had this unique trajectory: The patients were using it on their own, and then you had these papers, often based on a few case studies. And sometimes, you had later trials which led to drugs — like with H.I.V. patients’ using cannabis, which led to Marinol.

Tell us about some of your own research.

One investigation we published in the Canadian Medical Association Journal in 2010 studied 23 patients who used three slightly different levels of cannabis preparations and one placebo for two months. They had one puff three times a day. We found that the 9.4 percent THC level was superior to the placebo in terms of its effect on pain.

We also found that it helped with anxiety and sleep. Interestingly, our patients appeared to actually use very small quantities of the drug to control their symptoms, a lot less than recreational users.

Later this spring, we hope to take this research further by launching what we think will be the first ever longitudinal study of medical marijuana patients. We’ll follow the long-term effects of those of our regular patients who’ve been using it for chronic conditions. We’ll look at safety over the years.

Why do you think cannabis use has been generally so under-researched?

The fundamental answer is that the illegality of the drug has stigmatized most research. In Canada, people are sometimes afraid because of the perception that they are working with illegal substances, even when that’s no longer the case.

In the United States, it’s a different matter, because on the federal level, cannabis is listed as a Schedule I drug, like heroin. That means that the medical community is quite restricted in gaining access to research materials.

At the same time, there are more than 20 states where medical marijuana, to differing degrees, is legal. However, the plants grown in Colorado may be quite different from those grown elsewhere. Moreover, the medically eligible conditions vary from state to state.

This lack of standardization has been another factor making research difficult, because when you’re talking about cannabis in one state and cannabis in another, you may not be talking about the same thing.

You’ve said that physicians call you frequently for practical advice about the drug. What do they ask?

The most common question is, “How do I make the distinction between patients who want it for medical or recreational use?” The other call I get is from a clinician who wants me to take his patient and explain whatever I can.

Actually, I wish those doctors would inform themselves better; a lot of information does exist, though we need more. I believe that by not informing themselves, physicians aren’t fully serving their patients.

In Canada, for instance, we’ve noticed that our oncologists generally don’t tell their patients about medical marijuana. It’s the nurses who’ll go, “Dear, why don’t you go outside and have a puff.”

Your own Canadian Medical Association reminds its members that they are not obligated to write marijuana prescriptions because there is “insufficient evidence on clinical risks and benefits.” What is your take on their stance?

Well, I agree with them, at least on this: We need more research.

I think the time has come for us as a global community to agree on what we want to know and then go get it. And our patients need to move away from self-experimenting with substances and derivatives we don’t know about, and move to a situation where we know what they are using and where we can better help them. This isn’t going away.