The Cannabis Question

Anna Begin spent five years worrying she would get a phone call telling her that her son had killed himself. After Ryan came home from Iraq with his right elbow blown off, he went on benders, wrecked two trucks, was jailed, disappeared for weeks and tried to commit suicide several times. 

“It was an absolute living hell,” Anna says.

Being around Ryan, who served in the Marine Corps, wasn’t much better. The cocktail of narcotic painkillers, anti-anxiety medications, antidepressants and sleeping pills prescribed first by the military and then VA made him violent and unpredictable. “When he was on that medication, he would have a wild look in his eyes,” Anna says. “I never worried about him hurting anyone else. But you never knew when he was going to spark up in a temper or sleep all day and then be up all night. We couldn’t hold family functions here because his mood would be all over the place.”

“It was a rough road,” Ryan concedes. “I don’t know why I am alive.”

After five years of this ordeal, he found a private physician about two hours from his home in Jackman, Maine, who prescribed medical marijuana and meditation instead of prescription drugs. 

“Dr. Sulak and medical marijuana saved my son’s life,” Anna says.

Ryan can openly use cannabis to alleviate his pain and post-traumatic stress because Maine is one of 23 states that has legalized medical marijuana – part of a dramatic change in national attitudes that is fraught with legal and regulatory conflicts, controversy about marijuana’s medical viability, and a Catch-22 that has all but prohibited research into the potential healing properties of marijuana. 

It’s also a change that is likely here to stay. A recent Pew Research Center poll found that 52 percent of Americans support legalizing marijuana. “It’s partly a cultural shift on what a drug is,” says Jim Moore, director of the Tom McCall Center for Policy Innovation at Pacific University in Forest Grove, Ore. More people believe marijuana is less harmful than alcohol and no longer view cannabis as a gateway to harsher illegal-drug use, he says. 

Many fiscal conservatives are also weary of the cost of the drug war. FBI statistics show that marijuana accounts for nearly half of all drug arrests in the United States, Moore says. Likewise, half of the people behind bars on drug charges were imprisoned for marijuana offenses. “The incarceration costs for drug crimes are enormous,” he adds.

Public acceptance of marijuana has been building for decades. Oregon was the first state to decriminalize possession of pot in 1973. By 1978, eight other states – including Alaska, North Carolina and Ohio – had followed suit. Nearly 20 years later, California led the nation in decriminalizing medical marijuana. And in the past two years, Colorado, Washington, Alaska and Oregon legalized recreational use of marijuana. In addition, the spending bill approved by Congress in December prohibits the U.S. Justice Department and the Drug Enforcement Agency from interfering with state medical marijuana laws.

National legalization is inevitable, although it may take 20 years, Moore predicts. “We’re moving toward a critical mass,” he says. “States, in effect, are going to force the federal government’s hand. They either have to change how they enforce things – how they interpret the current law – or wholesale rewrite the federal drug laws, tax policy and banking laws.”

As that showdown lingers, there’s a growing clash between veterans who want the option of using medical marijuana and VA, which prohibits its physicians from discussing the topic even in states where medical marijuana is legal. Veterans also report losing medical care when VA learns they are using marijuana – a fear that has effectively driven most use underground. “I call it the new ‘don’t ask, don’t tell’ policy,” says Michael Krawitz, an Air Force veteran and executive director of Veterans for Medical Cannabis Access. “I tell veterans to shut up.” 

VA faces a dilemma. Federal law classifies marijuana as a Schedule I narcotic with no recognized medical use and a high risk of addiction. Its doctors can’t talk pot because “federal employees must comply with federal law,” says VA spokeswoman Gina Jackson. 

VA acknowledges that veterans who use marijuana may lose access to some medical care. “In some cases, participation in state marijuana programs may be inconsistent with treatment goals, and therefore treatment plans may be modified accordingly for the health of the patient,” Jackson adds.

Some members of Congress want to unsnarl this conflict. A bipartisan coalition that includes U.S. Reps. Earl Blumenauer, D-Ore., and Dana Rohrabacher, R-Calif., has introduced legislation that authorizes VA physicians to recommend marijuana as a treatment option in states where it’s legal. “Our antiquated drug laws must catch up with the real suffering of so many of our veterans,” Rohrabacher says. “It is unconscionable that a VA doctor cannot offer a full range of treatments, including medical marijuana.”

But Congress has sent mixed messages on marijuana. The December legislation that prohibited federal law enforcement from interfering with state medical marijuana laws also blocked a voter initiative legalizing recreational marijuana use in Washington, D.C. And Congress previously blocked the district’s voter-approved medical marijuana initiative.

As marijuana hangs in this legal limbo, former servicemembers contend that narcotic painkillers, sleeping pills, amphetamines, antidepressants and drugs they are being prescribed are dangerous, if not lethal. “With 22 veteran suicides a day, it’s clear we don’t know what we’re doing,” says Sean Kiernan, an Army veteran who had his own brush with suicide after being treated with prescription drugs.  

Other veterans say the status quo pharmaceuticals leave them stupified. “Shortly after I got out, I started experiencing symptoms of PTSD,” says Sean Azzariti, who served two tours in Iraq with the Marine Corps. “I was prescribed Trazodone, Klonopin and Adderall – 13 pills total a day. I was just becoming an unfunctional human being.” 

Some physicians acknowledge the downside of conventional treatment. “Doctors like me have put patients through the gantlet with FDA-approved drugs and we’ve turned these patients into zombies,” says Sue Sisley, a psychiatrist in private practice in Arizona who treats veterans, police officers and firefighters. “They are plagued with the side effects.” 

The narcotic painkillers commonly prescribed to veterans are also highly addictive and can lead to overdose deaths, says Iraq veteran Scott Murphy, founder of Veterans for Safe Access and Compassionate Care. Medical marijuana can help veterans reduce their opiate dependence and leads to fewer suicides, Murphy and many other veterans and marijuana advocacy groups contend. 

“Several veterans I’m close with had severe PTSD issues and suicidal tendencies when they came home,” says Kerri Babbitt, an Army reservist who deployed to Afghanistan as an MP. Many have successfully used medical marijuana to treat their symptoms, she adds. 

“If you are willing to give someone a dangerous drug like an opiate, it seems insane not to give them a less dangerous option,” Murphy adds. “And this would be under a doctor’s supervision.” 

There is little research to back the use of medical marijuana to reduce opiate dependence. However, a recent study published in JAMA: The Journal of the American Medical Association shows that states with legal access to medical marijuana had fewer painkiller overdose deaths. 

“We found a 25 percent lower rate of opiate overdose deaths in states that had enacted medical marijuana laws,” says Marcus Bachhuber, Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania and the Philadelphia VA Medical Center. “We were surprised by the magnitude of the result,” he says of the study, which examined narcotic painkiller overdoses from 1999 to 2010. 

That’s significant considering that use of narcotic painkillers quadrupled in the United States during the years Bachhuber studied. In addition, 60 percent of the people who died from painkiller overdoses had legal prescriptions for those drugs. But the study doesn’t conclusively credit marijuana for reducing the rate of fatal painkiller overdoses. “We think this might be due, in part, to other things states are doing to address opioid overdoses, like educating medical providers or educating the public,” Bachhuber says. “We need large studies that follow individuals with chronic pain over time and evaluate the effect of medical marijuana on their pain.”

The skeptics include Anthony Dragovich, a former Army pain specialist now in private practice in Virginia. “There’s no evidence marijuana would decrease (narcotic painkiller) dependence,” he says. “Actual experience would hint otherwise.” He likewise doubts that marijuana lowers the risk of suicide.

“There is some evidence it works for pain, nausea, emesis (vomiting) and some neurological conditions,” Dragovich says. “But it isn’t well-studied. I would be very concerned about using medical marijuana as a cure for anything rather than part of an intensive psychological rehabilitation program for patients with significant PTSD.”

A study that followed 80 veterans in New Mexico – one of the states that has legalized medical marijuana – found a 75 percent decrease in PTSD symptoms, Sisley says. But additional research on the effectiveness of medical marijuana is all but impossible because of federal regulations. 

“There are so many barriers that no other Schedule I drug has to face,” she says.  

Last spring, Sisley won approval for another study using medical marijuana to treat PTSD after a four-year fight with the National Institute on Drug Abuse and other agencies. She promptly lost her job at the University of Arizona, where she planned to conduct the research. “They could never deal with the optics of having veterans smoking marijuana on campus,” she says. “That would have been a media frenzy.” (The university says it cannot comment on Sisley’s departure because it’s a personnel matter. The institution would have hosted the project “with a different chief scientist,” a university spokesman said.)

Sisley now plans to split her study between Johns Hopkins University and another as-yet-unnamed research institution. “I think we have a duty to these veterans to study this drug in the most rigorous way,” she says. “It’s possible the plant could be a detriment. We’ll be able to collect the data on the good and the bad and put it out there for public scrutiny.”

It’s important to note that Sisley came to this work opposed to cannabis. She chastised veterans who first told her they were using medical marijuana to treat their PTSD. “I tried to persuade them to use conventional methods,” she says. “But there were more and more high-ranking conservative veterans, who hated street drugs, who were using medical marijuana.” 

Sisley has also has been persuaded to dig deeper as a result of the anecdotal evidence showing that cannabis helps address sleep problems. “Sleep deprivation is particularly brutal for veterans with PTSD,” she says. “People who live with chronic sleep deprivation are at high risk to end their life. If marijuana could help stabilize these symptoms, it might curb the suicide epidemic.”

Still, physicians, patients and families are careful to say cannabis isn’t a universal cure. Even Ryan Begin’s mother is ambivalent about recreational marijuana. But watching her son get control of his life convinced her that medical marijuana should be available to veterans and civilians dealing with chronic pain and post-traumatic stress. 

Ryan credits his family and friends for helping him get off prescription pills and connect with the right physician, and with medical marijuana. “Now I’m in a position physically and mentally where I can help other vets,” he says. He won custody of his 8-year-old daughter a year ago. He remarried in September. Today he’s looking at buying a home. 

“I’m amazed at how far he’s come,” Anna says. “For me, it’s like winning the lottery.” 

Ken Olsen is a frequent contributor to The American Legion Magazine