Roberto Pickering lost many friends as a sniper for the Marine Corps during the invasion of Iraq in 2003. It marked the start of a war that would lead to thousands of deaths among US service members. But for those who did come home, their prospects were also grim. About 20 veterans commit suicide every day, and Pickering was almost one of them—until he started smoking weed again.
"I was at war and then I literally was in my parent's basement drinking myself to death for three years," recalls Pickering. "I was a mess."
An estimated 11 to 20 percent of the US veterans who invaded Afghanistan in 2001 and Iraq in 2003 have post-traumatic stress disorder (PTSD). The numbers are similar for those who served in the Gulf and Vietnam wars. The treatments available now are just not working for everyone. It's widely accepted among PTSD therapists and researchers that there's a need for novel solutions.
More than a dozen organizations run by veterans think cannabis could be it. But the federal classification of marijuana as Schedule I—defined as having "no acceptable medical use"—makes it so that vets in some states are at risk of losing their disability payments or other resources provided through their local Veterans Affairs hospital if they self-medicate with pot.
This is why the Multidisciplinary Association for Psychedelic Studies (MAPS), a research and educational nonprofit, has spent the last seven years advocating for a FDA-approved trial investigating cannabis as a treatment for PTSD. After navigating the many bureaucratic barriers (including a tedious FDA approval process and a shortage of government-approved cannabis), they finally started enrolling veterans in February. They'll sign up their twelfth volunteer today.
"We've all seen patients who have walked away from their other medications using cannabis alone," says Sue Sisley, a principal investigator on the trial. "The problem is all the studies before us were observational, so they don't have credibility with the scientific community."
These days, veterans who go to the VA for help with their PTSD often receive prolonged exposure, the gold standard talk-therapy treatment for the condition. But it has a 20 percent dropout rate, and often includes treatment with a variety of psychiatric medications, many of which have a high potential for abuse.
Pickering says he's lost just as many friends to opioids, a class of addictive pain medications often prescribed to veterans, as he did in the war. He was never on opioids, but he was given a cocktail of other drugs that made it difficult for him to function. At one point, he was prescribed 14 different pills at once, including Trazodone for his insomnia to Xanax for anxiety. "These guys at the VA, on so many different drugs, they are just frickin' zombies. It didn't feel right," he says.
He kept going back to alcohol to numb the pain until his dad's friend inspired him to give cannabis a try. By then he had had three DUIs and more than six visits to a psychiatric facility for alcoholism. Cannabis was the first thing that worked, reversing his insomnia and easing his depression and anxiety.
Sisley says her patients have told her that cannabis's ability to quell their nightmares is one of its most transformative effects. A lack of sleep can seriously exacerbate irritability, stress, lack of sociability, and other common symptoms of PTSD. She points to a paper published in 2014 that found that cannabis helped reduce the symptoms of PTSD in 80 patients by 70 percent as some of the most compelling evidence in support of their trial. The doctor who wrote the paper, George Greer, said it was highly sought on the journal's website for two years, including by states seeking some kind of scientific evidence for their medical cannabis programs, as little else existed. But this kind of case study—for a number of reasons stemming from its design—cannot be seriously considered by the FDA or the medical community.
Thus, despite years of advocacy by vets, most insurance companies don't cover cannabis, doctors can't prescribe it, and many veterans won't have access to it without millions of dollars of randomized clinical trials that meet the federal government's criteria. MAPS' trial at the Scottsdale Research Institute in Arizona is a crucial first step.
"MAPS' work is really important because obviously there are a lot of patients that are just hesitant about cannabis or unable to participate," says Michael Krawitz, executive director of Veterans for Medical Marijuana and a retired United States Air Force Veteran.
Sisley says she thinks there's a misconception among the public that a large number of veterans are using cannabis to treat their PTSD because the ones who are have been disproportionately vocal about it. "The truth is, there are a ton of vets who will never come near it until the law changes," she says.
If the trial is successful, Sisley and her colleagues could get a cannabis treatment for PTSD approved for market as soon as six years from now. But the data from the trials will only be seen as applicable to the particular varieties of cannabis researched; It will not have legal implications for products sold at dispensaries or the federal classification of the marijuana plant as a whole.
The researchers were adamant that they're not just trying to get cannabis reclassified anyway. First and foremost, they're seeking objective data, and this includes the risks of marijuana use among veterans. Nine percent of people who use cannabis develop what's called "cannabis use disorder," a dependency that can lead to withdrawal symptoms such as insomnia, depression, and anxiety. And the potential for addiction could be even higher among veterans with PTSD, 20 percent of whom struggle with substance abuse.
According to Ryan Vandrey, a Johns Hopkins University researcher who studies the behavioral pharmacology of marijuana, cannabis can also cause paranoia and acute psychotic episodes. Scientists don't know how much cannabis should be consumed as a PTSD treatment (if any at all), what type of cannabis might be the most optimal, or even if patients who self-medicate now might build a tolerance over time.
Researchers including Vandrey, Sisley, Greer, and others agree that cannabis seems to be more for managing PTSD symptoms than it is a true cure. This makes it a fundamentally different kind of treatment than, say, prolonged exposure—which has been shown on MRIs to change the way the brain processes fear—and MDMA (or ecstasy)—a drug that has also shown promise for extinguishing PTSD in coordination with therapy. There's an "urgent need," Vandrey says, for researchers to figure out what exactly seems to be working for people with PTSD already using cannabis.
In the meantime, veterans like Pickering are continuing to travel around the country speaking to legislative bodies and their fellow vets about what they see as the life-changing potential of cannabis. Before Pickering started consuming marijuana, he could barely motivate himself to leave his parent's basement in Athens, Georgia. He was 25 at the time.
Now, at 37, he runs a cannabis brand called The Vision Project in Oakland, California, which is sold in more than 70 dispensaries and employs fellow veterans. His only medicine is a 20 milligram cannabis-infused chocolate bar, which he eats before bed each night to help him sleep.
"I'm by no means trying to preach cannabis," he says. "It's just worked for me and it's worked for a lot of guys. I mean, every single one of my friends had PTSD and it's just awful."
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