"I tell you that it makes me feel better and I don't have to take narcotics and I can sleep at night. Who are you to tell me I can't use it? It burns me up."
-Perry Parks, US Army helicopter pilot, Vietnam War
As a country that engages in a fair amount of war, you'd think that the least America can do is offer some level of comfort to veterans once they return. Unfortunately, that's not as simple as providing traditional benefits. A sizable chunk of veterans from the past four major US international interventions (Vietnam, Iraq, Iraq II, and Afghanistan) return with Post-Traumatic Stress Disorder (PTSD), and afterward endure flashbacks to horrific events, severe mood instability, and debilitating sleeplessness, among other problems.
PTSD causes a vast and complex set of symptoms that demand a solution, and the Department of Veterans Affairs (VA)—which is charged with providing medical care for veterans— fights PTSD with a multi-pronged approach that involves psychotherapy and a tightly scheduled cocktail of benzodiazipenes, opiates, antidepressants, and mood enhancers. Each of these addresses a fraction of the total symptoms but comes with a host of side effects, including sleep disturbance, anxiety, and suicidal tendencies—some of the same effects of PTSD the cocktail aims to treat.
Could marijuana be the solution America's vets have been waiting for, and if so, why does the federal government continues to stand in the way?
"I fully admit that I participated in this for years, pummeling these veterans with all kinds of FDA-approved meds," Dr. Suzanne Sisley, a PTSD researcher, told me over the phone. Last year, the University of Arizona fired Sisley just after she received federal approval to study the effects of cannabis on PTSD, and she recently re-established the pursuit with funding from the state of Colorado, where recreational marijuana is legal. Sisley sees great promise in pot as a PTSD treatment, even if she once employed conventional pharmaceutical remedies.
"I'd have them on ten to 12 different meds, each to treat one of these active target symptoms," she said. "These veterans would be completely useless because they were so riddled with side effects and drug interactions. The notion that there could be a single plant that could manage the entire myriad of PTSD symptoms… Well, that would be an incredible breakthrough."
Sisley doesn't smoke pot, nor does she seem eager to try. Her enthusiasm for cannabis stems purely from what she sees as its potential to revolutionize PTSD treatments. Thus far, the evidence in favor is at least somewhat encouraging. Sisley was inspired by a 2014 study conducted for New Mexico's medical cannabis program that found cannabis reduced PTSD symptoms in 80 veteran subjects by an average of 75 percent. Her new study seeks to test the positive clinical response established by Dr. Raphael Mechoulam, an Israeli cannabis research pioneer credited as the first to isolate THC. Mechoulam discovered an effect of cannabis called memory extinction, which diminishes the link between triggers and the bad memories they invoke. That's the premise most modern cannabis PTSD treatment hypotheses are based upon. His home country Israel currently has a progressive stance on medical cannabis for soldiers in the Israel Defense Forces. IDF reserve troops who hold a medical marijuana prescription are allowed to use it even while on active duty, a policy in line with Israel's efforts to liberalize medical marijuana in light of new research.
Mechoulam's 2014 THC/PTSD study included ten human subjects, five of whom had experienced war-related trauma, and his team recorded significant reductions in nightmares, flashbacks, and an improvement in sleep quality. Such findings are finally being established scientifically, but anecdotal evidence has existed for decades; in fact some of the strongest proof of the medical efficacy of cannabis comes from the veterans themselves.
"When the war is over for the day you sit around in a little circle and pass a joint," Perry Parks told me. As a helicopter pilot in the Vietnam War, Parks saw his share of death and tragedy, and pot provided him reprieve.
"Other than the actual effect, the whole act of smoking is what gave me relief," he said. "At the end of each day, it was kind of like the war went away."
Weed was abundant and cheap in Vietnam at the time, and many soldiers smoked it recreationally, both during the war and afterward in the US. Parks stopped using pot after Vietnam and remained in the military until 2003, a year after he was diagnosed with PTSD. When he retired, he was on a heavy regimen of prescription narcotics and antidepressants. After trying cannabis, he found that he could sleep soundly, uninterrupted by nightmares.
"The first thing I did was throw out all my sleeping pills," he said. It incensed Parks that a potentially effective remedy for combat-related PTSD was completely excluded from care provided by the VA and motivated him to become an activist for the cause. At the time, he could have lost his access to prescription drugs if he tested positive for marijuana. That didn't personally matter all that much to Parks, who shifted his regimen to exclude pills, but many veterans (including those in Mechoulam's study) find the best results using cannabis in conjunction with their prescription drugs.
The VA began easing their restrictions on medical marijuana for veterans in 2011, after pressure from veterans advocacy groups. Historically, the VA has reserved the right to deny patients pain medicine if they violate the terms of their Opioid Pain Care Agreement by testing positive for marijuana. Furthermore, VA doctors have generally been severely discouraged from recommending medical marijuana to patients even in states where it is legal. A 2008 internal memo from the VA's general counsel said that doctors could have their licenses revoked and face criminal charges. As a federal department, the VA and all its employees are required to follow federal law, which places marijuana in the most dangerous category of drugs—"schedule I"—and states that it has no potential medical applications. Veterans with PTSD are victims of a bureaucratic discrepancy between state and federal law on cannabis—or at least they were until they took the issue into their own hands.
In 2010, disabled Air Force veteran Michael Krawitz and his advocacy group, Veterans for Medical Marijuana, publicly campaigned to change the VA's marijuana policy. Reforming federal law was a virtual impossibility in the short run, but Krawitz sought to work with the VA to establish a middle ground that would allow veterans to use cannabis in conjunction with prescriptions and keep doctors on the right side of federal law. The VA responded by issuing a new directive that explicitly prevented doctors from cutting state-level medical marijuana patients off from prescription drugs, and instead requires monitoring of all cannabis consumption. Doctors are still barred from recommending or prescribing cannabis, but within the bounds of the law, this is pretty much the best the VA can do.
"The VA has done as much as they can to accommodate us" Krawitz said. "They've tried to give us as much space as possible to use marijuana under medical orders."
Though they're barred from expressing it publicly, VA doctors are by no means all ideologically aligned with the restrictions dictated by federal law. Dr. Michael Hill-Jackson, a physician at the VA of Palo Alto, California, told me, "We've actually embraced lot of holistic approaches, but unfortunately marijuana is not part of that yet, until a federal law passes… Once things change, I think it will really change the way we treat PTSD, but until then, there's nothing we can do."
Another doctor at the Palo Alto VA, Dr. Marcel Bonn-Miller, is more skeptical of the impact pot might have on PTSD sufferers. "In terms of the science behind marijuana and PTSD, there's not enough evidence at this point for anybody to make an informed decision about prescribing it anywhere," he said. Still, Bonn-Miller acknowledges the benefit of the VA's (relatively) marijuana-friendly policy and follows its guidelines.
On the spectrum of federal treatment of marijuana, the VA's cooperation is remarkable. The DEA has fiercely pursued state-legal medical marijuana as part of the War on Drugs, at least until Congress moved to defund those operations in December. The Supreme Court upheld the federal prohibition of medical marijuana the last time it crossed their desk in 2001. The DOJ has been ineffective in implementing marijuana banking guidelines. And last year, the House of Representatives rejected a measure that would have allowed VA doctors to recommend medical marijuana to patients. That bill's sponsor, California Democrat Dana Rohrabacher, presented a similar measure in November called the Veterans Equal Access Act. Its passage is a tall order considering the Republican takeover of Congress.
For now, veterans with PTSD who have a medical marijuana prescription can balance their pharmaceutical drugs with cannabis self-medication. But that still leaves those who live in medical marijuana states that don't include PTSD as an "approved condition" for cannabis treatment, along with vets in the 27 states that still prohibit cannabis completely. That's thousands of people who will continue to be prescribed a host of pills and all the side effects that come with them rather than a plant that offers the prospect of at least some relief. Marijuana policy in America is on a clear path to liberation these days, but the painfully slow movement in the bureaucracy that looks after its military veterans is stark reminder of what remains to be done.
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