Philly420: Marijuana, PTSD and Pennsylvania

Military veterans are committing suicide. Prescription painkiller overdose deaths are skyrocketing. There is a national discussion around these issues. Medical marijuana can help. In these cases it could save lives.

A special working group of Pennsylvania House Representatives is trying craft a medical marijuana bill for the lower chamber. A bill already passed the state Senate earlier this year. Two of their biggest issues are whether to include Post Traumatic Stress Disorder (PTSD) and chronic pain as qualifying conditions.

Senate Bill 3 includes PTSD but Rep. Ron Marsico's House bill did not.

According to the US Department of Veterans Affairs, there are nearly one million vets living in the Keystone State. More than 236,000 are categorized as Gulf War vets, a category that includes the recent conflicts in Iraq and Afghanistan.

Those who live with PTSD often have terrifying flashbacks, avoidance of friends and family, serious sleep disturbances and a variety of other symptoms. PTSD is currently treated with cognitive behavioral therapy and a variety of medications. Drugs such as serotonin reuptake inhibitors like Paxil are often used.

Recognizing PTSD in returning vets and treating it effectively has been woefully inadequate. The condition has taken a particular heavy toll on the Gulf War vets. These soldiers have truly alarming rates of suicide. It's not just PTSD itself but also the side effects of the drugs used to treat it that are seen as the main factors in this disturbing trend.

For decades many vets have turned to cannabis. But there are hundreds of strains of the plant with a wide array of chemical profiles. Some varieties have high THC, others have a mix of THC and Cannabidiol (CBD). Not every strain works. As medical marijuana programs in California and other states opened, expanded and became easily accessible, more and more vets were able to refine their cannabis therapy.

Yet, not all medical marijuana programs allow PTSD as a qualifying condition. For example, Colorado does not, even though that state is seen as a mecca for modern marijuana.

Two weeks ago, a Colorado Department Of Health panel refused to allow PTSD as a qualifying condition. Instead vets can simply purchase cannabis in the legal, recreational stores. In fact, Sean Azzerati, an Iraq War vet who suffers from PTSD, was the first person to legally purchase in Colorado on January 1, 2014.

Delaware and Washington D.C.'s medical cannabis programs provide for PTSD. So do the programs in Hawaii, Oregon and Washington state. New Jersey and New York do not allow PTSD as a qualifying condition.

This has created a difficult patchwork of laws and regulations for vets to navigate.

Earlier this summer Dr. Sue Sisley traveled from Arizona to speak at a news conference in Harrisburg. She urged legislators to include the condition. Dr. Sisley is one of the leading experts studying military vets and cannabis. She was going to perform scientific research on the topic at the University of Arizona when the school suddenly fired her. Now, under a multi-million dollar grant from the State of Colorado funded by recreational marijuana sales, her work is going forward.

Sisley's study has been five years in the making and has a local connection. The research is being performed in conjunction with the Multidisciplinary Association for Psychedelic Studies (MAPS) and overseen by the University of Pennsylvania and the Department of Veterans Affairs' National Center for PTSD.

For the project the federal government will supply four strains of cannabis with a variety of THC and CBD levels to 76 veterans in Arizona and Maryland. The hope is to find the cannabinoid levels that work best.

"Individuals with PTSD suffer decreased quality of life," said  Sisley,"Anxiety increases along with depression. PTSD sufferers face an increased risk of poor health. Relationships suffer, divorce rates increase, success in school fades, and many become unemployed. At this moment over 100,000 veterans — many with PTSD — are homeless."

She adds that there is no pharmaceutical drug that effectively treats with PTSD.

"The current use of SSRI-type anti-depressants and anti-anxiety medications, the mainstay of treatment, are of limited value for many patients. Often, these medications don't work well, or the side effects, such as obesity, grogginess, or decreased sexual function, cause many patients to discontinue therapy. Psychotherapy may be helpful for some but is of limited availability. An additional pharmacological agent to treat PTSD could be very beneficial for many patients."

Thus the real promise of medical marijuana. Vets have already found that cannabis helps make them more social, alleviates reliving traumatic experiences and helps with sleep. The high or "feeling good" is a positive side effect.

Sisley said some of the best research done on vets and PTSD was from a state with a safe access system.

"We have a very good retrospective study from the State of New Mexico Medical Advisory Board," says Sisley, "New Mexico was the first state to approve PTSD as a qualifying condition for treatment under their medical cannabis program."

That report found: "Greater than 75% reduction in CAPS [Clinician Administered PTSD Scale] symptom scores were reported when patients were using cannabis than when they were not…There is extensive evidence that cannabinoids may facilitate extinction of aversive memories." 

The New Mexico report concludes, "(t)here are currently 3350 patients enrolled in the PTSD program. To date, there have been no incidents or adverse events."

But vets have to deal with the federal government and it isn't easy.

Federal VA Hospitals and doctors take an odd approach. For many years vets faced an ominous problem; they were kicked out of free pain management programs if they tested positive for THC. They are regularly tested for drug levels not to see if they have any dependence problems but to assure that they are taking their prescribed opiates.

In 2009 the VA instructed their network to stop kicking people out for pot. There's a catch. Only if the individuals were registered in state medical marijuana programs could they test positive for THC. This left most vets, even those in Pennsylvania and New Jersey out of luck.

VA doctors also can not sign off on cannabis therapy. All states require a doctor's recommendation for medical marijuana. That means vets who do want to access cannabis have to pay out of pocket to another physician.

Then in May of this year a light appeared at the end of that tunnel. The U.S. Senate Appropriations Committee approved language in a funding package that could, one day, allow VA doctors to discuss and even recommend medical marijuana for their patients. But, again, that will only be in states that already have a program running.

Mike Whiter, a U.S. Marine Corp vet who served in Iraq and now lives in Philadelphia, has spent the last three years pushing for a medical marijuana bill in Pennsylvania. He wasn't pleased when PTSD was temporarily excluded from the Senate bill and now remains uncertain in the House. He is holding out hope that it will be included.

"Veterans are being over-medicated," said Whiter adding, "More than 22 veterans commit suicide every day, and pharmaceutical overdoses are a leading cause of death. Cannabis is a safe alternative to pharmaceutical treatment. In conjunction with therapy, marijuana can help a veteran regain control of his or her life."

Whiter is a success story. He attributes a real turnaround in his life to the plant.

Whiter is now a photography student whose latest project is called #OperationOverMed. He invited veterans to pose for a series of striking portraits that have been featured on several news outlets.

Another issue that remains contentious among the Pa. House Representatives working on the marijuana bill: Pain. They are not sure if they will include chronic pain into the list of qualifying conditions.

Opiod painkillers like oxycontin have been ravaging the country. Overdose deaths, as Whiter mentioned, are all too common.

Last year, a local data gathering project discovered something that made international headlines. Dr. Michael Bachhuber MD, the Robert Wood Johnson Clinical Scholar at the Philadelphia Veterans Affairs Medical Center, found that painkiller overdose deaths are 25 percent lower in states with medical marijuana.

More importantly, the National Bureau for Economic Research published data replicated those results. The most crucial takeaway from the NBER report is that the dramatic effect is only seen in states that have easy access. States like New Jersey where the program is limited and difficult with few patients registered still struggle with opiate overdoses.

Pa. House Speaker Rep. Mike Turzai said that he is giving hard scrutiny to the medical marijuana bill. Legislators, even those who are  supportive, keep hinting at having a "restrictive" program here. The bill that passed the Senate already prohibits smoking medical marijuana and has a short list of conditions compared to some other states.

If chronic pain and PTSD are excluded in Pa. then politicians will be ignoring the biggest impacts we can have with a cannabis therapy program.

PTSD and pain are not just just for military vets. Those who suffer many injuries or traumatic events like sexual assault or natural disasters live with these conditions.

Legislators must also recognize reality. Tens of thousands of Pennsylvanians are already buying pot underground to treat their medical conditions.

Although there is a sincere effort underway, it remains uncertain if our politicians can get their act together. If they favor limitations instead of easy access then the whole concept will fail.

Vets like Mike Whiter can find some solace in avoiding an arrest, criminal fines and penalties by living in decriminalized Philly. But patients like Mike will not consistently find the specific strains they require unless there is a real medical cannabis program in place.

But he is not waiting and is not going back.

"Marijuana saved my life," says Whiter.

It can save thousands more but only if Pa. legislators focus on care instead of politics.

Chris Goldstein is associate editor of Freedom Leaf magazine and co-chair of PhillyNorml. Contact him at chris@freedomisgreen.com.