Veterans Fight for Medical Marijuana to Reduce Their Chronic Pain

When Roger Martin, 65, left the United States Army decades ago to return to civilian life, he had hoped to leave memories of his service behind. What he could not have known then, though, is that he would soon find himself facing a different kind of fight.

 

Veterans and Medical MarijuanaOne obstacle to using medical cannabis is the lack of concrete research but studying it is restricted due to its classification as a Schedule I controlled substance.Searching for Ways to Manage Pain and Other Symptoms

Roger Martin is one of many veterans grappling with chronic pain, Post-Traumatic Stress Disorder (PTSD), and insomnia, due to injuries and illness sustained during active duty. He is also one of the many veterans managing his symptoms using medical marijuana, or cannabis. But the path for veterans to access marijuana is fraught with controversy, especially since the drug (which is classified as Schedule 1, along with heroin) is not currently legal at the federal level but according to National Conference of State Legislatures, 28 states and the District of Columbia have legalized medical marijuana (as of September 2017).

As a result, veterans cannot access medical cannabis through the US Veterans Health Administration, despite it being legal in more than half of the states in the nation. This conflict prompted Martin to start a nonprofit organization called Grow for Vets USA in 2014. Grow for Vets raises funds to provide free marijuana and hemp products, along with educational programs on the safest strains and doses to use for different conditions, to veterans in states where cannabis is permitted.

Understanding the Landscape

The conflict between the federal prohibition and different state laws can indeed be an added source of stress for veterans, according to Jordan Tishler MD, president and chief marketing officer of InhaleMD. Dr. Tishler has worked for the Veterans Administration for 15 years and seen first-hand the suffering many veterans experience as a result of their active service.

“Veterans have sacrificed so much to protect our country and we owe them the best healthcare available,” he told Practical Pain Management. Dr. Tishler started his own private practice to help veterans gain access to cannabis treatments under the guidance of a physician. “This enables me to provide care to veterans and civilians outside of the major medical systems in which I’ve practiced as a way to get around some of the roadblocks to care,” he explains. Dr. Tishler also serves as regional director of the Society of Cannabis Clinicians, which represents cannabis patients’ needs.

The Society for Cannabis Clinicians is just one of many groups that work to promote the medical benefits of cannabis and to advocate for more supportive federal policies of medical marijuana, including through the Veterans Health Administration. One obstacle, points out Dr. Tishler, is a lack of concrete research substantiating the use of medical cannabis to improve patient outcomes. “The current Schedule 1 status of cannabis means there are very limited circumstances under which research can be done,” he explains. “This really boils down to preventing large, multi-center, randomized controlled trials, which is what we need next. There is a ton of good observational research, but large trials remain to be done.”

With a growing spotlight on the use of opioids to treat pain and the potential for addiction, more veterans are turning to medical marijuana as an alternative option when possible.

Turning to Cannabis after Opioid Use

Grow for Vets’ Founder Martin experienced first-hand the potentially addictive nature of using opioids to control pain and other symptoms. “My private physician initially [in the year 2000] prescribed 10 mg of oxycontin, twice a day. By October 2010, I was taking 60 mg three times a day, so a total of 180mg/day. I was also initially prescribed 10 mg per night of Ambien for sleep. By October 2010, I was taking 40mg, just to be able to sleep for 1 to 2 hours,” Martin says.

Roger Martin with ABC reporterRoger Martin with an ABC reporter

Eventually, he decided to stop taking the opioid cold turkey.  That’s a very dangerous move given the dose he was taking…and underwent a severe withdrawal process, including the inability to sleep for days at a time, which led him to seek out medical cannabis. While it took a little experimenting, says Martin, once he discovered a method that worked, he found himself able to control his pain. Now, he can work a full day and sleep well at night. For him, the best combination is vaping [after quitting cigarettes, Roger noted that he is anti-smoking] during the day as needed and eating a cannabis-infused edible. For him, vaping provides relief almost immediately, while an edible provides about 8-12 hours of relief. He admits, however, that finding what works best is an ongoing process as his symptoms change over time. 

Sharing Reliable Information

Like Martin, Tony (who asked that his last name not be used) is another veteran dealing with chronic pain who has discovered relief with medical marijuana. His pain was caused by a gunshot wound to his left hand and PTSD. His treatment regimen includes counseling and vaping medical marijuana at night to help him sleep. “I have a caregiver that abides by state laws and is very reliable,” he says.

Better yet, he believes that the medical cannabis brings him tangible benefits. “Ever since I started using medical marijuana, I’m able to get a full night’s sleep.  I rarely have night terrors as my sleep pattern has improved tremendously,” he adds.

Tony’s success with medical marijuana inspired an online resource called Weedguide, a search platform that enables veterans and others to navigate the wealth of reliable cannabis information that exists more easily and effectively. “It was actually Tony’s story of how marijuana has helped him begin coping with PTSD that really moved Weedguide’s CEO Claudio Cañive when we were just starting development [of our service],” explains Sarah Dailey, Weedguide’s Chief Marketing Officer.  “We’ve heard hundreds of stories from everyone—from veterans to cancer survivors to families of children with epilepsy—about how important it is to have access to reliable, trusted information about effectively and safely using medicinal marijuana,” she adds. 

The Other Side of the Story

Despite the anecdotes of veterans—and so many others—who have found pain and other symptom relief through cannabis, there are still experts that do not support its medical use. David Cosio, PhD, a psychologist in the Anesthesiology Department’s Pain Clinic at Jesse Brown VA Medical Center in Chicago, explains the other side of the equation, but stresses that he is speaking on behalf of himself and not as a representative of the VA.

“It continues to be federally illegal to use cannabis in the United States. Therefore, government employees are discouraged from recommending the use of cannabis for the treatment of chronic pain [and not allowed to ‘prescribe’ its use],” he says. “Living in a state that has made medicinal marijuana legal, we face this question regularly and have come up with the following response: The research investigating the use of cannabis for the treatment of chronic pain is scant. There are more than 80 to 100 different types or strains of cannabis,” which poses real challenges for researchers who want to better understand the drug and its implications.

Dr. Cosio further points out that the marijuana one typically can buy on the street is not regulated, so dosages and quality are unknown. “Even when it is regulated in a dispensary, there are still potential risks,” he says. “For example, one dispensary in California had to recall their product due to it being laced with another substance that was causing its users harm,” he explains.

Exploring Cannabinoids

For those patients suffering from chronic pain that feel the benefits of medical marijuana outweigh the possible risks, there may be another option: synthetic cannabinoids. These Class II chemical compounds contain a synthetic form of tetrahydrocannabinol (THC), which is the psychoactive component natively secreted by cannabis that acts on the nervous system to enhance the appetite and possibly offer other health benefits. FDA has approved a few synthetic cannabinoid drugs for targeted uses, such as chemotherapy-induced nausea and HIV-caused neuropathy, but they are not currently indicated for treating chronic pain, according to both Dr. Cosio and Dr. Tishler.

Nonetheless, Dr. Tishler says he believes veterans are far better off than they were in the past. “There used to be a gag order preventing physicians from discussing cannabis with patients. That is now long gone. Clinicians [at the VA] are free to address cannabis use with patients, and cannabis use cannot be used to withhold other treatments. Presently, VA policy as derived from the law states that VA doctors cannot prescribe cannabis, nor can they recommend it through state programs where it may be legal. However, VA doctors can refer patients to cannabis specialists for treatment. Essentially, if it is legal in your state for a civilian, then it’s okay for veterans too, but they have to get it as a civilian,” he explains.

Divergent Directions are Possible

As the research, pain care industry, and US government work to answer outstanding questions around and regulation of the use, dosing, and long-term impact of medical marijuana, veterans and other patients living with chronic pain are in somewhat of a holding pattern. Patients must work with their doctors to determine the best path forward for their individual situation, weighing both potential benefits and risks.

For example, advises Dr. Cosio, “If frontline providers [outside of the VA] are turning to cannabis because opioids are being discouraged and they can’t find another alternative that patients are able or willing to explore, my fear is that we may be turning to cannabis without the needed research to support its use in the long-term and we might be creating a similar epidemic to the [opioid] one we face now.”

As research continues, Dr. Tishler believes the federal government may act to re-schedule or de-schedule cannabis in the next five years. In the meantime, he recommends that veterans who live in states where medical cannabis is legal to try this approach: “Talk to your VA doctors but understand they can only refer you outside of the system. Since most physicians don’t know much about using cannabis therapeutically, a visit to a cannabis specialist is the best way to get it and use it safely and effectively.” For anyone considering medical marijuana, he stresses that it should be used in moderation, and “only from state-legal, tested sources,” he adds.

 

Updated on: 11/15/17
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Introduction to the Smart Patient's Guide to Chronic Pain Management
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