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Marijuana as a Treatment for PTSD

Does the VA Care?

by FRED GARDNER

U.S. District Judge Samuel Conti will rule any day now on a suit brought by Veterans for Common Sense and Veterans United for Truth. The vets want the judge to order the Department of Veterans Affairs to upgrade its mental-health services. Some 500 vets are committing suicide every month. There is a backlog of 600,000 disability claims, half of them involving post-traumatic stress and depression. The wait to have your claim adjudicated can be five years or more. Lawyers for the VA state that 1,300 therapists have been hired to solve the problem; and anyway, they contend, a judge can’t tell the VA how to conduct itself, only Congress can.

Outside Conti’s courtroom in the San Francisco federal building one morning a Vietnam vet I’d met long ago asked what I was doing there. I said maybe I’d write about the runaround that vets have been getting from the VA in connection with PTSD. He said, "Welcome back," as if I had gone somewhere. Single Issue Politics separates us from our potential allies.

California cannabis specialists report that 3-5% of their patients have PTSD diagnoses. The late Tod Mikuriya, MD, being a psychiatrist who made his own diagnoses, saw a slightly higher percentage. This is from Mikuriya’s classic 2005 paper on the subject:

“Approximately eight percent of the >9,000 Californians whose cannabis use I have monitored presented with PTSD (309.81) as a primary diagnosis. Many of them are Vietnam veterans whose chronic depression, insomnia, and accompanying irritability cannot be relieved by conventional psychotherapeutics and is worsened by alcohol. For many of these veterans, chronic pain from old physical injury compounds problems with narcotic dependence and side effects of opioids.

“Cannabis relieves pain, enables sleep, normalizes gastrointestinal function and restores peristalsis. Fortified by improved digestion and adequate rest, the patient can resist being overwhelmed by triggering simuli. There is no other psychotherapeutic drug with these synergistic and complementary effects.

“In treating PTSD, psychotherapy should focus on improving how the patient deals with resurgent symptoms rather than revisitation of the events. Decreasing vulnerability to symptoms and restoring control to the individual take priority over insight as treatment goals. Revisiting the traumatic events without closure and support is not useful but prolongs and exacerbates pain and fear of loss of control."

Veterans in California and other states with medical marijuana laws are faced with an especially cruel choice, says disabled Air Force vet Michael Krawitz (who lives in Virginia): “use medical marijuana and leave the VA or take the VA’s medicine and stop using medical marijuana.”

It has been well established that pain patients can cut their opioid use in half by adding cannabis to their regimen. Krawitz, 44, is challenging the legality of the “pain contract” that the VA insists some patients sign in order to get their prescribed opioids —thereby subjecting them to having their urine tested for illegal drugs. Krawitz says forced drug testing by the VA violates the 4th Amendment protection against unreasonable search; the 5th Amendment protection against forced self-incrimination; and the 14th Amendment right to equal protection under the law (because only pain patients are made to sign the contract).

Do Ted Kennedy’s Doctors Know?

Jeffrey Hergenrather, MD, a Sebastopol, California doctor, reports in the current O’Shaughnessy’s on a case in which cannabis apparently countered the advance of glioma multiforme (the aggressive brain tumor that has afflicted Senator Edward M. Kennedy).

P.J., a 50-year-old man, was still enjoying motorcycle riding and surfing
when he began having right parietal headaches with increasing frequency and severity in the spring of 2003. Within three weeks from the onset of pain, P.J. saw his primary-care doctor, who advised over-the-counter pain medications. A few weeks later the pain worsened and P.J. began to drop things from his hands and slur his speech. On hearing this, the doctor ordered a brain scan.

P.J. was found to have a large stage-4 brain tumor, subsequently diagnosed as a glioblastoma multiforme. P.J. got his brain surgery in July ’03, followed by radiation therapy. He was also referred to a study group at a major teaching hospital. Now, more than four years since his surgery, P.J. continues to improve despite the ominous prognosis with the diagnosis of glioblastoma multiforme. Untreated patients are found to live about three months from diagnosis. Treated patients have a median survival of 10-12 months. In the best case scenario people with this tumor are alive at 18 months. Very few are still alive after five years.

What’s different in P.J.’s case is that every day he eats at least five cannabis capsules that he prepares for himself. The cannabis helps P.J. with his appetite and sense of well-being.

Of great interest is the fact that he has been seizure-free and there has been no recurrence of the tumor on his follow-up brain scans, MRIs, and PET scans (conducted three or four times per year since 2003). Just back from a road trip to visit family, P.J. is out riding his bicycle on the rural roads with increasing confidence and he has re-applied for his driver’s license.

Several labs have reported in recent years that cannabinoids can inhibit the growth of gliomas in various in vivo and in vitro models. Researcher Herbert Schuel (who has elucidated the role of cannabinoids in fertilization) predicted in 2005 that if and when the FDA approves a cannabis-based medicine, it will be as a treatment for glioma. “They have nothing else for glioma,” said Schuel. “Nothing else that works.” 

The drug companies would have us believe otherwise. “Hints of Progress, and Longer Life, as Drug Makers Take on Brain Cancer” read the headline on a New York Times piece May 23. It ballyhooed Temodar, a drug from Schering-Plough shown in clinical trials to extend patients’ survival from 12.1 months to 14.6 months (in conjunction with surgery and/or radiation). Temodar “is on track to surpass $1 billion in sales this year, which would make it the first blockbuster drug for brain cancer.”

Medical news on the business pages is never ironic; it’s simply a given that profit is the primary goal of research. Thus the Times’ brain-cancer story by Alex Pollack noted matter-of-factly that the brevity of life after a glioblastoma multiforme diagnosis –the speed with which it kills— has inhibited drug development. “The typical life span isn’t that long, so it doesn’t have the recurring revenue stream,” Pollack quotes the chair of a nonprofit that promotes brain-cancer research.

“But the situation is changing,” Pollack goes on. “As pharmaceutical companies have been able to sharply raise prices for cancer drugs in recent years, it has become possible for treatments for even rare cancers to have hefty sales —as demonstrated by Temodar.”

FRED GARDNER edits O’Shaughnessy’s the Journal of Cannabis in Clinical Practice. He can be reached at fred@plebesite.com