If you’ve followed this blog for a while, you probably know that I have a soft-spot for Service Veterans. My father started working for the VA in 1978 and eventually became Associate Chief of Medicine for Education and served as Acting Chief of Medicine for a prolonged time, here in New England.
I went to work for the VA in 2001 as an attending physician in the Emergency Department (ED) and only left when my cannabinoid medicine practice, inhaleMD, became my full-time gig.
My career at the VA led to my interest in cannabinoid medicine. Having seen so many veterans harmed by alcohol and a few other substances, it was my a-ha moment when I realized that I’d never seen anyone harmed by cannabis (believe me, I have now).
This spurred me to delve deeply into the data around cannabis and led to my understanding of how cannabis can be used as a medicine. As with all medicines, it’s in how you use it that determines whether it is beneficial or harmful.
Unfortunately, in my cannabinoid practice I see first-hand how misinformation and deliberate misdirection can lead to poor outcomes, and nowhere do I see this more than among veterans. So, let’s talk about how cannabis can be helpful to veterans and how it can be harmful as well.
Veterans and Pain
Veterans typically have a lot of physical pain (we’ll discuss emotional pain next). Stories about GIs humping it through the Afghani desert, vaulting 6 foot walls at a run, all while wearing 120 lbs. pack plus weapons, it’s no wonder soldiers bodies give out about the time they’re done their tour(s).
I also remember vets telling me that they were just given Ibuprofen and sent back out.
Needless to say, the spines, knees, hips, and shoulders of these young men and women looked like crap on x-ray, and the reason for their pain not a mystery. What to do about that pain is another story.
As you know, we have a very limited arsenal of pain treatments. Basically there’s the first-line agents: Acetaminophen and Non-steroidal anti-inflammatories (NSAIDs) like Ibuprofen. These are great when they’re great, but don’t always cut it when things are really rotten. Psychological approaches, like CBT, and medications like Gabapentinoids can be a helpful next step but often are not sufficient either.
Then what’s left? Opioids. In the ED, I was always known for being a stingy-bastard about opioids while the rest of the world was pressing for even more use. I have had a lot of professional and some personal negative experience with opioids and would never want to contribute to the problem.
That said, I firmly believe that opioids have their role to play but like any dangerous medicine, must be used carefully and thoughtfully.
What we need is more options, and cannabis/cannabinoids provide a great resource. Cannabis, when used carefully and thoughtfully, can be a very helpful approach to pain management.
This doesn’t mean smoking endless amounts of weed, but low-dose, appropriately timed cannabis medications, primarily given orally, can be great for mild-moderate pain.
There are clearly instances when opioids are needed. However, using cannabis first makes a lot of sense when comparing the acute and long-term risks of these agents. Further, in those cases where some opioid is necessary, studies have shown that using cannabis first/alongside the opioid leads to much less opioid needed.
Less opioid equals less risk.
Veterans and PTSD
Veterans, particularly but not limited to combat vets, have a whole host of psychological consequences to their service.
While we lump these symptoms under the umbrella of PTSD, they can manifest as anxiety, depression, insomnia, nightmares, hypervigilance, anger, panic, and undoubtedly many other related emotions. Cannabis can be used to address many of these.
In the 1960/70s soldiers in Vietnam and returning from combat understood the benefit of cannabis. Unfortunately, those soldiers were caught up in the prohibition of cannabis that was instated by Richard Nixon as a way to prosecute hippies and black Americans.
While Nixon eventually lost his war on hippies and POC, we’re still dealing with this ideologically based prohibition, despite the medical and scientific evidence that cannabis can be a helpful medicine. I’m hopeful that we’re on a (slow) path to changing this now.
Nonetheless, these laws have put veterans at unnecessary risk for decades, not only of arrest and prosecution, but also of self-medicating with the guidance of buddies and salespeople, instead of getting proper medical care. This, too, needs to change.
Veterans at Risk
The problem for veterans who are self-medicating their PTSD with cannabis is that, without proper guidance, this treatment can make things worse. Low doses of cannabis have been demonstrated to be helpful, but higher doses have been shown to exacerbate the very symptoms they’re trying to treat.
Studies of cannabis for PTSD in veterans show mixed results largely because they don’t control for dose and timing. In the anxiety literature, it’s clear that dose and timing are king.
Dose and timing are only going to be correctly communicated to ailing vets by people who understand cannabinoid medicine. Studies show that vets typically get their guidance from their well-meaning buddies who smoke and now the cannabis industry, and that under those circumstances, veterans often go from not using cannabis to problematic use of cannabis remarkably rapidly.
And why wouldn’t they, the whole industry is pushing for more use, which serves the seller but not the veteran.
Ultimately, veterans deserve better. They deserve effective and safe treatment for their medical problem, especially pain and PTSD. The only way to get there is with unbiased, caring guidance by clinicians who know about cannabis but also don’t deify the plant.
All medications have risk along with potential benefit. The trick is knowing when and how to best use that medication to get the best outcome with the least risk.
Consult with a Qualified Boston Medical Marijuana Expert Today.
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically. Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them.
For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.