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Health/Medical
See other Health/Medical Articles

Title: The American Legion Wants Marijuana Reclassified to Help Treat PTSD
Source: Reason
URL Source: https://reason.com/blog/2016/09/06/ ... an-legion-wants-marijuana-recl
Published: Sep 6, 2016
Author: Scott Shackford
Post Date: 2016-09-07 07:37:27 by Deckard
Keywords: None
Views: 19647
Comments: 72

Marijuana

These aren't your filthy hippies and stoners looking for an excuse to toke (not that there's anything wrong with that!): The American Legion is calling for the federal government to reclassify marijuana to acknowledge its potential benefits as a medical treatment.

As Jacob Sullum previously noted, The Drug Enforcement Agency (DEA) is stubbornly refusing to change the federal classification of marijuana as a drug that has no "accepted medical use" until science proves them wrong. Fortunately they're easing off on the Catch-22 situation that has resulted in this classification making it extremely difficult for researchers to perform the very scientific testing that could determine marijuana's medical value.

One of the potential medical values of medical marijuana is as a treatment for Post-Traumatic Stress Disorder (PTSD). And in what must certainly at this point make it abundantly clear where the majority of Americans stand on marijuana use, the American Legion has just voted at its national convention to support a resolution calling on Congress to legislatively reclassify cannabis and place it in a category that recognizes its potential value.

The resolution, readable here at marijuana.com, highlights a number of important statistics that have helped push the Legion to support it. Across two years, the Department of Veterans Affairs have diagnosed thousands of Afghanistan and Iraq War veterans as having PTSD or Traumatic Brain Injuries (TBI). More than 1,300 veterans in fiscal year 2009 were hospitalized for brain injuries. And the resolution notes that systems in the brain can respond to 60 different chemicals found in cannabis.

Therefore, the American Legion wants the DEA to license privately-funded medical marijuana and research facilities and to reclassify marijuana away from being lumped in with drugs like cocaine and meth.

Tom Angell over at marijuana.com notes that Sue Sisley, a psychiatrist and medical marijuana researcher, has been lobbying the Legion and their local posts to get their support. Sisley is notable for actually getting federal permission to research marijuana as a treatment for PTSD and then getting dumped by the University of Arizona (where she worked) in 2014.

What does this mean for a legislative effort to give VA docs permission to actually talk about medical marijuana as a treatment for veterans? As I noted in May, there was an amendment to a military appropriations bill that would end a gag order that prohibits VA doctors from recommending or even discussing medical marijuana treatment with patients, even in states where it had been legalized. The amendment would end the gag order, but wouldn't permit the VA to prescribe or pay for marijuana.

The amendment passed the House and Senate, but as Angell notes, after the two sides went through the reconciliation to hammer out any difference, the language completely disappeared. It is no longer part of the Veterans Administration package.

Legislators return to session today to hammer out last-minute spending bills to keep the government running (and the Democrats and Republicans are currently in disagreement on how long to extend spending authorizations for the incoming administration). Technically the amendment's language could be restored. (1 image)

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#20. To: nolu chan (#14)

In what medical dosage? Two tokes every four hours as necessary?

Whatever works best for the individual.

I realize that this is an alien concept for you two fed.gov shills, but the government does NOT own your body.

“Truth is treason in the empire of lies.” - Ron Paul

"America is at that awkward stage. It's too late to work within the system, but too early to shoot the bastards."

Deckard  posted on  2016-09-07   10:24:39 ET  Reply   Trace   Private Reply  


#21. To: misterwhite (#16)

I believe the "doctor's" recommendation for marijuana would read more like, "Smoke as much as you want, as many times as you want, for as long as you want."

Yep. Any kind of doctor. It could be Deckard's proctologist writing exactly that scrip because Deckard's ass wants to get high.

nolu chan  posted on  2016-09-07   10:25:18 ET  Reply   Trace   Private Reply  


#22. To: nolu chan (#21) (Edited)

It could be Deckard's proctologist writing exactly that scrip because Deckard's ass wants to get high.

Scumbag asshole coward.

This isn't about getting high you simpleton.

Chickenshit motherfucker.

“Truth is treason in the empire of lies.” - Ron Paul

"America is at that awkward stage. It's too late to work within the system, but too early to shoot the bastards."

Deckard  posted on  2016-09-07   10:28:02 ET  Reply   Trace   Private Reply  


#23. To: Deckard (#20)

Whatever works best for the individual.

five-part test for determining whether a drug is in "currently accepted medical use":

(1) The drug's chemistry must be known and reproducible;

(2) there must be adequate safety studies;

(3) there must be adequate and well-controlled studies proving efficacy;

(4) the drug must be accepted by qualified experts; and

(5) the scientific evidence must be widely available.

57 Fed.Reg. at 10,506.

Rx: Whatever works.

Whatever works best sounds like a plan. If a beer or a shot of scotch works best, get a scrip for it and have health insurance pay for it.

nolu chan  posted on  2016-09-07   10:34:07 ET  Reply   Trace   Private Reply  


#24. To: Deckard (#19)

So sayeth the almighty DEA.

How many doctors did the DEA consult with?

The medical opinion of the DHHS is binding on the DEA.

Look at the quacks that you rely on:

Alliance for Cannabis Therapeutics v. DEA, 15 F.3d 1131 (D.C. Cir. 1994)

[8] Moreover, our review of the record convinces us that the Administrator's findings are supported by substantial evidence. See 21 U.S.C. § 877 (1988) (substantial evidence standard applies to findings of fact in rescheduling proceedings). The Final Order canvasses the record at length. It recites the testimony of numerous experts that marijuana's medicinal value has never been proven in sound scientific studies. The Administrator reasonably accorded more weight to the opinions of these experts than to the anecdotal testimony of laymen and doctors on which petitioners relied. The Administrator noted that

[w]ith one exception, none of [these doctors] could identify under oath the scientific studies they swore they relied on. Only one had enough knowledge to discuss the scientific technicalities involved. Eventually, each one admitted he was basing his opinion on anecdotal evidence, on stories he heard from patients, and on his impressions about the drug.

Final Order, 57 Fed.Reg. at 10,502-03.

nolu chan  posted on  2016-09-07   10:39:10 ET  Reply   Trace   Private Reply  


#25. To: nolu chan (#23)

five-part test for determining whether a drug is in "currently accepted medical use":

Fuck you clown boy.

Like I said, the DEA or any government agency does not decide what medicine works best for an individual.

Rant on with your precious opinions, but the fact remains - the DEA is keeping cannabis as a Schedule I drug simply to protect big pharma.

“Truth is treason in the empire of lies.” - Ron Paul

"America is at that awkward stage. It's too late to work within the system, but too early to shoot the bastards."

Deckard  posted on  2016-09-07   10:44:24 ET  Reply   Trace   Private Reply  


#26. To: Deckard (#22)

Scumbag asshole coward.

This isn't about getting high you simpleton.

Chickenshit motherfucker.

Bullshit. This is not about medicine. You just want to go to a quack, say you want something for your head, and get a phony scrip. Next would be getting your Obamacare to pay for it.

To be medicine, a substance, every substance, must pass tests. Marijuana has not.

DEA, 81 FR 53780, August 12, 2016

Currently, no published studies conducted with marijuana meet the criteria of an adequate and well-controlled efficacy study. The criteria for an adequate and well-controlled study for purposes of determining the safety and efficacy of a human drug are defined under the Code of Federal Regulations (CFR) in 21 CFR 314.126. In order to assess this element, FDA conducted a review of clinical studies published and available in the public domain before February, 2013. Studies were identified through a search of PubMed[12] for articles published from inception to February 2013, for randomized controlled trials using marijuana to assess marijuana's efficacy in any therapeutic indication. Additionally, the review included studies identified through a search of bibliographic references in relevant systematic reviews and identified studies presenting original research in any language. Selected studies needed to be placebo-controlled and double-blinded. Additionally, studies needed to encompass administered marijuana plant material. There was no requirement for any specific route of administration, nor any age limits on study subjects. Studies were excluded that used placebo marijuana supplemented by the addition of specific amounts of THC or other cannabinoids. Additionally, studies administering marijuana plant extracts were excluded.

The PubMed search yielded a total of 566 abstracts of scientific articles. Of these abstracts, a full-text review was conducted with 85 papers to assess eligibility. Of the studies identified through the search of the references and the 566 abstracts from the PubMed search, only 11 studies met all the criteria for selection (Abrams et al., 2007; Corey-Bloom et al., 2012; Crawford and Merritt, 1979; Ellis et al., 2009; Haney et al., 2005; Haney et al., 2007; Merritt et al., 1980; Tashkin et al., 1974; Ware et al., 2010; Wilsey et al., 2008; Wilsey et al., 2013). These 11 studies were published between 1974 and 2013. Ten of these studies were conducted in the United States and one study was conducted in Canada. The identified studies examine the effects of smoked and vaporized marijuana for the indications of chronic neuropathic pain, spasticity related to Multiple Sclerosis (MS), appetite stimulation in human immunodeficiency virus (HIV) patients, glaucoma, and asthma. All studies used adult subjects.

The 11 identified studies were individually evaluated to determine if they successfully meet accepted scientific standards. Specifically, they were evaluated on study design including subject selection criteria, sample size, blinding techniques, dosing paradigms, outcome measures, and the statistical analysis of the results. The analysis relied on published studies, thus information available about protocols, procedures, and results were limited to documents published and widely available in the public domain. The review found that all 11 studies that examined effects of inhaled marijuana do not currently prove efficacy of marijuana in any therapeutic indication based on a number of limitations in their study design; however, they may be considered proof of concept studies. Proof of concept studies provide preliminary evidence on a proposed hypothesis involving a drug's effect. For drugs under development, the effect often relates to a short-term clinical outcome being investigated. Proof of concept studies often serve as the link between preclinical studies and dose ranging clinical studies. Thus, proof of concept studies generally are not sufficient to prove efficacy of a drug because they provide only preliminary information about the effects of a drug.

In addition to the lack of published adequate and well-controlled efficacy studies proving efficacy, the criteria for adequate safety studies has also not been met. Importantly, in its discussion of the five-part test used to determine whether a drug has a ''currently accepted medical use,'' DEA said, ''No drug can be considered safe in the abstract. Safety has meaning only when judged against the intended use of the drug, its known effectiveness, its known and potential risks, the severity of the illness to be treated, and the availability of alternative remedies'' (57 FR 10504).

nolu chan  posted on  2016-09-07   10:50:14 ET  Reply   Trace   Private Reply  


#27. To: Deckard (#25)

Fuck you clown boy.

Like I said, the DEA or any government agency does not decide what medicine works best for an individual.

It is the medical and scientific opinions of the DHHS that are binding on the DEA, you ignorant jerk.

Americans for Safe Access, et al., v. Drug Enforcement Administration, No. 11-1265 (D.C. Cir. 22 January 2013) slip op

As noted above, DHHS’ recommendations are binding on the DEA insofar as they rest on scientific and medical determinations. 21 U.S.C. § 811(b).

The government decides what may be lawfully prescribed as medicine and what is illegal to cultivate, distribute or possess.

nolu chan  posted on  2016-09-07   11:05:25 ET  Reply   Trace   Private Reply  


#28. To: nolu chan (#27)

It is the medical and scientific opinions

ESAD.

“Truth is treason in the empire of lies.” - Ron Paul

"America is at that awkward stage. It's too late to work within the system, but too early to shoot the bastards."

Deckard  posted on  2016-09-07   11:11:05 ET  Reply   Trace   Private Reply  


#29. To: Deckard (#25)

Rant on with your precious opinions, but the fact remains - the DEA is keeping cannabis as a Schedule I drug simply to protect big pharma.

And you just want to be able to go to your proctologist and get a scrip to get your ass high.

Marijuana is a schedule drug by international treaty, and federal law, and fails all five prongs of the test for being authorized as medicine.

nolu chan  posted on  2016-09-07   11:11:43 ET  Reply   Trace   Private Reply  


#30. To: Deckard (#28)

ESAD.

YMFCSCJSDEKLSOBWBC.

nolu chan  posted on  2016-09-07   11:12:59 ET  Reply   Trace   Private Reply  


#31. To: nolu chan (#1)

Which part of "calling on Congress to legislatively reclassify cannabis" did you not understand, nolu spam?

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-07   11:13:03 ET  Reply   Trace   Private Reply  


#32. To: Deckard (#28)

Americans for Safe Access, et al., v. Drug Enforcement Administration, No. 11-1265 (D.C. Cir. 22 January 2013) slip op

As noted above, DHHS’ recommendations are binding on the DEA insofar as they rest on scientific and medical determinations. 21 U.S.C. § 811(b).

nolu chan  posted on  2016-09-07   11:15:20 ET  Reply   Trace   Private Reply  


#33. To: Deckard (#0)

No way, Jose!

Watch Colorado for an example of what ensues when knuckleheads legalize a hallucigenic drug. Scores of brain-addled numbskulls on the road and when they enter another state the police are always looking for Colorado tags on a car driving erratically.

This is a Pandora's Box!

Liberals are a lot like Slinkys, they're good for nothing but they bring a smile to your face as you shove them down the stairs.

HomerBohn  posted on  2016-09-07   11:17:59 ET  Reply   Trace   Private Reply  


#34. To: HomerBohn (#33)

"Since marijuana legalization, highway fatalities in Colorado are at near-historic lows" - www.freerepublic.com/focus/f-chat/3280359/posts

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-07   11:23:43 ET  Reply   Trace   Private Reply  


#35. To: Deckard (#8)

Piss up a rope psycho.

Oh, you poor little baby....you should try not to get so upset when facts are presented to you.

Try....try hard.

Gatlin  posted on  2016-09-07   11:30:58 ET  Reply   Trace   Private Reply  


#36. To: Gatlin (#35)

Facts?

nolu spam posts opinions

“Truth is treason in the empire of lies.” - Ron Paul

"America is at that awkward stage. It's too late to work within the system, but too early to shoot the bastards."

Deckard  posted on  2016-09-07   11:41:14 ET  Reply   Trace   Private Reply  


#37. To: ConservingFreedom (#34)

Articles posted there aren't to be believed.

Liberals are a lot like Slinkys, they're good for nothing but they bring a smile to your face as you shove them down the stairs.

HomerBohn  posted on  2016-09-07   12:07:49 ET  Reply   Trace   Private Reply  


#38. To: ConservingFreedom (#31)

Which part of "calling on Congress to legislatively reclassify cannabis" did you not understand, nolu spam?

Which part of "reclassify it in a category that, at a minimum will recognize cannabis as a drug with potential medical value," makes sense to you?

I know this is really taxing for you, but it seems to be lacking any scientific evidence to justify anything.

Moreover, you seem to fail to recognize wordsmithing signifying nothing.

WHEREAS, In April 2016, the Drug Enforcement Agency gave its approval to a study on the effect of medical marijuana on post-traumatic stress disorder, the first randomized, controlled research in the U.S for PTSD that will use the actual plant instead of oils or synthesized cannabis; now, therefore, be it

RESOLVED, By The American Legion in National Convention assembled in Cincinnati, Ohio, August 30, 31, September 1, 2016, that The American Legion urge the Drug Enforcement Agency to license privately-funded medical marijuana production operations in the United States to enable safe and efficient cannabis drug development research; and, be it finally,

RESOLVED, That The American Legion urge Congress to amend legislation to remove Marijuana from schedule I and reclassify it in a category that, at a minimum will recognize cannabis as a drug with potential medical value.

DEA, 81 FR 53779-53781, August 12, 2016

Marijuana does not meet any of the five elements necessary for a drug to have a ''currently accepted medical use.''

Firstly, the chemistry of marijuana, as defined in the petition, is not reproducible in terms of creating a standardized dose. The petition defines marijuana as including all Cannabis cultivated strains. Different marijuana samples derived from various cultivated strains may have very different chemical constituents including delta9-THC and other cannabinoids (Appendino et al., 2011). As a consequence, marijuana products from different strains will have different safety, biological, pharmacological, and toxicological profiles. Thus, when considering all Cannabis strains together, because of the varying chemical constituents, reproducing consistent standardized doses is not possible. Additionally, smoking marijuana currently has not been shown to allow delivery of consistent and reproducible doses. However, if a specific Cannabis strain is grown and processed under strictly controlled conditions, the plant chemistry may be kept consistent enough to produce reproducible and standardized doses.

It cannot meet the first test to safely prescribe as medicine.

As to the fifth part of the test, which requires that information concerning the chemistry, pharmacology, toxicology, and effectiveness of marijuana to be reported in sufficient detail, the scientific evidence regarding all of these aspects is not available in sufficient detail to allow adequate scientific scrutiny. Specifically, the scientific evidence regarding marijuana's chemistry in terms of a specific Cannabis strain that could produce standardized and reproducible doses is not currently available.

Alternately, a drug can be considered to have a ''currently accepted medical use with severe restrictions'' (21 U.S.C. 812(b)(2)(B)), as allowed under the stipulations for a Schedule II drug. Yet, as stated above, currently marijuana does not have any accepted medical use, even under conditions where its use is severely restricted.

In conclusion, to date, research on marijuana's medical use has not progressed to the point where marijuana is considered to have a ''currently accepted medical use'' or a ''currently accepted medical use with severe restrictions.''

Marjuana has been determined to not have a "currently accepted medical use," nor a "currently accepted medical use with severe restrictions.''

Officially, within the schedule system, what the hell does it mean to "reclassify it in a category that, at a minimum will recognize cannabis as a drug with potential medical value?"

Nobody said it does not have potential medical value. It has no currently accepted medical use.

A requirement for Schedule V is "The drug or other substance has a currently accepted medical use in treatment in the United States."

Absent a finding of some "currently accepted medical use in treatment in the United States," marijuana (or any other substance) is not even assignable to Schedule V, the lowest schedule.

There is no schedule category that recognizes a substance with potential medical value. Just about every substance may have potential medical value. That does not connote that it has any currently accepted medical use.

- - - - - - - - - -

nolu chan  posted on  2016-09-07   12:26:04 ET  Reply   Trace   Private Reply  


#39. To: Deckard, nolu chan (#36)

Facts?

nolu spam posts opinions

And you post Yellow Journalism half truths and lies.

Chan makes sense....you make yourself look like the idiot that you are.

Gatlin  posted on  2016-09-07   12:29:01 ET  Reply   Trace   Private Reply  


#40. To: Deckard, Gatlin (#36)

nolu spam posts opinions

Deckard posts recycled bullshit over and over.

nolu chan  posted on  2016-09-07   12:32:48 ET  Reply   Trace   Private Reply  


#41. To: HomerBohn (#37)

Articles posted there [FR] aren't to be believed.

LOL! Now, now ... I also was banned from FR*, but however goofy JR and the mods are, it's just not the case that fact becomes fiction simply by being posted to FR.

*Details here if you're interested: http://libertysflame.com/cgi-bin/readart.cgi?ArtNum=45337

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-07   12:37:09 ET  Reply   Trace   Private Reply  


#42. To: nolu chan (#38)

Marijuana does not meet any of the five elements necessary for a drug to have a ''currently accepted medical use.''

Are you this stupid, or are you hoping others on LF are? "The five elements" are authoritative because of authority that ultimately derives from Congress and its legislation; when the subject is (urged) Congressional CHANGES to legislation, the CURRENT state of the rules is no longer binding.

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-07   12:41:34 ET  Reply   Trace   Private Reply  


#43. To: ConservingFreedom (#42)

Marijuana does not meet any of the five elements necessary for a drug to have a ''currently accepted medical use.''

Are you this stupid, or are you hoping others on LF are? "The five elements" are authoritative because of authority that ultimately derives from Congress and its legislation; when the subject is (urged) Congressional CHANGES to legislation, the CURRENT state of the rules is no longer binding.

I have given up all hope for you. Your brain has apparently been fired on drugs.

reclassify it in a category that, at a minimum will recognize cannabis as a drug with potential medical value.

It is already in a Schedule where it already has been recognized as a substance with potential medical value. It just kind of lacks "currently accepted medical value.

DEA, 81 FR 53779-53781, August 12, 2016

The review found that all 11 studies that examined effects of inhaled marijuana do not currently prove efficacy of marijuana in any therapeutic indication based on a number of limitations in their study design; however, they may be considered proof of concept studies. Proof of concept studies provide preliminary evidence on a proposed hypothesis involving a drug's effect. For drugs under development, the effect often relates to a short-term clinical outcome being investigated. Proof of concept studies often serve as the link between preclinical studies and dose ranging clinical studies. Thus, proof of concept studies generally are not sufficient to prove efficacy of a drug because they provide only preliminary information about the effects of a drug.

nolu chan  posted on  2016-09-07   14:17:56 ET  Reply   Trace   Private Reply  


#44. To: nolu chan (#43)

"Are you this stupid, or are you hoping others on LF are? "The five elements" are authoritative because of authority that ultimately derives from Congress and its legislation; when the subject is (urged) Congressional CHANGES to legislation, the CURRENT state of the rules is no longer binding."

I have given up all hope for you.

You've answered my question - you are that stupid.

Poor stupid nolu spam.

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-07   14:27:57 ET  Reply   Trace   Private Reply  


#45. To: ConservingFreedom (#44)

Poor stupid nolu spam. ----- ConservingFreedom

The government decides what may be lawfully prescribed as medicine and what is illegal to cultivate, distribute or possess. --- nolu chan

To nolu, (and his buddies here) the government is all powerful and can declare damn near ANYTHING, or any behavior, illegal. - --- This is beyond stupid, -- it is an anti-constitutional theory.

tpaine  posted on  2016-09-07   16:47:54 ET  Reply   Trace   Private Reply  


#46. To: Deckard (#0)

I guess the WWII and Korea Vets are all gone.

redleghunter  posted on  2016-09-07   17:00:24 ET  Reply   Trace   Private Reply  


#47. To: redleghunter, Deckard (#46)

I guess the WWII and Korea Vets are all gone.

Nope - membership is declining because Vietnam vets haven't joined: articles.latimes.com/1998/nov/11/local/me-41612

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-07   17:23:34 ET  Reply   Trace   Private Reply  


#48. To: tpaine (#45)

the government is all powerful and can declare damn near ANYTHING, or any behavior, illegal. - --- This is beyond stupid

Listening to two stoned dopers who believe they are having a conversation is listening to pure stupid.

it is an anti-constitutional theory.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of really good shit.

nolu chan  posted on  2016-09-07   17:31:58 ET  Reply   Trace   Private Reply  


#49. To: Deckard, Gatlin, ConservingFreedom, redleghunter, tpaine (#36)

Facts?

A friend who is a Vietnam vet, also retired from the California National Guard about 4 years ago.

He has PTSD and has been on prescription psych drugs for about 30 years or more. He called me up a couple of years ago, all jazzed because his VA psychiatrist took him off of all prescription drugs. For the first time in decades he's off of the hated psych meds and drug free, but with California Medical Marijuana as a back up, as needed. He's officially considered cured, and weed helped.

That one story is enough to convince me that MM should be available to all.


The D&R terrorists hate us because we're free, to vote second party

Castle(C), Stein(G), Johnson(L)

Hondo68  posted on  2016-09-07   18:38:15 ET  Reply   Trace   Private Reply  


#50. To: hondo68 (#49)

A friend who is a Vietnam vet, also retired from the California National Guard about 4 years ago.

He has PTSD and has been on prescription psych drugs for about 30 years or more. He called me up a couple of years ago, all jazzed because his VA psychiatrist took him off of all prescription drugs. For the first time in decades he's off of the hated psych meds and drug free, but with California Medical Marijuana as a back up, as needed. He's officially considered cured, and weed helped.

That one story is enough to convince me that MM should be available to all.

PTSD: National Center for PTSD

Marijuana Use and PTSD among Veterans

Marcel O. Bonn-Miller, Ph.D. and Glenna S. Rousseau, Ph.D.

Marijuana use for medical conditions is an issue of growing concern. Some Veterans use marijuana to relieve symptoms of PTSD and several states specifically approve the use of medical marijuana for PTSD. However, controlled studies have not been conducted to evaluate the safety or effectiveness of medical marijuana for PTSD. Thus, there is no evidence at this time that marijuana is an effective treatment for PTSD. In fact, research suggests that marijuana can be harmful to individuals with PTSD.

Epidemiology

Marijuana use has increased over the past decade. In 2013, a study found that 19.8 million people reported using marijuana in the past month, with 8.1 million using almost every day (1). Daily use has increased 60% in the prior decade (1). A number of factors are associated with increased risk of marijuana use, including diagnosis of PTSD (2), social anxiety disorder (3), other substance use, particularly during youth (4), and peer substance use (5).

Cannabis Use Disorder among Veterans Using VA Health Care

There has been no study of marijuana use in the overall Veteran population. What we do know comes from looking at data of Veterans using VA health care, who may not be representative of Veterans overall. When considering the subset of Veterans seen in VA health care with co-occurring PTSD and substance use disorders (SUD), cannabis use disorder has been the most diagnosed SUD since 2009. The percentage of Veterans in VA with PTSD and SUD who were diagnosed with cannabis use disorder increased from 13.0% in fiscal year (FY) 2002 to 22.7% in FY 2014. As of FY 2014, there are more than 40,000 Veterans with PTSD and SUD seen in VA diagnosed with cannabis use disorder (6).

Graph of VHA Trends 
in diagnoses by drug for Veterans with PTSD and SUD in VA Health Care: This 
graph shows the rates of SUD diagnoses (y-axis) by drug type (lines on graph: 
amphetamines, cannabis, cocaine, and opioids) among Veterans with PTSD treated 
in VA health care. Data is shown for each fiscal year (FY) from 2002 through 
2014 (x-axis). Data was provided by the Veterans Health Administration, 2015. 
<p>
<b>Cannabis use disorder is the most diagnosed SUD among Veterans with PTSD in 
VA health care in FY14. Rates of cannabis use disorder diagnoses grew from 13.0% 
in FY02 to 22.7% in FY14</b>. Cocaine use disorder was the most diagnosed SUD 
among Veterans with PTSD in FY02, at 18.9%. In FY09, cocaine became less common 
than cannabis use disorder (15.4% and 15.9% respectively), and as of FY14, 
cocaine use disorder is the second most common SUD diagnosis among Veterans with 
PTSD, at 14.8%. Among this subset of Veterans, opioid use disorder was diagnosed 
at a rate of 9.9% in FY02, rising to 12.5% in FY14. Amphetamine use disorder was 
diagnosed at a rate of 2.6% in FY02 and rose to 4.4% in FY14.

Problems Associated with Marijuana Use

Marijuana use is associated with medical and psychiatric problems. These problems may be caused by using, but they also may reflect the characteristics of the people who use marijuana. Medical problems include chronic bronchitis, abnormal brain development among early adolescent initiators, and impairment in short-term memory, motor coordination and the ability to perform complex psychomotor tasks such as driving. Psychiatric problems include psychosis and impairment in cognitive ability. Quality of life can also be affected through poor life satisfaction, decreased educational attainment, and increased sexual risk-taking behavior (7). Chronic marijuana use also can lead to addiction, with an established and clinically significant withdrawal syndrome (8).

Active Ingredients and Route of Administration

Marijuana contains a variety of components (cannabinoids), most notably delta-9-tetrahydrocannabinol (THC) the primary psychoactive compound in the marijuana plant. There are a number of other cannabinoids, such as cannabidiol (CBD), cannabinol (CBN), and cannabigerol (CBG). Marijuana can vary in cannabinoid concentration, such as in the ratio of THC to other cannabinoids (CBD in particular). Therefore, the effects of marijuana use (e.g., experience of a high, anxiety, sleep) vary as a function of the concentration of cannabinoids (e.g., THC/CBD). In addition, the potency of cannabinoids can vary. For example, the concentration of THC in the marijuana plant can range in strength from less than 1% to 30% based upon strain and cultivation methods. In general, the potency of THC in the marijuana plant has increased as much as 10- fold over the past 40 years (9,10). Recently, cannabis extract products, such as waxes and oils, have been produced and sold in which the concentration of THC can be as high as 90%. Thus, an individual could unknowingly consume a very high dose of THC in one administration, which increases the risk of an adverse reaction.

Marijuana can be consumed in many different forms (e.g., flower, hash, oil, wax, food products, tinctures). Administration of these forms also can take different routes: inhalation (smoking or vaporizing), ingestion, and topical application. Given the same concentration/ratio of marijuana, smoking or vaporizing marijuana produces similar effects (11); however, ingesting the same dose results in a delayed onset and longer duration of effect (12). Not all marijuana users may be aware of the delayed effect caused by ingestion, which may result in greater consumption and a stronger effect than intended.

Neurobiology

Research has consistently demonstrated that the human endocannabinoid system plays a significant role in PTSD. People with PTSD have greater availability of cannabinoid type 1 (CB1) receptors as compared to trauma-exposed or healthy controls (13,14). As a result, marijuana use by individuals with PTSD may result in short-term reduction of PTSD symptoms. However, data suggest that continued use of marijuana among individuals with PTSD may lead to a number of negative consequences, including marijuana tolerance (via reductions in CB1 receptor density and/or efficiency) and addiction (15). Though recent work has shown that CB1 receptors may return after periods of marijuana abstinence (16), individuals with PTSD may have particular difficulty quitting (17).

Marijuana as a Treatment for PTSD

The belief that marijuana can be used to treat PTSD is limited to anecdotal reports from individuals with PTSD who say that the drug helps with their symptoms. There have been no randomized controlled trials, a necessary "gold standard" for determining efficacy. Administration of oral CBD has been shown to decrease anxiety in those with and without clinical anxiety (18). This work has led to the development and testing of CBD treatments for individuals with social anxiety (19), but not yet among individuals with PTSD. With respect to THC, one open trial of 10 participants with PTSD showed THC was safe and well tolerated and resulted in decreases in hyperarousal symptoms (20).

Treatment for Marijuana Addiction

People with PTSD have particular difficulty stopping their use of marijuana and responding to treatment for marijuana addiction. They have greater craving and withdrawal than those without PTSD (21), and greater likelihood of marijuana use during the six months following a quit attempt (17). However, these individuals can benefit from the many evidence-based treatments for marijuana addiction, including cognitive behavioral therapy, motivational enhancement, and contingency management (22). Thus, providers should still utilize these options to support reduction/abstinence.

Clinical Recommendations

Treatment providers should not ignore marijuana use in their PTSD patients. The VA/DoD PTSD Clinical Practice Guideline (2010) recommends providing evidence-based treatments for the individual disorders concurrently. PTSD providers should offer education about problems associated with long-term marijuana use and make a referral to a substance use disorder (SUD) specialist if they do not feel they have expertise in treating substance use.

Individuals with comorbid PTSD and SUD do not need to wait for a period of abstinence before addressing their PTSD. A growing number of studies demonstrate that that these patients can tolerate trauma-focused treatment and that these treatments do not worsen substance use outcomes. Therefore, providers have a range of options to help improve the lives of patients with the co-occurring disorders. For more information, see PTSD and Substance Use Disorders in Veterans.

References

  1. SAMHSA. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. (Vol. NSDUH Series H-48, HHS Publication No. (SMA) 13-4795). Rockville, MD: Substance Abuse and Mental Health Services Administration.

  2. Cougle, J.R., Bonn-Miller, M. O., Vujanovic, A. A., Zvolensky, M. J., & Hawkins, K. A. (2011). Posttraumatic stress disorder and cannabis use in a nationally representative sample. Psychology of Addictive Behaviors, 25, 554-558. doi: 10.1037/a0023076

  3. Buckner, J.D., Schmidt, N. B., Lang, A. R., Small, J. W., Schluach, R. C., & Lewinsohn, P. M. (2008). Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research, 42, 230-239. doi: 10.1016/j.jpsychires.2007.01.002

  4. Butterworth, P., Slade, T. & Degenhardt, L. (2014). Factors associated with the timing and onset of cannabis use and cannabis use disorder: Results from the 2007 Australian National Survey of Mental Health and Well-Being. Drug and Alcohol Review, 33, 555-564. doi: 10.1111/dar.12183

  5. von Sydow, K., Lieb, R., Pfister, H., Höefler, M., & Wittchen, H. U. (2002). What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug and Alcohol Dependence, 68, 49-64.

  6. Program Evaluation and Resource Center, V.A., 2015.

  7. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. B. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370, 2219-2227. doi: 10.1056/NEJMra1402309

  8. Budney, A. J., Hughes, J. R., Moore, B. A., & Vandrey, R. (2004). Review of the validity and significance of cannabis withdrawal syndrome. American Journal of Psychiatry, 161, 1967-1977.

  9. Mehmedic, Z., Chandra, S., Slade, D., Denham, H., Foster, S., Patel, A. S., Ross, S. A., Khan, I. A., & ElSohly, M. A. (2010). Potency trends of ”9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008. Journal of Forensic Sciences, 55, 1209-1217. doi: 10.1111/j.1556-4029.2010.01441.x

  10. Sevigny, E. L., Pacula, R. L., & Heaton, P. (2014) The effects of medical marijuana laws on potency. International Journal of Drug Policy, 25, 308-319. doi: 10.1016/j.drugpo.2014.01.003

  11. Abrams, D. I., Vizoso, H. P., Shade, S. B., Jay, C., Kelly, M. E., & Benowitz, N. L. (2007). Vaporization as a smokeless cannabis delivery system: A pilot study. Clinical Pharmacology & Therapeutics, 82, 572-578.

  12. Grotenhermen, F. (2003). Pharmacokinetics and pharmacodynamics of cannabinoids. Clinical Pharmacokinetics, 42, 327-360.

  13. Neumeister, A., Normandin, M. D., Pietrzak, R. H., Piomelli, D., Zheng, M. Q., Gujarro-Anton, A., Potenza, M. N., Bailey, C. R., Lin, S. F., Najafzaden, S., Ropchan, J., Henry, S., Corsi-Travali, S., Carson, R. E., & Huang, Y. (2013). Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: A positron emission tomography study. Molecular Psychiatry, 18, 1034-1040. doi: 10.1038/mp.2013.61

  14. Passie, T., Emrich, H. M., Brandt, S. D., & Halpern, J. H. (2012). Mitigation of post-traumatic stress symptoms by Cannabis resin: A review of the clinical and neurobiological evidence. Drug Testing and Analysis, 4, 649-659. doi: 10.1002/dta.1377

  15. Kendall, D.A. & Alexander, S.P. H. (2009). Behavioral neurobiology of the endocannabinoid system. Current topics in behavioral neurosciences. Heidelberg: Springer-Verlag.

  16. Hirvonen, J., Goodwin, R. S., Li, C-T., Terry, G. E., Zoghbi, S. S., Morse, C., Pike, V. W., Volkow, N. D., Huestis, M. A., & Innis, R. B. (2012). Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers. Molecular Psychiatry, 17, 642-649. doi: 10.1038/mp.2011.82

  17. Bonn-Miller, M. O., Moos, R. H., Boden, M. T., Long, W. R., Kimerling, R., & Trafton, J. A. (in press). The impact of posttraumatic stress disorder on cannabis quit success. The American Journal of Drug and Alcohol Abuse.

  18. Crippa, J. A., Zuardi, A. W., Martìn-Santos, R., Bhattacharyya, S., Atakan, Z., McGuire, P., & Fusar-Poli, P. (2009). Cannabis and anxiety: a critical review of the evidence. Human Psychopharmacology, 24, 515-523. doi: 10.1002/hup.1048

  19. Bergamaschi, M. M., Queiroz, R. H. C., Hortes, M., Chagas, N., de Oliveira, C. G., De Martinis, B. S., Kapczinski, F., Quevedo, J., Roesler, R., Schröder, N., Nardi, A. E., Martín-Santos, R., Hallak, J. E. C., Zuardi, A. W., & Crippa, J. A. S. (2011). Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology, 36, 1219-1226. doi: 10.1038/npp.2011.6

  20. Roitman, P., Mechoulam, R., Cooper-Kazaz, R., & Shalev, A. (2014). Preliminary, open-label, pilot study of add-on oral ”9- tetrahydrocannabinol in chronic post-traumatic stress disorder. Clinical Drug Investigation, 34, 587-591. doi: 10.1007/s40261-014-0212-3

  21. Boden, M. T., Babson, K. A., Vujanovic, A. A., Short, N. A., & Bonn- Miller, M. (2013). Posttraumatic stress disorder and cannabis use characteristics among military Veterans with cannabis dependence. The American Journal on Addictions, 22, 277-284. doi: 10.1111/j.1521- 0391.2012.12018.x

  22. Roffman, R. A. & Stephens, R. S. (2006). Cannabis dependence: its nature, consequences, and treatment. International research monographs in the addictions. Cambridge, UK; New York: Cambridge University Press.

http://www.ptsd.va.gov/professional/c o-occurring/marijuana_use_ptsd_veterans.asp.

Gatlin  posted on  2016-09-07   19:41:17 ET  (1 image) Reply   Trace   Private Reply  


#51. To: Deckard (#4)

Nothing the government says about anything is true.

You know that and I know that and soon a lot of other people are going to find this out.

I do not go to church every time the doors are opened, but I love Jesus Christ. I am only human and fail Him daily. I believe Jesus is the Son of God, was born of a virgin, was crucified on a cross, died for my sins and rose from the dead and that He loves us dearly, and is faithful to forgive us of our sins. But He says that if you deny me in front of your friends I will deny you in front of my Father. Can I get an Amen!

U don't know me  posted on  2016-09-07   21:11:07 ET  Reply   Trace   Private Reply  


#52. To: redleghunter, y'all (#46)

I guess the WWII and Korea Vets are all gone.

Not quite. -- Technically speaking, I'm a Korean war vet, as I joined on Jan 31st, 1955.

Never saw Korea though, served two years in Munich, 56/58.

tpaine  posted on  2016-09-08   0:31:49 ET  Reply   Trace   Private Reply  


#53. To: nolu chan, and his progressive prohibitionist buddies (#48)

To nolu, (and his buddies here) believe the government is all powerful and can declare damn near ANYTHING, or any behavior, illegal. - --- This is beyond stupid, -- it is an anti-constitutional theory.

Listening to two stoned dopers who believe they are having a conversation is listening to pure stupid.

Never smoked much POT. -- Booze is my drug of choice, mainly single malts, red wine, and wheat beers.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness, -- free from prohibitionists who are afraid that someone, somewhere, is living large.

tpaine  posted on  2016-09-08   0:45:16 ET  Reply   Trace   Private Reply  


#54. To: nolu chan (#48)

certain unalienable Rights, that among these are Life, Liberty

Yup - liberty means it's none of your business nor government's what someone puts in their own body.

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-08   10:27:20 ET  Reply   Trace   Private Reply  


#55. To: ConservingFreedom (#54)

"The first duty of the Government is to afford protection to its citizens."

Legalizing all drugs for all citizens seems to violate that duty. And forcing citizens to care for those who put shit in their own body definitely does.

misterwhite  posted on  2016-09-08   10:50:09 ET  Reply   Trace   Private Reply  


#56. To: misterwhite, hypocritical prohibitionist (#55)

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness, -- protected from prohibitionists who are afraid that someone, somewhere, is living free.

Misterwhite ---- "The first duty of the Government is to afford protection to its citizens." --- Legalizing all drugs for all citizens seems to violate that duty.

Only to prohibitionists is there a 'government duty' to criminalize certain substances. -- Dangerous materials can be reasonably regulated without unconstitutional bans.

And forcing citizens to care for those who put shit in their own body definitely does.

We agree on forcing citizens to care, yet you're FOR forcing citizens with prohibitions on drugs, guns, moral issues, etc.

Whatta hypocrite.

tpaine  posted on  2016-09-08   11:18:25 ET  Reply   Trace   Private Reply  


#57. To: misterwhite (#55)

"The first duty of the Government is to afford protection to its citizens."

Legalizing all drugs for all citizens seems to violate that duty.

How so? Certainly it's not a duty nor even a legitimate function of government to protect its citizens from themselves ... unless you want your diet and bedtime monitored.

And forcing citizens to care for those who put shit in their own body definitely does.

Agreed. Including shit like tobacco or a steady diet of fast food.

A government strong enough to impose your standards is strong enough to ban them.

ConservingFreedom  posted on  2016-09-08   17:13:20 ET  Reply   Trace   Private Reply  


#58. To: ConservingFreedom (#57)

"Certainly it's not a duty nor even a legitimate function of government to protect its citizens from themselves"

It's not illegal to consume drugs. But if Congress wishes to regulate the interstate transportation of substances harmful to people, they have that power and that duty.

misterwhite  posted on  2016-09-08   19:31:26 ET  Reply   Trace   Private Reply  


#59. To: Deckard (#36)

Well, I guess this means that the American Legion is now officially on the Shit List of the Canary Klan.

The Legion should be prepared for raids, tanks crashing through the walls, and Swat Teams storming in, with summary executions on the spot.

Si vis pacem, para bellum

Those who beat their swords into plowshares will plow for those who don't

Rebellion to tyrants is obedience to God.

if you look around, we have gone so far down the the rat hole, the almighty is going to have to apologize to Sodom and Gomorrah, if we don't have a judgement come down on us.

President Obama is the greatest hoax ever perpetrated on the American people. --Clint Eastwood

"I am concerned for the security of our great nation; not so much because of any threat from without, but because of the insidious forces working from within." -- General Douglas MacArthur

Stoner  posted on  2016-09-08   20:05:51 ET  Reply   Trace   Private Reply  


#60. To: misterwhite, prohibitionist, and proud of it. (#58)

Misterwhite ---- "The first duty of the Government is to afford protection to its citizens." --- Legalizing all drugs for all citizens seems to violate that duty.

Only to prohibitionists is there a 'government duty' to criminalize certain substances. -- Dangerous materials can be reasonably regulated without unconstitutional bans.

It's not illegal to consume drugs. But if Congress wishes to regulate the interstate transportation of substances harmful to people, they have that power and that duty.

Congress has SEIZED that power, unconstitutionally. --- And it has turned us into a,nation of scofflaws, -- as all prohibitions do. -- Millions of citizens disregard our stupid 'laws' on guns, drugs, etc. -- And we all pay the price to hold them in jails.

tpaine  posted on  2016-09-08   21:10:01 ET  Reply   Trace   Private Reply  



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