[Lucas Jackson]

Cannabis for the Wounded

By FRED GARDNER

Screaming Chris Mathews and the corporate media would have us believe that it's only the living conditions at Walter Reed Army Medical Center that are deplorable, not the medical care itself. Donna Shalala and Bob Dole have been assigned to investigate the situation. A superficial clean-up will ensue -rodents poisoned, moldy drywall replaced- while the quality of care gets lauded and prosthetic limbs are presented as proof that all is state-of-the-art.

Out in California, however, doctors in the Society of Cannabis Clinicians question the care doled out at Walter Reed and other military hospitals where wounded soldiers and vets are treated with toxic medications* while the safest painkiller known to man is systematically withheld. "If anybody needs and deserves cannabis-based medicine, it's the thousands of soldiers who have been seriously wounded in Iraq," says Philip A. Denney, MD. "Cannabis would help in treating insomnia, pain, PTSD, and a whole array of symptoms that wounded vets typically face."

Tod Mikuriya, Md, who has monitored cannabis use by more than 8,500 patients, reports that approximately 8% had a primary diagnosis of PTSD. His findings and observations are confirmed by every doctor in the field. Many PTSD patients, according to Mikuriya, "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 stimuli. There is no other psychotherapeutic drug with these synergistic and complementary effects.

"Physical pain, fatigue, and sleep deficit are symptoms that can be ameliorated. Restorative exercise and diet are requisite components of treatment of PTSD and depression. Cannabis does not leave the patient too immobile to exercise, as do some analgesics, sedatives biodiazapenes, etc. Regular aerobic exercise (where injury does not interfere) relieves tension and restores control through kinesthetic involvement. Exercise also internalizes the locus of control and diminishes drug-seeking to manage emotional response.

"PTSD often involves irritability and inability to concentrate, which is aggravated by sleep deficit. Cannabis use enhances the quality of sleep through modulation of emotional reactivity. It eases the triggered flashbacks and accompanying emotional reactions, including nightmares. The importance of restoring circadian rhythm of sleep cannot be overestimated in the management of PTSD. Avoidance of alcohol is important in large part because of the adverse effects on sleep. The short-lived relaxation and relief provided by alcohol are replaced by withdrawal symptoms at night, causing anxiety and the worsening of musculoskeletal pain...

"Based on both safety and efficacy, cannabis should be considered first in the treatment of post-traumatic stress disorder. As part of a restorative program with exercise, diet, and psychotherapy, it should be substituted for 'mainstream' anti-depressants, sedatives, muscle relaxants, tricyclics, etc."

Somewhere at Walter Reed or elsewhere in the system there are vets who know from direct experience that cannabis eases their symptoms and who, sooner or later, will assert the right to use it openly. Donna Shalala and Bob Dole are the last people in the world who would allow cannabis use by wounded vets. Shalala stood alongside Barry McCaffrey to denounce Dr. Mikuriya and Prop 215 at a well-covered press conference in December '96. She stated that nobody should ever use marijuana "because it's illegal" and the reason it's illegal is "because it's 'wrong.'" This absurd moralism from the government's top official in charge of "Health."

Bob Dole's last public appearance in a "medical" context was as a pitchman for Viagra. His educational effort should be rewarded by changing the name of the condition from "Erectile Dysfunction" to "Bob Dole Disorder." Wouldn't most men be more comfortable talking to their doctors about BDD than about ED? Dole also did a Pepsi ad that made reference to his Viagra ad. In the Pepsi ad he's watching Brittney Spears gyrate and his little terrier gets aroused and trots off.

In the spring of 2004 I left a copy of O'Shaughnessy's at a Walter Reed checkpoint for a high-ranking Army doctor who, I'd been told by a mutual friend, might be interested in the suggestion made in the editorial ("Cannabis for the Wounded"). This is what the Army doctor emailed in response: "Thanks for sending me the copy of O'Shaughnessy's. I was curious why L. passed my name along to you -perhaps because I was a botanist in my pre-medicine days and have an interest in the non-recreational use of psychoactive plants, or because I know Marcus Conant, or because I'm a military doc. In fact, for some of my essays required for military professional development, I wrote on the military's approved uses of drugs... But the topic of medical uses of marijuana is not among my interests so I'll stand back to watch the debate from afar." I took this to mean: "I have every reason to be interested in medical marijuana but I'm afraid to bring it up at Walter Reed."

* Commonly prescribed medications for PTSD as listed in "Postraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq," by Matthew J. Friedman, MD, PhD, in the April 2006 American Journal of Psychiatry:

SSRIs

Paroxetine, Sertraline, Pluoxetine, Citalopram, Fluvoxamine May produce insomnia, restlessness, nausea, decreased appetite, daytime sedation, nervousness, and anxiety, sexual dysfunction, decreased libido, delayed orgasm or anorgasmia. Clincically significant interactions for people prescribed monoamine oxidase inhibitors (MAOIs). Significant interactions with hepatic enzymes produce other drug interactions. Concern about increased suicide risk in children and adolescents.

Other second-generation antidepressants: Trazadone may be too sedating, may produce rare priapism. Velafaxine may exacerbate hypertension. Buproprion may exacerbate seizure disoder. Mirtrazepine may cause sedation.

MAOIs

Phenetzine Risk of hypertensive crisis; patients required to follow a strict dietary regime. Contraindicated in combination with most other antidepressants, CNS stimulants, and decongestants. Contraindicated in patients with alcohol/substance abuse/dependence. May produce insomnia, hypotension, anticholinergic side effects, and liver toxicity.

Tricyclic Antidepressants

Imipramine, Amitriptyline, Desipramine. Anticholinergic side effects (dry mouth, rapid pulse, blurred vision, constipation). May produce ventricular arrhythmias. May produce orthostatic hypotension, sedation, or arousal.

Antiadrenergic Agents

Prazosin, Propranolol, Conidine, Guanfacine: May produce hypotension, brachycardia (slow heartbeat), depressive symptoms, psychotomor slowing or bronchospasm.

Anticonvulsants

Carbamazepine may cause neurological symptoms, ataxia, drowsiness, low sodium level, leukopenia. Valproate may cause gastrointestinal problems, sedation, tremor and thrombocytopenia (low platelet levels in blood). It is teratogenic (induces mutations, should not be used during pregnancy). Gabapentin may cause sedation and ataxia (difficulty forming sentences). Lamotrigine may cause Stevens-Johnson syndrome, rash, fatigue. Toprimate may cause glaucoma, sedation, dizziness, and ataxia.

Atypical Antipsychotics

Risperidone, Olanzapine, Quetiapine: May cause weight gain. Risk of type 2 diabetes with olanzapine.

BUT DON'T LET 'EM HAVE ANY MARIJUANA!

Fred Gardner edits O'Shaughnessy's, the Journal of Cannabis in Clinical Practice (soon to have a presence on the web). He can be reached at fred@plebesite.com