Nearly two decades after the destruction of the World Trade Center and the subsequent American forever wars, the failure of the orthodox medical system has been laid bare by its inability to adapt and effectively respond to the latest needs, type, and severity of injuries experienced by our returning veterans. And, I am not talking about physical trauma care which is exceptional and better than at any previous point in medical history. I am referring to the soul crushing damage done by PTSD.
Post-traumatic stress disorder (PTSD) is a debilitating condition affecting the body, mind, and spirit. The condition results from direct exposure to an extreme traumatic event such as war, assault, abuse, rape, kidnapping, torture, explosions, life-threatening illness, or any situation involving the threat of death, extreme fear, dread, and helplessness. PTSD most often results from sudden trauma that happens without warning, was repeated over long periods of time, included intentional violence to body and psyche and/or involved grotesque injury and death, rape, or the loss of a close friend or relative. PTSD can affect witnesses, victims, and perpetrators alike.
While history brims with cases describing patients suffering from the symptoms of PTSD, the allopathic health care system, including hospitals charged with caring for veterans, has been very slow to acknowledge the condition. During WWI and WWII it was called “battle fatigue” or “shell shock,” respectively. The British military placed more than 300 soldiers in front of a firing squad and shot them to death, ostensibly for cowardice before the enemy or desertion, when most of them were likely suffering from PTSD. The current term, PTSD, was formulated during the Vietnam War when thousands of soldiers came home suffering from a collection of common symptoms including depression, flashbacks, insomnia, the inability to be close to loved ones, or the lack of meaningful connection. However, it was not until 1980 that PTSD was codified and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Despite these minor integrations into the system effective support by orthodox health care is still largely wanting. For many soldiers, PTSD is still a toxic and for far too many of them an extremely hopeless and ultimately fatal reality.
The National Coalition for Homeless Veterans estimates that at any given night there are over 40,000 homeless veterans looking to sleep on the mostly urban streets of the United States of America. An additional 1.4 million veterans are at risk due to poverty and lack of meaningful and effective support. For many it is a humiliating sense of betrayal by the very country they once proudly served. A psychic strain that expresses itself through the mental-emotional symptoms of PTSD such as the desperation, alienation, loneliness, shame, or guilt and their consequent physical manifestations of homelessness, drug use and dependence, over-dose, and suicide deaths.
Left with few options a great number of veterans’ attempt to self-medicate and numb the mental-emotional pain so central to PTSD with opioids and many become subsequently addicted and exposed to an increased risk of dying from an overdose. In fact, opioid-related overdose deaths among veterans increased by 65% in the years from 2010-2016 and in many states these horrific numbers are still climbing.
If all that wasn’t bad enough, consider this: of those veterans who were laid to rest in the years from 2001-2007 roughly one in five committed suicide (deployed 21.3%, non-deployed 19.7%). Most suicides were carried out by firearm second to the use of poison. The VA (United States Veteran Affairs) surveyed the records of 55 million veterans and found that for the first decade and half of the new millennia about 20 veterans’ lives were lost every single day to suicides (i.e. 7,300 every year).
However, not all numbers are this bleak. In fact, if we consider that states that implemented medical cannabis programs or recreational cannabis policies saw an actual drop in total opioid related death by 25% (general population) there is room for hope. Simple math (7,300 x 25% divided by 100% = 1,825) allows us to extrapolate these numbers across the veteran population that died from suicide in the past decade. Translating these numbers into meaning posits that safe access to cannabis across all of the United States could save more than 1,800 veterans’ lives every single year.
Cannabis and PTSD
At this point it might be helpful to examine in greater detail the relationship between PTSD and cannabis. With the advent of new imaging techniques, researchers discovered new insights pertinent to PTSD. A meta-analysis of available neuroimaging research suggests measurable physiological changes in the limbic system in patients with PTSD. Researchers measured actual reductions in size of the amygdala, responsible for the processing of fear, the medial prefrontal cortex involved in cognition, and the hippocampus, needed for the formation of long-term memories for example. With the shrinking of these essential organs of the limbic system in patients with active PTSD comes a decline in their neuronal and functional integrity.
While these physiological changes are demonstrable across the board in patients with PTSD, the way each responds can vary significantly from one person to another. Some may experience only mild and passing symptoms, while others may feel numb, yet others progress to developing full-blown PTSD with long-term or chronic consequences. Symptoms often begin within three months after the traumatic event and may include profound lack of care for anything, emptiness, hopelessness, helplessness, worthlessness, distrust, paranoid behavior with hypervigilance, inexplicable fear, anxiety, lost memories, passivity, withdrawing, fits of anger with little or no provocation, irritability, impatience, lack of focus, insomnia, fitful sleep with sweating, nightmares, generalized weakness or fatigue, flash-backs, and avoidance of anything associated with the traumatic event.
Avoidance strategies themselves can become an additional problem for patients with PTSD. The compounding effects of detachment and unhealthy tension-reducing behaviors such as substance/food abuse, cutting, or promiscuous sex can make recovery more challenging than it has to be.
The primary treatments within orthodox medicine are pharmaceutical medications, primarily antidepressants and anxiolytics as well as talk-therapy. However, misuse of prescription drugs and possible severe adverse effects with these classes of medication frame the clear and present limitations of pharmaceutical intervention. In addition, despite success from behavioral-cognitive therapies in the treatment of PTSD, patients often show vulnerability to reversal of progress by exposure to stress and stress triggers. So, it should come as no surprise that more and more veterans are turning to cannabis for help. In fact, a review published by American Society of Health-System Pharmacists not just confirmed the common use but also states: “Data from 4 small studies suggested that cannabinoid use was associated with global improvements in PTSD symptoms or amelioration of specific PTSD symptoms such as insomnia and nightmares.”
More specifically, researchers from Haifa, Israel, discovered that the fear-processing center of the brain (amygdala) contains a significant number of endogenous cannabinoid receptors (CB1) and as such present a new potential avenue for treatment. Observations demonstrated that when a synthetic cannabinoid (a CB1 agonist with similar strength as THC at the same receptor site) was injected into the amygdala of rats, it reduced anxiety responses via regulation of the hypothalamic-pituitary-adrenal axis, which control stress responses, and as such was able to reduce the negative effects of stress itself. Moreover, it demonstrated that microinjecting the CB1 agonist into the baso-lateral amygdala (BLA) before exposing the rats to a stressor reversed the otherwise damaging effect. These findings provide insights into why cannabinoids can modulate panic responses not just after extremely painful and traumatic events but also before.
Additionally, a human trial conducted on forty-seven PTSD patients suffering from a number of symptoms that failed to adequately respond to standard pharmaceutical antidepressants and hypnotics from Ottawa, Canada reported that cannabis, in the form of Nabilone a synthetic version of THC, could remove fear responses to stressors such as nightmares, poor sleep, night sweats, and flashbacks. Results showed that: “The majority of patients (72%) receiving Nabilone experienced either cessation of nightmares or a significant reduction in nightmare intensity. Subjective improvement in sleep time, the quality of sleep, and the reduction of daytime flashbacks and night sweats were also noted by a number of patients.”
Irrational fears or anxieties, overly aggressive behaviors, pacing, rocking, and isolating or unsafe behaviors are often used to cope with perceived intolerable memories and emotions. However, while these coping mechanisms may be initially practical and useful in getting through or surviving the key event, over time they become a liability. Cannabis can create the space to relax and in doing so allow the patient to not just re-experience the “otherwise intolerable” but further to reframe the destructive meaning ascribed to them in an often cathartic fashion. Cannabis-assisted healing of PTSD involves shifting from a state of mind that is constantly bombarded with fight, flight, and freeze responses to one that induces relax, rest, digest, and repair responses. And, it is the latter where deep healing happens.
Final thoughts—The right type of cannabis, at the proper dose, matched to each individual needs can heal and save lives by:
- Reversing PTSD-induced physiological changes to the limbic system (e.g. amygdala).
- Providing a deep sense of relaxation to body, mind, and spirit.
- Making it okay to be in the presence of otherwise intolerable emotional materials (and sometimes that itself is enough to make a therapeutic difference).
- Switching from fight, flight, and freeze to relax, digest, rest, and repair mode.
- Treating panic responses before and after extremely painful events.
- Revealing/releasing mental-emotional underpinnings of PTSD.
- Realizing that appropriately expressed feeling, emotions, and other perceived vulnerabilities can be a source of strength rather than a weakness.
- Unlearning and replacing fear/stress-triggered destructive behaviors.
- Helping to accept and forgive self and others.
- For those who also need analgesia, co-administration of cannabis allows for lower opioids dosages reducing at once treatment costs, addiction potential, and overdose deaths.
- Providing solid job opportunities in a growing industry with a future.
Veterans Crisis Line
The Veterans Crisis Line connects Veterans in crisis and their families and friends with qualified, caring VA responders.
Veterans and their loved ones can anonymously:
Call 1-800-273-8255 and press 1
Confidential help is available 24 hours a day, 7 days a week.
To learn more about cannabis jobs for veterans consider going to leafedIn.org.
Here is a relevant link to an article you might find helpful: https://leafedin.org/marijuana-news/cannabis-industry-offers-marijuana-jobs-veterans/
Veteran Cannabis Project is an advocacy group dedicated to full legal access for veterans.
For more information go to: https://www.vetscp.org
This article was based, in part, on research conducted for my books The Cannabis Health Index, Breaking the Cycle of Opioid Addiction: Supplement Your Pain Management With Cannabis, and the latest release coming to friendly neighbor bookstores in 2019 entitled Healing With Cannabis: Optimizing Your Ideal Ratio of CBD:THC.