In 2010, Boone Cutler was taking 30 milligrams of morphine, 70 milligrams of oxycodone and other opioids each day. He regularly went three to four days without sleep. The Army veteran had survived a blast injury while deployed in Sadr City, Iraq, and has since endured seven knee surgeries, five shoulder surgeries and back surgery. He also suffers from Parkinson's Disease.
“I did my time,” Cutler says. “I’ve been beat up a few times.”
That year, however, Cutler abandoned his treatment through the Veterans Affairs Department and checked himself into a psychiatric ward at a private hospital, where he quit his prescribed cocktail of opioid painkillers cold turkey. Upon leaving the hospital, a coworker convinced him to try something new for his physical and psychological symptoms: marijuana. He was reluctant, telling his colleague, “I’m not one of those pot heads.”
The more he thought about it, the more he realized he had nothing left to lose: “I tried everything,” he says. “Nothing worked.”
But after trying cannabis, Cutler experienced something for the first time since he returned from Iraq: He slept for five hours.
“I thought it was a fluke. I tried it again, and it happened again,” he says. “That was an absolute, 100 percent, 180-degree life changing event for me.”
Cutler is part of a growing community of veterans who depend on cannabis to treat post-traumatic stress and pain from service-connected injuries. Some vets returning from combat tours of duty have reported that the drug has reduced nightmares and flashbacks, eased pain and helped eliminate their dependency on opioids. The drug nonetheless remains classified as “schedule one” by the federal government, which it defines as “drugs with no currently accepted medical use and a high potential for abuse.” While some studies have examined the potential medicinal benefits of cannabis and a growing number of states have legalized medical and even recreational marijuana, there has never been a federally-approved study of its impact on post-traumatic stress disorder with the potential to change the federal government’s scheduling.
Dr. Sue Sisley and the Multidisciplinary Association for Psychedelic Studies are trying to change that. Sisley and the group have worked for 10 years to get their triple-blind study with a placebo on the impact of marijuana on veterans with PTSD off the ground. Sisley’s research now has approval from the Food and Drug Administration, the Drug Enforcement Administration and the Health and Human Services Department’s National Institute on Drug Abuse, which is supplying the marijuana for the study. The research has finally commenced, and Sisley now has 28 participants in treatment. She will need 76 to complete the study, but she is facing a significant barrier: she is running out of veterans who qualify to participate, and the Veterans Affairs Department is refusing to help her identify more.
Unlike Cutler’s state of Nevada, where marijuana is now legal, Thomas Brennan lives in North Carolina, where the drug remains outlawed in all forms. The Marine Corps veteran who completed tours in Fallujah, Iraq, in 2004 and the Helmand Province in Afghanistan in 2010 felt he had no choice but to set up a cannabis distribution network with a handful of other veterans. While they had the marijuana shipped from Marines they trusted located in other parts of the country, they knew they were putting themselves in jeopardy.
“Veterans know this is better than the alternative and were willing to take the risks to deal with this,” says Brennan, who suffers from PTSD.
Brennan also tried to use VA as his primary care provider, but felt shunned after informing his doctors there he used marijuana.
“They treated me like a drug addict when I told them about my cannabis use,” says Brennan, who considers himself lucky because he is now entitled to TRICARE by virtue of being medically retired. “They weren’t willing to help me wean off narcotics.” Brennan, before he started using marijuana, took a mixture of antidepressants, sedatives, amphetamines and mood stabilizers that VA sent him through the mail.
Brennan credits marijuana with saving his life, saying without it, he would have committed suicide.
VA says it is willing to examine research on medical marijuana.
“There may be some evidence that this is beginning to be helpful,” VA Secretary David Shulkin said in May. “And we're interested in looking at that and learning from that.”
To veterans like Cutler and Brennan, and service organizations like the American Legion, which is pushing VA to adopt a more lenient position on medical marijuana, the department is standing directly in the way of researchers trying to collect that evidence. The researchers will continue their work even if they cannot sign up a sufficient number of veterans, according to MAPS’ Brad Burge, by opening up the study to anyone with PTSD. Burge said it is unclear if such a study would still be generalizable to the veteran community.
VA, for its part, said it is bound by federal law that prohibits its clinicians from recommending patients for studies involving marijuana. A spokesman blamed Sisley and MAPS for not finding other means to recruit veterans for their research.
“Federal law restricts VA’s ability to conduct research involving medical marijuana, or to refer veterans to such research projects,” said Curt Cashour, the VA spokesman. “If the researcher is truly interested in finding veterans for her study, she should spend more time recruiting candidates and less time protesting to the media.”
Sisley says VA is poorly informed, noting she and her team have been “pounding the pavement” to recruit participants. She has screened more than 4,000 veterans over the last two years, but most of them are not qualified to participate. Veterans enrolled in VA health care are uniquely qualified subjects, she explains, as they are likely to have already attempted other treatment and are less likely to already depend on marijuana.
“If you’re in the VA system, that means you’ve already raised your hand and said ‘I need help,’” Sisley says. She adds the department is being disingenuous when it says it wants to examine more research: “It’s very negligent for VA to be begging for more data, and then refuse to cooperate with the federally legal, FDA-approved study that is happening right in the backyard of a VA facility. They should be ashamed.”
Sisley’s study is not receiving any federal funds. She has a $2.1 million grant awarded from the state of Colorado, and received the marijuana from a National Institute on Drug Abuse contracted facility at the University of Mississippi (all federally approved research on marijuana comes from plants grown at that facility). To advocates, VA already has the authority to refer its patients to the study.
“We’ve been, to no avail, trying to work locally with the hospital director and the [Veterans Integrated Service Networks] director to try to get them to build some kind of bridge, some kind of information bridge between the [researchers] and the VA, and they’ve just been really resistant to doing that,” said Lou Celli, American Legion’s VA director. He noted VA’s laudable history in research, with its clinicians winning three Nobel prizes.
“The time is ripe for this administration to take the lead on this issue and really come out looking like superheroes,” Celli said. “It’s not a controversial topic. It’s only controversial in their own minds.”
The American Legion is hopeful if Sisley’s study is completed, and its results are accepted by the FDA, it would just be the tip of the iceberg into researching the possibilities of medical marijuana. Like Brennan and Cutler, he acknowledges cannabis will not cure PTSD for any veteran. The alleviation it does provide, however, enables them to seek further help.
“The most common term I hear is, ‘It helps keep the visitors away,’ meaning the nightmares, the flashbacks,” Celli says. “We don’t believe there is any study that will prove cannabis cures PTSD. But what it does do is it relaxes them enough, and it lowers their inhibitions enough to be able to receive counseling and to be able to work through whatever issues that they have.”
Sisley says marijuana could help address the epidemic of veteran suicides, and if the plant can save even one life, her research is worth pursuing.
“Please allow science to stop being shackled by VA politics,” she says in a plea to the department. Absent such action, the American Legion plans to mobilize its 2 million members to lobby VA and members of Congress to help the study move forward.
Getting Out of Bed
Cutler describes the period of his life in which he was taking an ever-growing opioid cocktail as a “never-ending blackout.” He went through cycles in which his tolerance would soar, he would detox, the pain would continue and he would repeat the process all over again. He now takes cannabidiol tablets during the day, which he says have no psychoactive effect, and smokes marijuana at night before going to sleep. Cutler calls the VA “hypocritical” for prescribing addictive opioids, but refusing to even research marijuana.
“You send us to war,” he says, “and you deny us medication.”
Brennan knows marijuana is not a cure-all. He still takes some prescription drugs. He still has migraines. He is, however, sleeping more easily and for longer. He has seen gradual improvements to his depression, mood and relationships. He no longer feels numb.
“Sometimes,” Brennan explains, “the smallest reasons for getting out of bed in the morning are what can make a difference for mental health.”