Correction: An earlier version of this article incorrectly said that antidepressants and antipsychotics are the most common treatments for post-traumatic stress disorder. They are the most common medications used to treat the disorder, but counseling is also a common treatment. The article also incorrectly described Risperdal as the antipsychotic most widely prescribed for the disorder. It is widely prescribed, but others are also commonly used. And the article incorrectly referred to Israeli psychology researcher Irit Akirav as “he” and as a physician. Akirav is a woman who holds a doctorate. This version has been corrected.
Antidepressants or antipsychotic medications are among the most common medications to treat post-traumatic stress disorder and the insomnia, anger, nightmares and anxiety that often come with it.
Unfortunately, they’re not guaranteed to be much help.
That’s what a study in August’s Journal of the American Medical Association suggested. Risperdal, a widely prescribed antipsychotic, is no more effective in treating PTSD than placebos, it reported. This finding adds to earlier research on the ineffectiveness of most PTSD medications.
But there is a drug that has been shown to alleviate the symptoms of PTSD. Unfortunately, Veterans Affairs doctors can’t recommend it, and the federal government won’t allow research to proceed that could prove its effectiveness. What’s the drug? Marijuana.
Sixteen states and the District of Columbia have medical marijuana laws on the books, but we are still a long way from general acceptance of the drug as a medicine. If we’re serious about seeking an effective remedy for post-traumatic stress, and serving the hundreds of thousands of veterans with the disorder, this needs to change. It’s not a guaranteed solution, but sufficient evidence exists to show that it’s a treatment that needs to be explored further.
In 2006, one of the pioneers of medical marijuana in the United States, the late Tod Mikuriya, published a paper in a cannabis research journal reporting on his experience with PTSD sufferers. He compared marijuana to commonly prescribed medications and noted that the former worked better to control chronic stressors, without adverse side effects. “Based on both safety and efficacy,” he wrote, “cannabis should be considered first in the treatment of post-traumatic stress disorder.”
A few years later, the Israeli physician Irit Akirav published a study in the Journal of Neuroscience that alluded to the potential benefits of marijuana for PTSD patients. He found in an animal study that cannabinoids — the active chemicals in marijuana — may reduce the effects of PTSD. “The results of our research,” Akirav noted, “should encourage psychiatric investigation into using cannabinoids in post-traumatic stress patients.”
In New Mexico, where PTSD was added as a qualifying condition to the state’s medical marijuana program after an evaluation of the available research, more patients use marijuana for PTSD than for any other condition.
Veterans, if given the option to use marijuana to alleviate PTSD, would probably take advantage of the opportunity. In September, the military newspaper Stars and Stripespublished a story about Army Sgt. Jamey Raines, who talked openly about how he had used marijuana to treat PTSD triggered by heavy combat duty in Iraq. Marijuana was not just helpful, Raines said — it was the only substance he found effective.
Of course this evidence is still limited and in some cases anecdotal; for conclusive answers, we need FDA-approved research to assess the benefits of marijuana in a clinical environment. Fortunately, earlier this year, the FDA approved such a protocol to study the therapeutic potential of marijuana for veterans suffering from chronic, treatment-resistant PTSD. But that’s where the good news ends.
If this were any other drug, the researchers would probably be organizing or conducting trials now. But this isn’t a new chemical compound dreamed up by a pharmaceutical company. It’s marijuana, and the anti-marijuana forces in the federal government are powerful.
Here is how this research has been stymied. In April, the researchers submitted their protocol to the Public Health Service (PHS) and the National Institute on Drug Abuse (NIDA) along with a request to purchase marijuana from NIDA, which has a monopoly on the supply of pot used for research in the United States. In September, the PHS and NIDA rejected the protocol and refused the researchers’ request to purchase marijuana for the study. They criticized the protocol design — the same design that the FDA had approved — and directed the researchers to redesign it and resubmit it, a process that will result in at least an additional year’s delay. The reviewers even reserved the right to raise new criticisms after the old ones had been addressed. It is likely that the researchers will never be able to purchase the marijuana from NIDA.
The research, it seems, is a victim of marijuana politics. Under federal law, a drug is considered most harmful — and placed in the most restrictive category, Schedule I — if it has “no currently accepted medical use.” Although marijuana was listed as a medicine in the U.S. Pharmacopoeia before its prohibition and was widely used for dozens of conditions, Congress temporarily placed it in Schedule I in 1970, pending the outcome of a government study. The study, produced by a national commission on drug abuse, ultimately concluded that marijuana’s harmful effects were so limited for light and moderate users that it should not even be a criminal offense to use it. But its status as a Schedule I drug has not changed.
Advocates have been working toward a change since 1972, when the first petition to reschedule marijuana was filed with the Bureau of Narcotics and Dangerous Drugs, the predecessor of the Drug Enforcement Administration. After many refusals to act and a few court rulings, the DEA finally initiated hearings on rescheduling in 1986 — 14 years after the first filing.
These hearings led to an opinion in 1988 by the DEA’s chief administrative law judge, Francis Young, who wrote: “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man. . . . It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record.” He concluded that the provisions of the Controlled Substances Act “permit and require” the transfer of marijuana from Schedule I to a less restrictive category.
Yet the DEA administrator did not reclassify marijuana. Since that time, the agency has denied two other rescheduling petitions, most recently in July.
It is bad enough that the DEA has repeatedly ignored existing evidence regarding marijuana’s therapeutic value in order to maintain the drug’s Schedule I status. But both the DEA and NIDA have taken further steps to block any new evidence from being produced. Most notably, the DEA has refused for 10 years to grant a license to the University of Massachusetts to cultivate marijuana for FDA-approved research, providing a privately funded alternative source to NIDA’s marijuana supply. The refusal has occurred despite yet another DEA administrative law judge ruling that the license would be “in the public interest” and should be granted.
Federal marijuana policy is thus trapped in absurd circular logic. Officials argue that marijuana must be kept illegal because it is a “dangerous” Schedule I drug. They refuse to move it out of Schedule I, claiming that there is no evidence that it has medical value. They refuse to allow private entities to cultivate marijuana for research to demonstrate that it has medical value. And they set up endless obstacles for any researchers who hope to conduct potentially favorable studies with the marijuana controlled by the government. No research, no evidence, no rescheduling. Therefore, marijuana is still dangerous.
The federal government’s stance has led to our current state-by-state battles over medical marijuana. We will continue to fight and will add more states to the pro-medical-marijuana side of the ledger. But it will be many years, possibly decades, before marijuana is legal for medical purposes in all 50 states.
When current and former service men and women are seriously suffering — to the point where some have even taken their own lives — we at least owe it to them to explore any treatment that might be effective.
It is time for government officials to take this nation’s veterans off the medical marijuana battlefield. NIDA should grant the researchers’ request to purchase marijuana and allow the FDA-approved PTSD study of veterans to move forward. These brave men and women don’t have decades to wait for relief.
Steve Fox is the director of government relations at the Marijuana Policy Project and the co-author of “Marijuana Is Safer: So Why Are We Driving People to Drink?”