Veterans consume cannabis at rates far higher than the general population, and many report using it for medical purposes
“Among 24,089 eligible respondents, 420 (1.7 percent) reported a current clinical diagnosis of post-traumatic stress disorder. In total, 106 (28.2 percent) people with post-traumatic stress disorder reported past-year cannabis use, compared to 11.2 percent of those without post-traumatic stress disorder.”
Among military veterans who acknowledged using cannabis within the past year, 41 percent classified their marijuana use as medical – a percentage that is twice as high as is reported by adults in the general population.
According to nationwide survey data compiled by the group Iraq and Afghanistan Veterans of America, 75 percent of military veterans “would be interested in using cannabis or cannabinoid products as a treatment option if it were available.”
According to nationwide survey data conducted by The American Legion in 2017, 39 percent of respondents affirmed that they “know a veteran” who is using the plant medicinally. Twenty-two percent of respondents said they themselves “use cannabis to treat a mental or physical condition.”
Medical marijuana use among veterans would likely be even higher were not VA physicians forbidden under federal law from recommending cannabis therapy in the states that permit it. According to a December 2017 policy guidance update issued by the US Department of Veterans Affairs, doctors may facilitate to discussions with veterans about their cannabis use “due to its clinical relevance to patient care,” but “providers are prohibited from completing forms or registering veterans for participation in state-approved [medical marijuana] program[s].”
Many veterans report substituting medical cannabis for prescription drugs and alcohol
“A total of 510 veterans of US military service participated in the survey. … A majority of participants (463; 91%) reported that medicinal cannabis treatment helped them to experience a greater quality of life, fewer psychological symptoms (407; 80%), and fewer physical symptoms (371; 73%). Many more reported using less alcohol (236; 46%), fewer medications (229; 45%), less tobacco (120; 24%), and fewer opioids (105; 21%) as a result of medicinal cannabis use.”
“Participants [in the study] were 93 US military veterans and members of the Santa Cruz Veterans’ Alliance (SCVA). … The majority of participants reported that they use cannabis as a substitute for other licit and illicit substances. … [P]articipants reported a high degree of substitution behavior, particularly for alcohol. … [N]early half the sample reported substituting cannabis for prescription medications. … The current study also confirms the findings of previous studies that have documented a trend in substitution behavior, where cannabis is substituted for other drugs, which, if associated with reduced harm, could be beneficial for overall health.”
Veterans often report using cannabis to treat symptoms of chronic pain and mood disorders, like post-traumatic stress. Clinical and observational data supports the use of cannabis treatment for these indications.
“In this retrospective naturalistic study, we followed 14 relatively mature (32-68 years of age), treatment-resistant, chronic combat post-traumatic patients who remained severely symptomatic despite treatment with many lines of conventional treatment prior to receiving medicinal cannabis. … To the best of our knowledge, this is the first published study examining long-term cannabis efficacy in chronic combat treatment-resistant PTSD patients. … After treatment with cannabis, total sleep score, subjective sleep quality, and sleep duration significantly improved. … Total PTSD symptom score and its subdomains (intrusiveness, avoidance, and alertness) showed [also] improvement. … Future research should clarify the long-term effects of cannabis on different groups of patients suffering from PTSD.”
“This study investigates health-related quality of life (HRQoL) changes and adverse events in patients prescribed CBMPs [cannabis-based medicinal products] for PTSD. Of 162 included patients, 144 were current/previous cannabis users. HRQoL was assessed at 1-, 3-, and 6-months using validated patient reported outcome measures. … This observational study suggests an association between CBMP treatment and improvement in PTSD-specific, HRQoL [health-related quality of life], sleep, and anxiety outcomes at up to 6-month follow-up. CBMPs were well-tolerated and adverse events manageable. … [T]his study can serve to inform future randomized placebo-controlled trials with the aim of confirming these promising effects, whilst informing current clinical practice.”
“[Older] veterans reported positive effects of cannabis use for their pain, sleep quality, health conditions, and QOL. … Veterans in our study were more likely to use cannabis [as compared to non-veterans] for mental health conditions. … [T]he results make sense in that Veterans report mental health condi- tions such as PTSD, anxiety, depression, and insomnia at higher rates than the general population. … Our study results suggest older Veterans may be turning to cannabis as a way to cope with mental health conditions such as PTSD, insomnia, depression, and anxiety.”
“For this review, four cohort studies, four randomized clinical trials, one case report, and one case series were obtained from PubMed within the last 10 years. Cannabis extracts, tetrahydrocannabinol (THC) and cannabidiol (CBD), and synthetic cannabinoids were used in the studies to target the cannabinoid receptors 1 and 2. Cannabinoids were shown to improve overall PTSD symptoms, including sleep quality and quantity, hyperarousal, and treatment-resistant nightmares. Summary and outlook: Cannabinoids have been shown to be an effective treatment option for patients with PTSD. Besides aiding to relieve the symptoms and enhance extinction training, they also are relatively well tolerated.”
In an analysis of over 61,000 patients seeking medical cannabis authorizations in 12 states, nearly ten percent of patients reported seeking cannabis to mitigate symptoms of post-traumatic stress. PTSD was the third most common condition reported among those seeking authorizations, following only chronic pain and anxiety.
“The study was a 1-year, longitudinal, prospective assessment of PTSD symptoms among Colorado residents with PTSD, which compared PTSD symptoms and functioning among cannabis-using participants and nonusing controls. … Participants who used primarily THC-dominant cannabis reported a greater reduction in PTSD symptom severity over time compared to controls. Cannabis users also showed a greater than two-fold rate of remission from their PTSD diagnosis (defined by no longer meeting criteria for a PTSD diagnosis on the CAPS-5) compared to controls by the 1-year follow-up assessment. … This study provides evidence that the types of cannabis available in recreational and medical cannabis dispensaries might hold promise as an alternative treatment for PTSD.”
“THC, dronabinol or nabilone could help with hyperarousal symptoms, insomnia, anxiety, and extinction deficits related to PTSD. Indeed, despite the limited number of published studies, available data suggest that low doses of THC potentiate fear memory extinction in healthy volunteers and reduce anxiety responses in anxious and PTSD patients without inducing a psychotic effect.”
“In multivariable analyses, post-traumatic stress disorder was significantly associated with recent major depressive episode and suicidal ideation among cannabis non-users. Post-traumatic stress disorder was not associated with either outcome among cannabis-using respondents. … This study provides preliminary epidemiological evidence that cannabis use may contribute to reducing the association between post-traumatic stress disorder and severe depressive and suicidal states.”
According to a review of over 10,000 studies by the National Academy of Sciences, “In adults with chronic pain, patients who were treated with cannabis … are more likely to experience a clinically significant reduction in pain symptoms. … There is conclusive or substantial evidence that cannabis and cannabinoids are effective for the treatment for chronic pain in adults.”
A retrospective review of PTSD patients’ symptoms published in 2014 in the Journal of Psychoactive Drugs reported a greater than 75 percent reduction CAPS (Clinician Administered Posttraumatic Scale) symptom scores following cannabis therapy.
“Cannabis may dampen the strength or emotional impact of traumatic memories through synergistic mechanisms that might make it easier for people with PTSD to rest or sleep and to feel less anxious and less involved with flashback memories. … Evidence is increasingly accumulating that cannabinoids might play a role in fear extinction and anti-depressive effects.”
In states where medical cannabis is legal, opioid-related mortality has fallen significantly
“[M]edical marijuana laws reduce the misuse of prescription opioids, as reflected in treatment admissions and overdose deaths, primarily through the allowance and opening of dispensaries.”
“Colorado’s legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month reduction in opioid-related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado.”
“[S]tates permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.”
“States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%), year 2 (−25.2%), year 3 (−23.6%), year 4 (−20.2%), year 5 (−33.7%), and year 6 (−33.3%).”
Studies of pain patients eligible for medical marijuana access find that most subjects significantly reduce or eliminate their use of opioids following cannabis therapy
“Between August 1 – December 31, 2016 a total of 2290 patients were enrolled in the program under the qualifying condition of intractable pain; 45 of these patients were previously enrolled in the program under an additional qualifying condition. This report focuses on the 2245 patients who were certified for intractable pain and enrolled in the program for the first time during this interval. … A large proportion (58%) of patients on other pain medications when they started taking medical cannabis were able to reduce their use of these meds according to health care practitioner survey results. Opioid medications were reduced for 38% of patients (nearly 60% of these reduced at least one opioid by ≥50%), benzodiazepines were reduced for 3%, and other pain medications were reduced for 22%. If only the 353 patients (60.2%, based on medication list in first Patient Self-Evaluation) known to be taking opioid medications at baseline are included, 62.6% (221/353) were able to reduce or eliminate opioid usage after six months.”
“During the study period, 2736 patients above 65 years of age began cannabis treatment and answered the initial questionnaire. The mean age was 74.5 ± 7.5 years. The most common indications for cannabis treatment were pain (66.6%) and cancer (60.8%). After six months of treatment, 93.7% of the respondents reported improvement in their condition and the reported pain level was reduced from a median of 8 on a scale of 0-10 to a median of 4. … After six months, 18.1% stopped using opioid analgesics or reduced their dose. … Cannabis use may decrease the use of other prescription medicines, including opioids.”
University of New Mexico investigators assessed opioid prescription use patterns over a 21-month period in 37 pain patients enrolled in the state’s medicinal cannabis program compared to 29 non-enrolled patients. Compared to non-users, medical cannabis enrollees “were more likely either to reduce daily opioid prescription dosages between the beginning and end of the sample period (83.8 percent versus 44.8 percent) or to cease filling opioid prescriptions altogether (40.5 percent versus 3.4 percent).” Enrollees were also more likely to report an improved quality of life. “The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.”
“Among respondents that regularly used opioids, over three-quarters (76.7%) indicated that they reduced their use since they started MC (medical cannabis). … Approximately two-thirds of patients decreased their use of anti-anxiety (71.8%), migraine (66.7%), and sleep (65.2%) medications following MC.”
“Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP (chronic pain) patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications.”
“The treatment of chronic pain with medicinal cannabis in this open-label, prospective cohort resulted in improved pain and functional outcomes, and a significant reduction in opioid use. … Opioid consumption at follow-up decreased by 44%.”
