Pubdate: Mon, 12 Mar 2007
Source: CounterPunch (US Web)
Column: Pot Shots
Copyright: 2007 CounterPunch
Author: Fred Gardner
Note: Fred Gardner is the editor of O'Shaughnessy's Journal of the California Cannabis Research 
Medical Group.
Bookmark: (Marijuana - Medicinal)
Bookmark: (Chronic Pain)


Cannabis for the Wounded

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:


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.


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.


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.


Fred Gardner edits O'Shaughnessy's, the Journal of Cannabis in 
Clinical Practice (soon to have a presence on the web). 
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MAP posted-by: Richard Lake