Pubdate: Mon, 12 Dec 2016
Source: Minneapolis Star-Tribune (MN)
Copyright: 2016 Star Tribune
Author: Patricia Dickmann
Page: A11

Mental Health


The decision is to take effect in August, but evidence counters the
notions that the drug is beneficial and that there aren't

As a staff psychiatrist working at the Minneapolis VA Medical Center,
I was alarmed to hear that the Minnesota Department of Health (MDH) is
adding post-traumatic stress disorder (PTSD) as a qualifying condition
for medical marijuana use starting in August 2017.

During a press event on Dec. 1, Dr. Ed Ehlinger, commissioner of MDH,
was quoted as saying, "PTSD presented the strongest case for potential
benefits and a … lack of treatment alternatives."

I strongly disagree.

At the American Society of Addiction meeting in April 2016, addiction
medicine specialists from across the country specifically stated that
marijuana use is not associated with improvement in PTSD. On the
contrary, initiating marijuana is associated with worse outcomes in
PTSD symptom severity, measures of violent behavior, and alcohol problems

In a study by Sam Wilkinson, Yale School of Medicine, published in the
September 2015 issue of the Journal of Clinical Psychology, he writes:
"Marijuana may actually worsen PTSD symptoms or nullify the benefits
of specialized, intensive treatment. Cessation or prevention of use
may be an important goal of treatment."

The Wilkinson study included 2,276 veterans admitted to U.S.
Department of Veterans Affairs treatment programs for PTSD. They were
almost all male and, on average, older than 50 and primarily white.

The study "can't prove causation but it definitely strongly suggests
that marijuana use can be associated with worse outcomes," he said.

Dr. Ehlinger suggested there is a "lack of treatment alternatives" for
PTSD, which is untrue. There are many high-quality research studies
that demonstrate that psychotropic medications, prolonged exposure
therapy (PE), cognitive processing therapy (CPT), and
mindfulness-based stress reduction are all effective treatment options
for PTSD. In the August 2015 issue of the Journal of the American
Medical Association (JAMA), a review of randomized clinical trials
studying psychotherapy for military-related PTSD by Maria Steenkamp
and colleagues demonstrated that "trials of the first-line
trauma-focused interventions CPT and prolonged exposure have shown
clinically meaningful improvements for many patients with PTSD."

In the same JAMA issue, a study by Minneapolis VA psychologist Melissa
Polusny and her colleagues showed that mindfulness-based stress
reduction therapy significantly decreased PTSD symptom severity.

There is substantially more research backing the efficacy of the
aforementioned PTSD treatments, as compared to marijuana. Colorado
recently voted against adding PTSD to the medical conditions eligible
for treatment under the state's medical marijuana program because
scientific evidence does not support it.

Marijuana use can cause irreversible psychosis (auditory
hallucinations, visual hallucinations, paranoia) in genetically
susceptible individuals. Marijuana use can also lead to cognitive
impairment, memory problems, psychomotor slowing, impaired driving,
birth defects, and mood changes.

Our state's veterans are receiving mixed messages about the utility of
marijuana, which makes my job as a physician even more challenging. I
urge the Minnesota Department of Health to reconsider its decision.

Patricia Dickmann is a staff psychiatrist in the VA Health Care System 
in Minneapolis.
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MAP posted-by: Matt