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Spring 2004
O'Shaughnessy's
Journal of the California Cannabis Research Medical Group

Editorial

Cannabis for the Wounded

If anybody needs and deserves cannabis-based medicine, it’s the thousands of soldiers who’ve been seriously wounded in Iraq. An article by Sara Corbett in the 2/15 New York Times Sunday Magazine described what a few of them are going through. Cannabis would help in treating every condition referred to by Corbett: insomnia, rage, pain, PTSD, looming alcoholism...

“Robert Shrode can’t sleep... Before the war, he could have six beers and sleep like a baby, but now that works against him. Drinking may help get his head to the pillow, but it also ratchets up the nightmares... He pops Ambien to coax some sleep. The results are mixed. On the advice of his doctors, he is taking three different pills for pain, a pill for swelling and another pill for depression....
Shrode and his buddy Bricklin “say they have frequent nightmares. And then there’s something less tangible, a visceral undercurrent of anger that makes them walk around feeling ready to explode. ‘I can go from being happy-go-lucky and joking to having someone’s throat in my hand, like that,’ Bricklin says, snapping his fingers. Shrode nods. ‘My fuse is short,’’ he says. ‘It’s real short.’”
“The discomfort [of the one-armed man] feels irresolvable. ‘Somebody stares at it, I get mad at them,’’ Shrode says. ‘Somebody looks away, and I get mad at that.’”
“One day, as Shrode was walking down a hospital hallway, a civilian passing by happened to toss out an innocent ‘Howyadoin,’ which somehow, in that moment, became the last straw. ‘Ninety-nine percent of the time, I tell them what they want to hear,’ Shrode says. But in this instance he couldn’t help blurting out a truth that was becoming more evident each day. ‘Buddy, going to hurt the rest of my life.’”

Soldiers applying for a medical discharge go before the Army Physical Evaluation Board. Their disability pay depends on a rating from the Department of Veterans Affairs. A 100 percent disability qualifies a soldier for $2,239/month. “An amputated arm generally gets you a 60 to 90 percent disability rating,” according to Corbett.

“For every broken body in this room, there are hundreds more confined to hospital beds across the country and hundreds more again who, by choice or by circumstance, are gutting out the effects of their injuries without the help of peers or mental-health counselors... Thanks to the lifesaving properties of body armor and largely impenetrable Kevlar helmets, combined with highly advanced battlefield medicine, more soldiers are surviving explosions and gunfire than in previous wars. The downside of this is that the injury rate in Iraq is high: an average of nine soldiers have been injured per day. The pace shows little sign of slowing, which means it’s possible we will bring home another 1,500 wounded before the start of summer.
“The government’s reports on the wounded can be confusing. In early February, the Department of Defense web site listed 2,600 soldiers as wounded in action in Iraq and another 403 as injured in ‘nonhostile’ incidents like helicopter or motor-vehicle accidents. Meanwhile, the Army Surgeon General’s office said that only 804 soldiers have been evacuated with battle wounds and that over 2,800 have been injured accidentally. In addition, the Surgeon General’s office reported that another 5,184 soldiers have been evacuated from the theater for other medical reasons, which could include anything from kidney stones to nervous breakdowns. To date, 569 of these have qualified as psychiatric casualties.”
[As O’Shaughnessy’s goes to press in late March, The McLaughlin Report puts the number of U.S. casualties in Iraq at 14,000.]

“Although many of the soldiers who attend the support group at Fort Campbell have escaped enemy fire, their injuries reflect the full spectrum of what can go wrong during war: Sgt. Jenni McKinley had her right hand crushed when her Humvee blew a tire and flipped over on a sandy road outside of Baghdad. Chief Warrant Officers Emanuel Pierre and Stuart Contant were pilots whose Apache helicopter reportedly malfunctioned and then crashed in Afghanistan, requiring them to spend months in the hospital and to endure multiple operations. There is a medic who is physically uninjured but tormented to the point of agony by memories of treating his wounded and dying colleagues. And then there is a quiet young private who comes because her hair is falling out and her fingers are numb and nobody seems able to tell her why...
“It was pure desperation that led McKinley to the support group, which she learned about through her occupational therapist at Fort Campbell’s hospital. The sessions also gave her the courage to see a therapist, who prescribed Clonazepam for her anxiety and Lexapro, an antidepressant. On her third visit to the group, she managed to sputter out the story of the dead marine before breaking down in tears.”

Wounded soldiers who still hope to continue their military careers resist asking for antidepressants to protect their chances of promotion. “Patient privacy laws apply only loosely in the military,” Corbett notes, “where commanders have access to a soldier’s medical history, including what goes on in counseling sessions.”

A soldier named Gilbert “was hoping to stay in the Army for a few more years after he recovered, but worried that if he ‘toughed it out’ for a while, the fact that he was able to perform his duties (though in pain) would lower his disability rating when he did leave the service —a difference of potentially thousands of dollars. And as it often does, fatherhood also rearranged his priorities. While earlier he was eager to get well so he could be redeployed to the Middle East, he announced to the support group in December that he’d changed his mind. ‘I’m not going back there,’ he said, imagining a conversation with some higher-up in the Army. “I’m not going to die for you.’”

“Caleb Nall, a blue-eyed 23-year-old corporal from Louisiana, was recovering after being hit in the back by a rocket-propelled grenade. His torso had been severely burned; a gaping shrapnel wound had hollowed out part of his pelvis, and his left leg had been damaged. The explosion left him about 70 percent deaf in one ear...
“When it came time for the group’s next meeting, Nall showed up. He wore a pile jacket and a pair of jeans, his wounds hidden well away but his anger fully exposed. After a visiting V.A. representative started to natter on about how soldiers needed medical evidence and a formal diagnosis of post-traumatic stress disorder to receive relevant disability payments, Nall jumped in. ‘Would you say waking up with the sound of a mortar round going off next to your head counts?’ he asked, the bitterness thinly wrapped in his Louisiana drawl. ‘Jumping six inches off your bed?’
“After the V.A. rep left, Nall turned to the group at large. ‘Anyone else here having sleep problems?’ he asked.
“Brent Bricklin raised his hand. So did Jeremy Gilbert and Jenni McKinley and Robert Shrode, as well as four of the five other soldiers who had come that day. Everybody but Nall burst out laughing.

“I take two Percocets and drink two six-packs of beer and I still can’t sleep.”

“‘Is there something else they did for you?’ he continued, perplexed. ‘I’m on morphine, Percocet, Elavil...’
“‘I did Vicodin and Benadryl, but they counteract each other,’ offered a soldier across the room.
“‘Have you tried drinking?’ asked another.

Nall nodded earnestly. ‘I take two Percocets and drink two six packs of beer, and I still can’t sleep.’

“Nall nodded earnestly. ‘I take two Percocets and drink two six packs of beer, and I still can’t sleep.’
“This set off a voluble round of pharmaceutical recipe-swapping. Injured soldiers, I have learned, are nothing if not experts on painkillers and sleep aids. And yet little seems truly to work. A few complain that their antidepressants cause them to sleep all the time; more —like Nall- report that they sit up half the night in a drugged daze, waiting for sleep to come...”
“Earlier in the fall, Gilbert, who is studying to apply for a physician’s assistant degree and can be aptly professorial, cautioned everyone about Percocet. ‘They say it’s as addictive as heroin,’ he said. Having recently replaced Percocet with controlled-release OxyContin, Gilbert admitted to having a ‘serious physical dependence’ on it, developing a crushing headache every time he tried to skip a dose. ‘It gets to where you’ll kill somebody because you need that fix,’ he joked.
“ ‘I’m strung out on Demerol all the time,’ Jenni McKinley piped up. ‘I know it’s time to take my meds when I start screaming at my kids for little things.’
“She added, ‘My doctors are talking about switching me to methadone.’
“Gilbert laughed. ‘Mine said the same thing.’”


“Viet Nam vets have shown me that, in many cases, cannabis is the one medicine that has consistently helped their seriously disabling symptoms, allowing them to function, hold jobs, keep their relationships intact, raise families, for the past 30 or so years, when years of therapy, numerous meds have not.” —Frank H. Lucido, MD



On PTSD: The horrific indelible experiences of the Vietnam veterans who discovered the therapeutic benefits of self-medicating with cannabis make up a portion of my psychiatric consultative practice. The chronic depression, sleep deprivation and irritability is not relieved by conventional psychotherapeutics and is worsened by alcohol. Chronic pain from old physical injury compounds problems with narcotic dependence and side effects of opioids.
Survivors of childhood abuse and other trauma will experience the same symptoms of loss of control and recurrent episodes of anxiety, depression, panic attacks and mood swings. Chronic sleep deficit and nightmares also typify the symptom profile.
Cannabis should be considered first in the treatment of posttraumatic stress disorder. As part of a restorative program with exercise, proper diet, and psychotherapy, the cannabis can be used as a substitute for medications with adverse side effects.
Psychotherapy should be oriented to optimizing function and avoid revisiting these memories without closure and support. Decreasing vulnerability to symptoms should be a salient treatment goal instead of insight. Revisiting the events without closure and support is not useful but prolongs and exacerbates pain and fear of loss of control.
—Tod Mikuriya, MD

 

 

O'Shaughnessy's
O'Shaughnessy's is the journal of the CCRMG/SCC. Our primary goals are the same as the stated goals of any reputable scientific publication: to bring out findings that are accurate, duplicable, and useful to the community at large. But in order to do this, we have to pursue parallel goals such as removing the impediments to clinical research created by Prohibition, and educating our colleagues, co-workers and patients as we educate ourselves about the medical uses of cannabis.
 
SCC
The Society of Cannabis Clinicians (SCC) was formed in the Autumn of 2004 by the member physicians of CCRMG to aid in the promulgation of voluntary standards for clinicians engaged in the recommendation and approval of cannabis under California law (HSC §11362.5).

As the collaborative effort continues to move closer to issueing guidelines, this site serves as a public venue for airing and discussing these guidelines.

Visit the SCC Site for more information.