Could PTSD Help Legalize Marijuana Everywhere?
In 2016, the dominoes appeared to be falling in favor of proponents for the use of medical marijuana to treat symptoms of post-traumatic stress disorder.
In May, the U.S House of Representatives and Senate separately voted to allow Veterans Affairs doctors to discuss medical marijuana with their patients as an option for treatment.
Then in June, PTSD was among 20 qualifying conditions listed under Ohio’s medical marijuana legislation signed into law by Gov. John Kasich.
In July, Rhode Island Gov. Gina Raimondo signed a law that listed PTSD as a “debilitating medical condition” for medical marijuana treatment.
And this month, Arkansas became the first Bible Belt state to legalize medical marijuana for PTSD and other medical issues.
Along with those moves, over 20 states, Washington, D.C., and Guam now allow for medical marijuana to be used for PTSD, according to the Marijuana Policy Project. At least four more states could join that tally if medical marijuana ballot initiatives prove successful this November.
But not all are falling in line.
Absent from that list is Colorado. The trailblazer in recreational cannabis legislation has not added a medical condition to its registry since voters approved the MMJ amendment in 2000.
And despite the rapid public policy adoption of medical marijuana as a treatment for the triggering mental health condition and its symptoms, questions loom for some in the medical and mental health communities.
“The politics are far outpacing the research,” said Dr. Samuel Wilkinson, a resident physician in the Yale School of Medicine’s Department of Psychiatry. “We need more funding. We need more studies.”
Hoping to strike gold
The Colorado Board of Health has denied petitions for conditions such as Tourette syndrome and most recently, PTSD, mainly due to a lack of “peer-reviewed published studies of randomized controlled trials or well-designed observational studies showing efficacy in humans” for the subject condition, said Mark Salley, a Colorado Department of Public Health and Environment spokesman, citing state regulation.
The Board of Health’s 6-2 ruling last year not to allow PTSD as a condition for medical marijuana spurred outrage from advocates, with one audience member shouting after the vote: “Blood is on your hands.”
A complaint was filed against the board in Denver District Court by a group of five plaintiffs diagnosed with PTSD. Among them is former Air Force combat veteran Stephen Otero, who testified to the board before its vote, and who recently told The Cannabist that marijuana “worked 100 times better” for him than the pharmaceuticals he was prescribed for PTSD. The case continues to work its way through the state courts.
Randomized controlled trials are viewed as the “gold standard” of evidence for treatment by medical professionals, Wilkinson said. That research on cannabis and PTSD is coming — it’s just a question of whether the results released a couple of years from now will be the mother lode or a mere flake.
Earlier this year, the U.S. Drug Enforcement Administration gave its blessing to the first placebo-controlled trial that uses raw marijuana for PTSD research.
The study, which will take three years to complete, is being conducted in part by Dr. Sue Sisley, an embattled scientist who was abruptly fired by the University of Arizona as she pursued federally approved PTSD research involving marijuana.
“We’ve overcome all of the federal hurdles,” said Sisley, who worked for nearly a decade to win the DEA approval. “The barriers to research that still exists in this DEA monopoly, this (National Institute on Drug Abuse) monopoly … We don’t have all the strains that we’re requesting.”
Why The Delay?
A combination of factors have contributed to a delay in Sisley’s team receiving the study drug, she said.
Since Colorado awarded the $2 million research grant, NIDA took 20 months to grow the plants but failed to achieve the phenotype and the potency requested, she said. And following her termination from the University of Arizona, Sisley ran into roadblocks in finding a property owner in that state willing to ink a lease due to concerns of veterans smoking cannabis on-site per U.S. Food and Drug Administration protocol, she said.
Sisley said that she’s now awaiting NIDA’s confirmation of lab testing of the current batches as some results differed from when the plants were stored in the agency’s freezer nearly two years ago. It’s likely that the blended study drug’s potency levels for psychoactive tetrahydrocannabinol (THC) and non-euphoric cannabidiol (CBD) could be in the 7 percent range as opposed to the requested 12 percent range, she said.
“We are spending $2 million of medical marijuana surplus money to study what most people would consider a sub-optimal study drug,” Sisley said.
NIDA has yet to receive an official request and formal order package for the study drug from Sisley’s research partner the Multidisciplinary Association for Psychedelic Studies, according to information provided to The Cannabist by NIDA. The federal institute has talked informally with the project’s clinical trial lead to finalize the specifics of the materials, NIDA said in an e-mailed statement.
“We want to be ready to expedite the formal request when we receive it,” according to NIDA. “We are committed to working with the researchers for this project and to finalize the marijuana materials that they need and, once they send their official order package, we anticipate sending out their requested materials in a timely manner.”