Journal of the California Cannabis Research Medical
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
“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
“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
“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
“ ‘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
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