Medical Marijuana and Veterans 1

Medical Marijuana and Veterans: Truly a Treatment for Chronic Pain and PTSD?

Janae Debeltz

jdebeltz@knights.ucf.edu

IDS 4934 – Interdisciplinary Studies Capstone Spring 2019

Devon Cadwell Bazata

College of Undergraduate Studies

University of Central Florida

Medical Marijuana and Veterans 2

Does Medical Marijuana Truly Assist Veterans with Chronic Pain and

Post-Traumatic Stress Disorder (PTSD)?

Section 1 – Introduction and Problem Statement

Chronic pain and Post Traumatic Stress Disorder (PTSD) afflict many veterans and

military personnel world-wide, which provokes a multitude of problems with these individuals’

physical, mental, and emotional abilities; however, alternative treatment methods allow these

patients a different path than continuing opioid treatment while providing the possibility of

regaining most function within a short time frame. Unfortunately, the alternative treatment of

medical marijuana—that assists some veterans with PTSD and chronic pain—is fairly complex

in nature due to the legal situation involved, the depth of information required to

comprehensively understand the treatment and the process of obtaining the prescription itself.

A singular discipline cannot analytically approach this treatment method alone because

singularly no discipline provides enough information to completely analyze the process involved

to obtain, the plant itself, and the pharmaceutical effects resulting from using marijuana. The

category of natural sciences provides information on the physical world while analyzing the

viewpoints involved with the disciplines and various factors within it. Medical marijuana utilizes

the disciplines of biology, chemistry, and earth science to understand the scientific basis of the

plant’s natural properties that allow humans to experience the pain-relieving and calming effects.

The social sciences provide two disciplines that assist with understanding the interdisciplinary

factors concerning medical marijuana. Political sciences provide a legal viewpoint towards

understanding federal and state laws that provide information towards continuing legal

processes. Since medical marijuana is currently a Schedule I controlled substance within the

United States and is considered federally illegal there are many laws associated with the plant
Medical Marijuana and Veterans 3

itself along with the process of producing and obtaining legal medical marijuana that may hinder

patients in obtaining their prescription. Economics allows for a concentrated understanding of

complex interactions between consumers and markets which provides data to be analyzed for

further clarification on subsections of economics. The medical marijuana market has quickly

become larger each month it is open within the United States and is becoming more widespread

by crossing new state lines each year.

Since the marijuana market continues to grow, this marijuana market provides a positive

economic outcome for the states that approved this market. The only humanities discipline

involved with medical marijuana is history. Marijuana had been used in medicine for centuries

around the world before it was made illegal in the United States in the early 20 th century; today,

this provides an obstacle for patients who want to use medical marijuana for their chronic and

debilitating conditions. Now, between 10% to 30% of returning veterans have experienced PTSD

and at least half of returning veterans experience some form of chronic pain; as numbers

continue to grow, veterans returning from overseas affected by these debilitating conditions

which require medications to control is becoming a larger issue in the United States (U.S.

Department of Veteran Affairs, 2018). A large portion of the time medications prescribed to

veterans are opioids and antidepressants, which can provide positive and negative effects for

them; however, some individuals do not wish to use these prescription drugs due to the high-risk

of abuse and addiction. In these cases, medical marijuana provides a refuge for them as being

one of the few holistic approaches to treat chronic pain and PTSD.

Section II - Background/History
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Marijuana has been vastly utilized by various cultures around the world for many

centuries in order to provide assistance medically, spiritually, and recreationally for the

individuals using it. According to Bostwick, “The first medical use probably occurred in Central

Asia and later spread to China and India. The Chinese emperor Shen-Nung is known to have

prescribed it nearly 5 millennia ago,” (2012, 2). Although medical marijuana use began in

ancient Asia, it was used throughout the early 20th century in the United States until it became

disgraced by the federal system in the 1930’s. Once it became a legally controlled substance in

the 1970s, marijuana became considered taboo medically; due to this, research was scarce for a

few decades.

Within the last 15 years, marijuana has been found to increasingly help chronic pain and

psychological conditions which has led to the legalization of marijuana for medical purposes in

33 states, including Florida. Nearly three-quarters of the legal medical marijuana states include

chronic or severe pain, PTSD, or both as qualifying conditions for the use of medical marijuana.

Florida has become one of the most recent states to approve marijuana as a medical treatment for

qualifying conditions to serve as an alternative treatment for many people, including veterans.

Veterans seem to develop extensive physical and psychological conditions resulting from their

deployment overseas; these conditions may foster the need for alternative treatment methods in

which medical marijuana has become a viable option.

Many institutions, mostly state-funded, are continually researching marijuana and the

possible effects provided by the drug— both beneficial and harmful— on individuals’ bodies,

minds, and quality of life regarding the legal system and their socioeconomic status. Researchers

focusing on disciplines regarding biology, chemistry, earth science, economics, and political
Medical Marijuana and Veterans 5

sciences would all benefit from researching marijuana and the medical purposes; this may lead to

an interdisciplinary approach.

Section III - Justification of Interdisciplinary Approach

The treatment of medical marijuana for veterans’ conditions involving pain and PTSD

requires the use of multiple perspectives in order to form a complete understanding of the

treatment. A singular approach will not successfully explain the treatment of chronic pain and

PTSD using medical marijuana due to the extensive factors required to understand each

subsection of the treatment or process; therefore, an interdisciplinary approach would be

beneficial. An interdisciplinary approach provides a detailed understanding of the complex

situation regarding marijuana and its use for medicinal purposes through involving the multiple

disciplines that offer varying perspectives toward the treatment. Marijuana has become an

increasingly growing economical market which facilitates the need for legal action— a section of

the political science discipline; this along with the medical nature of the drug itself provides a

plethora of information from various disciplines.

The multiple disciplines and the immense amount of information provide a platform for

interdisciplinary work to be performed in order to assist veterans with their medical needs. The

need to understand the effects marijuana provides patients allows researchers the opportunity to

study the endocannabinoid system as being a “… physiologic modulator not only of the central

nervous system but also of the autonomic nervous system, immune system, gastrointestinal tract,

reproductive system, cardiovascular system, and endocrine network,” (Bostwick, 2012, p. 7).

Due to the extensive nature of the endocannabinoid system, it is essential to understand the scope
Medical Marijuana and Veterans 6

of the physiologic properties provided by the system and the possible outcomes regarding

ingesting marijuana. Providing a medical viewpoint regarding the endocannabinoid system is

helpful when considering the chemistry behind the interactions involved between the

endocannabinoid system and marijuana. Chemically, each endocannabinoid has a different

receptor-mediated effect; Bostwick mentions this through using Ben Amar’s thoughts regarding

pathology, “… for each pathology it remains to be determined what type of cannabinoid and

what route of administration are most suitable to maximize the beneficial effect of each

preparation and minimize the incidence of undesirable reactions,” (2012, 9). This connection

between the biology and chemistry disciplines creates legal bureaucratic problems regarding

research on marijuana due to the substance being considered federally illegal.

As marijuana becomes increasingly nationally recognized, the economic expansion

continues to be questionable federally due to the factor of taxation. As the number of disciplines

involved with this alternative treatment continues to increase, the requirement of an

interdisciplinary approach becomes increasingly appealing and important in understanding

medical marijuana.

Section IV - The Most Relevant Disciplines

Prior to discussing the disciplines relevant to the treatment of chronic pain and PTSD

with medical marijuana for veterans, the scope of this project must be considered. Unfortunately,

this project did not allow me to employ the proper time or resources to properly investigate all of

the disciplines involved with the topic of medical marijuana as an alternative treatment for

veterans suffering from chronic pain and PTSD. With this being said, there are multiple
Medical Marijuana and Veterans 7

disciplines involved with the concept of medical marijuana as a treatment itself and some

additional disciplines must be considered when involving veterans and their medical symptoms.

The treatment of medical marijuana itself involves political science through the issue of the drug

being considered a Schedule I controlled substance, federally, within the United States; this

provides the requirement that legal actions must be taken. Within the state of Florida, and 32

other states, marijuana is legal for medical use for various qualifying conditions – including

chronic pain and PTSD; however, due to the federal illegality of the drug it requires states to pass

many laws regarding the use of medical marijuana across the state.

Economically, marijuana is a thriving business within the medical and recreational

sphere; this has been proven throughout the last decade as the marijuana industry has

exponentially grown. In some states it has been difficult in order to determine laws regarding

taxation due to the medical laws regarding prescriptions and the involvement of health care. In

regard to utilizing earth science, marijuana is a flowering botanical that is produced through the

use of agricultural techniques in order to provide the various resulting strains that can be used to

create further marijuana-based products. Since marijuana is a flowering botanical, it requires

specific calibrations regarding various agricultural products and procedures to produce it as a

healthy plant that is inhalable and ingestible.

The marijuana industry also utilizes chemistry in which much of the research done has

been regarding the compounds found within the flowers grown by the plant and the effects

caused by inhalation. Chemistry provides an important insight on the exact mechanisms used by

the compounds to produce the desired effects by the marijuana. Marijuana and biology

interweave through the need to understand the effects regarding marijuana on the human body

and the physiological process involved with treating the multiple conditions approved for
Medical Marijuana and Veterans 8

medical marijuana treatment. As a discipline, biology provides a medical perspective towards

understanding both the desired and non-desired effects regarding medical marijuana. Each of

these disciplines offer varying perspectives toward understanding medical marijuana and the

effects that assist patients in treating their chronic pain and PTSD symptoms. The approach of

interdisciplinary work allows the connection between these disciplines to create a more

comprehensive viewpoint of medical marijuana as a treatment— for veterans in particular.

Section V - Insights from the Literature Review

Medical marijuana provides an oasis for many; however, there is still a plethora of

information we are unaware of regarding the alternative treatment. The endocannabinoid system

information within this article will provide another biological point within my research paper.

The reclassification of marijuana from a Schedule I controlled substance to a Schedule II

controlled substance is warranted in order to further research and understand the effects provided

by marijuana for patients as requested by the Institute of Medicine, the American Medical

Association, and the American College of Physicians (Bostwick, 2012, p. 12).

Many of the patients considered for the study created by Davidson et al. either were not

able to participate or had died previous to the study, so a total of 206 subjects were part of the

intent to treat population and 176 subjects were part of the per protocol population. After the

study was completed, the results indicated that pain symptoms improved in both testing group

populations. It is noted within the study that many of the study participants reduced their opioid

therapy resulting from this study. In general, it seems as if marijuana assisted chronic pain

participants with their quality of life and pain levels throughout the seven months this study was

conducted.
Medical Marijuana and Veterans 9

Unfortunately, the sample involved with the study developed by Belliner, Brown, &

Ortega was only comprised of 29 people; this provides issues when generalizing the data

collected from the sample population. Additionally, this study had a lack of blinding within the

sample due to the patients being aware they were taking medical cannabis along with selective

bias due to not testing their sample for cannabinoids previous to beginning the research. The

study, although small, provides information regarding decreases with the number of opioids

ingested, the pain experienced by patients, quality of life as reported, and analgesic prescription

costs.

Only 9% of the veterans sampled admitted to using cannabis within 2016, but 48% of

these veterans lived in a legal medical marijuana state; of the 48%, 41% of the veterans living in

a medically legal state report using medical marijuana for medicinal purposes (Bohnert, 2018, p.

4). Results from veteran samples were analyzed to estimate the general association between the

categories’ results and veterans while simultaneously providing the differences based on

demographics. Unfortunately, this study does not provide further information involving veterans

and cannabis; such as, the prevalence of medical purposes that cannabis is utilized for within this

veteran population.

Out of 66 people within this study 43 have sought out medical marijuana for PTSD and

41 have sought out medical marijuana for chronic pain (Aston, 2018, p. 6). Many of the veterans

within the study reported using marijuana for medical purposes even though only about 25% of

them have their medical marijuana card. Nearly 97% of the veterans that use marijuana and have

a condition found it to help moderately or better. Overall, the study seemed to indicate that more

than half of the veterans that used marijuana for medical purposes seemed to use it for PTSD or

chronic pain, possibly both. Throughout the results it was noted that veterans used medical
Medical Marijuana and Veterans 10

marijuana daily; due to the information previously stated it is most likely to cope with symptoms

of PTSD and chronic pain.

Since PTSD is now a recognized condition to treat with medical marijuana in certain

legal states, the factors associated with PTSD patients may differ from chronic pain patients. Of

the 841 veteran participants within the study, 78% used medical marijuana for severe, chronic

pain while 6% responded using medical marijuana for PTSD (Bonar, 2016, p. 3). There are

possible co-occurring symptoms with veterans using medical marijuana; if these symptoms are

not simultaneously addressed, then medical marijuana may not be as effective. This study used a

multitude of analytical tools to determine the differences between various data that was collected

with their research. Due to the data being self-reported it may have been biased due to

retrospective recall and social desirability.

Section VI - Identify Conflicts

The immense differences regarding the various studies creates some discourse in

understanding the true conflicts between the researchers; fortunately, after analyzing the theories

and solutions between each literary work, the conflicting ideologies and processes were clear.

According to Bostwick, decriminalization of marijuana needs to be put into effect in order to

create more thorough research and for patients to more easily obtain their medication (2012, pgs.

183-184). The additional literary works chosen did not support nor disapprove of the

decriminalization of marijuana; however, it was mentioned by Belliner et al. that it may

encourage the research required to understand marijuana further.

Criminalization of marijuana also causes an issue for patients when obtaining

prescriptions since there is a grey area regarding law enforcement and driving with marijuana.
Medical Marijuana and Veterans 11

Although Belliner, et al. and Furmanov et al. had similar studies, there were further studies

warranted by Belliner et al. regarding side effects, drug interactions, dose response, and

monitoring parameters—ultimately opposing Furmanov, et al. (Belliner, 2018, Discussion).

Substance use causing issues with veterans’ substance use treatment theorized by Bonar, et al. is

ideologically predictable, but according to the other various research discussed in the articles by

Furmanov, et al. and Belliner, et al. opioid use seems to significantly decrease with the use of

medical marijuana. Throughout the literary articles there were many distinctive differences

regarding each study; however, the few conflicting theories and solutions are complex, yet

integration of these conflicts is still possible.

Section VII - Common Ground

Throughout the articles, researchers seem to agree that using medical marijuana has a

correlation with the reduction in pain levels for patients— including veterans; this pain reduction

subsequently causes a chain reaction. As pain is reduced, the patients’ opioid use seems to be

diminishing as well according to the studies developed by Belliner et al. and Davidson et al.

Although many of the researchers do not clearly support or oppose medical marijuana, it is clear

that each study’s results have supported the reduction of pain levels and opioid use; therefore,

this supports the claim that medical marijuana assists individuals—specifically veterans— with

their chronic physical conditions that are often debilitating.

Half of the articles—including Bostwick, Basset et al., and Belliner— provide similar

information involving the tense economical perspective of the patients using medical marijuana;

this similar information involves the topic of the legal market’s medical marijuana prescription

costs and the possible effects afflicted onto these veterans and patients. Medical marijuana
Medical Marijuana and Veterans 12

prescription costs truly pose a problem for patients obtaining it due to the inflation costs put upon

the drug due to the continual federally illegality and the possible extra production techniques that

apply.

Although there are details that are common between specific articles, each article infers

that marijuana may have some medicinal benefit towards both general citizens and veterans.

Throughout the articles it can be seen that the researchers used supporting evidence from

colleagues’ papers, some included the authors from the additional articles chosen. As this is

continuously recognized throughout each article, it provides concrete evidence that there is

common ground between multiple disciplines, the articles themselves, and the ideology of the

researchers.

Section VIII - Interdisciplinary Understanding/Solution

As our military continues to replenish with new service men and women, more veterans are

returning home from their service with chronic pain and Post-Traumatic Stress Disorder (PTSD)

from the physically and mentally demanding missions required of them. Due to the symptoms

caused by chronic pain and PTSD, veterans seek assistance from pain medication, but

unfortunately the various opioids may not always provide relief. Due to the continuing pain,

some veterans seek out the assistance of alternative treatments; this may lead them towards

researching and using marijuana for medical purposes. Due to the complexity of medical

marijuana, multiple disciplines are utilized —including biology, chemistry, history, political

science, economics, and earth science; however, an interdisciplinary approach using each

discipline would provide an increasingly comprehensive understanding.

Medical Marijuana and Veterans 13

From the information gained through the literary works, it provides a more

comprehensive understanding regarding medical marijuana and the resulting effect on veterans’

symptoms caused by chronic pain and PTSD. This increasingly interdisciplinary understanding

provides the necessity for the federal decriminalization of marijuana and further interdisciplinary

studies to provide additional research and statistical information regarding medical marijuana

and veterans, the symptomatic effects caused by this treatment, and the resulting

sociodemographic effects. Decriminalizing marijuana across the United States will essentially

provide researchers the ability to create new proposals and theories regarding veterans and

medical marijuana. The information provided by the resulting research data will assist and

encourage physicians and veterans to further interpret that information to determine if medical

marijuana would be beneficial for themselves or their patients.

Federally decriminalizing marijuana would not only create an influx of research and

information, but it would create an economic growth that has become increasingly needed

throughout the past decade due to an increase in the United States’ economic debt. With the

federal acceptance of marijuana for medical purposes it would provide a connection for the legal

marijuana and pharmaceutical industries to collaborate and create affiliated products to combat

symptoms experienced by non-veteran patients and veterans—specifically with chronic pain and

PTSD. This cooperation would cause prescription medical marijuana prices to lower and create

an easier route of access for veterans to obtain their medical marijuana card without

discrimination from the United States Department of Veteran Affairs (VA) or their physicians.

Research has proven that humans have an endocannabinoid system, within the nervous

system, that extends throughout the body as a physiological modulator—almost like the

circulatory system. According to Bostwick, “… due to the near absence of brainstem CB1
Medical Marijuana and Veterans 14

receptors, the drug spares the autonomic nervous system, no matter how much is ingested, with

the result that a lethal overdose in humans has never been reported,” (2012, pg. 8). Since

marijuana has never caused a lethal overdose, federal legalization would not truly endanger lives

of medical patients utilizing the drug; therefore, this policy would ultimately assist veterans in

gaining further information involving medical marijuana and medical marijuana cards.

As mentioned throughout the literary articles, marijuana decreases the symptoms

involved with chronic pain and psychological symptoms —not including schizophrenia.

Veterans that use marijuana for medical purposes tend to have increased symptoms, both

physical and psychological. Both Bohnert, et al. and Aston, et al. discuss veterans and their use

of marijuana —both medically and non-medically— which resulted in providing data pointing

towards more veterans using marijuana for medical purposes, compared to recreationally, and for

treating their severe chronic pain and PTSD symptoms.

Although medical marijuana has been shown to reduce symptoms associated with chronic

pain, studies researching the effects of medical marijuana on PTSD have not been established.

Therefore, to truly understand the relationship between veterans, marijuana, chronic pain, and

PTSD the federal decriminalization of marijuana must be implemented; this implementation

would provide an interdisciplinary platform for the multiple disciplines concerning medical

marijuana, including biology, chemistry, political science, economics, history, and earth science.
 Medical Marijuana and Veterans 15

Section IX - Works Cited or References Page

References

Aston, E. R., Bassett, S. S., Borsari, B., Jackson, K. M., & Metrik, J. (2018). Medicinal Versus

Recreational Cannabis Use Among Returning Veterans. Transitional Issues In Psychological

Science, 4 (1), 6-20. DOI: 10.1037/tps0000133

Bellnier, T., Brown, G. W., & Ortega, T. R. (2018). Preliminary evaluation of the efficacy, safety, and

costs associated with the treatment of chronic pain with medical cannabis. The Mental Health

Clinician, 8 (3), 110-115. DOI: 10.9740/mhc.2018.05.110

Bohnert, K. M., Davis, A. K., Ilgen, M. A., & Lin, L.A. (2018). Recent cannabis use among Veterans in

the United States: Results from a national sample. Addictive Behaviors, 76, 223-228. DOI:

10.1016/j.addbeh.2017.08.010

Bonar, E. E., Chermack, S. T., Davis, A. K., Ilgen, M. A., Perron, B. E., & Walton, M. A. (2016).

Factors associated with having a medical marijuana card among Veterans with recent substance

use in VA outpatient treatment. Addictive Behaviors, 63, 132-136. DOI:

10.1016/j.addbeh.2016.07.006

Bostwick, J. M. (2012). Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana. Mayo

Clinic Proceedings, 87 (2), 172-186. DOI: 10.1016/j.mayocp.2011.10.003

Medical Marijuana and Veterans 16

Davidson, E., Furmanov, K., Ginosar, Y., Haroutounian, S., Meidan, R., Ratz, Y., & Saifi, F.

(2016). The Effect of medicinal cannabis on pain and quality of life outcomes in chronic

pain: a prospective open label study. The Clinical Journal of Pain, 32 (12), 1036-1043.

U. S. Department of Veterans Affairs. (n.d.). How Common is PTSD in Veterans? Retrieved

from https://www.ptsd.va.gov/understand/common/common_veterans.asp