ANOTHER WALTER REED SCANDAL

Cannabis for the Wounded

Screaming Chris Mathews and the corporate media would have us believe
that it's only the living conditions at Walter Reed Army Medical
Center that are deplorable, not the medical care itself. Donna
Shalala and Bob Dole have been assigned to investigate the situation.
A superficial clean-up will ensue -rodents poisoned, moldy drywall
replaced-while the quality of care gets lauded and prosthetic limbs
are presented as proof that all is state-of-the-art.

Out in California, however, doctors in the Society of Cannabis
Clinicians question the care doled out at Walter Reed and other
military hospitals where wounded soldiers and vets are treated with
toxic medications* while the safest painkiller known to man is
systematically withheld. "If anybody needs and deserves
cannabis-based medicine, it's the thousands of soldiers who have been
seriously wounded in Iraq," says Philip A. Denney, MD. "Cannabis
would help in treating insomnia, pain, PTSD, and a whole array of
symptoms that wounded vets typically face."

Tod Mikuriya, MD, who has monitored cannabis use by more than 8,500
patients, reports that approximately 8% had a primary diagnosis of
PTSD. His findings and observations are confirmed by every doctor in
the field. Many PTSD patients, according to Mikuriya, "are Vietnam
veterans whose chronic depression, insomnia, and accompanying
irritability cannot be relieved by conventional psychotherapeutics
and is worsened by alcohol. For many of these veterans, chronic pain
from old physical injury compounds problems with narcotic dependence
and side effects of opioids.

"Cannabis relieves pain, enables sleep, normalizes gastrointestinal
function and restores peristalsis. Fortified by improved digestion
and adequate rest, the patient can resist being overwhelmed by
triggering stimuli. There is no other psychotherapeutic drug with
these synergistic and complementary effects.

"Physical pain, fatigue, and sleep deficit are symptoms that can be
ameliorated. Restorative exercise and diet are requisite components
of treatment of PTSD and depression. Cannabis does not leave the
patient too immobile to exercise, as do some analgesics, sedatives
biodiazapenes, etc. Regular aerobic exercise (where injury does not
interfere) relieves tension and restores control through kinesthetic
involvement. Exercise also internalizes the locus of control and
diminishes drug-seeking to manage emotional response.

"PTSD often involves irritability and inability to concentrate, which
is aggravated by sleep deficit. Cannabis use enhances the quality of
sleep through modulation of emotional reactivity. It eases the
triggered flashbacks and accompanying emotional reactions, including
nightmares. The importance of restoring circadian rhythm of sleep
cannot be overestimated in the management of PTSD. Avoidance of
alcohol is important in large part because of the adverse effects on
sleep. The short-lived relaxation and relief provided by alcohol are
replaced by withdrawal symptoms at night, causing anxiety and the
worsening of musculoskeletal pain...

"Based on both safety and efficacy, cannabis should be considered
first in the treatment of post-traumatic stress disorder. As part of
a restorative program with exercise, diet, and psychotherapy, it
should be substituted for 'mainstream' anti-depressants, sedatives,
muscle relaxants, tricyclics, etc."

Somewhere at Walter Reed or elsewhere in the system there are vets
who know from direct experience that cannabis eases their symptoms
and who, sooner or later, will assert the right to use it openly.
Donna Shalala and Bob Dole are the last people in the world who would
allow cannabis use by wounded vets. Shalala stood alongside Barry
McCaffrey to denounce Dr. Mikuriya and Prop 215 at a well-covered
press conference in December '96. She stated that nobody should ever
use marijuana "because it's illegal" and the reason it's illegal is
"because it's 'wrong.'" This absurd moralism from the government's
top official in charge of "Health."

Bob Dole's last public appearance in a "medical" context was as a
pitchman for Viagra. His educational effort should be rewarded by
changing the name of the condition from "Erectile Dysfunction" to
"Bob Dole Disorder." Wouldn't most men be more comfortable talking to
their doctors about BDD than about ED? Dole also did a Pepsi ad that
made reference to his Viagra ad. In the Pepsi ad he's watching
Brittney Spears gyrate and his little terrier gets aroused and trots off.

In the spring of 2004 I left a copy of O'Shaughnessy's at a Walter
Reed checkpoint for a high-ranking Army doctor who, I'd been told by
a mutual friend, might be interested in the suggestion made in the
editorial ("Cannabis for the Wounded"). This is what the Army doctor
emailed in response: "Thanks for sending me the copy of
O'Shaughnessy's. I was curious why L. passed my name along to you
- -perhaps because I was a botanist in my pre-medicine days and have an
interest in the non-recreational use of psychoactive plants, or
because I know Marcus Conant, or because I'm a military doc. In fact,
for some of my essays required for military professional development,
I wrote on the military's approved uses of drugs... But the topic of
medical uses of marijuana is not among my interests so I'll stand
back to watch the debate from afar." I took this to mean: "I have
every reason to be interested in medical marijuana but I'm afraid to
bring it up at Walter Reed."

* Commonly prescribed medications for PTSD as listed in "Postraumatic
Stress Disorder Among Military Returnees From Afghanistan and Iraq,"
by Matthew J. Friedman, MD, PhD, in the April 2006 American Journal
of Psychiatry:

SSRIs

Paroxetine, Sertraline, Pluoxetine, Citalopram, Fluvoxamine May
produce insomnia, restlessness, nausea, decreased appetite, daytime
sedation, nervousness, and anxiety, sexual dysfunction, decreased
libido, delayed orgasm or anorgasmia. Clincically significant
interactions for people prescribed monoamine oxidase inhibitors
(MAOIs). Significant interactions with hepatic enzymes produce other
drug interactions. Concern about increased suicide risk in children
and adolescents.

Other second-generation antidepressants: Trazadone may be too
sedating, may produce rare priapism. Velafaxine may exacerbate
hypertension. Buproprion may exacerbate seizure disoder. Mirtrazepine
may cause sedation.

MAOIs

Phenetzine Risk of hypertensive crisis; patients required to follow a
strict dietary regime. Contraindicated in combination with most other
antidepressants, CNS stimulants, and decongestants. Contraindicated
in patients with alcohol/substance abuse/dependence. May produce
insomnia, hypotension, anticholinergic side effects, and liver toxicity.

Tricyclic Antidepressants

Imipramine, Amitriptyline, Desipramine. Anticholinergic side effects
(dry mouth, rapid pulse, blurred vision, constipation). May produce
ventricular arrhythmias. May produce orthostatic hypotension,
sedation, or arousal.

Antiadrenergic Agents

Prazosin, Propranolol, Conidine, Guanfacine: May produce hypotension,
brachycardia (slow heartbeat), depressive symptoms, psychotomor
slowing or bronchospasm.

Anticonvulsants

Carbamazepine may cause neurological symptoms, ataxia, drowsiness,
low sodium level, leukopenia. Valproate may cause gastrointestinal
problems, sedation, tremor and thrombocytopenia (low platelet levels
in blood). It is teratogenic (induces mutations, should not be used
during pregnancy). Gabapentin may cause sedation and ataxia
(difficulty forming sentences). Lamotrigine may cause Stevens-Johnson
syndrome, rash, fatigue. Toprimate may cause glaucoma, sedation,
dizziness, and ataxia.

Atypical Antipsychotics

Risperidone, Olanzapine, Quetiapine: May cause weight gain. Risk of
type 2 diabetes with olanzapine.

BUT DON'T LET 'EM HAVE ANY MARIJUANA!

Fred Gardner edits O'Shaughnessy's, the Journal of Cannabis in
Clinical Practice (soon to have a presence on the web).