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April 20, 2018

RESEARCH
STUDY: VETERANS
AND MARIJUANA

COMBAT PTSD (/research/?category=COMBAT+PTSD), Marijuana

(/research/?category=Marijuana), VA (/research/?category=VA), SUICIDE
(/research/?category=SUICIDE), MENTAL HEALTH (/research/?
category=MENTAL+HEALTH)

ABSTRACT

On April 20th, 2018 Operation Vet Fit conducted a first-of-its-kind

marijuana research study to investigate if marijuana demonstrates
measurable medicinal values in outcomes on depression, anxiety and pain
amongst US Military veterans.

BACKGROUND

Marijuana is still federally classified as a Schedule 1 drug based on its

designation of having, "no medical use and a high potential for abuse
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/)". Further,
that marijuana, under Schedule 1 classification, is considered as
dangerous as: "heroin, lysergic acid diethylamide
(LSD), methylenedioxymethamphetamine (ecstasy), methaqualone, and
peyote" (DEA).

Moreover, marijuana's classification also identifies it as more dangerous

than: "Vicodin, cocaine, methamphetamine, methadone,
hydromorphone (Dilaudid), meperidine (Demerol), oxycodone
(OxyContin), fentanyl, Dexedrine, Adderall, Ritalin, Tylenol with
codeine, ketamine, anabolic steroids, testosterone, Xanax, Soma, Darvon,
Darvocet, Valium, Ativan, Talwin, Ambien, and Tramadol" (DEA).
Marijuana's schedule 1 classification also makes medical research elusive,
if not impossible due to institutional fears of shut-down, loss of licensure,
defunding and criminal prosecution. Such concerns have created barriers
to research making data on the plant's medical impact hard to attain from
credible agencies such as the Veterans Affairs (VA) and United States
college and university research teams. This lack of available and credible
data have stifled lawmakers' attempts to reclassify the plant
(https://www.congress.gov/bill/115th-congress/house-bill/1227) as
medicine rather than a dangerous and addictive drug.

Currently, twenty veterans commit suicide daily.

(https://www.scribd.com/document/346483090/What-Caused-the-
Veteran-Suicide-Epidemic-of-22-a-day) And while the VA's current "best
practices"
(https://www.ptsd.va.gov/professional/treatment/overview/decision_aid_p
ro.asp) for pain management and PTSD include prescribing a cocktail of
medications, including dangerous opioids that are highly addictive,
veterans living in states with medical marijuana laws are coming forward,
sharing their stories (https://www.youtube.com/watch?
v=F1yV0CDVYGo) of freeing themselves from opioids by choosing
medical marijuana as the alternative.

The timing of this study comes as the President of the United States
(https://youtu.be/F0Y3ytZrN_s) has declared the opioid overdose and
addiction epidemic a national emergency.
The goal of our agency's research herein is to measure marijuana's impact
on pain, anxiety and depression. To do so we will be utilizing our combat
veteran population living in states where they are legally able to attain
medical marijuana. Should this study infer a medical benefit, further
research amongst our more highly funded and independent institutions
can and should follow.

METHOD

Participants - Thirty-two veteran

members of the United States Armed
Forces were recruited via social media
(http://www.operationvetfit.org/research/
2018/3/28/veterans-and-medical-
marijuana-does-it-have-medicinal-value).
Veteran status was verified via
confidential submission of participants'
DD214 (Certificate of Release or
Discharge from Active Duty) with names
and Social Security numbers omitted. Of
the thirty-two original registrants, ten
did not submit a copy of their DD214
making them ineligible to participate in
this study.
As a result, twenty-two verified US
Armed Forces Veterans were provided
with direct website links to complete pre
and post measures (BDI, BAI, Pain
Scale), just prior to and following their
marijuana utilization.

Of those twenty-two provided the web

links to the anonymous pre and post
surveys, only eleven completed the pre
measures. Of them, ten completed the
post measures.

The identities of those completing the

measures remained annonymous
throughout and following the study
conclusion. Only those who provided a
copy of their DD214 were granted
website links and password access to the
measures for completion.

Additionally, we collected data on each

participant's current VA disability rating,
as well as their VA disability rating for
PTSD and total number of years they
have been utilizing marijuana to treat
their symptoms.

Population Demographics - Of the 22

initial participants, 21 were male.
Average age was 38 with a (SD=10.58).
Ages ranged from 25-62 years. Nine of
the participants were engaged by or
engaged the enemy in combat (Combat
Action). Of those nine, average combat
theatre exposure was 14 months (SD=
10.07) with 33 months in theatre being
the lengthiest observed
participant. Eleven participants served in
a combat theatre but did not engage in
combat action. Average population
deployment time total was 13 months
(SD=15.11). Five subjects never
deployed. Of those who did deploy,
average deployment time total was 17
months (SD=15.35). The subject with
the lengthiest deployment history served
59 months overseas. Average rank of all
participants was E4 (SD=1.5), with only
enlisted veterans making up the total
population. All but one of the
participants had a VA disability rating.
Average VA disability rating of the
population group was 70% (SD 30.01)
with 73% having a VA diagnosis and
rating for PTSD. No officers participated
in this study. Six of the participants
served in Iraq, five served in Afghanistan,
two in Somalia, and one in the Gulf
War.

Measures Used:
Post Traumatic Stress Disorder
(https://www.ptsd.va.gov/professional/assessment/overview/index.asp)
(PTSD) - Rating was based on veterans' VA determination of severity as
provided by the participant. VA ratings for PTSD require exhaustive
evaluations using both objective and subjective measures. The reliability
of a VA rating is far superior than requiring the the veteran to complete a
separate individual subjective questionnaire. For these reasons we are
avoiding the use of additional PTSD measures.

Depression

(http://www.apa.org/pi/about/publications/caregivers/practice-
settings/assessment/tools/beck-depression.aspx) - Was measured using the
Beck's Depression Inventory (BDI) taken prior to and following
utilization of medical marijuana. Pre marijuana utilization scores for
depression in the population sample demonstrated a mean of 24.18
n=11; (SD=13.98) placing the population sample, prior to using
marijuana, within the second highest depression category of "Moderate
Depression"(Beck et al., 1988).
The Beck Depression Inventory (BDI) is a 21-item, self-report rating
inventory that measures characteristic attitudes and symptoms of
depression (Beck, et al., 1961). Internal consistency for the BDI ranges
from .73 to .92 with a mean of .86. (Beck, Steer, & Garbin, 1988). The
BDI demonstrates high internal consistency, with alpha coefficients of .86
and .81 for psychiatric and non-psychiatric populations respectively (Beck
et al., 1988).

Anxiety

(https://www.sciencedirect.com/topics/medicine-and-dentistry/beck-
anxiety-inventory)- Was measured using the Beck's Anxiety Inventory
(BAI) taken prior to and following ingestion of medical marijuana. Pre
marijuana utilization scores for anxiety in the population sample
demonstrated a mean of 23 (n=11); (SD=17.29) placing the population
sample, prior to using marijuana, within the category of "Moderate
Anxiety"(Beck Epstein, Brown & Steer 1988).
The Beck Anxiety Inventory (BAI), created by Aaron T. Beck and other
colleagues, is a 21-question multiple-choice self-report inventory that is
used for measuring the severity of anxiety in children and adults. The
questions used in this measure ask about common symptoms of anxiety
that the subject has had during the past week. Several studies have found
the Beck Anxiety Inventory to be an accurate measure of anxiety
symptoms in children and adults (Leyfer, Ruberg, & Woodruff-Borden,
2006 ). The Beck Anxiety Inventory is a well accepted self-report measure
of anxiety in adults and adolescents for use in both clinical and research
settings (Groth-Marnat, 1990). The BAI is psychometrically
sound. Internal consistency (Cronbach’s alpha) ranges from .92 to .94 for
adults and test-retest (one week interval) reliability is .75 (Beck
Epstein, Brown & Steer 1988).

Pain - Was measured utilizing the Universal Pain Assessment Tool below
taken prior to and following ingestion of medical marijuana. Pre
marijuana utilization scores for pain in the population sample
demonstrated a mean of 4.91 n=11; (SD=2.23) placing the population
sample, prior to using marijuana, within the "Moderate Pain" category.
The Universal Pain Assessment Tool (UPAT) combines the advantages
of four types of pain assessment instruments – Visual Analogue Scale,
adjective scales, Numerical Rating Scales (NRS) and Faces Scales. The
Universal Pain Assessment Tool aims to describe completely the
individual's pain experience. The combination of NRS, verbal
description, association between pain and facial expression and individual
threshold of pain makes this instrument usable in all age groups
(Hockenberry, Wilson, Wilkenstein & Wong, 2005; Hesselgard, Larsson,
Romner, Strömblad &, Reinstrup, 2007; Edelen & Saliba, 2010).

RESULTS

Marijuana utilization amongst the population sample in this study

demonstrated significant reductions in pain, anxiety and depression for
100% of the participants. Graphical results of pre and post marijuana
utilization amongst our population sample have been provided below.
 DISCUSSION

The results contained herein, while promising for supporters of medical

marijuana, must also be weighed within the constraints of the population
sample size. That said, future research involving larger population
samples can now be obtained by utilizing our study methods to acquire
data from all citizens that currently rely on medical marijuana in states
where it is legal to obtain.
The results contained in this anonymous study are a call to action to all
institutions fearful of conducting this type of research within the confines
and restrictions of their institutions. Such fear has ultimately retarded
research. Such research dysfunction due to sociopolitical obstructions
continue to disproportionally impact lower income
communities. Moreover, prolonging the suffering being incurred by
trusting patients of medical doctors that are routinely prescribing a
myriad of medications to treat pain, depression and anxiety. Such
medications that are currently legal to prescribe have resulted in an opiod
and heroine epidemic that might argueably be halted via legal access and
utilization of marijuana to treat similar, as well as a growing number of
other symptoms.

This study has been conducted on the heels of United States President,
Donald Trump declaring an opioid crisis in America. Further, the
President has implored those of us in the fields of medicine, mental
health, research and social work to submit comments to the World
Health Organization specific to marijuana's classification as a Schedule 1
drug.

Such steps will eventually result in political debates within the halls of the
US Congress which will inevitably be delayed, tabled and put off at the
cost of American lives, families and strain within our social service and
prison systems. Such a realization should weigh heavily on the
consciousness of our law makers. Their (US Congressional) delay on this
matter is resulting in more deaths per year due to opioid overdoses
(https://www.cdc.gov/drugoverdose/data/statedeaths.html) than all of
America's war dead since 1965.

To reiterate, according to the CDC

(https://www.cdc.gov/drugoverdose/data/statedeaths.html), Opioids were
involved in 42,249 deaths in 2016 alone. To put this into truer
perspective, the number of Opioid related deaths in America in 2016 is
nearly six times greater than all of Americas war dead since September
11th, 2001 and nearly equal to all of our war dead from 1965 to present.

Meanwhile, research continues to compile studies such as this whereby

marijuana appears to not only have medical value, but may very well be
the plant that ends the opioid crisis.

Recognizing that much more research is still to be done on this plant, it

appears rather obvious that Marijuana is currently amongst the wrong
classification of drugs and deserves to be rescheduled and researched in a
more stable and clinical environment. Something that simply can not
occur as it stands as a Schedule 1 drug.

When the reclassification does occur, because it will, research will need to
look at this plant in all of its many facets specific to genetic variances,
Strains (https://www.scribd.com/document/374879725/Medical-
Cannabis-in-America-ASA-report-29-online), concentrations, and ratios
of each. Primarily, medical marijuana comes in an Indica, Sativa or
Hybrid blend of both strains. Future studies should also collect on these
variables to ascertain outcomes for each to assist the medical community
in addressing the question of dosage, timing and respective impact on
symptoms as well as ratios of various plant components such as
CBD:THC.

REFERENCES AND ADDITIONAL INFORMATION

American Forces Press Service. (2013) United States Department of

Defense. 18 January 2013. Archived from the original
(http://www.defense.gov/NEWS/casualty.pdf ) (PDF) on 16 January
2013. Retrieved 19 January 2013.

Beck A.T., Epstein N, Brown G, Steer RA (1988). "An inventory for

measuring clinical anxiety: Psychometric properties". Journal of
Consulting and Clinical Psychology. 56: 893–897. doi:10.1037/0022-
006x.56.6.893.

Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J.
(1961). An inventory for measuring depression. Archives of General
Psychiatry, 4, 561-571.

Beck, A.T., Steer, R.A., & Garbin, M.G. (1988). Psychometric properties
of the Beck Depression Inventory: Twenty-five years of
evaluation. Clinical Psychology Review, 8(1), 77-100.
Edelen MO, Saliba D. (2010). Correspondence of verbal descriptor and
numeric rating scales for pain intensity: an item response theory
calibration.J Gerontol A Biol Sci Med Sci. 2010;65(7):778-85.

Groth-Marnat G. (1990). The handbook of psychological assessment (2nd

ed.). New York: John Wiley & Sons.

Hedegaard H, Warner M, Miniño AM. (2016) Drug overdose deaths in

the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville,
MD: National Center for Health Statistics. 2017/ CDC. Wide-ranging
online data for epidemiologic research (WONDER). Atlanta, GA: CDC,
National Center for Health Statistics; 2016. Available at
http://wonder.cdc.gov

Hesselgard K, Larsson S, Romner B, Strömblad LG, Reinstrup P. (2007).

Validity and reliability of the Behavioural Observational Pain Scale for
postoperative pain measurement in children 1-7 years of age.Pediatr Crit
Care Med. 2007;8(2):102-8.

Hockenberry MJ, Wilson D, Wilkenstein ML. Wong (2005). Essentials

of Pediatric Nursing.7th ed.St Louis: Mosby.

Hojat, M., Shapurian, R., Mehrya, A.H., (1986). Psychometric

properties of a Persian version of the short form of the Beck Depression
Inventory for Iranian college students, Psychological Reports, 59(1), 331-
338.
Leyfer, OT; Ruberg, JL; Woodruff-Borden, J (2006). "Examination of the
utility of the Beck Anxiety Inventory and its factors as a screener for
anxiety disorders". Journal of anxiety disorders. 20 (4): 444–
58. doi:10.1016/j.janxdis.2005.05.004. PMID 16005177

Osman, A; Hoffman, J; Barrios, FX; Kopper, BA; Breitenstein, JL; Hahn,

SK (2002). "Factor structure, reliability, and validity of the Beck Anxiety
Inventory in adolescent psychiatric inpatients". Journal of clinical
psychology. 58(4): 443–56. doi:10.1002/jclp.1154. PMID 11920696.

Steer, R. A., Rissmiller, D. J.& Beck, A.T., (2000). Use of the Beck
Depression Inventory with depressed geriatric patients. Behaviour
Research and Therapy, 38(3), 311-318.

Medical Cannabis in America ASA_report_29_online

(https://www.scribd.com/document/374879725/Medical-Cannabis-in-America-ASA-report-29-
online#from_embed) by Daniel R. Gaita, CPT, MA, LMSW (https://www.scribd.com/user/17920208/Daniel-
R-Gaita-CPT-MA-LMSW#from_embed) on Scribd
MEDICAL
CANNABIS
IN AMERICA

THE MEDICAL
CANNABIS
BRIEFING BOOK
--.TH CONGRESS

AmericansForSafeAccess.org

MEDICAL
CANNABIS
IN AMERICA
Drug Schedules (https://www.dea.gov/druginfo/ds.shtml
(https://www.dea.gov/druginfo/ds.shtml))

>> Alphabetical listing

(http://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alph
a.pdf ) of Controlled Substances" (DEA)

Tagged: Medical Marijuana (/research/?tag=Medical+Marijuana),

Veterans and Marijuana (/research/?tag=Veterans+and+Marijuana),
Operation Vet Fit (/research/?tag=Operation+Vet+Fit), Daniel Gaita
(/research/?tag=Daniel+Gaita), Dan Gaita (/research/?tag=Dan+Gaita),
Marijuana and PTSD (/research/?tag=Marijuana+and+PTSD), Marijuana
and Anxiety (/research/?tag=Marijuana+and+Anxiety), Marijuana and
depression (/research/?tag=Marijuana+and+depression), Combat PTSD
and Marijuana (/research/?tag=Combat+PTSD+and+Marijuana), DEA
(/research/?tag=DEA), DEA Drug Schedules (/research/?
tag=DEA+Drug+Schedules)

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Results pending data collection on April 20th, 2018

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