For Wounded Veteran, Medical Marijuanas Been a Godsend

Originally appearing at AUGUSTA — Ryan Begin was checking a report of an improvised explosive device in Iskandariya, Iraq, on Aug. 1, 2004. Then the U.S. Marine Corps corporal saw one. It detonated, blowing apart his right arm. More than 30 surgeries later, Begin said he has regained some use of his arm. But the psychological damage has taken a harsher toll, including drug addiction and violence. Begin told doctors in federal health centers high-grade medical marijuana was his only hope for tamping down the innumerable nightmares, flashbacks and fears that followed him from the battlefield. “My mood’s stable now — no peaks and valleys, just stable ups and downs,” he said. His mother, Anna — “a little bit apprehensive” about medical marijuana at first — is a believer. “When he started the marijuana, it was like having my son back,” she said. Doctors in the federal veterans’ health care system aren’t as convinced. The substance remains illegal under federal law, and guidelines for federal health centers don’t support medical marijuana. That ended Begin’s relationship with the federal health system. Battle scars Today, Begin is unemployed, and one of 1,807 patients registered with the state to use marijuana medicinally. He entered the Marines in November 2001, and served two tours in Iraq, from March to June 2003, then from July to August 2004. Begin, 31, of Jackman, was given an early look at war. He said his first day in Iraq, March 23, 2003, was the battle of Nasiriyah — one of the Iraq invasion’s first large battles. Six soldiers, including Pfc. Jessica Lynch, whose capture and rescue were well-documented, were taken prisoner. More were killed. “Every day, someone new would die,” Begin said. When civilian families attempted to leave by running military checkpoints, they were often blown up and killed. Begin said there were times he had to clear charred bodies. “At the time, I was taught to not let emotion get involved,” he said. “You just do it.” He was honorably discharged in 2007 with the rank of sergeant, and returned home to Jackman. What followed was a string of reckless behavior Begin attributes, in part, to his treatment. “I was a mess,” he said. “I had so much anger. I just couldn’t cope with it.” On a cocktail of medications, he also drank heavily. One day in July 2007, he said he had two bottles of whiskey, took 90 valium pills and took to the roads in his truck. He got pulled over and tried to assault the officer. He was sentenced in 2010 to 43 days in Somerset County Jail after being found guilty of assault for that incident. Begin also was arrested on a charge of violating bail conditions in November 2007. He said it was for possession of marijuana, which he was using to illegally self-medicate. Then, Begin was sentenced to 180 days, all suspended, with two years of probation for an incident involving aggravated criminal trespass on Jan. 13, 2008. According to records, his wife got a protection-from-abuse order against him after he threw an ashtray that struck her. Seeking relief Meanwhile, Begin was being treated for battle injuries both physical and psychological. He provided medical records to the Kennebec Journal that detail treatment at Northampton VA Medical Center in Massachusetts and Togus VA Medical Center. The records detail military history, mental health narratives and medications. Begin was being treated for post-traumatic stress disorder in addition to physical injuries. Begin said he was harmed by the drugs he was prescribed and the psychological treatment he was offered. In addition to opiates such as morphine for pain, Begin was prescribed dextroamphetamine “for concentration, attention and mood.” “They focused on improving your memory,” he said. “Why would you improve someone’s memory who has bad memories?” In the records, he is quoted as saying he was addicted to prescribed opiates from 2004 to 2007. After years struggling with violent behavior and ineffective treatment, Begin in March got a state license to use medical marijuana after seeing Dustin Sulak, a Hallowell-based doctor known statewide as an advocate for medical marijuana. While records show Begin’s federal doctors had known about his past recreational marijuana use, Begin admitted he set up the appointment with Sulak without notifying his VA doctors. And Sulak wrote Begin’s recommendation for chronic pain in his right arm, not for PTSD. That’s because PTSD isn’t on Maine’s list of qualifying conditions for the medical marijuana program. “I knew (marijuana) would work for PTSD because it worked for me in the past,” Begin said. When he finally told VA doctors he had registered as a medical marijuana user, Begin said they gave him a choice. “‘If you’re pot-positive, we’re not writing you any prescriptions for anything,'” he said they told him. “They told me, ‘Prescription pills or medical marijuana.'” He chose the latter, and said he hasn’t been to Togus since. Stress factor A fact sheet from the Vietnam Veterans of America and Veterans of Modern Warfare said 300,000 veterans of the Iraq and Afghanistan wars are expected to suffer from PTSD or major depression. Charles Wynott, executive director of the Westbrook-based Maine Medical Marijuana Patients Center, said he gets calls from veterans with PTSD “all the time,” lamenting its exclusion from Maine’s condition list. “I sympathize with them and tell them I’m doing everything I can to get (the list of qualifying conditions) changed,” he said. “It’s definitely at the top of our list.” Gordon Smith, executive vice president of the Maine Medical Association, said his group would likely support expansion of the law into PTSD and mental health conditions — provided experts agree. Recent proposals would allow doctors to recommend marijuana for any condition they see fit. “I think there’s a feeling that that puts the law into a whole new realm,” Smith said. “I could see us getting involved if there was science.” Wynott said, “We have a lot of PTSD. We have a lot of veterans. And it’s only going to get worse as they’re taking troops out.” And Sulak said, “A lot of people outside my profession don’t realize how prevalent PTSD is.” Sulak said he has seen approximately 400 patients with PTSD accompanying pain come through his office. He calls PTSD “the second-most common condition people want marijuana to treat.” Pain is why Sulak says he can recommend a PTSD patient get marijuana. “Half of the people who come in with pain have it for traumatic reasons,” Sulak said. “We often think of remembering as important to health. Forgetting is just as important.” Tolerated, not allowed As a federal hospital, the Togus VA center is at a crossroads between state and federal law when it treats Maine veterans. Though patients who go there may be state-authorized to use medicinal marijuana, state law doesn’t apply there. Marijuana is an illegal drug in the eyes of the feds — protected by state law or not. And possessing medical marijuana on VA property is a criminal offense. Furthermore, a January directive from Undersecretary for Health Dr. Robert Petzel said the Veterans Administration believes marijuana has no currently accepted medical use. In a statement issued Friday, VA spokesman Josh Taylor said “the Department of Veterans Affairs understands the importance of alternative treatments,” but that VA personnel are not allowed to authorize or recommend medical marijuana.” Still, “VA patients will not be denied service because of their participation in a state-approved medical marijuana program,” the statement said. The 2011 directive says that any prescriptions for chronic pain must be managed under the auspices of the VA’s “stepped-care” model, and that VA doctors make no recommendation for medical marijuana. That model, outlined in 2009, outlines a three-step program that includ
es development of a network of primary caregivers, timely access to specialists and “advanced pain medicine diagnostics.” Opioids are listed as one of the main pharamacological interventions. “The use of addictive pain medication, particularly opioid pain medication, has been the primary means of pain management for a significant period of time,” according to a VA slideshow presentation. Begin asks, “Do they actually want people to get better, or do they just want them in a pill haze?” Sulak said he had been receiving referrals from Togus — not for marijuana, but for other integrative medical services his offices provide. Then he said he received an “opinionated” letter from the hospital saying it wouldn’t route patients that way. “Someone in the referral office decided marijuana was bad,” he said. He said he stopped getting referrals from Togus this past winter. Benefits of bud? Begin buys his marijuana from a caregiver. For $235 an ounce, he gets a high-grade product from which he says he gets real relief from PTSD. And he isn’t bashful about it. At a recent meeting, standing well outside his truck with his 4-year-old daughter leaning out the window, he lit up a marijuana cigarette in a parking lot and showed a reporter jars of pot and a tincture bottle. It’s a normal occurrence. He said he even smokes while driving, and claims marijuana doesn’t adversely affect him. “It puts memories in a safe in your mind. You can access that safe, but it isn’t tormenting you every minute,” he said. “It’s not pounding away at the back of your eyeballs.” Begin said he devotes his time to advocating wider use of medical marijuana. He wants PTSD added to that qualifying list of conditions and also calls for alternative pain treatment — not the prescription medication he said impeded his progress. He said he knows many veterans who use black-market marijuana to treat various ailments. When he tells them to register, they bristle. “They’re scared. They don’t want to tell their doctors,” Begin said. “They don’t want to lose what they have.” Veterans are speaking out about the urgent need for research into the therapeutic benefits of marijuana just as MAPS awaits word from the U.S. Department of Health and Human Services about whether the agency will allow us to proceed with our planned, FDA-approved study of marijuana for symptoms of PTSD in veterans of war. In this article, Sgt. Ryan Begin tells the story of how marijuana helps him cope with the psychological and physical pain of combat-related trauma, and explains why making it available for him and his fellow soldiers should be one of our highest national priorities.