Summary: The Establishment profiles marijuana researcher Sue Sisley, M.D., highlighting why Sisley is working on the MAPS-sponsored clinical study of medical marijuana as a treatment for posttraumatic stress disorder (PTSD) in military veterans. “I believe these veterans when they claim that they are better, but those are their subjective reports, and now it’s time to put the plant through the rigors of a randomized control trial and see what data we generate by that,” Sisley said.
Originally appearing here.
When Dr. Sue Sisley, a lifelong Republican, was just beginning her residency at the Veterans Affairs hospital in Phoenix, she refused to believe her patients when they told her about the healing potential of cannabis.
“I’ve always been interested in cannabis as a social justice issue and a matter of public policy, but I was never able to embrace it as medicine until these veterans really taught me how,” Sisley told me.
Sisley was “highly dismissive and judgmental” of marijuana at first but, over time, as more and more veterans shared their experiences, she started to accept its therapeutic potential.
Now, not only does she regularly treat multiple conditions by prescribing legal medical cannabis as an Arizona-based family physician, she’s part of a team involved in the first government-funded study to examine the effectiveness of cannabis in treating post-traumatic stress disorder (PTSD) in vets.
The growing awareness of this plant’s therapeutic potential—as well as the spread of legal recreational and medicinal cannabis across the United States—has eased issues of access, but some significant barriers remain. One such obstruction is a Veterans Affairs administration that remains resistant to the drug, asserting that “marijuana use for medical conditions is an issue of growing concern” and that “there is no evidence at this time that marijuana is an effective treatment for PTSD.”
This decade, however, has seen some movement on the issue: The administration today usually allows vets to use cannabis without penalty in states where its access is legal.
Still, the government writ large remains resistant to cannabis law reform, even though numerous studies already show that cannabis can hold promising benefits for treating PTSD and many other conditions, including chronic pain.
While Sisley and her colleagues are eager to begin studying cannabis’ potential benefits as scientists, veterans like Joshua Apollo are already helping fellow vets access cannabis and teaching them how to use it more effectively.
Apollo’s service as a U.S. Army infantryman left him with lingering physical injuries and struggling with post-traumatic stress disorder, all culminating in a suicide attempt before he began treating himself with cannabis in 2010.
“Cannabis was the ultimate treatment for me. It saved my life. I haven’t had suicidal thoughts or tendencies since starting marijuana,” Apollo told me.
According to a recent study conducted by the Department of Veterans Affairs, there are 20 veteran suicides per day in the U.S., many of them older vets—a shockingly high figure that some veterans I’ve spoken to speculate may actually be too low.
As a vice president of the Sacramento, California, chapter of Weed for Warriors, Apollo’s helping to raise awareness on the medical benefits of cannabis and the need for legal reform. Founded in San Francisco in 2014, the national nonprofit shares donated medical cannabis with veterans, ensuring they can afford their medicine and use it in the most effective ways possible.
And while medical professionals continue to debate the benefits of cannabis for PTSD, the plant is bringing veterans closer together—and giving them an opportunity to bond over their shared suffering.
“Our meetings aren’t just about passing out meds, they’re about bringing like-minded individuals, veterans, together so they’re not locked in their house, so they don’t feel so alone,” Apollo said.
Soon, in addition to this solidarity, Sisley’s research may allow more vets to access key—sometimes even life-saving—treatment options related to the plant.
Apollo enlisted in the U.S. Army in 2001 at 17 years old. “Within a week of signing my paperwork, September 11 happened and that changed a lot of my view of the service and the world and everything that was going on.”
Apollo was shuttled around the U.S. before being deployed to Afghanistan, where he faced frequent firefights. Within a week of deploying, an IED (homemade bomb) put his life at risk. “I lost friends and comrades in war and outside of war,” Apollo said, recalling a team leader and squad leader who died in a “horrific” car accident in Hawaii, and the suicide of one of his first roommates and friends in the military.
“I was not prepared for that at 18 or 19 years old,” he said. “Physically, mentally, my mind was warped by the things I was told to do, the things I witnessed. By the things I had to do.”
Apollo continued, “Coming back from that, what was the main issue was seeing my family and not being able to tell them [what I’d experienced] . . . and the nightmares, that was the worst part.”
Once he’d been released from the military, he struggled not only with chronic pain from a broken leg and several other injuries, but also with PTSD, which can cause depression, social anxiety, unexplained anger and other difficult emotions, insomnia, and unpleasant feelings of hyper-alertness, among other symptoms. Veterans Affairs’ prescribed three different pharmaceuticals for Apollo, which he said left him feeling mentally foggy. Typical VA treatment for PTSD focuses on SSRI antidepressants, but many are also prescribed sleep aids or anti-anxiety drugs.
Like Sisley, Apollo was resistant to the idea of cannabis at first. Desperate for him to experience cannabis’ benefits after his 2010 suicide attempt, Apollo said his little brother “forced marijuana on me. He put me in the truck and hotboxed the truck.”
As he inhaled thick clouds of second-hand cannabis smoke, the effects were almost instantaneous. “I felt clear, I felt normal. I could grasp what was going on around me.”
Within six months, he told me he had quit using illegal street drugs and weaned himself off the prescription medications prescribed by the VA.
He still struggles with nightmares and insomnia, but said, “the only thing that allows me to sleep is cannabis.”
It also eases his social anxiety. Without cannabis, he said, “I would lock myself in my house and not go anywhere. I’m very much a recluse and a hermit without cannabis.”
He continued, “I don’t like the world, I don’t like how it treats veterans, I don’t like how we’re just left to die. Without cannabis I would be dead.”
I asked Sisley about how she came to accept the potential therapeutic benefits of cannabis.
“There were a bunch of specific cases where patients had transformative responses where they went from being almost lifeless and nonfunctional on the conventional meds that I was giving them.”
Without Sisley’s endorsement, her patients would begin to treat themselves with cannabis after hearing about the plant’s potential by word-of-mouth from other veterans.
“Then these vets would come back to me. That’s what’s really impressive to me, when vets find that path with cannabis, they always are determined to share that with the world . . . They would always have their spouse or their kid in tow to corroborate their stories. Over time it was really compelling.”
Many veterans seem to have become self-taught experts on the plant and the ways it can be
ingested. “I use different strains, different types of concentrates for different things that are bothering me, for different ailments—if I need to sleep, if I’m in pain, if I can’t focus,” Apollo told me.
“It’s amazing how sophisticated these vets are. They attack it like a science,” Sisley remarked.
“I actually prefer tea,” said Victoria, another Weed for Warriors veteran I interviewed, when I asked how she treats her PTSD.
Victoria is a private pre-school teacher in California now, and cannabis helps her control symptoms that include depression and anxiety.
“I put medicated honey in my tea, and consume that. A warm cup of tea before bed helps me sleep through the night.”
She also uses cannabis edibles and even bath bombs. Of the latter, she said, “It’s not like a high, it literally calms you, it just relaxes you.”
She never uses cannabis at school, but Victoria told me she’ll sometimes wake up early, so she can medicate herself and wait for the high to pass before work. “So by the time my day starts I’m fine, and I’m calm,” she told me, ready to deal with her students whom she described as “loud, loud, loud!”
Like the other vets I interviewed for this story, Victoria lives in California, where medical cannabis is widely available. “I haven’t been on any medication since I’ve been diagnosed with PTSD in 2013. In three years, I’ve been just using cannabis without meds,” she said.
When she doesn’t have access to cannabis, Victoria said she struggles with her mood and feeling hyper-alert to stimuli. “My depression kind of takes over. I’m way more irritated and easily startled.”
Before moving to California, she experimented with prescription antidepressants, but found them ineffective with unpleasant side effects. “I had really bad headaches and I felt like I couldn’t feel. I was just here. I was a gray blob. Just an outline of myself.”
Until the Veterans Affairs issued an important 2011 directive on the use of medical cannabis, vets could lose access to other pain medications if they tested positive for marijuana. Thanks in part to veterans’ activism, the VA is no longer supposed to penalize vets for using cannabis in legal states. But even now, Sisley told me, the directive is “inconsistently” applied.
“There’s no consistent approach for how VAs will deal with this,” she continued. “Not to mention the other 20-plus states that have no legal market—those vets are out of luck. They have to stay on the black market.”
In July 2014, Kristoffer Lewandowski, a U.S. Marine Corps veteran, faced life in prison for drug possession after a flare-up in his PTSD symptoms led to a domestic violence report, and police discovered the cannabis plants he was using to treat himself. Freed on bail, Lewandowski and his family moved from Oklahoma to California, where he easily obtained a medical permit for his treatment. But law enforcement surprised him in May 2015 with a raid at his children’s preschool, and extradited him back to Oklahoma to stand trial as a fugitive. Federal marshals said he was wanted for missing a pre-trial hearing, but Lewandowski told OC Weekly’s Nick Shou on September 7 that he’d never been informed about the hearing.
Fortunately, after Lewandowski’s story went viral last year, the state dropped felony charges against him, although he could still be sentenced to up to five years in prison at an upcoming sentencing hearing. His story remains an example of what can happen to vets seeking medical cannabis during the war on drugs.
In states without medical marijuana programs, Sisley told me, vets often avoid treatment at VA hospitals and doctors altogether, out of fear of that they could be drug-tested and lose their health benefits or violate a pain treatment contract. “Most of these guys will not seek treatment for any other medical conditions because they realize that cannabis will be a deal-breaker for their care at the VA.”
Many of them believe their disability benefits could also be put at risk. “I haven’t seen evidence of that happening ever but it’s a concern on every vet’s mind who receives disability payments,” Sisley noted.
“Vets in general are appropriately distrustful of the government. They don’t want to be in the system and be monitored by the government, to be tracked,” Sisley added.
Sisley told me she’s seen “tons of patients who have opioid abuse or dependence and most of them are on methadone or suboxone and they can’t get off of it.” But here, too, cannabis offers promise as a “substitution therapy.” Sisley explained: “Cannabis has been a really successful intervention for a lot of guys who have been stuck on opioids for years. They micro-dose cannabis throughout the day to help manage the opioid withdrawal syndrome.”
As PTSD tends to provoke or worsen substance abuse issues, thousands of veterans are also struggling with addiction to prescription painkillers.
Michiko, another vet I interviewed, is self-treating her dependence on fentanyl, a potent and dangerous pharmaceutical opiate, with cannabis. After a total of six years of service in Afghanistan, she has PTSD, a herniated disk, and nerve damage in her spine.
“I joined the military basically in a man’s world,” Michiko said. “They never thought that I could do what they do. I was always looked at like basically I’m a weak link.”
Michiko’s using cannabis, in part, because her PTSD is triggered by hospital settings and authority figures, making it difficult or even impossible for her to receive conventional treatment. That’s because, when she was in basic training, Michiko’s commander raped her while she was in a military hospital suffering from a fever.
“I left with the same fever because I was so scared to be in there,” she recalled. “Then I come back and there’s [military police] at my basic training, and they’re hounding me for information.”
Although her commanding officer was eventually punished as a serial rapist, she told me she was left with little emotional support as her military career continued. In Afghanistan, Michiko was sexually assaulted again by another superior officer.
“Every time I go into a doctor’s appointment I get triggers,” Michiko said. “Even at dentist appointments they have to heavily sedate me.”
And managing her addiction is still a struggle—she told me sometimes she feels like she wants to tear off her own skin—but for her it’s far preferable to treatment in a clinical setting, and in general, cannabis helps her sleep at night and eases her pain.
“[The VA wants] to put me in a rehab program or a detox program in a hospital. Well what’s that going to do for a person like me? Trigger!”
Further, Michiko fears that if she sought treatment through Veterans Affairs, officials would “punish” her for her addiction by limiting her access to future pain treatment. And like Apollo, Michiko feels like the VA relies too much on pharmaceuticals.
“I feel like it’s a catch-22: medicate to medicate to medicate more—and they don’t hear me screaming for help.”
“Every time I go into a doctor’s appointment I get triggers.”_ Sisley agreed that conventional medicine has few reliable solutions for addiction, and said cannabis “desperately needs more testing, and hopefully you’re going to see a lot more scientists focusing on this.”
“We’re the opioid overdose capital of the planet here, and we don’t have any good solutions. We’re forcing doctors to go to seminars on how to cut back on their opioid prescribing, but honestly that’s not going to fix this. We have to find other good treatments to help the existing addicted population to stop, and we don’t have any good treatments now.” For her part, Michiko told me she doesn’t regret her military service, despite all she suffe
red. “It made me into the person I am today. And I’m a strong-ass person, and I wouldn’t give that up for the world.”
“I believe these veterans when they claim that they are better, but those are their subjective reports, and now it’s time to put the plant through the rigors of a randomized control trial and see what data we generate by that,” Sisley said.
Most studies of cannabis, especially studies with government funding, focus on the safety of cannabis, rather than attempting to quantify its potential benefits as a medicine. That’s beginning to change, in part thanks to a study—“Placebo-Controlled, Triple-Blind, Randomized Crossover Pilot Study of the Safety and Efficacy of Four Different Potencies of Smoked Marijuana in 76 Veterans with Chronic, Treatment-Resistant Posttraumatic Stress Disorder (PTSD)”—led by the Multidisciplinary Association for Psychedelic Studies (MAPS), which received final government approval to proceed in April.
The study has been years in the making, first originating in a 2009 conversation between Sisley and Rick Doblin, the founder and executive director of MAPS. The goal is to demonstrate whether smoking marijuana can reduce symptoms in veterans whose PTSD is resistant to conventional treatment.
“I never expected seven years ago when we started down this path that it would take us this long to implement a study that was FDA approved so quickly, and had full funding. I had no way to anticipate the relentless amounts of government red tape that would be involved in trying to implement this thing.”
Controversy over the study even led to Sisley being fired from the University of Arizona in 2014, adding yet another hurdle. She told me her “personal opinion” is that “super wealthy, powerful groups” like the pharmaceutical industry, police, and the prison-industrial complex “have an abiding interest in keeping cannabis illegal, and thus any data that might legitimize marijuana as medicine is very threatening to them and to their business model.”
Through MAPS’ advocacy, the study not only moved closer toward its launch date through the years, but helped pave the way for future research as well. In June 2015, President Obama ended Public Health Service review of cannabis research, an extra review process that would frequently last months and which duplicated existing FDA standards for research.
Another stumbling block for MAPS is that researchers must use strains of cannabis grown by the National Institute on Drug Abuse, a government-funded addiction research institute, which the government claims is a safeguard against research cannabis being leaked onto the black market. As a result, one of the four strains in the study is less potent than the team would like, and may not reflect the strength of cannabis that veterans are using in the real world. But, in August, the DEA agreed to let new growers provide cannabis for future studies. Though Sisley expressed grave concerns about the bureaucracy surrounding the process of accrediting growers, it’s still an important step toward opening the field to more research into how cannabis can heal.
This historic study is the first-ever randomized-control trial of the efficacy of whole-plant cannabis (as opposed to extracts or synthetic concoctions) in PTSD in veterans. Seventy-six veterans will be selected, each with chronic PTSD that is resistant to other forms of treatment. The research is funded by a grant of over $2 million from the Colorado Department of Public Health and Environment (CDPHE).
MAPS has assembled an impressive team of medical experts to take on the research. Sisley will study one cohort of veterans in Phoenix, while Dr. Ryan Vandrey will oversee the other at Johns Hopkins University in Baltimore. Dr. Paula Riggs from the University of Colorado School of Medicine is overseeing the scientific integrity of the study as a whole, with Marcel Bonn-Miller, PhD, from the University of Pennsylvania acting as the study’s coordinating principal investigator.
“I have been forced to become an activist just out of sheer determination to get this study implemented, and to make sure our veterans get answers to the legitimate questions that they have,” Sisley said. “I think the public has this impression that I’m pro-cannabis when I’m not at all.”
She continued: “I’ve never used cannabis personally; I’m not part of the industry, I don’t own dispensaries, I’m a completely independent thinker on this, and I really have no idea what the results are going to show here. I hope that our hypothesis will prove correct, but there’s also a lot of variables here.”
Still, Sisley remains cautiously optimistic that the study will at least open the way to future research. “We just want to get objective data from any starting point.”
At the end of our conversation, Sisley praised the work of MAPS, but told me she thinks veterans are really the ones leading the way to nationwide legalization of medical cannabis.
“The political activism of the veterans groups are really astounding. It’s truly the tip of the spear here in persuading even the most conservative Republicans that this is medicine.”