The medical ethics of denying veterans cannabis and other entheogenic medicines while allowing pharmaceuticals

Currently the United States is experiencing one of the worst suicide epidemics in its history.  Veterans make up a significant portion of that epidemic. Almost one of every five.

Until the most recent report from the Veterans Administration (VA), the VA stated that approximately 22 veterans a day kill themselves.  The newest number from the VA indicates that the number is 20.   Either way this number would still just be the national number of “official veteran suicides,” since as things like suicide by car accident or drug overdose do not count as official suicide as far as the VA is concerned.

In 2014, more than 7,400 veterans killed themselves. This is more than the entire number of soldiers killed in Iraq and Afghanistan to date.  All the data cited below comes from the VA’s own study.

  • The risk for suicide is 21 percent higher among veterans compared to civilians.
  • Since 2001, the rate of suicide among female veterans has increased 85.2 percent.
  • 66% of suicides were conducted with firearms.
  • Of the 20 veterans that die from suicide each day, only 30% were users of VA services.
  • For every one person who dies by suicide, there are nearly 60 who have survived a suicide attempt, and approximately 278 who have experienced serious thoughts about killing themselves.
  • As of 2014, the VA estimates there were 22 million military veterans in the U.S. (7.3% of total).
  • The main causes of the high suicide rate are post-traumatic stress disorder (PTSD), traumatic brain injury, and depression. They are usually treated with counseling and medication. Experimental treatments are also available, some of which may be promising.

These experimental treatments can include yoga, qigong and t’ai chi, meditation, acupuncture, floatation tank therapy, light therapy, EMDR, animal therapy, bio-feedback and of course cannabis and other entheogenic medicines which include plant medicines, other earth medicines and semi-synthetic cousins of the natural medicines.

The study correctly indicates however that the veterans are usually treated with medication.  That is an understatement.  They are overtreated with medication which is pharmaceutical in nature resulting in addiction, suicidal ideation and suicide.

  • An average of 117 people commit suicide every day in the United States. Veterans accounted for 18% of all the country’s suicides in 2014, while comprising only 7.3% of the population.
  • Military victims of violent assault or rape are six times more likely to attempt suicide than military non-victims.
  • The U.S. Pentagon now spends $2 billion a year on mental health alone. The VA’s mental health budget has risen from less than $3 billion in 2007 to nearly $7 billion in 2014.
  • From 2001 to 2009, the Army’s suicide rate increased more than 150% while orders for psychiatric drugs rose 76% over the same period. 85% of military suicide victims had not seen combat.
  • In 2005 alone, 13% of all VA mental health costs, or $274 million, were spent on treating PTSD.
  • Currently 80% of vets labeled with PTSD receive psychotropic drugs; 89% of these are given antidepressants, with 34% treated with antipsychotics.
  • Between 2005 and 2011, the rate of antipsychotic drug use in the U.S. military rose 1,100%.
  • “Mental illness” remains the leading cause of hospitalization for active-duty troops.
  • 17% of the active-duty force and 6% of deployed troops are on antidepressants.

Dr. Bart Billings, Ph.D., a retired Army Colonel and former military psychologist and founder and director of the military-wide Human Assistance Rapid Response Team program, has no doubt that the cause of suicides in the military is the direct result of the use of psychiatric drugs.  “These medications are a chemical lobotomy.”

It is important to realize one of the reasons that these drugs are a death sentence is that they are written off label.  For a drug to be written on label for a specific indication (medical condition) it must be tested for efficacy and safety for use for that condition.  This means that any drugs written off label have not been tested for safety or efficacy for the condition the doctor is prescribing it for.  Seroquel is a telling example.

According to the VA, nearly $850 million has been spent on Seroquel, an antipsychotic, prescribed to the troops for sleep disorders at a rate of 6.6 million prescriptions.  Seroquel was approved by the FDA for the treatment of bipolar disorder and schizophrenia.  There were more than 54,000 Seroquel prescriptions last year, with 99 percent of those prescriptions written off-label—for disorders not approved by the FDA.

The FDA’s approved Medication Guide for Seroquel lists “Risk of Suicidal Thoughts or Actions,” as one of Seroquel’s “serious side effects”  including, but not limited to: hallucinations, worsening mental or mood changes (e.g., aggressiveness, agitation, anxiety, depression, exaggerated feeling of well-being, hostility, irritability and panic attacks).

In 2007 the Food and Drug Administration, FDA, updated its 2004 black-box warnings, on all the antidepressants on the market. The FDA warning reads in part “Suicidality and Antidepressant Drugs: Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder and other psychiatric disorders.”

There are only two medications approved for PTSD.  Zoloft and Paxil.  They are both Selective Serotonin Reuptake Inhibitors (SSRI’s).  To measure PTSD in a medical setting, studies use the CAPS-2 (Clinician Administered PTSD Scale Part 2).  The maximum possible score is 136, and a score of at least 50 is generally required for study entry. In the Zoloft preclinical trial, the average CAPS- 2 score before treatment was 73.9 in the Zoloft group, which translates to “severe” PTSD symptomatology. The efficacy measure was the reduction in CAPS-2 score from baseline to endpoint.

After 12 weeks, the Zoloft group went from 73.9 to 40.9 (a 33 point, or 45% improvement); the placebo group went from 73.5 to 47.3 (a 26.2 point, or 36% improvement).  The bottom line is that 75-80% of antidepressant response rates in clinical trials are actually due to placebo response.

What is the solution to this downward spiral of treating PTSD with pharmaceuticals that don’t really work and instead make the problem worse and increase the likelihood of suicide?  The natural plant medicines and their close chemical cousins seem to fit the bill.

After veterans have come back from war with PTSD, traumatic brain injury (TBI) and pain from being blown up and shot, they are put on a cocktail of up to as many as 30 different drugs per day which can include: Tricyclics and Monoamine Oxidase Inhibitors, Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, Anticonvulsants, Antipsychotics, Benzodiazepines and Other GABAergic Drugs and Antiadrenergic Drugs.

They also generally self-medicate with the culturally approved temporary pain reducer-alcohol.  Eventually the result is that the medications’ side effect of suicidal ideation take their toll and veterans try to kill themselves.  If they are fortunate they find cannabis and contrary to the myth you have heard about it being a gateway drug, for veterans, it is a gateway to life. They are able to get off the pharmaceuticals and treat their PTSD, TBI and pain with cannabis.

Even so the cannabis treats the symptoms of the PTSD and not the underlying causes.  For that you need the power plants and medicines: ayahuasca, psilocybin, mescaline, LSD (semi-synthetic cousin of LSA found in morning glories), MDMA (semi-synthetic cousin of safrole), ibogaine, DMT and 5-Meo-DMT (the last two are neurotransmitters in the human brain, also both schedule 1 by the way).

These substances can allow the sufferer to treat the underlying reasons for the trauma allowing for permanent release.  With ibogaine you have the opportunity for treatment of addiction.  Also these substance can work on service trauma not connected with combat like military sexual trauma of which the military is facing another crisis.

One might legitimately argue that even though some of the medicines have been used for thousands of years how do we know that they are safe and that they work?  We’re not suggesting that we use them off label like the pharmaceuticals, are we? 😉

Well how does MDMA stack up against Zoloft and Paxil which are already on label for PTSD?  In 2010 Dr. Michael Mithoefer, MD and Annie Mithoefer, BSN conducted a MAPS-sponsored study – Randomized Triple-Blind, Phase 2 Pilot Study Comparing 3 Different Doses of MDMA in Conjunction with Manualized Psychotherapy in 24 Veterans with Chronic PTSD.

The results of the Phase 2 pilot study (which involved 20 patients with an average PTSD duration of over 19 years) showed that 83.3% of the experimental group subjects displayed a clinical response (defined as a 30% or greater reduction in score on the CAPS test) compared to only 25% in the group that received only therapy and active placebo.  The MAPS’ MDMA research program could now entering Phase 3 in the June 2017, with completion of Phase 3 and approval of MDMA as a prescription medicine estimated around 2020.

The FDA recently encouraged MAPS to apply for Breakthrough Therapy Designation for MDMA-assisted psychotherapy as a treatment for PTSD. According to the FDA, a breakthrough therapy is intended “to treat a serious or life threatening disease condition,” and “may demonstrate substantial improvement over existing therapies.” If approved, Breakthrough Therapy Designation could expedite the development and review of MDMA-assisted psychotherapy for PTSD.

I know the plant and earth medicines work for service trauma as I have gone to Peru and Mexico with other veterans where we have successfully used ayahuasca, ibogaine, 5-Meo-DMT and other plants to treat PTSD with the help of shamans, healers, facilitators and doctors and of course one another.  Veteran love is the best medicine.  Veterans have learned and recent studies have shown that the highest correlating factor for contracting PTSD from military service is childhood trauma.

The medicines help veterans achieve self-love, self-acceptance and self-forgiveness.  This healing allows for veterans to reintegrate into society.  These outputs of the war machine who swore an oath to defend the Constitution against enemies foreign and domestic, who signed their lives away on the dotted line and have not renounced their oath, who are trained in lethal force and are seeking belonging and a calling to a higher purpose, can take their rightful place in society as peaceful warriors showing the rest of humanity a way forward.

Veterans are the light at the tip of the candle, illuminating the way for the whole nation. If Veterans can achieve awareness, transformation, understanding and peace, they can share with the rest of society the realities of war.  And they can teach us how to make peace with ourselves and each other, so we never have to use violence to resolve conflicts again by Thich Nhat Hanh.

If we choose not to reintegrate these veterans we can expect to see many more situations like Fort Lauderdale, Dallas and Baton Rouge where unintegrated combat veterans kill civilians and police.

This is not an abstract issue for me.  I dedicate this article to the memory of Brandon Ketchum. He served three tours in Iraq and Afghanistan as both a Marine and a soldier in the Army.  During the two tours in Iraq, locating and clearing road side bombs, he survived five “hard hits” or explosions.

He was addicted to a high dose of narcotic pain meds, began abusing them and eventually started using heroin. In February 2015 he overdosed and nearly died but was saved by paramedics, one of whom had previously served in combat with him.  Brandon had just graduated from the VA’s substance use disorder program in March, 2016.  Here is a portion of his explanation of his desire to join us in Peru which ultimately became his own eulogy beyond the grave.

“Now that I have more control of myself and my life I have begun the daunting task of starting to piece my life back together after the traumas of three hard fought combat tours had taken a costly toll on nearly every aspect of my life.”

“The physical and mental symptoms of severe PTSD, depression, anxiety, and the inability to adapt back to the real world has been a tremendous obstacle for me, particularly going through nearly 25-30 different types of meds yet finding no solid gains or improvements. I am a firm believer in medical marijuana but unfortunately it is not yet legalized where I live.”

“Asking for help has only clouded my life with such a stigma that I have carried the “crazy” or “broken” labels, forcing me to have to fight for custody of my little girl that I love more than the world. I’m nearing some possible successes in some aspects of my life, directly as a result of my unwillingness to be discarded and dismissed by the country I swore to give my life for. But at the end of the day, I feel that I am also at war with myself and my “demons.”

He was scheduled to go with us to Peru for a 10-day dieta with three Shipibo shaman brothers last May to take ayahuasca and other plant medicines.  He couldn’t get his passport in time to go because of not having an original Texas birth certificate.  Less than 3 months later he went to his local VA and tried to check himself in but they refused him and he went home and killed himself.

“I requested that I get admitted to 9W (psych ward) and get things straightened out,” he wrote on Facebook hours before committing suicide. “I truly felt my safety and health were in jeopardy, as I discussed with the doc. Not only did I get a ‘NO’, but three reasons of no based on me being not f***** up enough. At this point I say, ‘why even try anymore?’ They gave up on me, so why shouldn’t I give up on myself? Right now, that is the only viable option given my circumstances and frame of mind.”

So if you support the troops and you also believe that we will one day that “they will beat their swords into plowshares and their spears into pruning hooks and that nation will not take up sword against nation, nor will they train for war anymore” then we must first heal our soldiers to be able to truly bring them home.

malachi-2

“Escape” by Malachi Muncy

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About Ian Benouis

Ian Benouis is a West Point graduate, former Blackhawk helicopter pilot, US Army officer and combat veteran who participated in Operation Just Cause in the Republic of Panama. This operation was the largest combat operation in US history focused directly on the War on Drugs. He was a pilot-in-command and his aviation brigade flew more night vision goggle hours than any unit in the military except for the Task Force 160 Special Operations which his unit was ultimately rolled up into when the Fort Ord, California military base was shut down. Ian grew up in Hawaii in the 1970’s where cannabis was decriminalized and fully integrated in to the culture. He has been healing himself of trauma for over 25 years with sacred plants, a spiritual practice, and being a student and practitioner of ethnobotany. Ian was a pharmaceutical representative for Pfizer after he got out of the Army witnessing firsthand the meteoric rise of the SSRI’s and synthetic opioids in the early 1990’s. He is a casualty of the drug war having been busted for a friend’s cannabis while in law school. Ian is an intellectual property attorney who has been working in the corporate world for over 20 years in the primary roles of VP of Sales and Marketing and General Counsel. He is a political activist in the cannabis and natural plant medicine space nationally and locally in Texas. Ian was previously the Chairman of the Board for a public policy foundation in Texas for over seven years. Ian was featured in the Spike Jonze produced episode Stoned Vets on Weediquette the cannabis focused series on Viceland on HBO with a number of other veterans protesting the VA’s policy on medical cannabis and trying to end the veteran suicide epidemic. In 2016 Ian organized a trip for six veterans with PTSD to Peru in May for a 10-day plant diet including ayahuasca and other plant medicines with three Shipibo shaman brothers that are third generation plant medicine healers. Ian also took some of the same veterans to Mexico for treatment with iboga and 5-Meo-DMT. This experience was captured on video and was released as a documentary on March 2017 entitled Soldiers of the Vine. He is member of the team working on the movie From Shock to Awe a feature-length documentary that will chronicle the journeys of military veterans as they seek relief from Post-Traumatic Stress Disorder with the help of ayahuasca, MDMA and cannabis.