Monday, February 21, 2011

Opiates For PTSD

As those of you who read me regularly know I have frequently been inflicting on you a link to my article Heroin in discussions of both the Drug War and PTSD. And some of you with an irrational hatred of Heroin have derided me and told me I'm full of it. The evidence in the article was circumstantial and not extremely strong. Well I have some extremely strong evidence now and it first surfaced in my article Underground In Las Vegas. And where did the evidence come from? Probably the most conservative sector of our society. The US Military.

And what is the military prescribing for PTSD? The article refers to them as narcotics. Really they are opiate analogs. Here is part of the story:

By some estimates, well over 300,000 troops have returned from Iraq or Afghanistan with P.T.S.D., depression, traumatic brain injury or some combination of those. The Pentagon has looked to pharmacology to treat those complex problems, following the lead of civilian medicine. As a result, psychiatric drugs have been used more widely across the military than in any previous war.

But those medications, along with narcotic painkillers, are being increasingly linked to a rising tide of other problems, among them drug dependency, suicide and fatal accidents — sometimes from the interaction of the drugs themselves. An Army report on suicide released last year documented the problem, saying one-third of the force was on at least one prescription medication.

“Prescription drug use is on the rise,” the report said, noting that medications were involved in one-third of the record 162 suicides by active-duty soldiers in 2009. An additional 101 soldiers died accidentally from the toxic mixing of prescription drugs from 2006 to 2009.
Obviously the military doctors are having no more luck with PTSD than their civilian counterparts. Which is to say - there is no cure.

But the civilian doctors in some states have an option the military doesn't have. Medical Marijuana.
Chronic pain conditions change peoples lives. The discomfort and pain is consuming. Many patients fail to truly weigh the pros and cons of the medications they are given for pain, especially those who have chronic conditions. Constipating opiates are almost always an option, but medical marijuana is rarely discussed. But, it should be an option for those facing hard treatment decisions regarding long term medication use. There are blood tests that doctors run to check for long term kidney and liver damage by medications, although they fail to mention all of the reasons for testing. The very idea that it is routine for some doctors to check to the amount of damage a medication can do to the kidneys and liver is indicative of its inherent damage. Medical marijuana presents none of those problems.

Chronic pain patients often end up at pain management facilities. Treating chronic pain is about providing the patient with the best quality of life while they are in pain, whether this is cancer pain or herniated disc pain awaiting new surgical fusion technology. Pain treatment often involves a combination of physical therapy, medication, relaxation, ice and heat rotations, and surgery. Doctors prescribe cocktails drawing from Opioids, Anti-convulsives, muscle relaxants, beta blockers, Benzodiazepines, antidepressants, and others. Rather than discuss medical marijuana and the proven efficacy of cannabis as a pain remedy, patients are given expensive cocktails. Medical marijuana has long been a taboo subject for patients, especially when it comes to asking their primary care doctor. The stigma associated with medical marijuana blinds physicians from seeing that cannabis often far outweighs the use of other medication combinations. Medical marijuana is a valid treatment for many conditions. Using medical marijuana can reduce the amount of other medications. Marijuana is safer.
Yep. Marijuana is safer. DEA Judge Young in a legal opinion about marijuana as medicine said:
Marijuana, in its natural form, is one of the safest therapeutically active substances known to man.
What else can marijuana do when combined with opiates?
Medical marijuana can help pain patients in many ways. Using cannabis as an adjunct medicine can help opiate pain meds work better. Medical marijuana can successfully treat pain and help lower the overall dose of narcotics, something that is healthy for the patient.
Marijuana is safer than a very common psychoactive over the counter drug. Alcohol. In fact some one has written a book about it.

Marijuana is Safer: So Why Are We Driving People to Drink?

In fact alcohol was considered a kind of folk remedy for PTSD before the condition had an official name. Back in the day it was called "shell shock" or similar. And as you might have guessed I have written something on the subject. See: The Soldiers Disease.

Our understanding of the use of marijuana for PTSD is rather advanced. See: PTSD and the Endocannabinoid System.

Now my questions are a simple ones. Why don't those who have so much compassion for our military men work for the repeal of Federal Marijuana Prohibition so those in desperate need can get better help than they are now receiving? And why aren't we looking at the vast untreated population in America with PTSD who are now self medicating with illegal drugs? Why are we punishing the traumatized in this country? Or at least those the government can catch and of course their suppliers. I do not consider the drug dealers evil. I think of them as heroes. They are helping people (for profit - just like the pharma companies) that our government in its infinite wisdom does not count as worthy of treatment. Unless their condition was acquired on the battlefield. Why are victims of sexual assault or child abuse any less worthy than the folks in the military?

Cross Posted at Classical Values


Clayton said...

You might want to go back and re-read that article in the Times a bit more carefully. Psychotropic drugs are being prescribed in large numbers for PTSD, and the interaction with narcotic painkillers (apparently not for PTSD, but for injuries) are causing a lot of deaths. My guess is that the pscyhiatrists prescribing for the PTSD are unaware of the painkiller prescriptions written by physicians for the pain.

IowaBill said...

Well Mark, you've been banging that drum for drug legalization for quite some time now...
And I've come to see legalization as an evil - but the lesser of two evils.
"Give strong drink to him who is perishing, and wine to him whose life is bitter." - Prov 31:6
So if people want to commit slow suicide by 'easing their pain', perhaps it is a lesser evil than crime for the sake of narcotrafficking.
'Tis a shame you make a convert out of me as I give up hope on others.

M. Simon said...


It is not entirely clear what the opiates (or their analogs) are prescribed for. Pain for sure.

this article may shed some light:

Morphine for Pain Linked to Reduced PTSD Risk in Soldiers

Or it may cloud the issue further.

PTSD and opiate use - an anecdote

It discusses the current nonsense about "treatment".

Morphine helps those with PTSD - NEJM - it points to the use of morphine immediately following trauma. How do you do that for 5 year old victims of sexual abuse who can't even tell what is going on?

An emerging body of research has documented a very strong association between Posttraumatic Stress Disorder (PTSD) and substance abuse. In most cases, substance use begins after the exposure to trauma and the development of PTSD, thus making PTSD a risk factor for drug abuse.

Early intervention to help children and adolescents who have suffered trauma from violence or a disaster is critical. Children who witness or are exposed to a traumatic event and are clinically diagnosed with PTSD have a greater likelihood for developing later drug and/or alcohol use disorders.

The Link Between PTSD and Substance Abuse

A comment:

Opiophile board

It makes sense. I mean if the stress during the experience is reduced, then the post-stress would have to be significantly reduced or eliminated as well.

But you would think this would kinda encourage the "something shitty happened -- take some morphine!" behavior in those people.


We have an under treated population. The under treatment comes from folks who hold your previous attitude. i.e. it is a moral question rather than a medical question. So much of what we call "morality" is mere superstition.

IMO government imposed moral sanctions should only apply between persons A and B. Not between person A and A. And if A and B consent (assuming consent is reasoned - i.e. children can't consent) then no problem. Of course there is more nuance than that (you can't consent to have yourself murdered) but that should be the general rule.

People learn from their mistakes (St. Augustine). We should let them.