iCount for Veterans: A Research Platform to Connect Veterans with Cannabis Research Studies led by the Cannabis Center of Excellence, UMass Dartmouth, and Patriots Helping Vets

A Hero’s Journey: Fighting for Medical Cannabis as a Patient, a Veteran, and an Advocate

Bipartisan Support Steps in to Help Veterans’ Access to Medical Cannabis

Americans for Safe Access’ Declassified Guide to Becoming a Medical Cannabis Advocate

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Cannabis Patient Care November/December 2022 Digital Edition

Anxiety, Trauma, and the Endocannabinoid System

Anxiety disorders are the most common type of psychiatric disorders, and they’re one of the most common conditions for which people use cannabis. One review found that among 6665 cannabis users with data collected from 13 different studies, 52% of the subjects reported using cannabis for anxiety, making it the second most commonly treated symptom, following pain (1). Anxiety disorders come in many forms, including generalized anxiety, social anxiety, and panic disorders.

While symptoms vary depending on the specific anxiety disorder, it’s been my clinical experience that any of the anxiety disorders can be treated with a high rate of success when cannabis is used appropriately. Perhaps this is related to the high density of cannabinoid type 1 (CB1) receptors in a brain region called the amygdala and in the sympathetic (that is, fight or flight) centers of nervous system. The amygdala plays a large role in modulating fear and anxiety, and its response to anxiety-provoking cues is exaggerated in people with anxiety disorders; stimulating CB1 can dampen this excessive activity. Similarly, the sympathetic nervous system contains CB1 receptors that will also dampen excessive activity related to the physical effects of anxiety like racing heart rate, sweating, or trembling.

Though they are closely related to anxiety disorders, the 

Diagnostic and Statistical Manual of Mental Disorders

, 5th edition (DSM-5) created a new category for “trauma- and stressor-related disorders” that includes acute stress disorder and post-traumatic stress disorder (PTSD) (2). These conditions develop as an abnormal adaptation to a traumatic event and symptoms include intrusive thoughts, nightmares and flashbacks, avoidance of reminders of the trauma, negative changes in cognition and mood, irritability, and increased sensitivity and reactivity known as hypervigilance, a perpetual scanning of the environment to search for anything threatening.

Like anxiety disorders, evidence suggests endocannabinoid system (ECS) dysfunction may contribute to trauma-related disorders. Reduced blood levels of the endocannabinoid anandamide (AEA), abnormal CB1 receptor signaling, and a compensatory increase of CB1 receptor availability are associated with PTSD and correlate with the degree of intrusive symptoms (3). For example, in one study of 46 individuals in close proximity to the World Trade Center at the time of the 9/11 attacks, the 24 subjects who met diagnostic criteria for PTSD had significantly lower circulating levels of the endocannabinoid 2-AG than those who did not have PTSD. Those with the lowest levels of AEA levels had the most intrusive symptoms, consistent with animal data indicating that reductions in AEA promote retention of aversive emotional memories (4).

Although anxiety disorders are categorized separately from trauma-related disorders in the allopathic psychiatry model, in my experience, most anxiety symptoms can be traced to traumatic or overwhelming experiences and the behavioral patterns that emerge thereafter. I suspect that regardless of the diagnosis, cannabis is likely working similarly in people with anxiety disorders or trauma-related disorders: dampening the anxiety response to certain cues or triggers, reducing the intensity of fight or flight symptoms, perhaps preventing the development of PTSD after a traumatic event, and, as described below, healing the traumatic memories themselves.

Why Does Cannabis Succeed Where Other Treatments Fail?

PTSD is often resistant to traditional antidepressant and anti-anxiety medications, in part because these treatments fail to address memory-related dysfunction seen in people with PTSD, such as the inability to extinguish learned fear responses, to suppress retrieval of traumatic memories, to acquire safety signals, and to dampen the over-consolidation

 process taking place right after reexperiencing symptoms. [*Note that consolidation is the process of transforming a short-term memory into a long-term memory. People who re-experience trauma can increase the consolidation of the traumatic memory with each re-experiencing episode, worsening the condition.]

The ECS is an important part of our ability to extinguish the emotional charge behind, and even forget our traumatic memories. Cannabinoids may be ideal for treating PTSD due to their dual anti-anxiety and memory-modulating effects. Animal and early clinical research have produced encouraging results targeting the extinction of fear memories, which could “reduce the conditioned fear and anxiety responses triggered by trauma reminders, increasing patients’ general ability to actively cope with the trauma without affecting the original memory trace” (5).

Furthermore, cannabis is safer than many anxiety drugs, especially those in the benzodiazepine class (such as Xanax or Valium) which, with long-term use, can cause dependence, neurotoxicity, cognitive and memory problems, and more. Patients are often successful replacing these dangerous anxiety medications with cannabis, and are motivated to do so because cannabis works better and has fewer side effects. One study found that 45% of benzodiazepine users stopped the drugs completely after starting medical cannabis (6). Another survey of 1513 dispensary members revealed that 71.8% of respondents reduced their intake of anti-anxiety medications (7).

The use of tetrahydrocannabinol (THC)-dominant cannabis has been associated with both anti-anxiety effects at lower doses and anxiety-causing effects at higher doses (8). Clearly, THC overdose often produces severe anxiety and paranoia; even though people often are certain they’re dying and require emergency medical care, that’s rarely the case.

For most people, there’s a wide range between a relaxing dose and an anxiety-producing dose.

Cannabis users who ingest drops, edibles, or capsules might have to consume 2-3 times their normal anti-anxiety dose or more to experience this paradoxical effect. Inhaled cannabis can be a little touchier for some people with anxiety. The rapid onset of anti-anxiety relief after smoking or vaporizing makes this an appealing route of administration, but small differences in the type of cannabis being inhaled or the total dose can swing some sensitive individuals into worse anxiety.

I’ve spoken with several patients who experience this side effect and think the best strategy is just to “deal with it.” They inhale cannabis, feel more anxious for 10-30 minutes, then appreciate the anti-anxiety effects in the following 1-3 hours. At the end of the article I provide practical solutions for people who can relate to this; most are able to modify their use pattern to achieve all relief and no exacerbation of symptoms.

While the bidirectional dose-response effect on anxiety may be most evident for THC-dominant cannabis, pharmaceutical-grade cannabidiol (CBD) has also demonstrated similar dose–response trends (9). For example, in one study of healthy subjects, a 300-mg dose of CBD was associated with improvements in anxiety scores compared to placebo during public speaking, while a 900-mg dose was associated with increased anxiety scores compared to placebo (10). These doses are not practical or necessary for most people; the more standard range of CBD dosing for anxiety, 10–50 mg up to 3x daily, is likely to help reduce and unlikely to increase anxiety.

As mentioned above, the ability to unlearn, or extinguish, fearful memories and their associated responses is an important part of the healing process in trauma-related disorders. This type of healing is often the goal of several non-pharmacological treatments like eye movement desensitization and reprocessing (EMDR), prolonged exposure therapy, cognitive and behavioral therapy (CBT), and emotional freedom technique. Several experimental human studies have indicated that cannabinoids can also be helpful in fear extinction, potentially improving the benefits of some of these other types of therapy when used together.

For example, a single 7.5-mg dose of THC administered 2 hours before fear extinction treatment, compared to placebo, resulted in significantly decreased threat responses 1 day and 1 week later, accompanied with functional brain imaging data showing a significant effect on the connectivity of threat-detection networks (11). Another study found that 32 mg of inhaled CBD enhanced consolidation of fear extinction learning in humans (12). Both suggest that cannabinoids may have potential as an adjunct to extinction-based therapies for anxiety and trauma disorders.

Another study found that among 136 individuals receiving cannabitriol (CBT) for co-occurring PTSD and substance use disorders, higher cannabis use was associated with greater PTSD symptom severity early in treatment but lower PTSD symptom severity later in treatment. The authors suggested that cannabis may have interacted synergistically with psychological treatment to reduce PTSD symptoms (13).

It’s important to remember that for those of us with anxiety and trauma-related symptoms, life is therapy, or at least it can be. We frequently encounter situations that trigger anxiety or intrusive thoughts; how we respond to these challenges determines whether the experience is healing or harmful. After talking to thousands of cannabis users in my clinic, I’m certain that cannabis can be intentionally used to increase the likelihood of healing.

For example, I’ve worked with a 34-year-old veteran who was injured by a roadside explosion in the Middle East. He returned to civilian life with recurrent episodes of extreme distress, most commonly triggered by visual stimuli while driving, such as a red flag tied to the end of lumber extending from the back of a pickup truck. These episodes were debilitating until he started using cannabis. He explained that every time he was triggered in this way, he would pull over, take an inhalation or two of THC-rich cannabis from a pipe he kept in his car, and then meditate for 15–30 min before continuing on his way (assuring me he avoided driving until any potential impairment had subsided). One day he was proud to report that seeing a red flag on the way to the office visit, for the first time since his injury, elicited no adverse response. Perhaps his use of cannabis with every trigger enhanced “fear extinction learning”—he was able to learn that the visual stimulus was actually non-threatening.

Surprisingly little high-quality research has directly evaluated the effects of medical cannabis on symptoms in patients with anxiety and trauma-related disorders, though the evidence is growing.

More studies have evaluated the use of nabilone, a synthetic THC analogue with better absorption, in patients with anxiety and PTSD than we’ve seen with herbal cannabis.

For example, a placebo-controlled crossover trial of nabilone (0.5–3 mg at bedtime) in 10 military personnel with PTSD demonstrated a significant reduction in nightmares, improvement in general well-being, and improvement in Clinical Global Impression of Change scores (14).

Another double-blind trial of 20 patients with anxiety treated with nabilone (1 mg three times daily) demonstrated dramatic improvement in anxiety in the nabilone group when compared with placebo (15).

In an observational study of six patients requiring multiple antidepressants for mixed anxiety and mood disorders, nabilone titrated from just 0.25 mg to 1 mg at bedtime showed an average improvement in Generalized Anxiety Disorder scores of 26.5% over 6 months (16). This supports my observation that some patients with anxiety are able to use cannabis in the evening with residual improvements in symptoms the following day, and that the response to this dosing strategy continues to improve over months.

In a larger retrospective study of 104 incarcerated men with serious mental illness, treatment with nabilone (average of 4 mg daily) led to significant improvement in PTSD-associated insomnia, nightmares, PTSD symptoms, and Global Assessment of Functioning scores, as well as improvements in chronic pain. Many of their other medications were able to be discontinued, and there was no evidence of nabilone abuse or diversion. The authors found it particularly noteworthy that, in virtually all subjects, nabilone targeted several symptoms simultaneously (average 3.5 symptoms per participant) (17), an outcome we’re used to seeing with cannabis treatments.

Other small studies have evaluated synthetic THC. For example, an open-label pilot study carried out in 10 patients with chronic PTSD, on stable medication, found that adding on 5 mg of THC twice a day led to statistically significant improvements in global symptom severity, sleep quality, frequency of nightmares, and PTSD hyperarousal symptoms (18).

There’s also some evidence from controlled studies using high-dose, purified CBD. For example, in one placebo-controlled study of 24 treatment-naïve patients with generalized social anxiety disorder, pretreatment with600 mg of CBD before a simulated public speaking test significantly reduced anxiety, cognitive impairment, and discomfort in speech performance (19).

Not all clinical evidence supporting cannabis for anxiety and trauma-related disorders comes from studies using isolated compounds. Eight cross-sectional studies evaluating the use of cannabis or cannabis-derived products reported relief of anxiety as a primary or secondary benefit (20). A retrospective study analyzing PTSD symptoms collected during 80 psychiatric evaluations of patients applying to the New Mexico Medical Cannabis Program during 2009–2011 identified >75% reduction in Clinician-Administered PTSD Scale for DSM-IV symptom scores when patients with PTSD were using cannabis compared to when they were not (21).

Dr. Sue Sisley and colleague’s long-awaited cannabis for military veterans with PTSD clinical trial was finally published in 2021. The trial compared four types of cannabis cigarettes: THC-dominant (type I), mixed THC/CBD (type II), CBD-dominant (type III), and placebo cannabis. Interestingly, all treatment groups (including placebo) achieved statistically significant reductions in PTSD severity. The improvements measured at 3 weeks were much greater than those reported in other drug trials for PTSD at 10 weeks (22). Due to the excellent response in the placebo group, the headlines surrounding this publication indicated the cannabis treatment was ineffective. Though the results in the placebo group are thought-provoking, this study did confirm the benefits reported by so many veterans who smoke cannabis for this purpose.

Regarding CBD-dominant cannabis treatment, a large case series found that CBD at doses of 25–175 mg/day reduced anxiety scores in 57 of 72 patients (23). Another case series on 11 adult patients with PTSD found an average of around 50 mg of CBD, added to their routine psychiatric care, reduced symptoms in 10 patients by an average of 28% after 8 weeks of treatment (24).

Finally, a recent open-label study followed 2820 subjects who used one of 13 brands of CBD products (including Healer) over four weeks, and collected survey responses on pain, anxiety, sleep, and quality of life. The results of those taking CBD products were compared with a control group of individuals on a wait list. Among those with anxiety, 46.6% of those using a CBD product experienced a clinically relevant improvement in their anxiety score, compared to 19.6% in the wait list group (25).

For some people, using a CBD-dominant preparation for anxiety may require fairly high doses, which can become cost-prohibitive. Though it hasn’t been directly studied in humans, my clinical observations also suggest cannabidiolic acid (CBDA) can help with anxiety, often at much lower doses than CBD. Some rodent data support this observation; one study found CBDA prevented the anxiety response to a specific trigger at a dose of 1 μg/kg, while the dose of CBD required to achieve the same effect was 5000 μg/kg (26). This is likely because CBDA also impacts the same 5-HT1A serotonin receptor as CBD, but much more potently.

When Cannabis Brings Trauma to the Surface

Consistent with the often-observed paradoxical effects of cannabis, it’s clear that for some people, at certain times, cannabis can provoke the surfacing of long-ago buried traumatic memories. I’ve listened to many reports of adults who have had years or decades of a relationship with cannabis that has reduced trauma-related symptoms and permitted improved function and quality of life, and then something changes. Often suddenly, though sometimes gradually, cannabis begins doing the opposite, increasing anxiety and remembering or re-experiencing traumatic memories.

My understanding of the healing nature of cannabis and observation of patients have always suggested that cannabis is more likely to have this effect when the individual becomes ready to heal the cause of the anxiety, usually trauma, and can ultimately derive more benefit from cannabis by addressing the underlying cause than simply relieving symptoms. As our self-understanding and self-love develops and we cultivate more supportive resources in our lives, our readiness to deal with the underlying trauma increases.

My recent work with a modality called Psychedelic Somatic Interactional Psychotherapy (PSIP) (27) confirmed my hypothesis and provided a framework for taking advantage of cannabis’ capacity to encourage the surfacing of old trauma. PSIP is a model of trauma therapy based in-part on the concept that some traumatic events are so overwhelming that aspects or layers of our psyche become dissociated (checked-out) to more easily deal with the intense terror and anxiety. While this can be adaptive in the short-term, over time it limits our capacity to fully feel like and act like ourselves. As we move towards healing, self-acceptance, and loving relationships, these limitations may become more apparent bottlenecks in our ability to live fully, and eventually our health attempts to re-integrate the dissociated parts.

Often, the process of reclaiming these lost parts of ourselves requires us to move from a comfortable but limited state of dissociation, back into the feelings of intense terror and anxiety associated with the trauma, and then finally back to a neutral, integrated state. The PSIP technique allows the soma (physical body) to express involuntary activity such as shaking, crying, vocalizations, and physically re-enacting aspects of old trauma, which can be very helpful in proceeding through these uncomfortable feelings and back to wholeness, instead of just visiting them and quickly retreating back into dissociation.

Of all the psychedelic-like substances that can facilitate this healing process, cannabis appears to be the strongest and most effective at catapulting these dissociated parts into the often-uncomfortable light of healing.

The following tips can help people with anxiety or PTSD get the best results with cannabis. For those who are used to using only inhaled cannabis for anxiety, I strongly recommend becoming familiar with and finding your optimal dose of cannabis drops or another oral or oromucosal product. Healer.com offers complimentary dosage programs that guide users through a process that will help you find your individualized, optimal dose.

One of the most important strategies for success is to prevent symptoms, instead of chasing them around, with low to moderate oromucosal or oral dosing 2–3 times daily. Many patients do well with CBD-dominant preparations in the daytime (10–50 mg per dose) and THC-dominant preparations before bed (5–25 mg). Many people also do well with THC-dominant preparations during the day, often at 1/4 to 1/3 of the dose required for sleep (such as 1–5 mg), which rarely causes any unwanted psychoactivity or impairment, and can be more cost effective than CBD for some.

For people who require high doses of CBD or don’t find that CBD helps with anxiety in the doses they’ve tried, CBDA may provide better anti-anxiety results at much lower doses, for example, 5–20 mg.

Cannabigerol (CBG)-dominant preparations can be very effective for relieving and preventing anxiety and trauma-related symptoms, especially the physical manifestations of anxiety. I see responses at doses as low as 5 mg, though some do well with up to 40 mg per dose.

Low-dose inhaled cannabis can be extremely helpful for breakthrough anxiety symptoms and, in the experienced user, to abort panic attacks and intense re-experiencing symptoms. This can be especially effective when the inhaled cannabis is followed by a relaxation technique.

I have observed nearly universal success reducing or resolving trauma-related nightmares and sleep disturbance with THC-dominant oral preparations, usually in the 5-25 mg range. This essential priority often yields global improvements in symptoms around the clock.

For people who inhale THC-dominant cannabis, selecting the right variety can be essential. Some THC-dominant varieties are known for their anti-anxiety effects, while others are commonly anxiety-producing. Inhaling CBD-dominant or mixed THC/CBD cannabis can also work very well with less risk of worsening anxiety.

Concurrent nonpharmacological treatments, such as cognitive and behavioral therapies, breathing exercises and meditations, biofeedback, and physical exercise, are likely to improve to effectiveness of cannabis. Videos teaching some of these techniques can be found at Healer.com/wellness.

High doses and inhaled delivery of THC-dominant cannabis, including cannabis concentrates, and are most likely to acutely increase anxiety.

Long-term, high-dose cannabis use that leads to tolerance may worsen baseline anxiety symptoms over time and increase the likelihood of anxiety symptoms during withdrawal. To learn how to reverse and avoid cannabis tolerance, see my Sensitization Protocol at Healer.com/programs/sensitization-protocol/.

In certain individuals with trauma-related conditions, cannabis use may increase avoidant behaviors. Regularly engaging in safe and supportive social interactions is essential, even if uncomfortable at first.

Dysfunction in the ECS may predispose people to developing anxiety and trauma-related disorders, and using cannabis to target the ECS in these conditions can address both the symptoms and support a healing process of the underlying problems. Human experiments also suggest that cannabinoids can be helpful as an adjunct to therapy. People often use cannabis to replace benzodiazepines and other anxiety drugs, and increasing evidence suggests hemp-based CBD or CBG products can be effectively used for anxiety at low or moderate doses.

Usually, cannabis will relieve anxiety and trauma-related symptoms, but sometimes it can bring traumatic feelings or memories to the surface for the purpose of healing. I’ve provided a framework for understanding this phenomenon and suggestions for how to get great results using cannabis for both symptom relief and healing.

It’s no surprise that anxiety is one of the most common symptoms for which people use cannabis. It’s usually safer, more effective, and more deeply healing than the alternatives, especially when it’s used optimally.

J.D. Kosiba, S.A.Maisto, and J.W. Ditre, 

https://doi.org/10.1016/j.socscimed.2019.06.005

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The Handbook of Cannabis and Related Pathologies,

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Doctor Focus

Dr. Dustin Sulak discusses his clinical experience with cannabis as a treatment for anxiety and PTSD as well as some of the clinical evidence surrounding the endocannabinoid system.

Cannabis for Anxiety and PTSD

In recent years there has been increased attention focused on the potential use of cannabis in the treatment of post-traumatic stress disorder (PTSD). Although many PTSD patients report that cannabis has helped with their condition, research backing up these assertions is still lacking. This column will examine the facts and how cannabis is becoming an increasingly popular treatment for PTSD.

To better understand the relationship between cannabis and PTSD, it is important to know what PTSD is and what symptoms accompany a diagnosis. PTSD is a psychological disorder that individuals may develop after experiencing or witnessing a traumatic event such as war, natural disasters, or domestic and sexual abuse (1). The impact of these events live with these individuals for years and maybe their entire lives with recurring, disturbing thoughts, visions, and feelings from the experience plaguing the victims with seemingly no end in sight.

However, some people diagnosed with PTSD have found solace in cannabis and say that using the plant helps ease intense anxiety and depression. It comes as a welcomed relief for those who have spent years cycling through pharmaceuticals trying to find the right treatment. Living day to day without the right treatment and help can feel like a never-ending uphill battle, making daily tasks and normal social interactions seem impossible. Which is exactly why cannabis legalization has felt so transformative for those living with PTSD. Accessibility and greater acceptance of cannabis are enabling people to experiment with cannabis like never before, in the hopes of gaining more control over their lives. In particular, victims of sexual abuse (2) and veterans are two groups that say cannabis helps them relieve anxiety, flashbacks, and depressive episodes that could otherwise consume their minds.

Although human trial studies backing up these assertions are sorely lagging, you can find a growing number of meta-analyses and animal studies for PTSD (3) on platforms like 

. One study (4) found that cannabis users reported a greater decrease in the severity of their PTSD symptoms. The data also showed that patients consuming cannabis were 2.5 times as likely to no longer meet the diagnostic criteria for PTSD as those patients in the study who did not use cannabis. The study suggests that in activating the endocannabinoid system (ECS), which regulates our mood, memory, emotions, sleep, and eating patterns, cannabis may help individuals find relief from their PTSD symptoms. Unfortunately, this study was not randomized, and the participation pool was too small to make a definitive conclusion on the efficacy of cannabis use to treat PTSD.

In addition, these small trials (5) have shown that cannabidiol (CBD) has had significant positive effects for those with PTSD all without the psychoactive properties of tetrahydrocannabinol (THC). Since CBD products are currently available in some capacity in every state except for three, its use could be a great option for those considering cannabis treatment. However, the best results typically come from a combination of both medication and psychotherapy, so if one wishes to try cannabis as a means of medication, it is recommended that therapy is sought out as well.

The results of these small studies demonstrate how urgently further research is needed. Further randomized control trials will need to be conducted to get a better understanding of the relationship between cannabis and PTSD. There is good news though, as more states move toward legalization, funding should be more accessible allowing for structured clinical trials to be conducted.

Since cannabis for medicinal purposes is still a relatively new field of research, there is room for improvement in the way its effects are studied in real-world applications. Nevertheless, hope is on the horizon as there has been a significant push in recent years to create credible studies and cases to showcase the numerous benefits cannabis has on treating mental disorders such as depression, anxiety, and PTSD.

https://psychiatry.org/patients-families/ptsd/what-is-ptsd

https://missgrass.com/blogs/sex/cannabis-and-sexual-trauma

https://cannakeys.com/thc-cbd-for-post-traumatic-stress-disorder/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8222769/#:~:text=77.2%25%20of%20the%20patients%2C%20had,not%20changes%20in%20PTSD%20symptoms

https://www.medicalnewstoday.com/articles/cbd-for-ptsd#treating-ptsd-with-cbd

 is a registered nurse and CEO, executive director, and founder of Leaf411, a 501(c)(3) nonprofit organization founded in 2019 with a mission to provide education and directional support to the general public about the safe and effective use of cannabis (marijuana and hemp). For more information or to schedule a consultation with a cannabis-certified nurse, call 844-LEAF411 (844-532-3411) or visit 

Nurse Focus

Although in-depth research lags due to its current scheduling, tetrahydrocannabinol (THC) and cannabidiol (CBD) remain increasingly popular treatment options for those struggling with the effects of trauma.

The Facts About PTSD and Cannabis

According to the US Census Bureau data, as of 2020, there are about 19 million veterans aged 18 and older in the United States, with more than 34% of those veterans using the US Department of Veterans Affairs (VA) for healthcare (1). US military service members and veterans often face different health issues than civilians because they are at risk for various injuries during their services. These injuries can happen during combat, while others involve physical stress to the body due to exposure to environmental hazards such as contaminated water, chemicals, infections, and burn pits—many of these injuries are life-threatening or can cause long-term disability (2). In addition, service members are also disproportionally at risk of developing a variety of mental health problems, including anxiety, post-traumatic stress disorder (PTSD), depression, substance use disorder (SUD), and suicide (2). Veterans may encounter a variety of stress-related disorders and challenges when reintegrating from the military into the community. Enabling veterans’ reintegration, readjustment, transition, coping, and community integration is a societal emphasis.

Every year more than 200,000 veterans transition out of service, and research suggests that supporting veterans in the early transition period is essential considering the readjustment challenges (3). Vogt and colleagues piloted a five-year study with a nationally representative sample of more than 9000 US veterans. This study was the first to explore how the US veteran population’s health and broader well-being (that is, work and social relationships) change in the first several years after they leave military service. The study found that veterans experienced decreases in health and well-being over the three years of the study—health concerns were the top cases, where many veterans reported having chronic physical (53%) or mental (33%) health conditions. The most significant conditions conveyed included: chronic pain, sleep problems, anxiety, and depression (4).

Chronic pain is more prevalent and eminent in veterans than in the general population (5). During 2019, veterans aged ≥20 years were more likely to have chronic pain than non-veterans (31.5% versus 20.1%), and among veterans, those aged 50–64 years had the highest prevalence of chronic pain (37.2%) (6). In addition, as the COVID-19 pandemic heightened so did the incidence and severity of mental health problems and substance use disorders in 2020—about 17 veterans committed suicide daily (7). Indeed, recent data point that among veterans committing suicide in 2020, about 1 in 3 suffered from depression, 1 in 4 suffered from anxiety, 1 in 5 suffered from alcohol use disorder, 1 in 4 had PTSD, and nearly 1 in 12 suffered from opioid use disorder (8).

The resulting and compounding health circumstances veterans meet post-deployment come with the demand for healthcare, numerous prescription medications, mental health interventions, and alternative treatments. A study conducted in 2020 of 1700 US Iraq and Afghanistan veterans discovered that 46% were prescribed anti-depressants, 36% sleeping pills, 35% anti-anxiety medications, and 32% opioids (9). Another survey led by the Defense Department uncovered that about one in four veterans had at least one opioid prescription in 2017, yet only one-tenth (0.001%) of them were obtaining care for a diagnosed opioid use disorder (10).

Increasing opioid dosing does not appear to improve chronic pain. A study by VA Portland researchers in 2020 noted that out of 500 patients with chronic pain, nearly 20% had their opioid dose increased, although solely 3% of those patients indicated meaningful progress in pain (5). Medical cannabis may offer a practical and low-risk treatment alternative for veterans, primarily when compared to conventional treatments (for example, alcohol, medications, and opioids) for health conditions, including PTSD (11). Expanding access to medical cannabis as an alternative to opiates and other prescription painkillers for the relief of chronic pain has the potential to help veterans relieve substance use disorders and increase their well-being (12).

Based on our research and findings in the studies described above, we set out to conduct an iCount for Veterans’ study to discover how medical cannabis was helping veterans in Massachusetts and nationally. iCount for Veterans is a partnership with Patriots Helping Vets, University of Massachusetts (UMass) Dartmouth, and the Cannabis Center of Excellence (CCOE) to expand access to cannabis for veterans and conduct real-world studies on its impact on health and wellness. This study is approved by the UMass Dartmouth Institutional Review Board (IRB), and the surveys and ongoing engagement with veterans as part of this study will be deployed and managed through iCount, a platform hosted by the CCOE. Study partners contribute cannabis for veterans’ research and access, depending on the unique research project.

Project partners provide the products or other offers to veterans and deliver the cannabis to the retail outlets in Massachusetts. Other project partners provide study products that are available nationally to veterans. The CCOE and Patriots Helping Vets will conduct research studies using the cannabis products to be sold to veterans through retail cannabis dispensaries in different parts of Massachusetts. Supported by Patriots Helping Vets to recruit veterans to participate, the CCOE facilitates the data collection (that is, basic demographics, self-reported health and wellness, and side effects of using cannabis) from veterans who get the cannabis and report for the research studies.

Veterans will be required to register to be part of the studies through a CCOE sign-up. They will receive a code to be presented at the participating Massachusetts cannabis retail outlets to confirm their status as a study participant. Here we report on some studies conducted through iCount for Veterans.

Recently, 368 veterans signed up for iCount for Veterans, and 232 have completed the iCount for Veterans intake survey. This survey enrolls veterans to be a part of the iCount for Veterans program, where veterans can participate in future studies without completing other intake questions.

In terms of health conditions veterans were experiencing (N=193), 75% reported depression/mood as the top health condition, followed by anxiety (74%), PTSD (63%), and chronic and severe pain (48%). Cannabis was most helpful for chronic pain (25.4%) and depression/mood (20%) for these respondents.

Among all veterans who responded (N=124), more than 26% rated anxiety as a symptom that is primarily associated with their primary health conditions, followed by depression (19.6%), sleep (12.6%), and pain (22.5%). Chronic and severe pain, depression/mood (20%), and anxiety (17.7%) were the primary health conditions for which the veterans found cannabis to be the most practical.

About 52.3% (N=130) of respondents were actively trying to lower medication use with cannabis. Veterans were also asked to identify all medications they attempted to drop by consuming cannabis. Overall (N=68), 47% of veterans reported trying to reduce antidepressants, 41% over-the-counter (OTC) medications, 26% mood stabilizers or anticonvulsants, and 22% muscle relaxants.

Regarding monthly out-of-pocket spending on cannabis versus medications, around 63% of veterans (N=82) spent US $0–17 on medications, whereas about 23% reported paying US $142–233 on cannabis (N=179). More than 85% of veterans who responded are covered by health insurance, and about 93% have prescription drug coverage.

Among veterans who responded (N=230), dispensary agents were the most notable place to get informed to make decisions about cannabis products (44%), followed by mobile apps and websites (42%), Google search (32%), and friends (31%).

Undoo softgels are an emergency supplement intended to clear your head and ease the intensity of the cannabis buzz in a short period of time. It does not eliminate the feeling of well-being often experienced with tetrahydrocannabinol (THC). The Undoo softgels formula has multiple uses including but not limited to: manage THC overconsumption and used to swiftly clear the consumer’s head from accidental overindulgence, to clear “brain fog” from residual consumption issues, and a “reset THC tolerance” for experienced cannabis consumers.

The CCOE is conducting a research study to assess the impact of Undoo on up to 500 veterans in the US. The research study launched nationally for US military veterans in August 2022. To be a study participant, veterans are required to visit the CCOE website and iCount for Veterans to get verified and enrolled. Veterans who enroll will receive Undoo packets as part of their participation and will be mailed the product (each package contains 30 soft gels) by the CCOE. After receiving the product, veterans will report its effectiveness for the intended outcomes. As of December 2022, 308 veterans have signed up for the Undoo study.

Veterans will be able to test out three Undoo products.

Frequent cannabis consumers and patients can experience a THC tolerance build up or diminished effects of their cannabis products. With Undoo Reset, consumers can restore their THC tolerance. Suggested use: participants must take 2 softgels (75 mg of olivetol per softgel) with 12–16 oz of water before bed for five consecutive nights and take no more than 6 softgels in a 24-hour period.

Whether someone is a new or experienced cannabis consumer, at times, THC can have unpredictable psychoactive effects, leaving them in an uncomfortable dysphoria. Undoo Rescue softgels can help clear their head and bring them to a more enjoyable state. Suggested use for participants:

Take 2 (60 mg of olivetol per softgel) softgels with 12–16 oz of water

Relax - relief is typically felt within 5–20 minutes

Take no more than 8 softgels in a 24-hour period

Lingering haziness from cannabis consumption can leave someone in a mental fog. Undoo Refresh softgels promotes clarity to bring someone to a more comfortable state. Suggested use for participants:

Take 1 softgel (60 mg of olivetol per softgel) with 12–16 oz of water

Undoo Rescue, Reset, and Refresh are available for people who have taken the products to self-report an assessment of each product’s impacts on intended outcomes. The surveys are available by QR codes or mobile or computer data entry links. Live data dashboards will be available for the project team to monitor real-time results. Veterans can also report a testimonial in their own words with the study for use with Undoo marketing.

The same six veterans completed the Undoo Rescue and Refresh survey about the time needed for both products to work. Two veterans reported that the rescue package started to kick in within 10 minutes after consumption, and most of those who took the refresh packet (2 veterans) felt the effects within 20 minutes (

). On the other hand, among veterans who responded to the Undoo Reset survey (N=11), about 45%, 18%, and 36%, respectively, rated as moderately, very, and highly tolerant of cannabis. More than 50% of those who responded were in a moderate need for a tolerance break (

Of those who responded to the Rescue study (N=6), about 83% reported that they would either reuse the product or recommend it to others. Around 67% felt that the Rescue product addressed their cannabis overconsumption, whereas the product was swift for 50% of the respondents. Please see 

In terms of feelings after taking each of the Undoo products, six respondents felt that the Undoo Refresh package successfully overcame their brain fog. More veterans also reported being more comfortable driving (8), operating heavy machinery (6), doing complex tasks (6), and talking with some authority figures (5), particularly after taking the Rescue and Refresh product (

). Authority figures that veterans would have been comfortable talking with before and after ingesting each Undoo product were about the same (

Veterans were also asked to identify other feelings (in addition to the above) that they found the packages helpful. Overall, more veterans (about a 50% increase) felt calm, cool, comfortable, and liked the effects they were experiencing after taking the products. The range of psychologically bad feelings also decreased dramatically after taking the products, and more veterans felt lively after taking the Rescue (2), Reset (2), and Refresh (2) packages. Regarding the Rescue package, most respondents reported anxiety (29%) and fatigue (29%) before consumption. However, confident, competent, and energetic became the most reported feelings after taking the product. Please see 

Among other feelings veterans reported having, mental clarity (40%), increased energy (40%), and decreased bruxism (20%) were the only feelings that appeared after taking the Undoo Rescue package. After consuming the Refresh product, these three feelings also become the most noted by veterans. Anxiety, dry mouth, and toughness to get started in the morning became the only existing veterans’ sensations after taking the Undoo Reset package (notice 

The US military veterans in our Undoo research study noted the effectiveness of three Undoo products in diverse intended conditions, including time to kick in, tolerance levels, and distinct physical and psychological effects following the consumption. In general, veterans reported that using Undoo products significantly enhanced their physical and mental health conditions. Most veterans will likely use the products again or suggest the products to someone else. Barriers to using the products include anxiety and dry mouth after taking the products and concern about possible side effects following cannabis consumption in the future. Further research with more samples and rigorous study designs will help better identify the results of the three Undoo products on various health conditions veterans face.

The CCOE, Gibby’s Garden, and Patriots Helping Vets established a cannabis access research project for veterans using Gibby’s Garden cannabis products to be offered at low cost to the first 450 qualifying veterans through four retail cannabis dispensaries in different parts of Massachusetts (MA): The Vault, Boston Bud Factory, South Shore Buds, and Seagrass Salem Dispensary.

The project was initiated in April 2022 and will be concluded in December 2022. Gibby’s Garden will donate products, designate the number of products and how the products will be packaged for veterans, and deliver the product to the retail outlets. The CCOE will enable the data collection and report from veterans who get cannabis for the study. The CCOE also partners with Patriots Helping Vets to recruit veterans for free or low-cost cannabis and report on health and clinical metrics about the impact on veterans’ health conditions and symptoms. Currently, 157 veterans have signed up for the study and 111 opted to report the impact of the cannabis using Tetragram, a mobile application (app) for patients to report the impact of their cannabis use and track usage over time.

 Qualifying veterans register for iCount for Veterans and take the CCOE Intake survey. They then select the cannabis dispensary they would like to purchase cannabis from in Massachusetts.

Veteran receives an email from the CCOE with information about the study, including a study code to present at the four retailers.

Veterans purchase cannabis from one of the four retail outlets in MA by presenting an email or screenshot of the study enrollment, along with their military ID, to qualify for the program.

Veteran reports on the impact of cannabis use on paper or using the Tetragram app to record the effects after each use.

The ideal minimum for each veteran is one-eighth of cannabis. Each package is tagged with a study number and packets come with a certificate of analysis (COA). The analysis will be matched with veterans who received the code upon registration with the CCOE for the study. Veterans can buy a package of products at a steeply reduced study rate at one of the four licensed cannabis retail dispensaries. The bundle includes the following:

The surveys and ongoing engagement with veterans as part of this study are deployed and managed through iCount for Veterans. The study will not demand veterans to fill in any personal identifying information. Still, it will collect basic demographics, self-reported health and wellness, product type, consumption methods, side effects of using the product, and a general overview of the product and their experience. Veterans will be requested to fill out the paper survey or log back into the Tetragram app for feedback each time they use the product and will receive the study results when it is concluded.

Among all veterans, 19 veterans have reported the impact of Gibby’s products using the Tetragram app. The most common reasons reported for consuming Gibby’s Garden cannabis products include: anxiety, joint pain, injury pain, depression, muscle pain, nerve pain, muscle spasms, agitation, headache, and insomnia. Overall, 46% of respondents rate Gibby’s Garden products a 5 out of 5 stars, and 39% rate them a 4 out of 5 stars.

In addition, Good Chemistry, the CCOE, and Patriots Helping Vets launched a veterans cannabis access research project in Massachusetts for qualifying veterans. Veterans can purchase products from Worcester, MA or Lynn, MA for special study pricing and share their feedback on the products! As part of the research study, veterans will be asked to report on access to cannabis issues, the products, and its impact on their health and wellness. This research study is approved by the UMass Dartmouth IRB. The bundle includes:

Day and night pre-roll pack: 1 sativa pre-roll and 1 indica pre-roll purchased at a steeply reduced study rate (select strains with focus on Amnesia Haze and Ingrid)

Mini joint packs: 4 each 1/2-gram pre-rolls purchased at a steeply reduced study rate (select strains with options for sativa and indica)

Once veterans purchase the bundle, we ask them to report its impact either using a paper form and returning it to Good Chemistry in an anonymous box (anon box) or using the Tetragram app. The surveys can help gauge the representativeness of individual views and experiences. The surveys focused on asking veterans’ responses on symptoms, consumption method, product type, specific consumption method (that is, joint, pipe, tincture, vaporizer, vape pen, and bong), and the overall review about their experience with the products. The result of this newly started survey will be discussed at the end of the study as critical evidence for cannabis decision-making moving forward.

Vaping (using an electronic vaporizer) is a reasonably new behavior that has spread among the world’s cannabis smokers. The appeal of vaping lies in lowered harm and cost while keeping a sufficiently similar or superior experience to the established cannabis smoking.

The CCOE, UMass Dartmouth, and Green Lion Partners launched a new online veterans vape survey on November 11, 2022. Veterans will be required to register through the CCOE iCount sign up to be part of the study. The survey would take 5 minutes, and the first five veterans to sign up for the survey will receive a free vape device to evaluate.

This newly conducted vape survey will further inform the development of new vaping devices and the standardization of quality and safety testing protocols designed for today’s complex cannabis vape devices.

The Cannabis Vape Survey collects data from veterans’ cannabis consumers in MA and will provide valuable insights surrounding vaping devices currently available. In the upcoming months, we will conclude the study and provide insights about veterans’ “real-world” vaping experience.

The landscape of medical cannabis is rapidly expanding as more and more people push for its legalization. As the acceptance and usage of cannabis continue to grow in the United States, the demand for a further complete understanding of cannabis and its effects on human health and well-being is required.

We invite individuals and companies to participate in this continuing cannabis for veterans’ research study with the CCOE and partners. We are accepting donations and new research study partners for the iCount for Veterans project. Be sure to ask us if anything is unclear or you want more information. Thank you for taking the time to read this report.

https://www.cannacenterofexcellence.org/veterans

https://www.census.gov/newsroom/press-kits/2021/acs-5-year.html

Research Focus

A veterans’ research study to discover how medical cannabis is helping veterans in Massachusetts and nationally. Here, the authors provide an overview of the current study and what the initial findings reveal.

iCount for Veterans: A Research Platform to Connect Veterans with Cannabis Research Studies Led by the Cannabis Center of Excellence, UMass Dartmouth, and Patriots Helping Vets

Content warning: This story contains references to suicide. If you or a loved one need assistance, contact the 988 Suicide and Crisis Lifeline 24/7 or visit 988lifeline.org

Steve Ellmore, founder of The Unprescribed nonprofit, is a 20-year Air Force veteran and currently works in the public sector helping veterans and their families. An anxiety sufferer, Ellmore also attempted suicide while on active duty, and has experienced traumas such as multiple car accidents, traumatic brain injury, and domestic abuse in addition to being in the military. Cannabis, Ellmore believes, can be the answer for veterans seeking alternative treatments to the opioids and other dangerous medications prescribed to them to treat their mental and physical trauma. These medications have contributed greatly to an epidemic of veteran suicide in the United States. Ellmore’s journey as a medical cannabis patient and advocate began with his award-winning 2020 film, Unprescribed, which documents the stories of veterans, cannabis advocacy, and the fight to end veteran suicide. “In their own words,” Ellmore said, “this film is the voice of veterans everywhere. We are asking for cannabis.” Ellmore’s mission is to share the stories of those who, like him, have found healing with cannabis and plant-based medicine.

A filmmaker and photographer by trade, Steve Ellmore accepted an offer in 2017 to film a documentary about a veteran-operated cannabis growing operation in the Midwest. While in the military and as a veteran, Ellmore had been presented with a negative image of cannabis. “You get into the military and you're told that it’s the devil's weed. It's a career killer. It's everything bad,” Ellmore recalled. Despite this, Ellmore decided to begin the project with an open mind and began to learn how veterans were using cannabis to treat post-traumatic stress disorder (PTSD). Though that documentary project did not come to fruition in the end, a new seed had been planted in Ellmore’s mind: was there more to explore with cannabis as medicine?

“The veterans with the grow had convinced me that cannabis was the answer—that cannabis could have prevented me from attempting to take my life,” he said. “So, I set out to find the real answers and talk to veterans.”

After speaking with the American Legion, Ellmore was directed to the people who would eventually be featured in his new film through a “right place, right time” sequence of events. He spoke with researcher Dr. Sue Sisley, veterans Boone Cutler and Joshua Frey, advocate Janine Lutz, Scheril Murray Powell, Esq., and dispensary owner Hope Wiseman. The result was a polyphonic story of the state of medical cannabis, veterans, advocates, and the decades-long struggle to access safe, plant-based medicine. “It pulled together a bona fide story of truth in cannabis,” said Ellmore. “And we discovered in the story that we've just been lied to. My idea behind the film was to make it an advocacy piece to get the American public to change their minds, to get them to convince the lawmakers to change the laws, to legalize cannabis. I use the film to say that this is the voice of the veterans, and we're all telling you that we're suffering and the drugs being giving us by the Veterans Affairs [VA] are killing us.”

It took Steve Ellmore three years to make 

 and it was entirely self-funded, self-edited, and self-produced. “The Congressional Cannabis Caucus invited me to actually screen the film on Capitol Hill at the Congressional Auditorium,” said Ellmore. “I got the audience that I wanted. And then COVID hit.”

Devastated at this setback when success had been within reach, he shelved the project. “With the anxiety, PTSD, and other things, it shut me down. That was almost my next suicide attempt. I was done. I dissolved my LLC,” said Ellmore.

Further into the pandemic, he eventually decided to put the film on Amazon Prime Video, and after word spread it started to get the attention Ellmore had hoped for. “That's what drove me back again. Fast forward, we got the nonprofit up and running.”

The goal of the nonprofit, called The Unprescribed, is education, influence, and to amplify the voices and stories in the 

 film to save more lives. “The unprescribed are the people who found healing through natural means and got off of the pharmaceuticals,” Ellmore explained. After releasing the film, Ellmore met and joined forces with AMVETS Chief Medical Executive, Cherissa Jackson. Through the nonprofit and with the support and collaboration of Jackson, The Unprescribed holds film screenings and panels across the country, posting videos of these discussions on YouTube to help increase awareness.

The driving force behind the foundation is the idea that the more screenings of the film, the more lives touched, but this kind of goal comes with its own inherent challenges to overcome. “We’re trying to raise money so that we can buy advertising to promote the film so that we can have more engagements where we can actually be out there,” said Ellmore. “We're looking for support and sponsorships to help keep us on the air, keep us in the public mind, and help me get out there to do more engagements. Veterans don't like asking for help. We want to do it by ourselves, otherwise we're seen as weak. And the same thing goes with the fundraising. I don't like asking for dollars. But I know I have to.” 

With the help of funding from the nonprofit, the panels of doctors, advocates, and veterans share more of their story and engage with the audience in Q&A sessions. “The best format for presenting the film is as a conversation piece with audiences because that opens up the minds of the audience and public, so that it’s not just about seeing the film, but actually bouncing off your thoughts with professionals,” Ellmore explained.

The screenings and discussions engage the audience in topics such as legalization of cannabis, holistic medicine, facing stigma and trauma, and veteran access to medical treatment. They create a safe place for sharing struggles and a starting point for difficult conversations. As described in the film, physical and mental trauma involves prescriptions with disastrous side effects: veterans are dying by suicide at the rate of 22 per day.

“These heroes are returning, and many veterans are coming back broken, and they're taking their lives because they don't see any solution in it,” said Ellmore. “I'm trying to inspire other people who have been through that trauma to tell their stories and show how cannabis helped them find balance. The whole point was we all have to overcome, though it's so easy to give up.”

Despite challenges and a massive mission, responses from veterans are an indicator that the message is reaching the hearts of those who need it most. “I continue to get screenshots from Boone of messages on social media of comments such as, ‘dude, you saved my life. I was about to take my life or do more drugs or do something else, and then I saw your thing about cannabis, and it changed me, and it changed my life.’ And that's why I’m still here, and I am here for a reason. I told myself that my mission is to be a suicide prevention and plant medicine healing advocate. That’s what I'm doing here today. And I'm just trying to be heard,” said Ellmore.

Challenges and Progress in Veteran Medical Cannabis Use

 gives a “boots on the ground” picture of the struggles veterans have faced and continue to face in treating mental and physical injuries, especially with medical cannabis. Some change has happened since filming began, but much more still needs to be done. Moving beyond the opioid crisis involves rethinking the broader approach to treatment at its core and the impetus behind traditional pharmaceuticals.

The struggle for adequate treatment became most prominent with the opioid epidemic and the overprescribing of opioids. “I was in the middle of interviewing Josh [Frey] when the VA finally figured out the opioid crisis problem,” said Ellmore. “And what did they do? Knee jerk reaction. They took all the drugs away. Now you got people becoming heroin addicts, and now we're looking at fentanyl and all these other drugs on the streets that veterans are dealing with. Then the VA said, ‘We got to come back. We got to do something right.’ So, they finally started introducing holistic medicine.”

The challenge, as always, is to get the message out and heard by the right people. “If I could ever sit down with the secretary of the VA and show him 

,” Ellmore said, “I would acknowledge that, following the opioid epidemic, you realized you made a mistake and took the drugs away. You're making the right path with introducing integrative medicine, but you're missing one key factor, and that's the endocannabinoid system. You can't have a full, complete holistic circle if you don't include all the pieces, because you're only as strong as the weakest chain and you're missing that link. I do believe that cannabis is the missing link in the holistic healing that they're now providing for veterans.”

Progress has been slow yet positive. “I've seen policy in the VA change from no tolerance of cannabis use to some tolerance,” he said. “The film is called 

 because you cannot be prescribed cannabis, it can only be recommended by your doctor. Though the VA still can't recommend it, veterans can actually talk about it now without the risk of losing their benefits. That was the number one concern of veterans, but they can engage with their VA doctors about it now.”

Ellmore’s journey into learning more about veteran treatment options has also taken him beyond the nation’s borders to learn how countries such as Canada incorporate cannabis and holistic medicine into treatment with their veterans. “With my nonprofit, The Unprescribed, we're not looking at just cannabis, we're looking at psilocybin and other plant medicines that can give you that whole plant medicine. Integrative medicine is our final approach,” he explained. “Canada is doing that, and I’m advocating to actually have the US follow that rule.”

, Ellmore was invited by Fabian Henry, a veteran, advocate, and mentor to Ellmore, to document veterans and integrative medicine in Canada. “He drove me to advocate for the four pillars of healing that he talks about and encouraged me to make another film called 

 to document what they're doing up there.”

 provides a counterpoint to the stories in 

 and follows the stories of veteran groups providing each other support and healing. One major difference between the two films is that veterans in Canada can be prescribed cannabis. “I want the US to use Canada as the playbook in their example,” Ellmore explained. “My end goal is that I want to see the VA actually prescribe cannabis to veterans for PTSD. That's the ultimate goal because that's exactly what they're doing in Canada.”

With the tagline for The Unprescribed nonprofit being “Plants Over Pills,” Ellmore looks forward to and visualizes harmonized medicine. “There are wonderful things about pharmaceuticals,” said Ellmore. “But as you've seen in the opioid crisis, there are so many terrible things in the pharmaceutical realm, and I'm biased on where I see them going with it. I'd love to advocate for them to be more supportive of cannabis, but what's that going to do? It's going to take away from all the growers and all the other people in the whole distribution chain and down to the patients. I'm a little scared about where the pharmaceutical companies fall into place.”

While pharmaceuticals have caused damage in the past and present, Ellmore doesn’t completely exclude the role of government regulation in medications for patient treatments. “I would like to see an equilibrium. I'd like to find a harmony where pharmaceutical companies can participate, perhaps in the cultivation, processing, or distribution, partnering with apothecaries and dispensaries or even making it a hybrid industry of canna-pharma culture,” he said. “From a patient point of view, I do want to see regulation. I would like to see the US Food and Drug Administration [FDA] get involved in cannabis. It would help keep it regulated, and I do believe they do right.”

As the idea of choosing plant-based and holistic treatment over pills takes root, the challenge for adequate research on treatment grows too. Conducting research that could illustrate the positive effects of cannabis is difficult, as exemplified with Dr. Sue Sisley, who is mentioned in 

 as the principal investigator for the only FDA-approved study looking into cannabis for treating veterans with combat-related PTSD. Frustrated by roadblocks to her research, Dr. Sisley filed a lawsuit against the US Drug Enforcement Administration (DEA) in 2019 for restrictions on the cannabis it allows for official research. “Because it's so tied to DEA and Big Pharma,” Ellmore explained, “the government sees research as a threat and the only studies being approved are the ones that focus on the dangers. If you want to get a study that tells you about all the bad, they'll almost give you the grants and the money to do it. But if you're trying to study the efficacy or the positive sides of it, they're going to stonewall you. Dr. Sisley was persistent enough to continue to fight, fight, fight, fight. To do everything they said, no matter how ludicrous it was. But she got it done.”

The mission of The Unprescribed is still primarily rooted in plant medicine, so above all else Ellmore promotes the use of plant medicine in its natural state. “We’re also seeing a lot of companies doing research so that they can make the synthetics,” he said. “To me, that defeats the whole purpose of the plant over pills. Why are you going to synthesize something that comes out of the Earth?”

Furthermore, using cannabis to treat physical and mental injuries can be complicated, especially without access to a medical provider’s guidance that comes with taking a prescribed pharmaceutical drug. In his own journey as a patient, Ellmore has learned about the importance of understanding how to address and balance the deficiencies our bodies may have. “Learn about the endocannabinoid system and how our bodies actually are connected to the plants,” he explained. “We all have deficiencies, and it's important to understand that we're missing something.”

As one example of how to do this, Ellmore explained how DNA testing kits from Cherissa Jackson’s company We Decode helped him gain new insights into how cannabis can work well on a molecular level. “It basically shows genetic indicators of traits you might have, from PTSD to alcoholism and a dozen others. Knowing these indicators allows me to better take care of my needs. It opened up my mind," he said. “It's supposed to measure your metabolism and digestion so you can find out which strains and terpenes work best for you and how you metabolize them. You could see, for example, if edibles are even good or if you should get tinctures or whatnot.”

Steve Ellmore, founder of The Unprescribed nonprofit, is a 20-year Air Force veteran. Here, Ellmore shares how his personal experience led him to become a medical cannabis patient and how his award-winning 2020 film, Unprescribed, documents the stories of veterans, cannabis advocacy, and the fight to end veteran suicide.