Gateway to Wellness: One Veteran’s Story of Healing Through Medical Cannabis

Stephen Mandile—veteran, cannabis patient, and advocate—shares his personal experience with medical cannabis and how it has given him a new mission to help other veterans gain access to this plant.

Post-traumatic stress disorder (PTSD) is defined by the Mayo Clinic (1) as a mental health condition triggered by experiencing or witnessing a terrifying or life-threatening event. Symptoms can range from flashbacks and nightmares to severe anxiety and uncontrollable thoughts about the event. The Mayo Clinic states (1) that “PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.” According to the American Psychiatric Association (2), PTSD affects approximately 3.5% of US adults every year, with an estimated one in 11 people being diagnosed with it in their lifetime.

Despite the high occurrence of PTSD in the general population, veterans of warfare are still more likely to experience symptoms of PTSD. The US Department of Veterans Affairs (VA) has a National Center for PTSD designed to lead research and assist veterans that are experiencing symptoms (3). The VA states that the percentage of veterans who experience PTSD varies depending on the service era. For example, according to the VA 11–20% of veterans that served in Operations Iraqi Freedom and Enduring Freedom are diagnosed with PTSD every year whereas 30% of veterans that served in Vietnam are estimated to have experienced PTSD at some point in their lifetimes (4).

While it is clear that PTSD is a problem for many veterans, there has been little change in treatment and medication for far too long. The typical medications prescribed for PTSD include antidepressants such as Zoloft, Paxil, Prozac, and Effexor. Studies have also shown that PTSD plays a role in veteran suicide (5), which according to the 2019 National Veteran Suicide Prevention Annual Report was as high as 17 (~16.8) veterans per day in 2017 (6). 

When faced with PTSD, many veterans turn to their local VA for help. Stephen Mandile, a veteran of Operation Iraqi Freedom and veterans’ advocate, was faced with this challenge upon returning home from Iraq by medivac. Here, he shares his story to find alternative treatment with medicinal cannabis and how that led him down a road of advocacy work to help other veterans.

Mandile’s Story

After suffering a spinal cord injury in Iraq, Mandile was sent back to the US by medivac and subsequently tested for PTSD. “I was having problems with aggression, alertness, depression, anxiety, and just being able to slow down,” said Mandile. “Everything felt like it was going 100 miles per hour.”

He tried a number of different medications to ease his pain and other symptoms. Ultimately, Mandile tried 57 different medications to give him relief from his PTSD and chronic pain but the effects made him feel numb to everything. Finally, Mandile’s wife gave him an ultimatum to get off of the medications that were not helping. She suggested that he try medical cannabis, which was shocking to Mandile at first because of his own bias towards cannabis as a drug of abuse.

“At first my reaction was that ‘I’m not I’m not going to become a druggie.’ I’m taking the medicines that my doctors are telling me are good and safe for me,” said Mandile. “Why would I ever take cannabis? But her suggestion planted a seed to get me looking into the medications I had been taking such as fentanyl, oxycodone, Xanax, and Klonopin.”

After doing some research, Mandile decided that the opioids and benzodiazepines he was taking were not right for him and decided to give medical cannabis a try. His first experience with cannabis was not perfect, but it did open his eyes to new feelings. He explained that an hour after he tried cannabis, they had to take his 6-month-old daughter to the emergency room and that made him feel very paranoid.

“At the same time though, I was glad to be feeling anything at all because when I was on the other medications, I was just numb and I didn’t care,” said Mandile. “So just being aware of my current state was something kind of shocking to me, like even the fact that I could feel paranoid was something I hadn’t felt in 10 years.”

Mandile also described how things started to feel more slowed down for him—a change from that 100-mile-per-hour feeling he mentioned earlier. He went from having no fuse and feeling like his anger went from zero to 100 in a second to having a few moments to catch himself and practice mindfulness. “Cannabis has allowed me to not think that the sky is falling because something happened,” said Mandile. “Another way I try to explain it is that without cannabis I feel like I’m listening to 100 different songs at the same time. And then with cannabis, it’s like putting on headphones and being able to focus on one specific song.”

More than anything though, cannabis has renewed Mandile’s sense of purpose and well-being. “Cannabis has helped my PTSD symptoms in so many ways: it’s allowed me to find purpose, it’s allowed me to find healing, and it’s the best tool I have to help me with pain, both mentally and physically,” he said.

Roadblocks to Medical Cannabis Access

Despite living in a state that had passed a medical cannabis law, Mandile’s road to access was not easy initially. He was able to get a medical cannabis patient card, but there were no dispensaries open to use it. Mandile turned to the illegal market at first, but he felt uneasy about coming off any of his prescription medications until he had access to a dispensary.

“I waited until June 2015 when the dispensaries first opened and knew I would have a reliable, consistent source of cannabis,” said Mandile. “After that it was about five months from starting until I was off of all those other medications, which included Ambien, Xanax, Fentanyl, Percocet, and a few antidepressants.”

Mandile has found a great alternative treatment for himself with medical cannabis, however, it was a path that he forged on his own. The VA and his other doctors were not guiding him in this treatment plan, so Mandile started doing his own research into different products and their effectiveness for his symptoms. In fact, Mandile states that even now—five years later—he is still experimenting with the right dose and products. “Although we do have access to a lot of great products, I go for what’s most affordable because I’m going from medications that I had paid nothing for—and in fact I’d earned through my service—to now having to pay out of pocket,” said Mandile. “I am on a fixed income with my disability benefits and Social Security, so I have to get what I can afford and I’m still trying to find the right method.”

“It’s pretty much trial and error,” said Mandile. “I had been keeping a journal to keep track of which products I was finding the most helpful, but after a certain period of time it became more about what was most affordable.”

Cost is a major obstacle for many veterans in situations like Mandile who live on fixed incomes and rely on the VA to help with their care after serving for their country. According to Mandile, current policy at the VA does not allow them to advise veterans on medical cannabis use. Mandile pointed out that this lack of information from reliable sources about the benefits of medical cannabis is another challenge. “I think many veterans are aware of the benefits, but there’s so much work to do to make sure more people know,” he said.

Mandile discussed how the VA in his area has become more receptive to cannabis lately. “In October, I spoke at a VA symposium on alternatives to healing and they specifically asked me to speak about the benefits of cannabis use,” said Mandile.

“The VA’s stance does vary from location to location though,” explained Mandile. “Massachusetts, Rhode Island, and the Northeast are pretty open to it, but some other VA’s will make you feel like you are making a huge mistake. You’re breaking the law. You have morality issues. You can’t be trusted. So, it does vary from facility to facility.”

Another obstacle that Mandile faced was that PTSD was not listed as a qualifying condition for a medical cannabis patient card in his home state of Massachusetts. According to Mandile, Massachusetts is the only state in New England that does not have PTSD listed as a qualifying condition and one of only seven states in the US (out of 33 at the time of this publication) with medical programs that does not have it listed. As a way around this, doctors in Massachusetts have the option to write in a condition under the “other” category, which was how Mandile was granted his medical patient card. However, Mandile explained that if someone was just looking to get into the program and didn’t see their diagnosis listed it might prevent them from looking into it further. As such, Mandile took this as a call to action and in the previous Massachusetts legislative session, he had a bill proposed that was going to add PTSD and opioid use disorder to the list of qualifying conditions.

Another aspect of the bill that Mandile submitted was to allow veterans in Massachusetts to be able to submit their VA paperwork to the state instead of having to go see another doctor. “I found that in North Dakota and Illinois, this is already the practice,” he explained. “A veteran doesn’t have to go to a doctor. They just submit their VA paperwork to the state and the state enrolls them in the program.”

Unfortunately, Mandile said that his bill got sent to study. This means that the Joint Committee is authorized to sit during recess and study the bill as well as similar ones and file a narrative report of its findings. However, the majority of bills that are sent to a study receive no further activity from the Committee (7).

Despite this, Mandile is not deterred. “We will be submitting a bill again this session to get those conditions added because being able to see them listed will also help break down barriers and destigmatize cannabis,” said Mandile.

The stigma around cannabis is another roadblock facing many veterans, as Mandile experienced first-hand with his own initial bias. He thinks that the stigma from prohibition at the VA is something that creates fear for every veteran. “Too many veterans believe, and I think this is from actual occurrences, that they can lose benefits for using cannabis, which was the case at one point,” said Mandile. However, he said that current VA directives have changed so veterans won’t lose their benefits or medications because of cannabis use.

Veterans do have other concerns about admitting to cannabis use such as losing their Second Amendment right to carry arms. Mandile explained that he got his license to carry at the same time he received his medical cannabis card, but still did not have a dispensary to go to. “I was still on all my other medications and there was no place for that to be listed on the application to carry but there was a spot for cannabis,” said Mandile. “So, it was okay for me to be on fentanyl, Xanax, and Ambien and have a firearm, but it was not okay for me to be using medical cannabis and have a firearm.”

As many people know, cannabis is still considered federally illegal in the US and it is listed as a Schedule I drug by the United States Drug Enforcement Administration (DEA). A Schedule I drug according to the DEA is a drug with no currently accepted medical use and a high potential for abuse (8), both of which have been proven false for cannabis through research and on-going studies around the world. This classification of cannabis is a major part of the problem surrounding the stigma of its use. It also restricts the level of research that can be done in the United States. Many researchers and advocates are pushing to have cannabis fully legalized in the best-case scenario or at the very least de-scheduled. This classification of cannabis explains some of the fear that veterans, and the general population, have about being added to a medical cannabis registry.

As a way around using a registry, some people don’t apply for medical cards and instead wait for adult use laws to pass in their states. “Adult use creates another pathway to access, but it really also helps break the stigma around cannabis,” said Mandile. “A lot of people also prefer to not be on a registry with a medical cannabis card, so this allows them to find cannabis treatments and maintain their privacy.”

Advocacy Work

Mandile’s experience with cannabis had such a great impact on his life that he felt a sense of duty to share his knowledge with other veterans and fight to make it more accessible. He related a story of one of his earliest experiences with cannabis that turned into an “aha” moment for him. Mandile was in his driveway in the winter after a snowstorm. He hadn’t shoveled or done snow removal of his driveway in a decade. This day, he decided to smoke a joint and go outside to see what he could do. He said he only wanted to shovel out or use his snow blower enough to get his truck out of the driveway. After an hour (and a second joint), he completed the whole driveway! “I couldn’t even get inside to tell my wife how amazed I was by it—I called her on my cell phone from the driveway and told her to look outside because I couldn’t believe what I just did,” said Mandile. “I thought, how is this possible? How is this not available? Why doesn’t everyone know about this?”

Mandile’s next thoughts went to all the sacrifices that his brothers and sisters in arms made. “It felt like my duty—my job—to help save the lives of my fellow veterans and make sure that they have every possible tool available to them,” he said. “If cannabis can help save one veteran’s life, then it is worth it. Cannabis is a tool that’s getting us to move in the right direction.”

From there, Mandile got to work and was able to get about a dozen medical dispensaries to start offering a 40% discount for veterans with a 100% disability rating. Another part of his work as a cannabis advocate led him to different cannabis events throughout Massachusetts. He had been continuously meeting with legislators as well as city and town officials for more than a year to share his story about how cannabis was so beneficial. He noticed that people were amazed by anecdotal stories such as his, but he felt that something was missing. He attended an event where Dr. Marion McNabb was speaking and realized that what he was missing was data.

After speaking with Dr. McNabb, they realized they could make a real difference working together. Mandile, Dr. McNabb, and Ann Brum formed the Cannabis Advancement Series to increase access to medical cannabis for veterans in Massachusetts. Dr. McNabb also led the charge for a data-driven study called the Veterans Health and Medical Cannabis Study (some of that data is presented in this special issue on page 6). Through this collaboration, the team presented their collected data and used it to drive the conversation at these curated community educational development events.

“It was eye opening for me to see how effective data is,” said Mandile. “People can say, ‘Yeah, that’s one person,’ when you’re telling your own personal experience, but when you have data on hundreds of veterans, your argument becomes that much greater. It’s not just hearts and minds. It’s numbers and actual statistics and research on it.”

Conclusion

Mandile describes his work as more than just advocacy—it has become his sense of duty and purpose, which for a long time he felt he’d lost. “One more thing cannabis brought me besides mindfulness was my sense of purpose and my ability to continue my service to my fellow veterans, my community, and my country,” he said.

He is careful to not over promise to his comrades though. He urges veterans to look at the facts. “I’m never going to tell a veteran this is going to make you feel better. This is something that’s going to work for you. We are all different. It works differently for each individual,” said Mandile. “But people need to really look at the statistics of the side effects on some of the medications we are prescribed—look at the bottle of your VA medication, you see some side effects of suicidal thoughts, coma, or even death. None of those come with cannabis. There are no reported overdose deaths.”

“Cannabis may not give you everything you want, but it may help take the edge off,” said Mandile. “It can be the gateway to healing.”

Mandile’s experience and dedication to helping others is inspiring. If nothing else, Mandile’s story and hundreds of others like him beg the question: Isn’t it worth investing time and research into medical cannabis as a treatment for the people that are willing to risk their lives for our country?

References

1. mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967.
2. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd#:~:text=PTSD%20affects%20approximately%203.5%20percent,with%20PTSD%20in%20their%20lifetime.
3. https://www.ptsd.va.gov/.
4. https://www.ptsd.va.gov/understand/common/common_veterans.asp.
5. https://www.ptsd.va.gov/understand/related/suicide_ptsd.asp#:~:text=Studies%20show%20that%20suicide%20risk,and%20poor%20control%20of%20impulses.
6. https://www.mentalhealth.va.gov/docs/data-sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_Report_508.pdf.
7. https://www.masslegalservices.org/content/legislative-process-massachusetts-0.
8. https://www.dea.gov/drug-scheduling.

About Stephen Mandile

Stephen Mandile is an Operation Iraqi Freedom Veteran in long-term recovery who advocates for policy change federally and in Massachusetts that provides pathways to healing and post traumatic growth. He supports all treatment and methods which help combat the disease of addiction, mental health issues, and improve the quality of life for veterans and non-veterans alike. Stephen also serves as a Selectman for the town of Uxbridge, Massachusetts, co-founder of the Cannabis Advancement Series, and the 2019 Veterans Health and Medical Cannabis Study.