Cannabinoids in the Veteran Population: Facts, Fiction, & Future Directions (original) (raw)

Given increasingly prevalent use of cannabinoids among Veterans to address such issues as pain and anxiety, it is incumbent upon providers to enhance their familiarity and clinical “comfort level” in working with Veterans who use these substances (Metrik et al., 2018). With the majority of U.S. states having adopted legislation to medically and/or recreationally legalize cannabis, the already high prevalence of cannabis use (Hasin et al., 2015) is expected to further increase nationwide, especially among existing users (Hall & Lynskey, 2016; Pacula & Lundberg, 2014). States that allow the legal use of cannabis for medicinal purposes have higher rates of cannabis use and cannabis use disorder (CUD) in national survey data (Cerdá, Wall, Keyes, Galea, & Hasin, 2012) and specifically within the Veterans Health Administration (VHA; Bonn-Miller, Harris, & Trafton, 2012). Veteran advocacy groups have been created to further veterans’ rights to access cannabis for medical (MC) purposes and discuss its use with their VHA providers (for e.g., “http://www.vetscp.org/#,” 2017). There are also published reports that veterans perceive cannabis to be a low-risk or safe substance unlike other drugs of abuse (Wilkinson, van Schalkwyk, Davidson, & D’Souza, 2016) and expect cannabis to provide relief from symptoms of combat-related trauma (Earleywine & Bolles, 2014). Bonn-Miller MO, Harris AHS, Trafton JA. Prevalence of cannabis use disorder diagnoses among veterans in 2002, 2008, and 2009. Psychological Services. 2012;9(4):404–416. doi: 10.1037/a0027622 Cerdá M, Wall M, Keyes KM, Galea S, Hasin D. Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol Dependence. 2012;120(1–3):22–27. doi: 10.1016/j.drugalcdep.2011.06.011. Earleywine M, Bolles JR. Marijuana, expectancies, and post-traumatic stress symptoms: A preliminary investigation. Journal of Psychoactive Drugs. 2014;46(3):171–177. doi: 10.1080/02791072.2014.920118 Hall W, Lynskey M. Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction. 2016;111(10):1764–1773. doi: 10.1111/add.13428. Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Grant BF. Prevalence of marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatry. 2015;72(12):1235–1242. doi: 10.1001/jamapsychiatry.2015.1858. Metrik, J., Bassett, S. S., Aston, E. R., Jackson, K. M., & Borsari, B. (2018). Medicinal versus recreational cannabis use among returning veterans. Translational issues in psychological science, 4(1), 6. Pacula RL, Lundberg R. Why changes in price matter when thinking about marijuana policy: A review of the literature on the elasticity of demand. Public Health Reviews. 2014;35(2):1–18. Wilkinson ST, van Schalkwyk GI, Davidson L, D’Souza DC. The formation of marijuana risk perception in a population of substance abusing patients. The Psychiatric Quarterly. 2016;87(1):177–187. doi: 10.1007/s11126-015-9369-z. Target Audience The primary target for this presentation is mental health clinicians at VA health care facilities (VHA), and this includes psychiatrists, clinical social workers, psychologists, LPCs, LMFTs, and psychiatric NPs. Outcome/Objectives At the conclusion of this educational program, learners will be able to: 1. Identify indications for cannabinoid use in the Veteran population, as well as evaluate claims not currently supported. 2. Identify the common pharmacological targets of cannabinoids, endo/phytocannabinoids 3. Discuss common formulations utilized by patients (e.g., edibles, vapor, tincture, whole flower) and risk-benefits associated with their use 4. Understand the evolution of cannabinoids from recreational to medical use