I never have met Dan’s mother but w have talked on the phone a good bit and by email. It was in one of those first written notes that she got my attention. I was riveted on her words.
“ Al, I gave the Marine Corps a fine young man, eager to serve his fellow Marines and his country and look what they gave me back”.
His mom has a full length cardboard cutout of her son in his full dress blues. It is a picture of the poster Marine, the one chosen to visually exemplify the rest. Sergeant stripes and combat action awards proudly worn. A newer cardboard cutout would show a demoted and fined corporal, racked by prescription drugs.
Pain drives his day from an explosion in Iraq. He is consumed by it. He’s a smart guy I judge from the many phone calls we have shared. He wants badly to work, to share his future life as an equal partner. His wife he credits with helping him adjust to living with PTS(d) and dealing with the non supportive KY facility. They were married in July of 2011 in simple ceremony and with his black Labrador Retriever work together toward their goals.
When the State of Oregon first opened their cannabis door for approved patients 70% of those initially applying wanted cannabis for pain. Trauma pain, arthritis, phantom pain, joint pain such as fibromyalgia, rheumatism, more. Now it hovers near 80%.
His physical pain is in his back. It will be there for his life. The explosion also caused traumatic brain injury (TBI), and as has become increasingly known from studying the history of multiple traumas, Dan has been diagnosed with Post Traumatic Stress (PTS).
During the recovery period from his physical wounds he found cannabis, used cannabis and it helped him – a lot. He was an active duty Marine subject at any time to a urine test not because he was deficient or had a negative attitude, or that he was acting abnormally for the uptight group but because.
I do not know what else to write about this test on Dan. Just – because – that’s what our country does now. Clinics, test labs, technicians, trucking companies, governments, multiple levels of business, national and international now spend billions of years of labor and dollars checking urine to prove only that the person in question did or did not use some prohibited substance recently. Other than the money flowing through that spigot the whole activity is illogical but it sure does let the worker know he or she is owned, controlled. Pretty close to military life.
He was doing well. Sure he hurt but it was bearable and he had hope- then- that prescription drugs and physical therapy and his youth would bring him to a functioning level or better. A urine test was announced and he told the Marines to save some money because he smoked pot and it helped him. Please help me he said.
He was “written up” for using an illegal substance, fined and demoted. He was placed on chemical drugs all while at a wounded warrior battalion in NC. Here he turned into a chemically induced zombie. Anger, confusion, terror, unconsciousness became his norm. The wounded with him did what you would expect, they protected and watched their buddy closely. They know that world of terror, wanting, needing it all to just go away. They saw the signs. He attempted to shoot himself in the head. The Marines stated that there were no suicides or attempted suicides that year at that command. His mother in KY was called and she and her husband were on the road. They drove straight through the night. Dawn saw them and the Officer in Charge of the wounded arrive.
By noon Dan and his parents were gone from the Marine base, going home to KY. He was not discharged but placed in the care of his family.
Nothing is ever over when you hurt day and night, and the terror inhabits your head. It’s worse when your two tours in Iraq as a rifleman are dismissed as irrelevant to your emotional health by demoting you from earned rank and fining you as though you brought this nightmare upon yourself and you should pay for getting ordered to the wrong place at the wrong time.
Twenty years ago as a Vietnam Vet and combat counselor I lectured in meetings with health care professionals in Virginia where I was educating them about post traumatic stress. I stressed dropping the “D”.
“Please drop the D. I know it is a medical term but it is inappropriate, it’s insulting. These men and women are reacting normally to a completely abnormal set of traumatic experiences. Theirs is a normal reaction and you all must accept that as reality.” Call it a “response syndrome” to trauma. Change the medical terminology so that words “do no harm”.
I also found in those years it was normal for a Vet to use cannabis to calm him, to sleep, to eat, to give up hard drugs, to reduce or end alcohol use. Twenty years have passed and yesterday I spoke briefly with a man, now a senior law enforcement official in NC, who had in the past worked for 5 years in a VA hospital.
“It was everywhere in the hospital. We all knew what they were smoking and why. It was OK with everybody.”
It has not been OK for Dan. The VA hospital in Lexington, KY has refused to prescribe opiate based pain killers to him because of his past cannabis use as an active duty Marine and his continued use. The half dozen, non-opiate based chemicals they did try on him failed.
My call is that the VA system and the Marines failed Dan not the other way around.
It is flat unethical to deny pain medication for anybody let alone someone known to be a severely injured US warrior. That is what has been done without excuse. It’s the hospital policy to deny opiates to known drug addicts an ER MD told Dan two weeks ago. Addict? It’s right here in your Marine record that you used cannabis and are therefore an addict. I cannot help you.
I co-founded a Veterans service organization, Veterans for Medical Cannabis Access for exactly the behavior exhibited by this VA facility. Behavior, aberrant, illogical and demonstratively damaging to another human being I always thought was worth worrying about. Urine testing for such action could be justified but is not in this case. The Commanding Officer who allows this type of judgment, actually a lack thereof to prevail needs the test not a “grunt” in pain.
I have a letter in my possession written by the Undersecretary for Health, Department of Veterans Affairs, dated July 06, 2010 addressed to my co founder of VMCA, in part it reads…
“This is a follow-up response to your letter requesting clarification of the Veterans Health Administration’s (VHA) policy regarding the practice of prescribing opioid therapy for pain management for Veterans who provide documentation of the use of medical marijuana in accordance with state law.” (State law is an important factor now in treatment for all Veterans regardless of duty period or medical problem. I call it treatment by geography. A completely new medical concept, never tried before in human history, being experimented with on the wounded.)
He continues, “If a Veteran obtains and uses medical marijuana in a manner consistent with state law, testing positive for marijuana would not preclude the Veteran from receiving opioids for pain management in a Department of Veterans Affairs (VA) facility.”
Dan did not in the Marines and does not obtain cannabis legally now in KY. If KY were to allow cannabis used clinically Dan would be OK.
Who or what do you want to blame for this travesty? The CO for being a bureaucrat instead of a doctor. Kentucky politicians for being feckless cowards. The ER physician for sending a man in pain out on the street. His case worker at the VA for being a lemming instead of a real advocate. The entire Congress of the United Sates for sending the youth off to war and then abandoning them because they smoked a joint? They all could be stand up humans but are not. Dan stood up and they could treat him as a role model instead they don’t treat him at all.
Dan did two tours in Iraq. He did them both with Larry. The first tour for them physically was a pass. Men died around them, the smell of rot filled their senses, doubt filled their soul, heat, boredom and sudden terror filled their days but they were physically OK. During the second tour the world as they knew it ended forever for Dan and Larry, Marines.
Each was blown up by an IED, what we called in Nam a mine, built out of unexploded bombs from aircraft, or scavenged containers, and scraps of wire and filled with nails and glass and metal pieces and exploded with stolen C4 or old ordinance buried until needed.
They were both returned to duty and continued to patrol as before, but this was before TBI and the resulting potential for PTS was considered a wound. After returning to the US Dan was treated for PTS and cannabis use at a six week inpatient facility under Marine care. Months later there was a “failed” urine test, cannabis use, at the VA hospital and without an explosion, instead a mendacious, illogical “policy”, a myth according to the Undersecretary, changed Dan’s life again and again for the worse. No pain control for a Marine in pain. “Support the Troops.” Picture all the yellow ribbons.
Larry was a California guy and returned to his home state after his discharge. He was and is treated in a VA hospital in that state. In California, its citizens voted to allow all residents to use cannabis therapeutically under medical supervision. The VA Undersecretary for Health as you have read has directed that opiate treatment be provided in VA facilities in “legal” states at the discretion and based on the judgment of the individual patients’ needs and the attending physician, NP or PA. Larry is registered cannabis patient and is treated for his pain with opiates. He is attending college.
On the phone Dan said to me, “Al, Larry and I were shot at by the same people. We shot at the same people. We got blown up by the same kind of bomb. The shrapnel I carry in me is the same shit that Larry carries in his body. Why won’t they help me?”
Riveting. Al Byrne for Patients Out of Time