Grants from the state of Michigan are funding research into if cannabis can treat mental health conditions, such as post-traumatic stress disorder (PTSD), and if it can prevent veteran suicide.
Between 2021 and 2022, the state has announced funding for research conducted by scientists at Wayne State University, the University of Michigan and the Multidisciplinary Association for Psychedelic Studies.
More than 1 in 10 veterans who have served in Operations Iraqi Freedom and Enduring Freedom, the Gulf War and the Vietnam War have PTSD, according to the U.S. Department of Veterans Affairs (VA). The VA also states that among veterans who use VA health care, about 23% of women have reported sexual assault when in the military, and about 55% of women and 38% of men have experienced sexual harassment when in the military.
In 2019 in the U.S., there were 130 suicides per day, and 17 of those deaths were veterans, according to the U.S. Centers for Disease Control and Prevention. Although veterans comprise about 7% of the U.S. population, they represented about 13% of lives lost to suicide that year.
The mental health of veterans was not lost on Michigan voters when they legalized adult-use cannabis via Proposal 1 in 2018. That initiative requires the state to provide $20 million annually “until 2022 or for at least two years” for clinical trials evaluating cannabis’ efficacy in treating U.S. veterans’ medical conditions and preventing veteran suicide.
The state has been working to help ensure a smooth rollout of the studies, says David Harns, public relations manager for Michigan’s Cannabis Regulatory Agency (CRA) and Department of Licensing and Regulatory Affairs.
“Overall, the most important thing is that we get true, accurate, scientific data that will help move the ball down the field in regards to these types of conversations,” Harns says. “By having these organizations that have been awarded these funds taking the time to study this, hopefully that’s going to be the case and we can have some good results from these studies.”
Representatives from three different agencies brought their specialized perspectives to the review of researchers’ requests for proposals, Harns points out. The committees that reviewed the 2021 and 2022 requests for proposals included representatives from the CRA (known as the Marijuana Regulatory Agency until April 2022), the Michigan Veterans Affairs Agency and the Michigan Department of Health and Human Services.
Proposal 1 states that institutions that conduct the research should receive approval from the U.S. Food and Drug Administration; however, Harns states that hasn’t yet happened and, as it stands, that approval will be needed for institutions to receive a percentage of funding.
Dr. Leslie Lundahl, associate professor and clinical psychologist in Wayne State’s Department of Psychiatry and Behavioral Neurosciences, will take a leading role in much of that institution’s research involving cannabis and veterans.
“Public perception and acceptance of cannabis as a pharmacotherapeutic, I think, has outpaced the science at this point,” Lundahl says. “So, we’re hoping to start this conversation, and we’re in a good position to do this because we have studied cannabis for a couple of decades now, and we’re quite well-versed in the risks that can be associated; looking at the possible therapeutics I think requires a balance of understanding what those risks could be.”
Evaluation of THC and CBD Use
In 2021, Wayne State University obtained a $7 million grant for the five-year project, “Wayne State Warriors Marijuana Clinical Research Program: Investigating the Impact of Cannabinoids on Veteran’s Behavioral Health.”
In one study that will be funded as part of the project, the researchers will administer THC and CBD in different ratios—low THC and low CBD, high THC and low CBD, low THC and high CBD, and high THC and high CBD—as well as placebos, to participating veterans, Lundahl says. Over a 12-week treatment period, researchers will analyze the effects on veterans’ PTSD symptom severity and frequency, and severity of any suicidal thoughts and behaviors.
“The other things we’re looking at are things like pain, impaired sleep, cognitive function, [and] quality of life,” says Lundahl, the lead principal investigator on the study. “We’re also going to match up endocannabinoid levels with the CBD and THC administration. So, we’re looking at a number of outcomes.”
Dr. David Ledgerwood, associate professor and clinical psychologist in Wayne State’s Department of Psychiatry and Behavioral Neurosciences, will lead a naturalistic observation study funded as part of the project.
The observational study involves two groups whose cannabis use will be monitored for a year, Ledgerwood says. The first group will use cannabis provided through the study as they choose, and researchers will monitor their use and their mental health symptoms; the second group will reduce their THC use and increase their CBD use, and researchers will monitor their use and their mental health symptoms.
Pairing Cannabinoids With Behavioral Therapy, Researching Neuroinflammation
In 2022, Wayne State University also received more than $12.5 million in grant funding from the state of Michigan to fund two more five-year studies.
In one of the studies, titled “Wayne State Warriors Marijuana Clinical Research Program: Cannabinoid Adjunct to Prolonged Exposure and Recovery,” researchers will analyze pairing cannabis use alongside prolonged exposure therapy for veterans.
Prolonged exposure therapy is a behavioral treatment for PTSD, phobia and anxieties, Lundahl says. “But with veterans, what’s been shown in the literature is that almost half of them don’t continue with the full course of treatment,” says Lundahl, a co-principal investigator on that study. “And then of those who do, about a third of them don’t experience a lot of relief. So, there is effective treatment out there, but there’s a lot of room for improvement.”
The scientific literature includes animal and human data that show there may be links between the cannabinoid system and the fear system, Lundahl says. “So, if we were to augment the behavioral treatment with THC, again, in combination with CBD, is that going to improve the outcomes of that treatment?” Lundahl asks.
The other Wayne State study announced in 2022, titled “Investigating the Therapeutic Impact of Cannabinoids on Neuroinflammation and Neurobiological Underpinnings of Suicide Ideation in Veterans with PTSD,” will be led by the university’s Dr. Hilary Marusak and Dr. Eric Woodcock.
“They’re using brain imaging and PET scans to look at levels of neuroinflammation,” Lundahl says. “What’s interesting is there’s some brand new data that shows that inflammation is associated with increased suicidal risk, and we know from animal data that CBD is thought to be anti-inflammatory. So, they’re looking at whether changing levels of THC and CBD might change the levels of inflammation down in the brain, and that might have an effect on suicidal thought.”
Possible Links Between Cannabis and Mental Health
Cannabis consumers and patients use cannabis for various symptoms such as pain relief, stress, various mental health conditions and more, Ledgerwood says.
“But there’s not really a lot of really rigorous, solid research out there to really show—what does it help and what might be the costs of that?” Ledgerwood says. “I think that’s the ultimate goal is for us to get somewhat of an understanding, at least in this area of: Can cannabinoids, whether that’s THC or CBD or some combination of the two, be helpful in addressing some of these symptoms that a lot of people are anecdotally already saying do help them? But we want to make sure that it’s being studied in a solidly rigorous way where we’re looking at both the potential benefits and the potential risks.”
Wayne State researchers noted in their request for proposal for one of the studies announced in 2021 that “The role of cannabis use in suicidal behavior is unclear,” citing various research. One cited study in Archives of Suicide Research showed a correlation between heavy cannabis use and post-military deployment suicide attempts, while another cited study in The Journal of Psychopharmacology that showed cannabis use may reduce the association between PTSD, severe depression and suicidal states.
“There’s a lot of thought that suicidal behavior or suicidal thoughts can arise because of depression and PTSD and anxiety and other conditions that are untreated or undertreated, and that that can be something that increases the risk for suicide,” Lundahl says. “Where cannabis use fits into that is something we’ll look at statistically to figure out. Does it interact in some way with those factors?”
The researchers will speak with the study participants weekly to see if and how the prevalence of any suicidal thoughts changes as the participants alter their cannabis use.
“… [I]f they’re using more and their suicidal thoughts come down, then that’s interesting,” Lundahl says. “But then is the cannabis reducing the suicidal thoughts, or is it reducing this anxiety and depression [and] that is also reducing the suicidal thoughts? So, you can see how complicated that can be.”
Partnering with a Michigan Cannabis Company
For the naturalistic observation study announced in 2021, Wayne State researchers will obtain cannabis prerolls with varying amounts of THC and CBD from Redbud Roots, a vertically integrated Michigan cannabis company headquartered in Buchanan.
Alex Leonowicz, co-founder and COO of Redbud, says it’s important that respected institutions are researching the effects of cannabis on veterans and others.
“To see that type of brain power getting dedicated towards cannabis, which, let’s say, seven years ago, you couldn’t have even talked about—that, to me, is the real impact to the story,” he says.
Wayne State researchers visited Redbud’s cultivation, processing, automation and packaging facilities in Buchanan to learn more about how cannabis is commercially cultivated and products are manufactured, Leonowicz says. The indoor cultivation facility is about 50,000 square feet, the processing facility is about 3,500 square feet, and the packaging and automation facility is 12,500 square feet, Leonowicz says.
Lundahl, who visited Redbud’s facility, says she had not previously been inside a cannabis facility of that size. “Overall, I think what I came away with was how incredibly professional and organized this production is,” Lundahl says. “I had no idea what it could look like. The attention to detail—even things as basic as the cleanliness—it’s pristine, there’s no contamination. I was really, really impressed.”
Leonowicz adds that the Wayne State staff also toured a New Standard dispensary, which sells Redbud product.
Multiple people involved in the research and Michigan’s cannabis industry have ties to military service. For example, Lundahl and Leonowicz share they have close relatives who have served in the armed forces. Leonowicz’ relatives who have served include his father, John Leonowicz, U.S. Army Military Police Corps; brother, James Cooper, U.S. Navy, deployed to Saudi Arabia and Iraq; and late brother-in-law, Greg Coltson, Vietnam U.S. Marines veteran. Additionally, Redbud’s Head of Facility Operations Joe Poquette served with the U.S. Army on three deployments to Iraq and in the National Guard, and now serves in the U.S. Army Reserves, Leonowicz says. Another team member in Redbud’s processing division also served in the military, Leonowicz says. And the CRA’s new acting executive director, Brian Hanna, served in the U.S. Army Reserve, including in a combat deployment to Afghanistan.
More broadly, Leonowicz and Lundahl note the lasting physical and mental toll that military service can have on U.S. veterans.
“I think we need to be doing everything we can to help our veterans, and it’s going to take some innovative and novel kinds of approaches to treatment,” Lundahl says. “We need to improve treatments; we need to come up with new treatments.”
Lundahl says she thinks cannabis could be used in coordination with other treatments, but as the scientists conduct the research, they will rely on the data before they draw any conclusions.