Sgt. Ryan Begin stationed in Iraq in 2003  Photo Courtesy of Ryan Begin
Sgt. Ryan Begin stationed in Iraq in 2003 Photo Courtesy of Ryan Begin
With strong support from veterans, medical marijuana patients and caregivers, a bill sponsored by Rep. Lizzie Dickerson (D-Rockland), which allows medicinal marijuana to be recommended for PTSD, became law last week. Currently, marijuana can legally be used to treat PTSD in six other states.

It's been an adventure," said Marine Sgt. Ryan Begin, 32, of his journey from the battlefields of Iraq, to jails and mental wards back home, and finally his quiet life farming in midcoast Maine. With his easygoing, friendly demeanor, at first meeting, it's hard to believe that Begin has had such a traumatic past. But as he recounts his tale, his voice drops and he raises his right arm, which is much shorter than the other and reveals the scar left by a roadside bomb in Iraq. Of the 1.7 million American men and women in the military who have served in Iraq and Afghanistan, Begin is one of the approximately 20 percent who have been diagnosed with post traumatic stress disorder (PTSD).

The War After the War

In the fall of 2001, following the terrorist attacks in New York on 9/11, Begin, who had recently left college, decided to enlist in the Marine Corps. A little over a year later, he found himself transplanted from his rural home in Jackman to the middle of the Battle of Nasiriyah, one of the first major campaigns of the Iraq War. Receiving wide media coverage at the time, the battle touched off on March 23, 2003, as a convoy and six soldiers, including Private Jessica Lynch, were captured. Begin and his company were involved in the rescue operation - wading through raw sewage to empty stranded trucks of essential supplies and walking the open streets as missiles rained down. He describes the chaos and confusion as he witnessed 18 of his fellow soldiers killed by friendly fire. Then, on his second combat tour on August 1, 2004, in Iskandariya, Begin was hit by an improvised explosive device, which blew his arm apart, taking his elbow. After returning home to Maine, and experiencing 30 surgeries, Begin found himself in the middle of what military veterans sometimes call the "war after the war."

"I never knew it was going to affect me so much mentally until I did it," says Begin. "I had PTSD so bad. I'd sit in my house with my guns loaded and windows shut. I couldn't deal with anyone. Now I'm here, talking to everyone. I've been to Augusta to speak at the hearings and I'm able to do that because of medical marijuana."

For the past few years, Begin says he has been able to smoke marijuana legally due to the chronic pain caused by his injury, but he says it has also helped him handle his stress and get off a cocktail of pharmaceutical drugs prescribed by doctors at the Veterans Administration Hospital. It was an experience he says almost killed him.

Upon returning to Jackman, Begin began building houses with a friend, while flying back and forth to Bethesda, Maryland, for surgeries on his arm. He used the insurance money from the military to buy a new truck, a house and some land. However, he had already begun to spiral to rock bottom.

"I felt like I was being set up for failure," says Begin. "If you're going to give someone money, why give it to them when they're all unstable and then give them all of these pills?"

During that time he says he was taking over 100 pills a day, from pain medications like morphine to anti-depressants and sleeping pills. He also began drinking heavily. In July 2007, Begin says he drank two bottles of whiskey and took several valium before getting pulled over by the police. He spent 43 days in the Somerset Jail for assaulting the officer. He ended up in trouble with the law over various infractions, such as an aggravated criminal trespass and violating his probation by smoking marijuana. His wife ended up getting a protection-from-abuse order against him after he threw an ashtray that hit her in a fit of rage. He says he tried to commit suicide several times.

The Debate

In the spring of 2010, Begin decided to try another route to treating his condition and he made an appointment with Dr. Dustin Sulak of Maine Integr8 Health in Falmouth. As a practicer of both conventional and alternative medicine, Dr. Sulak is one of a short list of doctors in Maine that openly takes medical marijuana patients. Although Dr. Sulak could not legally recommend medical cannabis to treat the PTSD, he wrote a recommendation for medicinal marijuana for Begin's pain derived from his injury. Begin had admitted to using marijuana recreationally to his doctors at the V.A., but when it was learned he was taking medical marijuana, he was taken off all of his other prescribed medications. He now smokes around five to seven joints a day and says it's the only medicine he needs now. According to Dr. Sulak, Begin's response to the drug is not uncommon among his patients.

"They come in wanting cannabis for one condition, say chronic pain, and they come back and say, 'Doc, I was able to stop using my oxycodone because the cannabis was working so well for me,'" said Dr. Sulak. " 'And not only is it working with pain, but it's also helping me sleep, so I stopped using my sleeping medication. And it's also helping me with my anxiety so I stopped using my benzodiazepine. And it's helped with my depression, so I stopped using my anti-depressants.' "
Dr. Sulak says that because the list of conditions for which a doctor can recommend medicinal marijuana was created by politicians and not doctors, he is unable to recommend the drug for a range of other ailments that he believes the plant could treat, without the harmful side effects of other pharmaceutical drugs. For instance, he says it can even be effective in treating eczema when concentrated into a non-psychoactive, topical salve.

However, Gordon Smith of the Maine Medical Association, an organization representing Maine physicians, says that the MMA is not against medicinal marijuana, but his members are concerned about making the list of qualifying conditions too broad.

"To eliminate the list and simply put doctors in a position where patients might come in and ask for it for anxiety or depression, this would be the most liberal marijuana law in the country except for the recent actions in Washington and Colorado, which simply legalized it," said Smith prior to the recent medical marijiana bill's passage.

A National Controversy

The hard evidence on whether medicinal marijuana is an effective treatment for PTSD continues to be debated within the scientific community and many say more research is needed. Since federal law still defines marijuana as an illegal Schedule 1 drug with no medical value, it's been difficult for researchers to get approval for further studies. The Multidisciplinary Association for Pyschedelic Studies (MAPS), a non-profit research and education organization dedicated to the study of psychedelics and marijuana, is currently in the process of trying to obtain federal approval of a randomized study of 50 veterans suffering from PTSD with the drug. Since Begin's last trip to the V.A., the administration has reversed its decision to refuse treatment to medical marijuana patients, but as federal employees, V.A. doctors are still prohibited from recommending the drug to patients.

Dr. Sulak believes that marijuana works for some of his patients because the human body already uses cannabis-like substances called endogenous cannabinoids to regulate cellular physiology throughout the human life-cycle. A 2009 study of synthetic marijuana on rats at Haifa University in Israel found evidence that the drug prevented the release of the hormone that the body produces in response to stress. Israel's Health Ministry and the Ministry of Defense have allowed the use of medicinal marijuana to treat soldiers sufferring from PTSD since 2004.

According to a study published this month in Molecular Psychiatry, researchers at New York University Langone Medical Center have found through brain imaging technology a connection between the number of cannabinoid receptors in the brain and PTSD. These CB1 receptors are activated when a person uses marijuana, reducing anxiety and impairing memory, such as traumatic life events.

A group called Veterans for Medical Marijuana has challenged the DEA's classification that marijuana holds no medical value, arguing that veterans should have the right to access medical cannabis for therapeutic purposes, such as treating PTSD. However, the long-standing lawsuit was thrown out of a federal appeals court in January. The court cited lack of scientific evidence to back up the claim that marijuana has medicinal properties.

The Healing Process

Whether or not the drug has the properties advocates claim, Begin says he's finally feeling like a productive member of society. He finished his probation in October and he says his moods are more stable and he no longer has nightmares. But he also believes that medicinal marijuana has only been the first step in his healing process. He says that working with animals and gardening on the farm has allowed him to reconnect with nature, while reading philosophy has allowed him to focus his mind on more positive thoughts. He says he wants to start an organization to help get veterans off pharmaceutical drugs and educate them about alternative forms of healing. He believes that there needs to be a better re-entry program for returning combat veterans.

"When you join the military and you go to war, you have to create a different identity to survive," said Begin. "If you don't, then you're not going to have a very good chance of survival. But then the problem is when you come back to a non-combative society. You play by the same set of rules that kept you alive in the combat zone and it gets you in jail, it gets you into mental wards, and it causes problems ... that's why a lot of [veterans] are having problems. They can't get away from the combat zone. The medical marijuana balances you, so you can start fresh. From there, you can gain knowledge, instead of fighting in your head all of the time. You're going forward."