Pot Shots

On July 27, Dr. William Ulwelling, an Albuquerque psychiatrist for more than 30 years, wrote a letter to the head of the state's medical marijuana program that may have large implications for nearly half of the program's patients.

"At the next hearing of the Medical Cannabis Advisory Board," he wrote, "I will petition the removal of Posttraumatic Stress Disorder from the list of eligible medical conditions for enrollment in the NM Medical Cannabis Program."

New Mexico is one of only three states with programs that recognize medical marijuana as a legitimate treatment for PTSD. PTSD sufferers make up the bulk of the MCP's patients, at roughly 40 percent. Many of them are veterans.

For the next two and a half months, the petition remained largely under the radar, but rumors swelled throughout the medical marijuana community. Last week, it finally went public, and medical marijuana advocates across the state responded with a backlash.

"It's insane. It's ridiculous," Len Goodman, executive director of medical marijuana producer New MexiCann Natural Medicine, tells SFR. "Sure, it's not for everybody. But for those who think they should use cannabis, why in the world would you want to turn them into criminals?"

Ulwelling says his concern stems from exposing PTSD patients to an "addictive substance"—marijuana—for a treatment that isn't backed up by sufficient clinical evidence. (Studies on the addictive properties of marijuana have been largely conflicting, however.)

"They're probably dependent on this stuff," Ulwelling told medical marijuana advocate Larry Love recently on Love's Medical Marijuana Radio podcast. "I would ask, 'What the heck is the state of New Mexico [doing,] making medical opinions against the overwhelming consensus of experts in the field?' I would stress that my opinion is not some nutcase opinion—it is the overwhelming consensus opinion of experts in the field."

But Love pointed out that Ulwelling's petition could harm the nearly 3,000 PTSD patients across the state.

"As a man—as a human being—how will you feel, knowing that your actions will cause so much pain to already-suffering people, especially the veterans of our wars?" Love asked.

Similarly, nurse practitioner Bryan Krumm, who manages patients enrolled in the program, is threatening to file a formal complaint against Ulwelling if he doesn't rescind the petition. In an Oct. 3 letter to Ulwelling, Krumm accused him of attempting to use his medical license "to do harm to thousands of New Mexico citizens."

"I will not allow such gross misconduct to go unchallenged," Krumm wrote. "I can only assume now that your position is based on arrogance, ignorance and/or intolerance. Medicine must be based on science, not politics."

But medical research on the subject—some of which suggests that marijuana can help alleviate PTSD symptoms—is still limited and largely anecdotal.

In June, for instance, researchers at the University of Arizona found little evidence supporting marijuana as either an effective or ineffective treatment for PTSD. That's largely due to marijuana's federal classification as a Schedule I controlled substance—meaning it's illegal and viewed as having no medicinal value—which has prevented adequate research on the subject.

The medical community remains divided on whether marijuana should be used to treat PTSD. Carola Kieve, a psychiatrist at the Community Mental Health Center in rural northern New Mexico, says she's seen two of her patients with PTSD drop their addictions to harmful drugs after enrolling in the cannabis program.

"The availability of treatment, for any diagnosis in this area, is scarce," she writes in an email to SFR. "I see absolutely no harm with [medical marijuana's] use in patients with PTSD."

Like Kieve's patients, many PTSD sufferers attest to cannabis' benefits, and several hundred are planning to show up during Ulwelling's appearance before the MCAB on Nov. 7.

One of them is Santa Fe resident Nat Dean, who suffered severe injuries in a car wreck in 1984. A few years ago, she was diagnosed with PTSD. Dean, who also suffers from chronic pain, says her symptoms spiked after pancreatitis forced her to have her bladder removed. She says that bad health care experiences were "the icing on the cake" for her PTSD symptoms.

"I feel like, [with] everything that was going wrong for me, I wasn't able to handle everyday living," Dean tells SFR. "You think you're losing your mind."

At one point, Dean was on 27 different drugs. Now, that number is down to six, and Dean largely credits cannabis for her recovery. She smokes two or three puffs of marijuana at night every few days.

Ulwelling concedes that patients like Dean may benefit from medical marijuana, but he argues that allowing the program to continue offering it to PTSD sufferers without proper scientific evidence could cause more harm than good.

He worries that some PTSD sufferers may come to rely on pot indefinitely, rather than seeking proper, long-term treatment.

"Marijuana can make you feel good," Ulwelling tells SFR, adding that beer can, too. "Just because people say, 'I've been helped by this' [doesn't mean] that's the end of it."

He adds that if his petition is successful, current PTSD-suffering medical marijuana patients in New Mexico should probably be "grandfathered in" since they, in good faith, relied on the state to admit them to the MCP.

Medical marijuana advocates question Ulwelling's priorities, noting that he hasn't treated a patient in five years, and that a 2007 lawsuit blamed him for a patient's suicide. However, the court ruled that Ulwelling committed no wrongdoing, and such lawsuits are also common for physicians like Ulwelling—a recent New England Journal of Medicine study concluded that at least 75 percent of physicians will be sued at least once in the course of their careers.

The University of New Mexico also took issue with Ulwelling's signature on the petition, in which he identified himself as a "clinical assistant professor" at UNM's medical school. UNM says Ulwelling hasn't had a contract there for five years.

Ulwelling says he started as a clinical assistant professor with the school in 1984 and that his contract could have become inactive since his semi-retirement a few years ago. He adds that his petition is in no way meant to represent UNM, and that he's in contact with the university and will change his signature to "former clinical assistant professor" if instructed to do so.

In his debate with Ulwelling, Love mentioned that research on the issue was still developing, and cited recent studies in Israel showing benefits.

"You need more research before you can take this medicine away from people," Love told Ulwelling on his podcast.

But Ulwelling argues just the opposite—that more research needs to be done before PTSD sufferers should be allowed to take marijuana.

"In a sense, we're doing that experiment now—on the citizens of New Mexico," he says.

To others in the medical industry, the dispute as to whether PTSD should be treated with marijuana is a low priority. David Bennahum, a UNM School of Medicine professor and a member of the school's Institute for Ethics, recently told SFR that the issue is a distraction from larger problems such as a lack of holistic health care.

"Today, we're very focused on pharmacology," he said. "It's much cheaper for insurance providers to pay for drugs than psychotherapy. It's not surprising, in a society that uses so many drugs, that we turn to drugs for our problems, because we're not invested in therapy." 

Santa Fe Reporter