Cannabis Patient Care - December 2022

Cannabis Patient Care- December 2022

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research focus 16 cannabis patient care | vol. 3 no. 4 iCount for Veterans: A Research Platform to Connect Veterans with Cannabis Research Studies Led by the Cannabis Center of Excellence, UMass Dartmouth, and Patriots Helping Vets B Y D R . M A R I O N M C N A B B , J U L I A N S A L I M , D J R I T T E R , V A N E S S A J O N E S , T O M R A N D , A N D D R . S T E V E N W H I T E A CCORDING TO THE US Census Bureau data, as of 2020, there are about 19 million veterans aged 18 and older in the United States, with more than 34% of those veterans using the US Department of Veterans Affairs (VA) for healthcare (1). US military service members and veterans often face different health issues than civilians be- cause they are at risk for various injuries during their services. These injuries can happen during combat, while others involve physical stress to the body due to exposure to environmental hazards such as contaminated water, chemicals, infections, and burn pits—many of these injuries are life-threatening or can cause long-term disability (2). In addition, service members are also disproportionally at risk of developing a variety of mental health problems, including anxiety, post-traumatic stress dis- order (PTSD), depression, substance use disorder (SUD), and su- icide (2). Veterans may encounter a variety of stress-related disorders and challenges when reintegrating from the military into the community. Enabling veterans' reintegration, readjust- ment, transition, coping, and community integration is a soci- etal emphasis. Every year more than 200,000 veterans transition out of ser- vice, and research suggests that supporting veterans in the ear- ly transition period is essential considering the readjustment challenges (3). Vogt and colleagues piloted a five-year study with a nationally representative sample of more than 9000 US veter- ans. This study was the first to explore how the US veteran pop- ulation's health and broader well-being (that is, work and so- cial relationships) change in the first several years after they leave military service. The study found that veterans experi- enced decreases in health and well-being over the three years of the study—health concerns were the top cases, where many veterans reported having chronic physical (53%) or mental (33%) health conditions. The most significant conditions conveyed in- cluded: chronic pain, sleep problems, anxiety, and depression (4). Chronic pain is more prevalent and eminent in veterans than in the general population (5). During 2019, veterans aged ≥20 years were more likely to have chronic pain than non-veterans (31.5% versus 20.1%), and among veterans, those aged 50–64 years had the highest prevalence of chronic pain (37.2%) (6). In addition, as the COVID-19 pandemic heightened so did the inci- dence and severity of mental health problems and substance use disorders in 2020—about 17 veterans committed suicide daily (7). Indeed, recent data point that among veterans com- mitting suicide in 2020, about 1 in 3 suffered from depression, 1 in 4 suffered from anxiety, 1 in 5 suffered from alcohol use dis- order, 1 in 4 had PTSD, and nearly 1 in 12 suffered from opioid use disorder (8). The resulting and compounding health circumstances veter- ans meet post-deployment come with the demand for health- care, numerous prescription medications, mental health in- terventions, and alternative treatments. A study conducted in 2020 of 1700 US Iraq and Afghanistan veterans discovered that 46% were prescribed anti-depressants, 36% sleeping pills, 35% anti-anxiety medications, and 32% opioids (9). Another survey led by the Defense Department uncovered that about one in four veterans had at least one opioid prescription in 2017, yet only one-tenth (0.001%) of them were obtaining care for a diag- nosed opioid use disorder (10). Increasing opioid dosing does not appear to improve chron- ic pain. A study by VA Portland researchers in 2020 noted that out of 500 patients with chronic pain, nearly 20% had their opioid dose increased, although solely 3% of those pa- tients indicated meaningful progress in pain (5). Medical can- nabis may offer a practical and low-risk treatment alterna- tive for veterans, primarily when compared to conventional treatments (for example, alcohol, medications, and opioids) for health conditions, including PTSD (11). Expanding access to medical cannabis as an alternative to opiates and other

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