The Colorado Board of Health voted 6-2 — amid shouts, hisses and boos from a packed house — not to add post-traumatic stress disorder to the medical conditions that can be treated under the state's medical marijuana program.
The board voted Wednesday against the recommendation of the state's chief medical officer.
A dozen of the veterans who testified said cannabis has saved their lives. Many said drugs legally prescribed to them for PTSD at veterans clinics or by other doctors — antidepressants, antipsychotics, opioids and others — nearly killed them or robbed them of quality of life.
"It is our brothers and sisters who are committing suicide every day. We know cannabis can help. We're not going to go away," said John Evans, director of Veterans 4 Freedoms.
"We've legalized it," Evans said. "We'll take the tax dollars from our tourists (for recreational marijuana) before we'll help our vets."
The president of the nine-member board, Tony Cappello, an epidemiologist, said he could not vote to approve pot's use for PTSD because scientific evidence does not support it. Most board members agreed that mountains of anecdotal evidence aren't enough. One board member was absent.
"I'm struggling with the science piece," board member Dr. Christopher Stanley said.
The American and Colorado psychiatric associations do not support it, said board member Dr. Ray Estacio, an internist at Denver Health and associate professor in medicine at the University of Colorado Anschutz Medical Campus.
But board member Joan Sowinski, an environmental and occupational health consultant, said the testimony from veterans and other PTSD sufferers was so persuasive — as was recent research about symptoms reduction — that she could support it. Jill Hunsaker-Ryan, an Eagle County commissioner, was the only other yes vote.
"Blood is on your hands," one audience member shouted after the board voted not to make Colorado the 10th state to allow medicinal marijuana use for PTSD.
The state's chief medical officer, Dr. Larry Wolk, director of the Colorado Department of Public Health and Environment, recommended the state add the condition. He suggested a provision that would cause the issue to be re-examined in four years, after two state-funded studies produced results.
Wolk said listing PTSD as a treatable condition would increase transparency and reveal actual usage, shedding light on its effectiveness and reinforcing a physician-patient relationship for many users.
Many veterans are self-medicating with recreational marijuana or using medical marijuana ostensibly as pain treatment, although it is really for PTSD, he said.
Currently allowed uses of marijuana include pain (93 percent of recommendations), cancer, epilepsy, glaucoma, muscles spasms, multiple sclerosis, severe nausea and wasting disease (cachexia).
Dr. Doris Gundersen, a psychiatrist who spoke at the meeting, said only 4 percent to 5 percent of the state's physicians recommend medical marijuana to patients. About 15 physicians make 75 percent of the recommendations, she said. The state has roughly 14,000 licensed doctors.
"Why are so few getting on board? (Because) there is a lack of quality evidence that it is safe and effective ... and does no harm," Gundersen said.
One of the state-funded medical marijuana investigators, Sue Sisley, who is looking at effects on veterans' PTSD, said federal policy on marijuana is a prime reason research is scant. It will take at least four years for her study, she said, because the team has been delayed in getting the study drug, still illegal under federal law, from the authorized supplier — the U.S. government.
A few of the roughly 30 public speakers noted that what patients want — not hard science — is driving demand for expanded medicinal uses of marijuana. That's not a bad thing, advocates said.
"It is very important patients become part of this discussion," said Teri Robnett, director of the Cannabis Patients Alliance and member of the state's advisory council. "Patients are getting enormous relief."