(The Arizona Republic) -- Emanuel Herrera returned from war addicted to painkillers and barely able to tolerate his children's voices.
The former staff sergeant from Glendale had enlisted in the Arizona National Guard after 9/11, wanting to help his country. In 2006, while providing security for a convoy near Camp Anaconda in Iraq, his truck hit an improvised bomb. The blast turned the night into day, nearly destroyed his neck, damaged the discs in his back and left him with brain injuries and post-traumatic stress.
Last year, despite warnings from medical staff at the local veterans hospital, he began to smoke pot legally under the state's new medical-marijuana program to cope with the physical and mental pains of combat.
"My doctors shunned me and didn't approve of me doing it," said Herrera, a Purple Heart recipient. "One doctor said I could get some repercussions for doing it. But I did it legally. And I know for a fact -- I'm a walking testimonial -- that it works."
No one collects data on the number of veterans participating in medical-marijuana programs in Arizona or the other 16 states where it is legal. But veterans and program advocates say those who have served are turning to cannabis more and more to deal with the disabling symptoms of post-traumatic stress disorder, traumatic brain injuries and chronic physical pain.
In Arizona, veterans are leading the push for health officials to add PTSD as a qualifying condition for the medical-marijuana program. Currently, only individuals with diagnoses such as chronic pain, cancer and other debilitating conditions qualify. Two other states include PTSD as a qualifying condition.
Dozens of veterans have written letters and testified at a public hearing at the Arizona Department of Health Services late last month about the benefits of cannabis, saying prescription pain drugs are inadequate.
But the federal government has sent mixed messages about its stance on the issue, with law enforcement opposing states' programs and VA medical staff allowing participation. Medical experts disagree on whether the drug helps or hurts veterans.
Veterans Affairs' policy
The U.S. Department of Veterans Affairs in 2010 formally began to allow patients treated at its medical facilities to use medical marijuana in states where it is legal. But because the drug remains illegal under federal law, VA doctors themselves cannot recommend it.
The directive put to rest concerns among some veterans and their families that they could lose benefits if they tested positive for marijuana.
But distrust of the government still prevents some veterans from signing up with state medical-marijuana programs, instead opting to buy the drug -- and ingest it -- illegally.
As chief of staff at the Phoenix VA Health Care System, Dr. Darren Deering is in charge of 200 doctors who see 85,000 veterans a year, 9 percent of whom are diagnosed with PTSD. He said physicians are at the forefront of the trend and often grapple with balancing traditional therapy and medicine with marijuana.
"There's a lot of gray area here," Deering said. "I would like to think our physicians aren't making moral judgments, because that's not what our mandate is.
"We can't deny patients care, and our physicians know that. But there might be times where we have to kind of tailor their treatment plans" to take into account the marijuana use.
The VA asks patients to tell physicians if they are using marijuana because it almost always affects their care. Typically, Deering said, physicians will alter patients' care until it is clear how the marijuana interacts with narcotics. He said marijuana is shown to help with certain medical conditions, but there is not a lot of scientific research on how it interacts with prescription drugs.
Paula Pedene, a spokeswoman with the VA hospital, said medical staffers urge patients to first try intense therapy to treat PTSD instead of self-medicating with marijuana, herbal remedies and other methods.
"They live in a place that has passed this law, and it's their choice to use it," Pedene said. "The question is: How can we co-manage their care?"
She said the VA does not keep track of the number of patients who say they participate in the medical-marijuana program, nor do they report them to federal agencies, such as the U.S. Department of Justice or the Drug Enforcement Administration.
Both agencies oppose medicinal use of pot.
Caught in a bind
Iraq veteran Cory Woodstock believes the VA abandoned him after he began smoking marijuana illegally. He suffers from a traumatic brain injury, PTSD, depression and physical pain.
While serving in the military, the security convoys he rode in were involved in three bomb attacks within 38 hours.
By the time the Purple Heart recipient returned home to Apache Junction, he was on 23 prescriptions, taking 57 pills a day. In 2009, he smoked marijuana for a short time after veteran friends told him it would help stop the voices in his head and the pain radiating through his body.
But once the pot showed up in his urine tests, he said, his VA doctor cut him off all prescriptions, which he still needed to manage his pain. He stopped ingesting marijuana, afraid federal officials would strip him of his benefits because they still consider pot to be illegal. He sought treatment outside the VA system but said it hasn't helped as much as the marijuana did.
"It was an experiment, and it worked," he said. "I was able to sleep. I wasn't so conscious about not being able to speak (well). I told the doctors I tried it and it helped. They said it voided my contract with the VA."
Woodstock wants to use pot again, but he will not sign up for the state's program unless federal law enforcement changes its stance.
"I'm leery of the federal government. I'm not going to take the chance," he said.
Doctors weigh in
Doctors disagree on how effective medical marijuana is to treat symptoms such as PTSD.
Dr. Sue Sisley, a Scottsdale internist in private practice and assistant professor of psychiatry and internal medicine at the University of Arizona, said marijuana is extremely effective for veterans. She said she sees many veterans who turn to marijuana only after conventional medicine doesn't help.
"It's really uncharted territory for veterans and the VA," she said. "The VA has taken a position where they're not going to terminate patients if they have a card, but the truth is that a lot of doctors have a strong bias against it -- they believe they are just drug addicts."
Dr. Edward Gogek, a Prescott addiction psychiatrist in private practice, believes people are pretending to use marijuana for treatment -- including veterans. He said most veterans are substance abusers and should not be allowed to ingest marijuana.
"You're talking about giving an addictive drug to people with substance- abuse disorders," Gogek said. He said there are non-addictive approaches to treating sleep disorders, PTSD and other conditions.
Ultimately, ADHS Director Will Humble will decide whether to expand the state's medical-marijuana program to include PTSD as a qualifying condition. Under the 2010 voter-approved law, state health officials must periodically consider adding conditions.
He expects to decide by mid-July. If approved, Arizona would become the third state to allow doctors to recommend medical marijuana to treat PTSD.
"(Veterans) sort of hold a special status in our culture, and every time you hear a veteran's story, it's compelling," Humble said. "But I will make a decision based on what the medical weight shows."
Across the nation, some veterans are urging the White House and Congress to legalize marijuana for veterans at the federal level. Michael Krawitz, executive director of Veterans for Medical Cannabis Access in Virginia, said veterans are "mercilessly being denied treatment" because they cannot access medical marijuana in all 50 states.
"Veterans found cannabis long before states started passing these laws," he said "By a long shot, it's better than the drugs they get at the VA."
For veterans like Herrera, marijuana helped him get his life back.
He typically buys marijuana once a month from a registered caregiver and uses certain strains of the drug to target the pain. He medicates anywhere from once to several times a day, he said one recent morning while toking on a small pipe.
"My family would tell you that, before this, sometimes I was like a madman," he said. "I kicked in my daughter's door and almost threw a bar stool out of the window. Not only has it helped my with anger and irritability issues, it's also helped keep my spirits up."
As of May 8, nearly 28,300 patients and 1,670 caregivers participate in the state's medical-marijuana program, which allows them to use or grow medical marijuana for certain conditions. If post-traumatic stress disorder is added as a qualifying condition, health officials expect to add 15,000 to 20,000 new patients.