Jose Martinez knows trauma. As a U.S. Army infantryman in Afghanistan, he lost both legs, his right arm and his left index finger to a land mine in 2012. Recovery was challenging. “In my eyes, I had pretty much failed when I stepped on a bomb and lost three limbs,” he says. “I was going insane because I did not understand why I was still alive.” Then, last December, he broke his maimed left arm, his lone remaining limb, when his car flipped over after hitting black ice in the high desert near his Apple Valley, Calif., home. It’s no surprise, then, that he also knows posttraumatic stress disorder. Doctors plied him with pills after both calamities. “I started taking so many prescription pills,” he recalls, “I was numb to the world.”
Over time, he ended up replacing those pills–up to 150 a day, he says–with marijuana. While Martinez says he smoked pot occasionally before enlisting in the Army in 2010, he obeyed the military’s prohibition against it before that bomb blast near Kandahar. He says marijuana has stayed his pain and tamed his demons. “My brain’s telling me to freak out because I’m missing my limbs, but when I’m on cannabis, it tells me to calm down, you’re O.K., you’re fine,” Martinez says. Not only does it soothe the phantom pain of his missing limbs, but it also eases a racing and apprehensive mind riven with PTSD. “It relaxes me and helps me sleep at night,” he says. “I’m so supervigilant, and it really calms my anxiety, which can shoot up when I’m around a lot of people I don’t know.”
Back home, Martinez, 28, is once again a frontline soldier, now in a new battle–to prove that the ancient herb can help veterans like him who suffer from PTSD, a signature wound of the wars in Afghanistan and Iraq. But marijuana’s checkered legal, medical and social history make it a controversial treatment. The federal government estimates that as many as 500,000 of the 2.7 million troops who served in those countries may have some kind of PTSD. Advocates like Martinez argue, on the basis of their experience, that marijuana is good for more than getting high.
Research has shown that pot can be useful in the treatment of pain, making it a potentially suitable alternative to opioids for some–though the research on medical marijuana and PTSD is wanting. That’s because the Drug Enforcement Administration (DEA) has listed marijuana as a Schedule I substance–dangerous, with no medical benefit–for nearly 50 years, a stance it reaffirmed Aug. 11, although it also opened the door to more research. Before that, in April, the government approved the first clinical study designed to determine if weed works to ease the anxiety, depression and sleeplessness that war can incite. If the answer ends up being yes, the benefits could go well beyond the battlefield. According to official estimates, which are considered by many experts to be conservative, about 1 in 15 Americans will suffer from PTSD at some point during their life. For some, the trauma will be sparked by man-made events such as combat, car crashes, violent attacks including rape or other abuse. For others, the trauma will be the result of disasters including fires, flooding, earthquakes, etc.
For all, the lasting effects can be debilitating, and a growing number of people are banking on the idea that marijuana may help. Compounds in marijuana, either individually or combined with others, affect cannabinoid receptors in the brain and elsewhere, influencing the user’s physiology and mental state. Marijuana’s mind-altering qualities were known when it was used as medicine in ancient China, and in fact, it was considered an accepted medicine by U.S. doctors until 1942, when the nonprofit U.S. Pharmacopeia removed it from its list of drugs deemed effective. Before that, marijuana-based prescription medicine was sold in the U.S. in the early 20th century; a 1937 law let the government levy a tax of $1 an ounce on medical marijuana.
Marijuana’s classification as a Schedule I drug in the 1970s ensured it would be nearly impossible for scientists to study it, and much of the research on its place in medicine halted. President Nixon viewed drugs as part of a broader plot against America. “That’s why the communists and the left-wingers are pushing the stuff,” he said in a 1971 Oval Office meeting with top advisers John Ehrlichman and H.R. “Bob” Haldeman. “They’re trying to destroy us.”
Some in the government disagreed. In 1972 a Nixon-appointed commission reported that marijuana was misunderstood and should be rescheduled. Nixon maintained that like other Schedule I drugs, marijuana had no accepted medical use but a high potential for abuse, and he ignored the findings. “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man,” Francis Young, an administrative law judge with the DEA, wrote in 1988. “By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care.” In recent years, selective breeding has bolstered the potency of marijuana well beyond its Vietnam-era levels, especially when it is added to foods and eaten rather than smoked.
In April, the DEA approved the first-ever study of the use of the marijuana plant itself, not individual extracts, as a therapeutic drug. Marijuana consists of more than 300 chemicals, and backers say it may be the interaction among them, and not any single ingredient, that generates its mellowing effect. It took the Multidisciplinary Association for Psychedelic Studies, a Santa Cruz, Calif., nonprofit that advocates for increased therapeutic use of psychotropic substances, more than five years to win the required approvals for the study from three federal agencies: the Food and Drug Administration (in 2011), the Public Health Service (2014) and the DEA (in April). Colorado–one of the first states to legalize marijuana–is funding the $2.2 million investigation.
The randomized, blind and placebo-controlled study will chart the impact of several strains of marijuana bred to contain varying amounts (from zero to 12%) of psychoactive tetrahydrocannabinol (THC) and cannabidiol. This summer, with U.S. government–grown marijuana from the National Institute of Drug Abuse’s farm, run by the University of Mississippi, 76 veterans with treatment-resistant PTSD living near the research sites in Baltimore and Phoenix will begin enrolling in the three-year study.
There is already promising research about pot’s growing place in medicine. Animal studies suggest that it can ease anxiety, depression and pain. But marijuana can also trigger problems among some users. A recent report on marijuana use by 2,276 veterans from 1992 to 2011 concluded that avoiding pot may be important for people with PTSD. “We definitely found a correlation between those who used marijuana, and used it more often, and PTSD-symptom severity,” says Samuel Wilkinson, a psychiatrist at the Yale School of Medicine and the lead author of the study, published last September in the Journal of Clinical Psychiatry. “There’s just no evidence that marijuana is beneficial for PTSD, and there’s some preliminary evidence–like from my study–that suggests it may be harming people.”
In other words, the science is mixed. “The belief that marijuana can be used to treat PTSD is limited to anecdotal reports from individuals with PTSD who say that the drug helps with their symptoms,” Marcel Bonn-Miller, a University of Pennsylvania psychologist, co-wrote in the Department of Veterans Affairs’ official statement on the topic. He included a lengthy list of problems researchers have uncovered among regular users, including addiction, bronchitis and psychosis. “There have been no randomized controlled trials, a necessary ‘gold standard’ for determining efficacy,” Bonn-Miller added in the statement.
He aims to change that. That’s because Bonn-Miller, who also works for the VA, is a principal investigator in the groundbreaking study. “A lot of veterans have gravitated toward cannabis,” he says. “That’s not a rigorous trial, but it shows that this is an important area to investigate.” Participants in the study will smoke up to 1.8 grams of marijuana daily, ideally through a pipe provided to them. (“It’s kind of hard to estimate what ‘a joint’ means,” the scientist in Bonn-Miller notes.)
Part of the push to use marijuana for PTSD owes to the fact that no existing therapy works for all PTSD patients. In cognitive-behavior and exposure therapies, counselors try to change how sufferers perceive their trauma and the reaction it causes, in hopes of reducing or eliminating symptoms. In group therapy, PTSD patients get together to discuss their fears in hopes of ridding them of their power. And there’s a medicine chestful of drugs–often selective serotonin reuptake inhibitors, a kind of antidepressant–that can ameliorate the sadness and worry that often accompany PTSD.
Backers argue that marijuana should simply be one more thing in a therapist’s tool kit. “Those of us who use it on a daily basis want nothing more than the research to be done,” says Aaron Newsom, a Marine who returned home to California from Afghanistan in 2005 with PTSD. After assorted pharmaceuticals failed to calm it, he says, he finally found relief with marijuana. That pushed him to help found the Santa Cruz Veterans Alliance, dedicated to sharing marijuana with fellow vets. “It is a safer and healthier alternative to most of the pharmaceuticals they pass out at the VA,” he says.
Congress is now considering lifting the ban on VA doctors’ discussing marijuana treatment options with their patients. This coincides with another challenge faced by PTSD sufferers: “Lethal opioid overdoses among VA patients are almost twice the national average,” said Representative Earl Blumenauer, an Oregon Democrat who championed the change, on the House floor in May. “This is at a time when the overwhelming number of veterans say to me that marijuana has reduced PTSD symptoms and their dependency on addictive opioids.”
While it’s nearly impossible to die from a marijuana overdose, prescription-opioid overdoses contributed to 14,000 deaths in the U.S. in 2014. A recent study found that opioid deaths fell by an average of 25% in states where medical marijuana use had been legalized. By comparison, alcohol abuse killed an estimated 88,000 people annually in the U.S. from 2006 to 2010.
Rigorous scientific studies of marijuana’s impact on PTSD should bolster arguments for or against its use, helping clear some of the 1960s haze from the debate. But skeptics say politicians and other advocates, pressured by true-believing marijuana boosters, have approved its use in 25 states–including Arizona, Connecticut, Delaware, Hawaii, Maine, Michigan, Nevada, New Mexico, Ohio, Oregon, Pennsylvania and Washington–without adequate vetting. While doctors cannot legally prescribe marijuana in any state (they can only recommend it), its use, recreational as well as for PTSD, is happening across the nation regardless of local laws.
The military has a love-hate relationship with marijuana. Soldiers on the front lines have long smoked weed to help them get through the nightmare of war, likely peaking at more than 50% use in Vietnam. But the military’s subsequent zero-tolerance policy sharply curtailed its use by troops in Afghanistan and Iraq. It would mark a surprising reversal for cannabis if, having been driven off the battlefield, it returned in joints, pipes and bongs for those suffering from PTSD after their service in those countries.
Some aren’t waiting for science to confirm how they feel. After the bombing that changed his life, but before toking up, Jose Martinez feared the outside world. “I was scared of people looking at me, and everybody was staring at me,” he remembers. “They looked at me like I was some type of animal, and I was feeling that and not really seeing what my life was about.” He credits marijuana with reintroducing him to the human race. “Smoking marijuana,” he says, “has slowly made me become the person I used to be.”
This appears in the August 29, 2016 issue of TIME.
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