Bryan Krumm, a psychiatric nurse practitioner in Albuquerque, New Mexico, was one of the petitioners whose call to reschedule cannabis was officially rejected by the Drug Enforcement Administration in August 2016. But Krumm is fighting on. A US Army veteran, he’s become the nation’s foremost voice for the use of cannabis in treating post-traumatic stress disorder. With the United States now at war in Afghanistan for 15 years, and in Iraq for 13, PTSD-related suicides among veterans have become a national health crisis.
Krumm filed his petition seven years ago. A second petition was later submitted by Lincoln Chafee and Christine Gregoire, the then-governors of Rhode Island and Washington State. Both were turned down by the DEA in its August decision.
Krumm spoke with High Times about how his petition differed from the one submitted by the governors, his current strategy to change the status of medical cannabis, and why this remains such an urgent question for the United States.
Tell us about the idea behind your petition.
I had filed in 2009, and then the governors of Washington and Rhode Island filed in 2011. Unlike them, I didn’t ask for cannabis to be placed in Schedule II [under the Controlled Substances Act]. I just said it has to be removed from Schedule I—by legal definition, because it has accepted medical use.
I also made an equal-protection argument. Four people are still getting cannabis from the federal IND [Investigational New Drug] program. They get nine to 12 ounces a month, and I argued that other people who need cannabis have an equal-protection claim.
I also argued on the basis of due process. Because of the arbitrary restrictions placed on cannabis and the way the process is set up by the DEA, we’ve been denied due process of law. It’s been set up in a way that it’s impossible for us to meet their criteria. They’re demanding very strict research be done with large populations and placebo-controlled, double-blind clinical trials. But the DEA has set it up so that these kinds of studies can’t be done in the United States.
It’s also a states’-rights issue. That’s really the crux of my argument: States have been given the right to determine medical practice, not the federal government. That was upheld in Gonzalez v. Oregon, the 2006 Supreme Court decision on the assisted-suicide issue. The court ruled that medical practice can only be regulated by the federal government to prevent doctors from abusing their prescription-writing authority to promote drug abuse.
We have 28 states that have accepted the medical use of cannabis, and the District of Columbia. If you include states with CBD-only laws, that brings the number to 40. We have numerous professional medical organizations that have recognized the medicinal value of cannabis. Even the NIH [National Institutes of Health] has a patent on cannabis extracts, and in their patent they argue for the therapeutic potential of cannabis. So even the NIH has accepted that cannabis has medicinal use. And the Supreme Court has determined that states have the right to set accepted medical practice.
But your petition was turned down. Where do things stand now?
I wasn’t terribly surprised by that. The DEA did acknowledge that more research has to be done, and they’ve supposedly eased up on restrictions on research. I actually received a CD in response to a Freedom of Information Act request with the FDA [Food and Drug Administration] that contained two letters—one from NIH to the DEA, and one from the FDA. In this correspondence, both of these agencies discussed how it’s impossible under current administrative process to ever say that cannabis has accepted medical use, because the DEA has blocked that kind of research.
But with the new decision, the DEA has agreed to loosen up a little?
Well, they’re going to allow more people to apply to grow medical cannabis, rather than it all coming from NIDA [the National Institute on Drug Abuse]. As long as people don’t have a history of breaking the law, they’ll be able to apply to grow their own, and make it easier for people to do this kind of research.
The new regulations have been published in the Federal Register, which makes them official. The DEA website now references “authorized marijuana manufacturers supplying researchers,” even though they’re keeping it under Schedule I.
Now I’m appealing the decision. If I can keep my appeal alive and get the 10th Circuit Court of Appeals [in Denver] to accept my case, I’m going to be asking for two things. First, that the DEA be ordered to remove cannabis from control under the Controlled Substances Act and allow it to be regulated like tobacco and alcohol by the states. The other option is to move cannabis from Schedule I to Schedule III, where Marinol is placed. That’s the synthetic form of delta-9 THC, the psychoactive component of cannabis.
So the synthetic form is Schedule III, but natural THC from the plant remains in Schedule I?
Exactly—because the pure THC molecule has been studied in clinical trials. But cannabis contains so many cannabinoids and flavonoids and components that they can’t isolate a single strain that’s been studied in controlled clinical trials.
If they choose to place it in Schedule III, I say they should order the scientific review to be done with public comment. Right now, the FDA conducts the review within their own department and ignores what all the experts have to say. This is such an arbitrary process by the FDA that it needs to be more open. They’re ignoring studies indicating that cannabis has therapeutic value. The Center for Medicinal Cannabis Research at UC San Diego has done dozens of studies, but they’re completely ignored—not even considered by the FDA in these reviews.
Tell us about your life. How did you come to be involved in this question?
Cannabis is what turned my life around and enabled me to get through school. I failed out of the University of New Mexico in 1983, when I was studying to be an electrical engineer. I failed because I dealt with my PTSD with alcohol. I was kicked out with 23 hours of F’s. After I was kicked out, I worked at Sears for a while and then joined the Army—that was before I realized I had PTSD. I was suffering from depression and anxiety. I realized later that came from having an abusive stepfather.
In 1984, I began a two-year enlistment in the Army. I did a lot of growing up there. I gained a lot of self-confidence, realized I could do more with my life by learning to be more responsible for myself. I did eight and a half months at Fort Sill in Oklahoma in training, and then I was stationed at Fort Carson in Colorado.
After that, I went back to school—and almost failed out again, and went back to drinking, which would have had me kicked out permanently. I realized something had to change. When I used cannabis, I was able to focus and tune in on my schoolwork and get things done that I needed to do. And the most important thing is that I didn’t drink as much when I was using cannabis.
I was able to talk to my instructor, and he changed my grade from a D to a C so I could stay in school. I switched my major from engineering to psychology—I was trying to figure out what was going on with me.
Later I switched to nursing, and graduated with a BA in nursing in 1993. I made it onto the dean’s list and honor roll after I started using cannabis medicinally. I got up to a 2.6 grade-point average even after all those zeros were factored in … not an easy task.
I’d started a NORML chapter at UNM in 1987. But after the medical marijuana initiative was passed in California in 1996, I switched to a medical focus. I said, “This makes more sense—let’s focus on this.” I helped put together the initial draft of the New Mexico medical cannabis law for State Senator Michael Sanchez in 2000. In 2007, New Mexico’s medical cannabis law was passed, incorporating some of the language of the draft I had worked on.
What do you think of the law?
There are parts of it I like. It’s not functioning the way it’s supposed to, in part due to the federal restrictions. A patient can have two ounces a month, basically—but somebody trying to treat cancer might need up to a pound a month. Animal studies show you need really high doses of cannabinoids to have an anti-tumor effect. That’s based on the protocol developed by [Canadian researcher] Rick Simpson using high-potency hash oil.
Most states with medical cannabis laws say a physician has to refer patients. Under the language in the draft I worked on, it was a practitioner rather than a physician. Under the definition I use, “practitioner” means anyone who can prescribe controlled substances. This includes not only advanced-practice nurses such as myself, but also dentists and veterinarians. If a veterinarian wanted to prescribe cannabis for a horse, he could do that.
But that language didn’t make it into the version that passed?
No. Rhode Island was actually the first state to pass a law with that language, in 2006. They sort of lifted language from the version I helped draft in New Mexico earlier.
When did you become a practitioner?
I went back to school in 2004 after working as a floor nurse and got my master’s and became a nurse practitioner. Now I have my own practice, Harmony Psychiatric. I’ve had it for just over a year. My specialty is treating PTSD using a combination of medical cannabis, dietary supplements, and lifestyle changes that support the endocannabinoid system and help get the cannabis working better for people.
I also have a clinic at Sage Neuroscience Center here in Albuquerque, where I manage close to a thousand patients. I see them once a year to renew their cards for the medical cannabis program. I’ve stopped prescribing pharmaceuticals—my only exception is Marinol or dronabinol, the generic variety. You don’t want to get on a plane and fly to Texas with your cannabis. So I write Marinol for patients who need to travel, but that’s it. A lot of patients I was able to get off pharmaceuticals. The ones who still need pharmaceuticals, I send to other providers in the clinic.
Do you really think cannabis can be released from the schedule system altogether?
That’s what I’m calling for—removing it from the schedule system entirely. It should no longer be controlled by the Controlled Substances Act. Let the states decide how to deal with it; that would be the ideal. If the courts aren’t willing to do that, I ask that cannabis be put in Schedule III—but only temporarily, pending a review that allows for the public to determine the scientific merits of medicinal cannabis.
Now, they just go to all these anti-marijuana groups like the ONDCP [Office of National Drug Control Policy], SAMHSA [Substance Abuse and Mental Health Services Administration] and NIDA, who tell them marijuana is bad.
That’s the first time I’ve heard you use the word “marijuana” rather than “cannabis.”
That’s right. They use the term “marijuana”—it’s their term, not mine.
There’s some suspicion of rescheduling due to fears that it could open the door to “corporate cannabis.”
The longer it takes for us to reschedule, the more entrenched the pharmaceutical industry becomes in medical cannabis, ready to take it over. They’re developing synthetic cannabinoids; they’re patenting plant-based cannabinoids. There’s this Arizona pharmaceutical company [Insys Therapeutics] that dumped over half a million dollars into negative advertising to defeat legalization [in Arizona’s November 2016 vote], and they produce the opioid fentanyl, which directly competes with cannabis. And in July, the DEA granted them approval to market a new THC product similar to Marinol.
So we’re in a race against time?
I think so. Ultimately, I would like to see cannabis be treated as another dietary supplement—just like if you go to a store and buy vitamins or fish oil or St. John’s wort, which is a natural, over-the-counter plant-based antidepressant.
You envision the day that we’ll be able to buy medicinal cannabis over the counter?
Yes, I do. Or grow it in your backyard.
Your solution does leave open the possibility of onerous state regulations.
That’s true. We can cross that bridge when we come to it. But we just need to get the research done. And now the DEA is going to allow that—or so they say.
We need to be demanding that we have access. Now, we have an arbitrary system where some states allow it and others don’t; you can be punished horribly in some places, and in others it’s okay. We’re determining medical policy by geography rather than allowing people access to the medicine that they need.
Tell us something about your work with veterans.
I believe that cannabis is the only medicine that’s effective in treating PTSD. Suicide is the only one of the top 10 leading causes of death in the United States that is increasing in frequency. We’re seeing now close to 120 suicides a day in the United States—and 22 of those are veterans. That’s 22 veteran suicides every day. Since I filed my petition in 2009, there have been more than a quarter-million suicides in the United States. In my clinical experience, cannabis has proven to be the only medication that can rapidly reduce suicidal thinking for most patients.
Just two or three years ago, we had maybe 100 suicides a day. It’s alarming to see the rate that it’s increasing at.
What do you think is behind this?
There are socioeconomic factors, stress factors—people are grasping at straws to explain this dramatic increase. But we’re not seeing these increases in states with medical cannabis laws to the same extent as in states without.
Personally, I attribute it to overloading our endocannabinoid system. Of the patients I see, 15 to 20 percent are veterans. Some have seen action in Iraq and Afghanistan, and a lot are Vietnam vets. They suffer from uncontrollable anxiety, hyper-arousal—they are hyper-vigilant, paranoid all the time, all the time watching their backs. They have flashbacks and nightmares, sleep disturbances, and can’t get their brains to shut off. They have irritability and anger and numbing symptoms where they can’t enjoy the things they used to, or isolate themselves and avoid people.
I would ask them, “Have you ever considered using cannabis?” But now more are coming seeking cannabis. I’ve been able to get many of my patients away from pharmaceuticals. And research also shows a reduction in the use of certain types of pharmaceuticals in states with medical cannabis laws.
And in states that have medical cannabis laws, we’ve seen a reduction in the rates of suicide. Endocannabinoid dysfunction is key in suicidal behavior. One of the things that contribute to the endocannabinoid system not functioning is diet. Most of our diets are far too high in Omega 6 fatty acids, as opposed to Omega 3 fatty acids. This burns out the endocannabinoid system.
We evolved to have a 1-to-1 ratio of Omega 6 to Omega 3, and now it’s 20-to-1. Sunflower and other seed oils that are high in Omega 6 have only come about in the past 100 years. This is something new to the human diet. Olive oil has been around a lot longer, and that’s a better oil to go to for healthier fat. Hemp oil has a good balance of Omega 6 and Omega 3, although it’s not great to cook with because it burns really easily. Fish oil has massive doses of Omega 3 and helps balance the endocannabinoid system so we can get the cannabis to work better for people. I take two capsules of fish oil every day. I also find I use less cannabis since I’ve been using Omega 3’s—because my endocannabinoid system is functioning better, so the cannabis gives me a better response at lower doses. Just smoking more will burn out your endocannabinoid system even faster.
How do you think your strategy for descheduling will be affected by the recent elections?
I’m kind of terrified by what I see happening, the people Trump is surrounding himself with—from his appointment for attorney general to all his key advisers. [Alabama Senator] Jeff Sessions is so hardcore anti-cannabis in his history—I’m not happy with him being attorney general and ultimately being the one to administer the Controlled Substances Act. It’s hard to say which way things are going to go. That’s why I’m hoping the courts will keep my petition in place and allow this case to be heard.
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