Dr. Sue Sisley, a psychiatrist overseeing the only approved study in the country to investigate the efficacy of medical marijuana in treating post-traumatic stress disorder, was dismissed a couple of weeks ago from her position at the University of Arizona.
In 2011, the FDA approved a protocol for her proposed study investigating the effects of whole-plant marijuana on veterans suffering from PTSD. The University of Arizona’s Institutional Review Board approved the study protocol the following year. After escalating pressure from veterans and media coverage, Sisley finally secured approval in April from two other federal bodies that must vet marijuana research — the US Public Health Service and the National Institute on Drug Abuse, which supplies the pot. She expected approval from the Drug Enforcement Administration to come after the university granted a space for the research. Two months later, the university suddenly chose not to renew her contract — effectively firing her.
Two politicians in particular have tried to stymie Sisley. Earlier this year, the president of Arizona’s State Senate, Republican Andy Biggs, attempted to push an amendment blocking university resources and money from the state’s general fund to support marijuana research, but withdrew it following public outcry. Republican State Senator Kimberly Yee also blocked a Republican-sponsored bill, overwhelmingly approved by Arizona’s House, which would have allowed member fees from the state’s medical marijuana program to fund Sisley’s research.
In early April, Joe “Skip” Garcia, the University of Arizona’s senior vice president for health sciences, spoke with Sisley. Sisley says Garcia told her that Senator Biggs had angrily called University of Arizona President Ann Hart and demanded that she hand over Sisley’s phone records and emails to account for what he called her political activism. Sisley agreed to send the information in a few days, but ended up writing a letter immediately after Garcia informed her that her job was in jeopardy.
The controversy seemed to have diminished, but Sisley now believes that the University of Arizona was waiting until the summer to terminate her employment. She spoke with VICE News about these events, her work with veterans over the past decade and half, and her plans going forward.
VICE News: Reports emerged earlier this month that the University of Arizona had you go. What do you think this had to do with your study on the use of marijuana to treat veterans with PTSD?
Dr. Sue Sisley: They stripped me of all my positions at the University of Arizona and took all my work away without giving a reason. I lost all my healthcare and pension on June 27. Then I wrote to Skip Garcia and said, “You stripped me of all my salary support, but it looks like I still have an academic appointment at the University and that’s great, because that enables me to continue to do the PTSD research I care so much about.” The next day, I had a FedEx letter at my door saying my assistant professorship had also been terminated. You cannot conduct a study at the University without an academic appointment.
I am a lifelong Republican, and I am very conservative. This is going to make me sound like a liberal but I’ll say it: members of the right-wing legislature in Arizona have never accepted the fact that the voters approved medical marijuana in Arizona in 2010. They’re furious and they’ve made attempts year after year to repeal the medical marijuana law, but they can’t.
They went and took out their resentment on me and my research project, and the University of Arizona buckled under pressure from these right-wing lawmakers who, by the way, control the university budget. The president of the Arizona Senate, Biggs, has gone on record saying he opposes marijuana research, and even went so far as to tack onto a bill an amendment that would block any funding of marijuana research. He’s saying he’s an elected politician who does not value science. Other right-wing lawmakers have also gone so far as to say that I support marijuana research because it’s a strategy for legalization. They are saying they’re afraid of research that might uncover the benefits of marijuana.
Maybe they don’t understand how research works. It’s a triple-blind randomized controlled trial — it’s the most rigorous science you can conduct in the US. It would have answered tons of questions for the veterans and the general public.
What was the status of the study when you were terminated?
I was trying to find funding, because the University of Arizona doesn’t provide funding, especially when Senator Biggs has gone on record against it. Pharmaceutical companies are not interested in helping. Our goal was to take the data and put it in the public domain, something pharmaceutical companies didn’t want.
You don’t want marijuana industry money for an objective study, so the only logical way to fund it was from the $9 million surplus from Arizona’s medical marijuana program. A bill proposing that was killed by State Senator Kimberly Yee, and that’s what put me in the crosshairs of these legislators.
How did you get started working with veterans?
I’ve been working with veterans for 16 years. I put these poor veterans through the gauntlet of every FDA-approved medicine on the market to try to reduce some of their PTSD symptoms. Nothing really helped. There are only two FDA-approved meds on the market for PTSD: Zoloft and Paxil. So they end up taking drugs off-label. Psychiatrists prescribe different medications for each targeted symptom. It’s a nightmare for veterans because PTSD has such a wide constellation of symptoms, and for each target symptom they would be offered another prescription. So in a month or in the course of a year, it would snowball into 10 to 12 different prescriptions taken all at once.
They were like zombies. It was so demoralizing for these veterans and it was awful for me to watch it and be the perpetrator, and to be at the point where I say, “I have nothing else to offer you, we’ve offered you every conventional treatment.”
When did marijuana first come up in your sessions?
Slowly, over the past 10 years, veterans have been disclosing to me that they are using marijuana. Initially I was highly judgmental and chastised them. I would try to find another prescription medicine, after they’d been on 30.
But more veterans started coming out of the shadows and disclosing in their private sessions to me that they were using the plant. You couldn’t ignore it after a while; it was a relentless stream of veterans. High-ranking veterans and veterans that were highly conservative would admit that they never ever wanted to go down that path, that they always wanted to be on the side of the law, and tell me how awful it was for them to be in the shadows and be afraid of being prosecuted just for minor possession. They would live with that fear every day because they knew this was the only thing that was helping them. So they’d go meet people in dark parking lots and get what they needed.
It took me a couple years to get where I could listen without prejudice. I learned from them, they began to teach me about how this plant was helping them and how effective it is in managing their daily symptoms. No one was arguing it was a cure; it just seemed to be very useful for controlling symptoms and much more so than the addictive meds that we were giving them, like Xanax and Ativan. All these were sedating and addicting, and patients would be totally nonfunctional on these meds.
What, specifically, do you believe marijuana’s potential benefits are for veterans suffering from PTSD?
Marijuana would really help with initiating sleep, which was the biggest problem these folks have. They can’t fall asleep because they have anxiety and flashbacks and nightmares — the nights are usually so awful, they are so plagued by all these horrific thoughts flowing through their heads. And no matter how many sleep medications we’d give them it wouldn’t work, or it would turn them into a zombie, which they hated. So what happened is they told me about how they could vaporize or smoke a tiny bit at night and it would help them initiate sleep and they would still wake up feeling well rested in the morning, even refreshed, for the first time after years of chronic sleep deprivation. It took me time, but eventually I realized that there is the potential for this plant to really help these veterans… to understand the potential and how we can harness that potential. So I started embarking on a study.
Our hypothesis is that medical marijuana can reduce the symptoms of PTSD in a dose-depending manner — the higher the dose, the more relief there is. We believe that there is potential that high CBD [cannibidiol] strains may be more effective in targeting those symptoms. There are certain structures of the brain that deal with anxiety, mood, and sleep and memories, and those particular areas of the brain also contain receptors that are affected by exogenous marijuana. We finally in the 1990s uncovered the reason why marijuana works and it finally gained credibility with the medical community. The plant can have a calming effect on those particular structures in the brain via the endocannabinoid system.
Why has it taken so long for the study to gain approval?
In April 2011, we got our FDA approval. And here we are, over 3 years later and still miles away from implementing the study. There is a systematic effort to impede marijuana research.
Marijuana is the only Schedule I drug that has this second, redundant review process. The Controlled Substances Act says NIDA will provide a continuous supply of marijuana for all FDA trials. If NIDA doesn’t like your study, they can simply end it by refusing to sell you study drugs. Even if it has been FDA approved, like ours was, they can step in and say we don’t like that because NIDA has a mission to curb all illicit drug use. You also have to run it by the federal Public Health Service and the university’s Institutional Review Board. With any other Schedule I drug, all you need is FDA approval, then University approval, and the DEA has to inspect your site. LSD, MDMA, Ecstasy, and heroin — you don’t need to run them by NIDA and Public Health Services.
It makes no sense to anyone in the medical community. The fact that it’s lumped in Schedule I is already an absurdity. On top of that, it’s treated like the most dangerous drug by having to go through all these extra hurdles. The FDA approved the study and it took the Public Health Service three years to get our approval.
These agencies have no timeline. They can take 10 years, 20 years. Only the FDA has a 30-day timeline to respond. Public Health Service, NIDA, and the DEA have no timetable. That’s how they obstruct marijuana research, through delays, relentless delays. They would have probably kept our study in this permanent review process if it weren’t for the media spotlight and veteran activism.
Several recent medical marijuana bills, including one signed this month in New York, specifically ban smoking marijuana and only allow oils, edibles, and vaporization — though likely not of whole plant material. Why do you want to study the whole plant?
There is no one doing whole-plant marijuana research and that was so sad to me, because that’s how patients are self-medicating. We wanted to do a real world study. But there are so many enemies of whole plant marijuana because they believe it will compete with their market share. The pharmaceutical industry has gone on record saying they are against whole plant marijuana research.
People want safe, legal access to a plant that they’ve already been using for years and years. Even if they switch to oils, most patients will not find relief from that. From my own discussions with patients, it’s clear that you need to have the option to explore different varieties, different strains, hybrids, and dosages of marijuana. To be stuck with an oil that has no other cannabinoids in it robs patients of the unique properties of the plant. The plant has 80 different vital cannabinoids that work synergistically with each other to create what we call an “entourage effect.”
That’s why instead of prescribing 10 different pills for each PTSD symptom, we can use marijuana — this entourage effect allows it to address the whole constellation of PTSD with a single plant. Many patients call it miraculous, and that’s why the pharmaceutical companies are so frustrated, because they’ve never been able to mimic the efficacy of the plant, which is impossible to recreate in a pill form or oil. They are all trying now, but I fear all of those attempts will be failures, because just look at the failure of Marinol, the synthesized THC pill — it’s a failure, no one uses it, no one prescribes it. But most patients don’t get any benefits from that pill and actually they get a lot of side effects, because if you give someone pure THC you’re going to give them a lot of psychoactive effects with fairly little therapeutic effect.
What are your plans now?
I want to be reinstated at my alma mater, the University of Arizona. I have no grudge, because I know this was the decision of a few short-sighted legislators at the highest level. You can call it whatever you want — non-renewal, whatever — but the general public knows that when you’re stripped of all your titles without a reason, without even being given a fair hearing, they deprived me of due process. So now I have a legal team that’s working on this, and they’re preparing to file an injunction against the University of Arizona. There are a lot of grounds to challenge this.
The University of Arizona may be willing to sacrifice our veterans, but I will not. I hope the University reverses this decision, but if it’s not there, then it will be somewhere else. I will find a home for this work.
Follow Samuel Oakford on Twitter: @samueloakford
Photo via Flickr