All across America and around the world, this
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.com. We're talking to a Dr. Kevin Banky today.
He's involved in a significant study about cannabis
and CBD used by veterans and its impact and possible,
you know, focus as a therapy for chronic pain.
I think you're gonna find this interesting, and
after we got done, he said we were talking about
the VA's current position, and he directed me
to a new public health announcement that VA put
out that I wanted to mention at least part of
this to you, some things that veterans should
know about marijuana and the VA. It's now their
position that veterans will not be denied VA
benefits because of marijuana use, and they're
encouraged to discuss marijuana use with their
VA providers. However, VA clinicians cannot recommend
medical marijuana or prescriptions for medical
marijuana, and VA pharmacies may not fill prescriptions
or pay for medical marijuana. But there is VA
research going down on the marijuana benefits
and risks, potential for abuse and under regulatory
approval. And it should also be pointed out that
the use or possession of marijuana is prohibited
at all VA medical centers, locations, and grounds.
So when you're on the VA grounds, it's controlled
by federal law, not your state law, and therefore
not allowed in any of the states, even though
states, over half of them now, authorize medical
or recreational marijuana. So kind of with that
opening, we're gonna hear from Dr. Kevin Banke
about the interesting research that's being done
that maybe will put a little more... emphasis
on, hey, this ought to be something VA can prescribe
and regulate on a going forward basis. We want
to welcome to Veterans Radio today Dr. Kevin
Benke. He is working in an area that's of all
interest to veterans. I get this all the time
from folks. He's looking into medical cannabis.
Kevin, welcome to Veterans Radio. Thanks so much
for having me. I'm delighted to be with y 'all
today. Well, you received your PhD from the University
of Michigan, you are an assistant professor of
anesthesiology at the university, and you are
the director of the Michigan, is it the psychedelic
center? Associate director of the psychedelic
center, yeah. We gave you a promotion. Can't
get you the money, but we at least can give you
the wrong title. Part of the reason we reached
out is because there is a study going on called
MI Vets Can Study looking into the whole issue
of chronic pain for veterans and whether or not
cannabis can be part of the tool and the tool
belt used by medical providers to help veterans
in this area. Talk to us a little bit more about
what this project is all about. Yeah, absolutely.
So this project is funded through the state of
Michigan. So back in 2018, when the adult use
cannabis law passed in the state of Michigan,
the law set aside money for institutions to do
clinical trials specifically to see if cannabis
could be helpful for treating medical symptoms
or conditions that affected veterans and that
were related to suicidality. And this is because,
you know, veterans have many health issues such
as pain, post traumatic stress disorder, many
things that relate to that service that they
did for our country. And so this money was put
aside to really see, is cannabis helpful? When
is it helpful? And can it be useful in the medical
context for veterans specifically? And so what
our project is doing is we're focused in on chronic
pain. because this is so prevalent among veterans
and we are doing two separate clinical trials.
One of them is focused on cannabidiol or CBD.
CBD is a compound that there's a lot of excitement
about because it doesn't get you high and it
has no abuse or addiction potential and it tends
to be very, very safe. So we want to see if this
is helpful for pain symptoms. So in this first
study, people can receive either CBD or placebo
that they can flexibly dose themselves for four
weeks. And we ship study medication to their
homes after they screen through the study and
go through all those things. and then they send
it back to us after taking it for four weeks.
In the second study, which is called CanCoach,
short for cannabis coaching, participants will
meet one -on -one with a trained cannabis coach.
So these are people who have their master's of
social work degree. They have been trained on
the scientific evidence around cannabis and pain,
its effects. on different pain symptoms, the
effects of things like CBD versus THC, the differences
between smoking, vaping, eating, all this information.
And these coaches work one -on -one with the
study participant to help them optimize their
use of cannabis for pain symptoms. So. the products
that people will use in this coaching intervention,
they will get themselves from, you know, state
licensed dispensers. But then they work with
that coach one -on -one to be like, OK, gosh,
like I used an edible one time and I slept really
well, but then I woke up feeling foggy and I
was affected the next day. So I want that sleep
effect because I know that helps my pain, but
I really don't want to be impaired the next day.
What do I do? And so the coach will work with
them in this sort of one -on -one context over
four individualized treatment sessions to help
them refine that use to maximize benefit and
minimize harm associated with cannabis and that
cannabis use for chronic pain. We're going to
back up and talk about some things you're talking
about, but I kind of want to... Highlight for
folks, and we're talking to Dr. Kevin Bohenke,
who is the assistant professor in the Department
of Anesthesiology. He's also the associate director
of the Michigan Psychedelic Center, and he's
involved in this MiVetsCan studies being funded
by the state of Michigan, where marijuana is
legal both for medical and recreational use.
But CBD, tell us how CBD is regulated as compared
to marijuana or cannabis. Yeah, so CBD is treated
a little bit differently. So products that have
less than 0 .3 % THC, so THC or delta -9 tetrahydrogen
or cannabinol, is the main intoxicating component
in cannabis. If they have more than 0 .3 % THC,
They're considered marijuana under federal law.
They're considered to be illegal and schedule
one product. So under the Federal Controlled
Substances Act, any substance that is schedule
one has no accepted medical purpose and a high
potential for abuse or misuse. And so it's not
used therapeutically. So those products that
are above that 0 .3 % THC threshold, Schedule
1, illegal, criminalized, technically no therapeutic
benefit according to federal law. If they have
less than 0 .3 % THC, then they are de -scheduled
under the Controlled Substances Act. So they're
not regulated under it. There's no criminal penalties
for use. And so CBD products that have less than
0 .3 % THC, like the one we're using for this
study, are de -scheduled. So that's the distinction.
So that 0 .3 % THC is the distinction between
a illegal criminalized product and a descheduled
legal product. What you're trying to do with
these studies is put some rigor around, some
clinical trial work around, hey, does CBD help?
Hey, does... cannabis help and put a little bit
more of scientific rigor around it rather than
just sort of anecdotal, hey, my buddy down at
the post told me he's taking it and it's help
and I'm gonna take it. So that's what you're
trying to get to is a more rigorous scientific
approach, I assume. Yep, that is exactly what
we're doing. We want to do high quality scientific
studies to say, is this something that's helpful?
Can we add it to, as you said, to the treatment
toolbox as something that might help people with
pain? And in Michigan, when they passed the law
about recreational, I think it was recreational
marijuana, they said, hey, we're going to take
some of the tax dollars we... we generate from
this and we're going to put it into research.
And that's where this study gets funded from.
And I point this out because we're at a point
in time when there's all this confusion about
VA funding and federal funding for research projects.
This project and these two studies, both CBD
CARE and CAN Coach, they're not impacted by all
that federal chaos that's going on, correct?
That is correct. They're funded by the state,
so we have had no issues. um with these studies.
Tell us a little bit about you know your mindset
as you went into this and kind of maybe where
you're at or thinking today as a research scientist.
Yeah so going into this project something that
was super important to me and the other folks
on the team was let's make sure that we're doing
work that is relevant and meaningful to veterans
with pain. So we went about that in a few different
ways. One, we obviously looked at the scientific
literature to say, what are the types of studies
that have been done and what hadn't been done?
And we noticed that the scientific literature
on CBD was extremely lacking. And so that was
a really strong place scientifically to look.
Then we went and spoke to different veteran organizations
like the Ann Arbor VA. um has their research
engagement council and so we went and presented
our ideas to them and said what do you think
is this something that might be helpful and so
many folks who we spoke to said we want to know
about CBD it doesn't get you high we don't want
to have issues with drug testing from our employers
like we want something that helps our pain and
allows us to function so we knew that that was
a really strong idea that had support and buy
-in from these veterans groups that we talked
to. For the coaching intervention, similarly,
we presented this idea, which as a researcher,
I and the folks on my team really liked because
we thought this will allow us to test a couple
things. One, can we help people use their cannabis
more skillfully? And two, How do we make sure
that we allow people to use the vast variety
of cannabis products that are available and legal
in the Michigan marketplace and not constrain
them to only being able to use a single product,
which is what you typically have to do when people
are enrolled in a clinical trial for a study
medication, they can pretty much only use that
study medication. With this coaching approach,
people can purchase and use like a topical product,
the tincture and a vaporizer all within their
treatment regimen. We work with them no matter
where they're at and help them optimize that
use. So we like that scientifically because it
provides more flexibility. The veterans we talked
to really liked that because they can then after
the study is done, they have the skills that
they need to operate within the legal climate
of having these medical and adult use dispensaries
where they can go buy these products. And they've
gotten the support that they need that oftentimes
they can't get from a physician either at the
VA or outside of the VA because most doctors
don't get any education about cannabis in medical
school. Yeah, I'm going to get to this a little
bit more, but I want to pick up on your you know,
the issue about legality and these numbers change,
but it's something like 39 of the 50 states in
the country allow it for medical use, and 24
states, so almost half of them, allow it for
recreational use. But it's still illegal, still
schedule one drug on the federal registry, although
that may change, who knows. But because of that,
and because this is sort of a new trend, as you
say, This isn't part of medical training for
doctors, primary care physicians, if you will,
or pain physicians when they go through medical
school. Can you talk a little bit about will
these studies, and maybe it's about how the coach
gets certified, deal with issues like? dosage,
efficacy, quality, delivery systems. I mean,
it's more complicated than going to your local
drug store and just getting the prescribed pills
over the counter. There's a heck of a lot of
variety today. And because it isn't so regulated,
how do you take that into account in the CanCoach
program? Yeah, so that's all those reasons that
you just mentioned are exactly why we developed
this. because we know that that's the exact information
that people need to use this information skillfully
and to use cannabis as a useful medication. So
we scoured the scientific literature and there
have been studies looking at what happens if
people smoke or they eat or they use a tincture
topical product. How quickly does it take effect?
How long does it last? What are the effects of
CBD versus THC in these acute dosing situations?
What kind of doses have been used in the scientific
literature? We compiled that all together. We
digested that all into easily deliverable information,
both in terms of the handouts that we give to
participants, as well as in this manual that
we developed for this intervention. So participants
will come into this study. They can ask the questions
they need to ask. We also have these really well
-crafted materials so they can walk away feeling
very comfortable. But what they're doing is informed
by the best available scientific evidence around
the effects of these compounds and how they might
be affecting their bodies, as well as how the
different delivery systems might affect them
and their unique situation. And when you generally
are talking medications, you're also worrying
about interactions between, oh, the heart doctor
gave me this, and my doctor for my gout gave
me that, and my headache doctor gave me that.
Sometimes we have cross, I'm not sure what the
right medical term is, but I'll call it cross
-contamination problems. these things working
against each other, how is that taken into account
to make sure that you're, when you're doing your
rigorous study here, you're not really seeing
the impact of, well, it's not the CBD or the
cannabis, it's that plus something else? Yeah,
this is a great question. So safety is our top
priority in these studies. So for the CBD study,
We're using a product that has been approved
by the FDA for other medical indications. It's
called Epidiolex. It contains plant -derived
CBD. And so that has been tested and is actually
available commercially for medical conditions
other than pain. So for example, you could go
to your physician and say, hey, I want this off
-label. prescription for Epidiolex. And if they
think that it would be helpful for you, you could
actually get it. So there's that side of things
on the purity of the product that we're using
for the CBD study. And because it's been tested,
it's gone through the whole FDA approval process.
We know a good deal about what kind of interactions
this CBD product has. And it's mostly with anticonvulsant.
medications. That's what showed up in those clinical
trials. There might be some other interactions
that continue to show up, but the FDA reviewed
this. We also have our own institutional review
board or IRB, and they look at studies like this
and they say, will this be safe? And if something
happens for a study participant where there's
a safety issue, how will you protect that person
and make sure they get what they need? So, you
know, we do phone calls with our study participants.
They can enter any side effects that they experience
into their study app, and we monitor these very
closely. as well. So there's these multiple different
systems that we use to ensure participant safety.
In the coaching intervention, because we're not
giving people study medication directly, they're
purchasing their own cannabis products from cannabis
dispensers. If they bring up a specific medication
to us, we can go and look at it, but we also
encourage people to talk to their clinicians
to say, is there a potential interaction with
some of these medications that you might be taking
with cannabis? Oftentimes, what we see in the
scientific literature is that there's a lot of
theoretical interactions. There's a few known
interactions, but a lot of times what happens
is when people add cannabis into their treatment
regimen, it is a, you watch, you're extremely
careful with your dosing. So you do a really
like a start low, go slow situation. And if you
notice anything that is concerning, then. You
stop what you're doing, you talk to a clinician,
and you make sure that you're keeping yourself
safe. You mentioned something that I want to
highlight, which is if you're out there, veterans,
using recreational cannabis because you're in
one of those 24 states or in even more medical
cannabis, you should be having a discussion with
your primary care physician about it so that
they know that you're using that as well. they
can look at issues of possible drug interactions.
But you can't really have that conversation with
the VA because it's not allowed to be prescribed
or used in the VA. So make sure your, as the
good doctor says here, start low, go slow. But
have that conversation. Don't think you should
do it all on your own. And that's why we're doing
these clinical trials, is to try to give better
information to people. Let me ask about clinical
trials, Dr. Bohanke, are all about size, right?
So talk to us about the size of the clinical
trial for CBD care and for CanCoach. Yeah, so
these are very large. clinical trials, each one
we're recruiting 468 individuals into. So this
is the size of study, very similar to some of
the large, you know, pain drug studies that are
done by pharmaceutical companies. So we are extremely
lucky and grateful to have this opportunity to
do studies like this, that, you know, they wouldn't
be possible without the advocacy of veterans
and other groups to get this money put aside
in the law that passed legalizing adult use cannabis.
So I'm just really grateful for that forethought
to be able to fund these sorts of well -powered
studies that frankly have not been possible in
a lot of different situations, both because of
cannabis legality and because it's the National
Institutes of Health and other large funding
bodies have historically kind of stayed away
from funding this kind of research. That is definitely
changing now. I'm glad to say, although with
this current situation, there's a lot more uncertainty
now with relation to that. But for example, my
colleagues and I are doing a separate study related
to CBD that is funded through the National Institutes
of Health. Some of these studies happening in
a different way now than was even possible like
10 years ago. So you have a large study group.
You're recruiting 468 individuals into each.
What's the timing on this? Does this take a year
or five years? What's the anticipated timing?
Yeah, we anticipate it will take at least a couple
more years. So and both of these studies are
available to uh veterans in any of these states
with legal adult use cannabis um and because
they're all done via telemedicine you know like
I said we can for people in CBD care we can ship
study medication uh to California or to Maine
um for can coach like those study sessions uh
happen via you know a HIPAA compliant video platform.
So it's something that you can meet with the
coaches in the comfort of your own home. So yeah,
it means that we're hoping to have a wide reach
with these studies. And that's really important.
We hear this and we hear this out of the VA research
when we talk to their researchers about You know,
veterans are of all types of races and ethnicities
and ages, genders. You have to have a big enough
study that you can say, well, this is what the
impact is to female veterans as compared to male
veterans and split that maybe into African American
veterans versus Hispanic. I mean, you're trying
to take all of that demographic stuff and figure
it out, right? Yeah, I mean, we're doing our
best to account for all those things. That's
why we've had such a strong, you know, engagement
component with veteran groups at each stage of
the way, and are hoping to continue that throughout
this study. And also knowing that like, even
though these are two large studies, it's important
to, you know, have these results looked at by
other teams and other investigators and ideally
have large other studies going by other teams
and other sites too to see if these results hold
up because even though these again are large
and well -designed studies, one study is never
definitive. I can tell you and I can tell our
audience what the last paragraph of your report
is going to say. It's gonna say further research
is still necessary Hey, I want to let our veteran
radio listeners know how they can learn more
about this and if you're a veteran or if you're
Friend of a veteran you say hey, I think my my
friend ought to get involved in this they can
how do I enroll? Go to the website. Am I? vetscan
.org, m -i -v -e -t -s -can -c -a -n .org, myvetscan
.org, talks about the study, talks about the
overview, there's tutorials and resources, but
there's a big green enroll now button and I assume
that's how people get themselves involved in
these things, doctor. Yep, that's exactly right.
So if you go to the website, you contact the
study team, you go to the enrollment place, you'll
be able to talk to one of our wonderful study
team members who can help walk you through the
process of, you know, signing up for these studies.
I will say also before joining one of the clinical
trials, you know, participants would need to
join the registrar, which helps them get acclimated
to the study procedures and the study app. And
just make sure that they're comfortable with
the whole situation. Once they're in that, then
they can participate in one or both of the clinical
trials, assuming that they meet the eligibility
criteria. And so it's... something we're just
really hoping that folks will be interested in
and find useful. So thanks so much for sharing
out the information about the study. Well, we
certainly appreciate Kevin Buchenke, PhD, principal
investigator on these studies, spending some
time today with Veterans Radio to talk about
these studies. Sort of the two different natures
of them a CBD care versus can coach very interesting
can coach so we would hope people all around
the country will go to the website and enroll
because Your involvement as a veteran will help
others Because this is a large study with rigorous
detail to it that can ultimately withstand scrutiny
and be used by others and maybe even the federal
government of the VA at some time will come around
on this issue. But Kevin, thanks for the time
that you've devoted to us today. And we'll be
back, I guess, in a year or two to find out how
the results are going. Sounds good, yeah. Would
be delighted to speak with you anytime. And thanks
so much for having me, Jim. Lovely speaking with
you today. That's Dr. Kevin Benke with the University
of Michigan MI Vets Can study. Very interesting,
and we'll keep an eye on that and report back
to you in the future. And I want to thank everybody
for listening to Veterans Radio today. I am Jim
Fossone. It's been a pleasure to be your host.
I'm a veterans disability lawyer at Legal Help
for Veterans and you can reach us at 800 -693
-4800 or legalhelpforveterans .com on the web.
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