Veterans with brain injury use more cannabis, study ignores ECS

This post was updated on February 3, 2022 to include a response from the first author of the study, Brandon Utter, PharmD.

A new study published by The Association of Military Surgeons of the United States looked at cannabis use amongst veterans. The researchers found that veterans with traumatic brain injury (TBI) use cannabis far more often. In conclusion, the study questioned the reason and also noted the option for non-cannabis treatments, disregarding the endocannabinoids system (ECS).

Observational trial by MIBH

163 patients at the Marcus Institute of Brain Health (MIBH) were included in the survey. The results were then compared to overall cannabis-use rates documented by the National Survey on Drug Use and Health in 2018. Accordingly, 8.6% of adults 26 years of age or older used cannabis in the US. In contrast, a significantly greater percentage of patients with mild TBI reported using cannabis at 44.2% of those surveyed at MIBH. Mild TBI patients preferred THC-based preparations with only 10 of the 72 patients using CBD, instead. (1)

Neuropsychiatric symptoms, pain, and insomnia were the most common ailments that mild TBI patients used cannabis to treat. Unfortunately, the study concluded self-administered cannabis preparations to be an insufficient form of treatment. That said, the study failed to highlight endocannabinoid system (ECS) deficiencies which might drive veterans with brain injuries to use cannabis more frequently. Moreover, the study hinted at investigating alternative, non-cannabis treatments for mild TBI patients.

Endocannabinoid deficiencies and disease

A confluence of receptors and transmitters comprise the endocannabinoid system (ECS); recently covered under the more broad endocannabinidiome. Diseases and ailments can occur when transmitters within the ECS become dysregulated.

Ethan Russo, MD first made the hypothesis as a possible root cause for migraine, fibromyalgia, and irritable bowel syndrome. (2) Following this, wheat sensitivity as a symptom of an ECS deficiency was hypothesized by this author. Whereas, early evidence has suggested that dysregulated endocannabidiomes are linked to trauma, requiring more investigation.

Poor ECS tones cause canna seeking

All of the symptoms associated with endocannabinoid deficiencies, however, are positive for an increase in cannabis use. This means that a person will unknowingly try and adjust low endocannabinoid tones and poor receptor densities by seeking out cannabinoids. Correcting these low tones is thought to be the driver behind increased cannabis use.

Veterans will often engage in an uphill battle after coming home to use cannabis under an insurable medical plan, or at all. Research showing such a traumatic increase in cannabis use should support those veterans and further validate their needs. That respect, however, will sadly only be available to veterans if science recognizes the importance of cannabinoid therapy and the endocannabidiome.

The Association of Military Surgeons of the United States (AMSUS) serves for a number of US government departments, including Veteran Affairs (VA).

Handpicked cannabis science

The study (1) featured an oddly selective group of reararchers. This included Brandon Utter, a Doctor of Pharmacy with zero prior publications regarding cannabis or endocannabinoid research. A Ph.D. of Clinical Psychology from MIBH with over fifteen years of prior experience with the Veterans Affairs, Catie Johnston-Brooks participated in the research. Her only other contributions to cannabis research were two similar papers from MIBH on brain injury and substance use.

Four Medical Doctors also collaborated on the research regarding increased cannabis use in veterans with mild traumatic brain injuries. Two MDs, C. Alan Anderson and David Arciniegas have not previously published research on the endocannabinoid system or cannabis. Anderson and Arciniegas do, however, serve as two primary editors for The Journal of American Neuropsychiatric Medicine. It appears any experience with cannabis on the project came from Chris Filley, MD. With a solely negative bias, however, Filley has done research whereby he attempted to find ways cannabis use can cause leukotoxicity and white matter disorders.

Shortly after the publication of this report, Dr. Utter did respond by email to confirm his interest in the theory of endocannabinoid system deficiencies. Likewise, MIBH does recognize ‘system’ deficiencies caused by trauma to the head including more quantifiable HPAxis disorders. Previous studies verified endocannabinoid deficiencies to an extent by taking spinal fluid from different groups of migraine patients (3) and cannabis consumers (4), yet this procedure is highly invasive.

I do like the theory, though. And if there is a feasible way (not requiring lumbar puncture) to determine cannabinoid system deficiency, then I think a strong research model could be built.

Dr. Brandon Utter – February 3, 2022.

With that said, respect must be given to the endocannabidiome. High THC levels can be required by certain patients to treat extreme pain, for example. Keep in mind, however, that these doses can lead to tolerance. This is because high doses of THC can cause receptor density to temporarily drop and those receptors to desensitize. But was it improper preparations combined with poor dosing that caused MIBH to find inclusive results? Or, did the researchers find little evidence to support veterans treating mild TBI symptoms with cannabis due to their negative bias?

Let us know in the comments if you have experience with cannabis use and brain injury. And check out this story to find out how to boost endocannabinoid tone with diet instead of THC.


  1. Brandon Utter, PharmD, C. Alan Anderson, MD, Christopher M Filley, MD, James P Kelly, MD, Catharine Johnston-Brooks, PhD, David B Arciniegas, MD, Cannabis Use in a Cohort of Healthcare-Seeking United States Military Veterans With Persisting Symptoms After Mild Traumatic Brain Injury: Preliminary Observations, Military Medicine, 2022;, usac011
  2. Russo E. B. (2008). Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?. Neuro endocrinology letters29(2), 192–200.
  3. Sarchielli, P., Pini, L. A., Coppola, F., Rossi, C., Baldi, A., Mancini, M. L., & Calabresi, P. (2007). Endocannabinoids in chronic migraine: CSF findings suggest a system failure. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology32(6), 1384–1390.
  4. Morgan, C. J., Page, E., Schaefer, C., Chatten, K., Manocha, A., Gulati, S., Curran, H. V., Brandner, B., & Leweke, F. M. (2013). Cerebrospinal fluid anandamide levels, cannabis use and psychotic-like symptoms. The British journal of psychiatry : the journal of mental science202(5), 381–382.