Solving the dilemma of polypharmacy with patient-based medical cannabis regimens: harm reduction in the Canadian Veteran population

Abstract: Polypharmacy is a major issue in the Canadian Veteran population. In addition to PTSD, veterans suffer from multiple mental and physical health issues, commonly including: major depressive disorder, insomnia, chronic pain, tinnitus, irritable bowel syndrome, erectile dysfunction, post concussion syndrome, brain injury, chronic fatigue and others. These complex clinical presentations often result in the prescription of polypharmacy, which is not adequately monitored. Iatrogenic effects of multiple prescription medications, drug-drug interactions, and adverse side effects of prescription medications are common. Furthermore, there are no evidence-based clinical trials, which demonstrate safety and efficacy of combining multiple drugs across multiple physical and mental health diagnoses. Many veterans are prescribed combinations of anti-depressants, psychotropics, hypnotics, NSAIDS, opioids, and other classes of medications. Often, veterans report having been medicated with polypharmacy both during and after active military service with polypharmacy ranging from 3 to over 10 different prescription medications. Clinically, these polypharmacy regimens cause harm by further undermining physical and mental function and are associated with iatrogenic issues, such as: cognitive dysfunction, emotional numbing, anger outbursts, suicidal ideation, gastroesophageal reflux disease, erectile dysfunction, irritable bowel syndrome, obesity, central and obstructive sleep apnea, metabolic syndrome, type II diabetes, liver function abnormalities, kidney function abnormalities, and others. Medical Cannabis (MC) is a medication, which is proving to be increasingly effective across physical and mental health diagnostic categories without the adverse side effects of other prescription medications. MC is a key player in the re-establishment of homeostatic balance in medically and mentally ill patients. Using a patient-based approach, we have developed personalized MC regimens in the veteran population, which allow for the weaning down of and discontinuation of prescription medications that have proved to be ineffective and/or caused adverse side effects. Instituting personalized MC regimens is proving to be a clinically effective harm reduction strategy in: 1) the reduction of polypharmacy, 2) the optimization of physical and mental health symptom management, and 3) improved physical and psychosocial function.