Policy and Research Gaps in Therapeutic Cannabis Use for GWOT Combat Veterans with Traumatic Brain Injury, PTSD, and Co-Occurring Conditions

Roberto Antonacci, MD
Green Express Med, LLC

Co-authors: Roberto Antonacci¹, David Miller¹, Roscoe Moore¹, Alexandra Perkins¹, Max Orezzoli¹, Greg Daniel^1
1Green Express Med, LLC

Background: Combat arms veterans of the Global War on Terror (GWOT, 2001–present), defined by Military Occupational Specialty (MOS), experience elevated rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Approximately 11–23% of GWOT veterans have sustained a TBI, with mild TBI often linked to repetitive blast exposure, including shoulder-fired weapon systems. PTSD prevalence estimates range from 15–30% in this population, with substantial comorbidity between TBI and PTSD. Frequent co-occurring conditions, including suicidality and polysubstance use, further complicate treatment. Despite increasing interest in medical cannabis as a therapeutic modality, research has been constrained by federal scheduling, inconsistent methodologies, and limited standardization.

Objective: This policy-focused analysis evaluates critical deficiencies in research on therapeutic cannabis use among GWOT veterans. Emphasis is placed on the lack of models correlating TBI mechanisms, PTSD symptom clusters, and therapeutic outcomes. This work highlights the absence of cannabis cultivar (chemovar) differentiation and the systematic exclusion or underrepresentation of concurrent conditions, including suicidality and polysubstance use.

Methods: A structured review of over 40 peer-reviewed studies (2015–2024) focusing on GWOT veteran populations was conducted. Studies were evaluated for design rigor, population stratification (including MOS and exposure type), outcome measures, and cannabis characterization. Policy analysis included recent federal cannabis rescheduling actions and implications for research expansion. Attention was given to methodological limitations of research conducted without cannabinoid and terpene profiling (chemovar standardization), as well as the exclusion of high-risk populations from clinical trials.

Results: The current evidence base is fragmented and lacks methodological cohesion. Few studies adequately stratify TBI by etiology (blast vs. blunt force), nor do they model the interaction between PTSD severity and cannabis use. Cannabis is frequently treated as a homogeneous intervention, obscuring differential therapeutic effects attributable to specific cannabinoid and terpene compositions. Furthermore, the exclusion of individuals with active suicidal ideation or polysubstance use significantly limits external validity. The absence of integrated, multidimensional correlation frameworks prevents meaningful interpretation of therapeutic outcomes across complex clinical presentations.

Conclusion: Recent federal actions on medical cannabis rescheduling present a pivotal opportunity to address longstanding research limitations. Future policy must prioritize large-scale, multicenter trials stratified by MOS, TBI mechanism, and PTSD phenotype, while mandating standardized cannabis chemovar characterization. Inclusion of populations with suicidal ideation and polysubstance use is essential to reflect real-world clinical conditions. Without these advancements, research will continue to lack translational utility. Addressing these gaps is critical to developing precise, evidence-based, and personalized therapeutic frameworks for GWOT veterans.