VA sending mixed messages for vets about cannabis use to treat PTSD
Despite increasing legal access to medical and recreational cannabis in states across the U.S., veterans face unfair treatment and stigmatization because the U.S. Department of Veterans Affairs refuses to recognize marijuana as a viable treatment option.
While the VA has embraced the federally illegal status of the drug, agency policy does not allow discrimination against veterans who acquire medical cards in states where it is allowed, although those who do get their MMJ cards do so with their own resources and at their own risk outside the purview of the Veterans Health Administration.
But that isn’t always the case, said attorney Derek Debus of Stone Rose Law in Scottsdale. A Marine veteran who now specializes in military law and VA benefit issues, Debus said having rules in place doesn’t guarantee fair treatment for veterans who legally use cannabis.
“I’ve had clients in the past that, if they admit to medical marijuana usage, won’t get any medication at all through the VA,” Debus said. “I’ve had clients that have gone to the VA for acute injuries like kidney stones, or even a broken arm, who were denied pain medication because they tested positive for cannabis and or have a state medical marijuana card.”
According to Debus, the level of stigmatization often correlates with where a veteran might seek treatment, as some state VA’s are run by more progressive leaders than others.
“That prohibition (against denial of benefits) alone doesn’t tell the whole story when you have individual providers who have their own animus towards cannabis use,” he said. “So, even in states that are very permissive with medical marijuana, like Arizona, the fact that the VA won’t assist veterans in obtaining the necessary certification does harm veterans.”
Debus cites the cost of obtaining a medical marijuana card and the stigmatization of cannabis as impediments to veterans gaining access as a reason for the pushback by vets on the issue.
VA policy at odds with VA policy
A recent study published on the U.S. Department of Veterans Affairs website appears to counter the spirit of Directive 1315, VA policy that does not allow discrimination against medical marijuana users, and the issue remains murky for vets with certifications in states where it is legal.
The April 2021 report found “growing interest and concern” over increased usage among veterans, as more states legalize cannabis use. The study — and the VA — states that “research to date does not support cannabis as an effective PTSD treatment, and some studies suggest cannabis can be harmful, particularly when used for long periods of time.”
The issue is growing in the veterans community as more and more states liberalize cannabis laws, either for adult-use recreational purposes or for medical use. There are currently 36 states where medical marijuana is legal and 18 (plus the District of Columbia) that have legalized it for public consumption.
Cannabis is still listed as a Schedule I narcotic by the U.S. government though, meaning it has no “currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.” Other drugs on that list include heroin, LSD, peyote, methaqualone and methylenedioxymethamphetamine (ecstasy, or MDMA).
Lack of evidence due to dearth of clinical studies
According to the VA, evidence of cannabis as an effective treatment of PTSD is primarily based on “anecdotal evidence from individuals with PTSD who report that cannabis helps with their symptoms or improves their overall life and functioning.”
Citing a lack of randomized controlled trials (RCT) on the drug’s efficacy to relieve the symptoms of PTSD, the report references the only RCT that has been completed on the plant released earlier this year that found “no significant difference in PTSD symptom reduction between placebo and any of the active cannabis preparations.”
The study that the VA cited was conducted in part by Dr. Sue Sisley of the Scottsdale Research Institute and the Multidisciplinary Association for Psychedelic Studies, a nonprofit research and educational organization focusing on psychedelics and marijuana as viable treatment options.
Sisley has spent more than a decade maneuvering the bifurcated system that allows legal use in many states but is heavily restricted by its federal status.
The results of the SRI trials, however, were likely affected by the poor-quality cannabis available for study. Until recently, cannabis researchers were required to only use plants grown at the University of Mississippi.
Often referred to as “lawnmower clippings,” cannabis mandated by the U.S. government through the National Institute on Drug Abuse has been described as sub-standard, usually containing stems and seeds and sometimes even mold. It is often stored in freezers for years at a time. And it has no more than 9% THC, the active compound in cannabis — far less than the 20% to 30% in the cannabis sold at medical and recreational dispensaries. Concentrates can contain even higher amounts of THC.
As a result, SRI/MAPS concluded there was no significant difference found within three groups that used varying levels of THC/CBD versus a group given a placebo.
At the time, Sisley stated that it was sometimes difficult to get subjects to use the marijuana and much of it was returned unused.
But the tide is turning: In May, the Drug Enforcement Agency announced new regulations allowing the use of commercial-grade cannabis and began the process of certification for a number of growers in the U.S.
SRI recently entered into an agreement with MAPS to do a second FDA-approved clinical trial and has been awarded nearly $13 million in grant funding from the state of Michigan’s 2021 Veteran Marijuana Research Grant Program.
That program is designed to evaluate “the efficacy of marijuana in treating the medical conditions of U.S. armed services veterans and preventing veteran suicide.”
“Suicide among Veterans is an urgent public health crisis, but it’s solvable if we invest in researching new treatments for pain, depression, and PTSD,” Sisley stated in a press release announcing the partnership. “This grant enables more rigorous study, overseen by the FDA, which may lead to cannabis flower becoming prescribable medicine someday. Veterans are demanding objective cannabis drug development research, and the state of Michigan is fulfilling our collective obligation to our beloved Veteran community.”
The study will be the second clinical trial ever that compares the safety and efficacy of cannabis against placebo, and the first to use high-THC cannabis.
Setting up the study has highlighted the differences in VA administration across the country, as SRI and MAPS have enlisted VAs in Tampa, Florida and Ann Arbor, Michigan to identify 320 veterans to participate in the study. The Phoenix VA has refused, despite medical cannabis being legal in the state since 2010.
“The Phoenix VA has indicated that it will not refer vets with PTSD to an FDA and DEA-approved study of cannabis for PTSD,” Rick Doblin, Ph.D. Founder and executive director of MAPS wrote in a recent email to the Arizona Mirror. “The Phoenix VA ill-serves the vets it is responsible for treating by declining to assist federally legal scientific research. This study will help generate essential data about cannabis for PTSD in vets, so we hope the Phoenix VA reconsiders.”
Questions directed to Samuel Aguayo, MD, associate chief of staff for research at the Phoenix VA Health Care System, were deferred to VA spokesperson Bobbi D. Gruner, who in an email stated that, “On a national level, VA does conduct research on medical marijuana, providing all regulatory approvals are in place for a Schedule I drug and involved investigators have no ethical and financial conflicts of interest.
“In addition, an Institutional Review Board is required to review research protocols and related materials to ensure protection of the rights and welfare of human subjects of research.”
Federal attempts to help veterans in the works
As the momentum for legalization continues to gain strength on a state level, the U.S. House of Representatives and the Senate have proposed legislation to change marijuana’s legal status federally through bills such as the SAFE Banking Act and the Cannabis Administration and Opportunity Act that have both passed the House, but died in the Senate.
A recent bill proposed by Sen. Mark Schatz (D-Hawaii), the Veterans Medical Marijuana Safe Harbor Act, was introduced in April and would allow the VA to legally prescribe and provide marijuana to veterans in states where it is legal.
The bill is cosponsored by Sens. Tim Kaine (D-Va.), Bernie Sanders (I-Vt.), Jeff Merkley (D-Ore.), Ron Wyden (D-Ore.) and Jacky Rosen (D-Nev.). There is also a companion bill in the House of Representatives, cosponsored by Representatives Barbara Lee (D-Calif.) and Dave Joyce (R-Ohio).
But federal legalization efforts keep running into the same Senate blockade as most other popular legislation, and that is Republican recalcitrance that leads to the inability to pass anything meaningful, including bipartisan bills.
“It seems like every year, every congressional session, more and more bills get introduced to allow the VA to prescribe medical marijuana, to allow the VA to reimburse for medical marijuana and to de-schedule marijuana,” Debus said. “None of these bills ever seem to get any further than being introduced, but simply creating an environment where VA providers can allow their patients to access cannabis is only one step of solving this problem.”
Debus added that while the VA is bound by federal law, there is an overarching culture that resists change and an active vilification of cannabis using decades-old scare tactics.
“Instead of just sitting on the sidelines, the VA is affirmatively pushing this mythology that cannabis has absolutely no benefit for treating PTSD,” he said. “It’s not just that we need to change the laws, we need to change the culture of the institution from the top down.”
This report was first published by the Arizona Mirror.