Global Ganja Report

The percentage of military veterans facing challenges from PTSD is staggering, but the Department of Veterans Affairs remains intransigent on allowing access to cannabis—the only treatment that provides relief for many. And there has been little progress on efforts in Congress to remedy the situation.

Growing numbers of military veterans are turning to cannabis to treat post-traumatic stress disorder (PTSD) and other ailments related to their service. But this reality is not recognized by the US Department of Veterans Affairs (VA). Currently, VA healthcare providers are prohibited from recommending that their patients use cannabis, or helping their patients obtain cannabis treatments.

The website of the VA's National Center for PTSD actually states that "there is no evidence at this time that marijuana is an effective treatment for PTSD. In fact, research suggests that marijuana can be harmful to individuals with PTSD."

In contrast, the Israeli Health Ministry approved use of cannabis to treat PTSD way back in 2015.

Legislative efforts stalled
A bill to at least allow VA doctors to recommend cannabis, the Veterans Equal Access Act, was reintroduced this March after failing to pass last year. The biill was sponsored, once again, by Congressional Cannabis Caucus founder Rep. Earl Blumenauer (D-OR).

But the following month, VA officials told lawmakers on Capitol Hill that the agency is opposed to the bill and related legislative efforts to expand access to medical marijuana for veterans.

As Stars & Stripes notes, the other bills include the VA Medicinal Cannabis Research Act, introduced by Rep. Lou Correa (D-CA), which directs the VA to carry out a clinical trial of the impacts of cannabis on chronic pain and PTSD. Another such effort is the Veterans Cannabis Use for Safe Healing Act, sponsored by Rep. Greg Steube (R-FL), which prohibits the VA from denying benefits because a veteran participates in a state-approved medical marijuana program.

In April testimony before the House Committee on Veterans Affairs, VA health consultant Larry Mole articulated the agency's position—which comes down to the notion that its hands are tied by federal law.  

"The authorization related to being able to recommend or prescribe is related to the Controlled Substance Act," Mole said. "As long as cannabis or marijuana remains a Schedule I drug, we are going to look to the [Drug Enforcement Agency] and the Department of Justice to get their opinion on what prescribers are able to do. This committee can make strong proposals for us to move forward with recommendations of filling out forms and such, but, in the end, we need to go back to DEA and DoJ for their opinion. I've not seen anything to suggest their opinion will change.”

Rep. Blumenauer countered: "One of great tragedies of our time is the failure to adequately address the needs of veterans returning home from Iraq and Afghanistan. We sent more than 2 million brave men and women to fight under very difficult circumstances. We can all agree the need to provide the care to veterans when they return home with wounds both visible and unseen."

The three bills have seen little progress in ensuing months.

Also introduced last year was the Veterans Medical Marijuana Safe Harbor Act, which would empower VA physicians to issue medical marijuana recommendations in states where it is legal, and allocate $15 million for cannabis research. It has likewise been reintroduced, by Sen. Brian Schatz Sponsor (D-HI)—and has likewise seen little progress.

The VA's one concession on this question was a 2010 policy change, under which veterans will not be denied treatment if they participate in a state-legal medical marijuana program, or discuss their cannabis use with their VA healthcare provider.

Ex-VA director comes around —after punting to Congress 
Last month, many veterans took heart when military affairs website Task & Purpose interviewed former VA secretary David Shulkin ahead of the release of his new book, It Shouldn't Be This Hard To Serve Your Country. Shulkin, who headed the VA from 2017 to 2018, surprised many by coming out flatly for medical cannabis.

Asked if he thought the VA should be researching medical marijuana, or if he could foresee the agency actually recommending cannabis, Shulkin replied forthrightly.

"I think the time is now," he said. "I believe that the VA should be involved in research on anything that could potentially help veterans and improve their health and well-being." He especially cited the growing problem of veteran suicides, "often because of issues related to chronic pain, depression, substance abuse." He added that "there is growing evidence that medical marijuana—I'm not talking about recreational marijuana, but properly prescribed—may have some real benefits in anxiety improvement, in pain management, and potentially, in the issue of substance abuse."

Reminded by the interviewer of the federal illegality of cannabis, Shulkin responded: "I do think that the way forward is a legislative solution... I believe this should be approached. I have no indication to believe that the president wouldn't be supportive of work that would help veterans improve their functioning and health." 

As Marijuana Moment notes, Shulkin in office refused to fund cannabis research, and punted to Congress when pressed on the issue. During a White House briefing in 2017, he said that state medical cannabis laws may be providing "some evidence that this is beginning to be helpful, and we’re interested in looking at that and learning from that." But he added that "until time the federal law changes, we are not able to be able to prescribe medical marijuana for conditions that may be helpful."

A growing health crisis
The depth of the crisis facing the nation's vets could hardly be more apparent. Military.com reported in September on an "alarming" new VA report showing that at least 60,000 veterans died by suicide between 2008 and 2017—with little sign of the crisis abating despite suicide prevention being the VA's top priority. In 2017, more than 6,100 veterans died by suicide, an increase of 2% over 2016 and a total increase of 6% since 2008.

A VA report in 2017 revealed that 247,243 veterans from the Iraq and Afghanistan wars have been diagnosed with PTSD. But as Daily Beast noted at the time, the report "was buried on the VA's website without fanfare." The VA's own studies show that up to 20% of veterans from Operation Iraqi Freedom and Enduring Freedom (the Afghanistan campaign) suffer from PTSD.

The situation with chronic pain is much worse. According to another recent VA study, 65.6% of veterans reported experiencing pain over a three month period, with 9.1% having severe pain. Severe pain was 40% greater in veterans than non-veterans.

There are over 20 million veterans currently living in the United States, but as an analysis in National Law Review notes, they are "increasingly underrepresented in the legislative decision-making progress." The percentage of veterans serving in Congress dropped from 81% in 1975 down to about 20% today.

Vets' experience overlooked
Cincinnati's WCPO last month provided some poignant profiles of vets who have turned to self-medicating with cannabis. Air Force veteran Robert Kowalski described his plight after returning to Wright Patterson Air Force Base after nearly two years on deployment in Iraq—which included time at the detention centers of Camp Bucca and the infamous Abu Ghraib.

"My first deployment wasn't too bad outside of mortar attacks all the time. It's like fireworks, you just kind of get used to it going off all the time," he said. "The second deployment, that's when I really started seeing things and doing things that you see in movies... [I]t wasn't until a couple months after I returned home from my second deployment that everything started to spiral out of control."

He used cannabis to calm his nerves, but as he was still active-duty, this was revealed in the routine monthly drug-testing that all service members are subject to. The Air Force reprimanded Kowalski for using cannabis, and sent him to base physicians who prescribed up to 16 different medications—which he said negatively affected him.  "They were prescribing me a lot," Kowalski said. "And it was getting me in trouble... I was on sleep medication, so I couldn't wake up and show up to work on time because the medication so messed me up."

Also profiled was  Nicholas Schneder, an Ohio National Guard infantryman who served in Iraq from 2006 to 2007. He also served at detention centers, and says he was traumatized by the experience after witnessing atrocities. Upon returning home, he first tried to drown his nightmares in alcohol. He was later prescribed opioids—which he said made him "feel like a zombie." He is now using medical marijuana under recommendation from from Dr. James Weeks of Cincinnati's One Heart Medical.

Schneder is still using opioids, but believes cannabis is helping him to get free of them. Dr. Weeks told WCPO, "What I found is when we...add medical cannabis to the regimen the quality of life is better, pain is better, and although we may not be able to completely stop conventional therapies we're able to wean the doses of those down."

But vets who don't live in medical marijuana states continue to find themselves in exile—and none will receive any assistance in accessing cannabis from the federal agency ostensibly charged with their care.
 

Cross-post to Cannabis Now

Graphic by Veterans and Friends Against War and Nuclear Weapons

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