Global Ganja Report

Military veterans continue to be denied much-needed treatment by the VA because of their cannabis use, even in states that have legalized. While there has been some progress on the question, vets are still being cut off—amid a combined national crisis of veteran suicides and opioid abuse.

One of the reasons John Penley moved out to Nevada from his native North Carolina last year was for the legal cannabis, which he uses to treat post-traumatic stress (PTSD) related to his military service in the 1970s.

He didn't anticipate that his use of state-legal cannabis could result in the US Department of Veterans Affairs (VA) cutting off the pain-killers that he also needs.

"Here I don't have to worry about getting arrested for using medical marijuana," Penley tells Cannabis Now. "But now it could cause me to lose all my veterans' benefits." 

Pain-killers cut for medical cannabis use
Penley's chronic back pain started to come on about 10 years ago, and it continues to get worse. He's been diagnosed with spinal stenosis, and the VA designates it a "nonservice-connected disability." The agency has been sending him a codeine-acetaminophen mix to control the pain. Acetaminophen is the generic variety of the over-the-counter brand Tylenol.

"I'm taking one a day to make 'em last," he says. "I won't get any more till I stop using cannabis and test again and come back clean for THC."

The pills arrive by mail, but Penley has to check in personally at the VA hospital in Las Vegas once month and have his urine tested. He says he believed this was just to monitor his levels of the blood-thinner Warfarin, which he also takes following a heart attack, and to check for use of other opioids and make sure his prescription was at the appropriate levels.

But after his last test in early September, he received a call from his VA doctor's nurse—informing him that he had tested positive for THC, and his pills were being cut off until he tested clean.

"It took me by surprise," he says. "I've been open with my VA doctors about using medical marijuana."

Penley worries that cutting off opioids could drive vets to the illegal market—where they face the threat of an overdose from fentanyl. He points out that the Las Vegas area is currently witnessing an explosion of fentanyl-spiked pain-killers on the illicit market. Last month, local health officials reported five overdose deaths related to street sales of the synthetic opioid over a 24-hour period.

Cannabis eases nuclear nightmares
In addition to his back pain, Penley suffers from PTSD, which he says is related to his service in the Navy from 1972 to '76. Working as an air-traffic controller at the Souda Bay base on the Greek island of Crete, he was responsible for aircraft carrying nuclear weapons. During the 1973 Arab-Israeli war, the base served as a "forward operating airfield" for US operations in support of Israel.

"I was extremely worried about a nuclear exchange between the US and Russia, which were backing opposite sides in the war," Penley recalls. "The whole area was swimming with Russian submarines, and Nixon put the US on the highest nuclear alert ever. I was afraid I was gonna get nuked in that control tower."

Nonetheless, he made petty officer second class before his honorable discharge. But Penley says he still has nightmares about being back in the control tower. And cannabis is what prevents the memories from haunting his waking life.

State-federal disconnect 
Today, Penley takes oral doses of THC oil to manage both the PTSD and back pain. Although he still needs the codeine-acetaminophen mix, he believes cannabis use obviates the need for the far more powerful oxycontin—or surgery. "I'm considering a back operation that I don't really want to get, but I can't take the pain," he says, taking stock of his cut-off by the VA.

Ironically, Penley had just been just re-approved for codeine earlier this year after having been cut off during the VA's crackdown on prescriptions in response to the opioid epidemic a few years ago.

In the intervening years, he had no alternative but to take large quantities of over-the-counter acetaminophen. "I was taking too much acetaminophen, a 500-milligram pill three times day," he says. In contrast, the combination pills he received from the VA contained just 300 milligrams of acetaminophen, and he only has to take one twice a day. Penley was recently diagnosed by the VA with kidney damage, which he attributes to overuse of acetaminophen during the last period when his codeine had been cut off.

"I don't like the fact that they're treating me as a criminal," Penley says. "Why should testing positive for cannabis affect the medicine I'm getting from VA—especially in a state where it's legal?"

And he points out another irony. "I receive a discount for veterans at the dispensaries here in Las Vegas," he relates. "You have the VA punishing veterans for using medical marijuana in the same states where vets are getting a discount."

Illusion of progress? 
The VA has been under growing pressure on this question, and there has actually been some recent progress—at least on paper.

The Missouri Independent reported earlier this month that VA policy does not allow discrimination against veterans who enroll in state medical marijuana programs—although they must do so with their own resources, outside the purview of the VA's Veterans Health Administration.

In December 2017, the VA issued Directive 1315, which states: "Veterans will not be denied VA benefits because of marijuana use."

This was certainly long overdue. The Missouri Independent quoted Derek Debus, an Arizona attorney and Marine veteran who specializes in VA benefit issues.  "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."

But remnants the official intolerance clearly remain intact. The VA website touts an April 2021 study from its own National Center for PTSD noting “growing interest and concern” over increased cannabis use among veterans, as more states legalize. The study 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.”

Yet there certainly seems to be plenty of countervailing research. For instance, a 2015 study of veterans in New York City, conducted by scholars at New York University, found: "Veterans' comparisons of cannabis, alcohol, and psychopharmaceuticals tended to highlight advantages to cannabis use as more effective and less complicated by side effects. Some participants suggested that cannabis can be part of an approach-based coping strategy that aids with introspection and direct confrontation of the sources of personal trauma."

Contacted by Cannabis Now, VA public affairs specialist Gary J. Kunich offered this explanation for how vets can still be cut off from receiving prescription meds for medical cannabis use in spite of Directive 1315: "Veterans will not lose access to VA financial or medical benefits because of medical marijuana use, but it may affect clinical decisions about other prescriptions, including those for pain management. These are clinical decisions that practitioners make according to a medical evaluation and are not determined by VA policy."

In any case, Penley says he is not enrolled in the Nevada medical marijuana program because he is a relatively new arrival in the state, and cannabis is available freely on the adult-use market. If enrolling in the state program was necessary to keep his pain-killer prescription from the VA, "nobody here advised me of that," he says. "Not even in the orientation when they prescribe your opiates. You’d think they would have informed me."

Veteran organizations embrace right to medical cannabis
In 2009, New Mexico became the first state to make PTSD sufferers eligible for medical marijuana. The condition has since been included in most state medical marijuana programs.

The effort to get the VA to take a more tolerant stance got another boost in 2016 when the American Legion, a veterans organization of 1.8 million members known for its conservative politics, urged Congress to remove cannabis from the federal list of prohibited drugs and allow research into its medical applications. Lawrence Montreuil, the organization's legislative director, told Stars & Stripes. "I think knowing an organization like the American Legion supports it frankly gives [lawmakers] a little bit of political cover to do something that they may have all along supported but had concerns about voter reaction."

The organization Disabled American Veterans (DAV), which actually donated the vehicle that picks up Penley for his VA doctor appointments, has also embraced exploring "medical cannabis as an alternative to opioids for veterans." A position statement on its website reads: "DAV calls for more research into medical cannabis as an alternative pain relief option for veterans with chronic pain, PTSD and TBIs [traumatic brain injury]."

A legislative solution? 
There have long been efforts on Capitol Hill to resolve this matter. The Veterans Equal Access Act has been repeatedly introduced in recent years, to facilitate medical cannabis access for military veterans suffering from chronic pain, PTSD, and other serious medical conditions. This bill would allow VA doctors to recommend cannabis under state medical marijuana programs, and assure that vets do not lose any benefits for enrolling.

This April, Sen. Brian Schatz (D-HI) joined with Congressional Cannabis Caucus co-chairs Reps. Barbara Lee (D-CA) and Dave Joyce (R-OH) to introduce another version of the bill, the Veterans Medical Marijuana Safe Harbor Act.

But as the cannabis advocacy group NORML notes, Congressional conservatives have repeatedly blocked such efforts: "In previous sessions of Congress, majorities in both the US House and Senate voted to include similar language as part of the Military Construction, Veterans Affairs and Related Agencies Appropriations bill. However, Republicans sitting on the House Appropriations Committee elected to remove the language from the bill during a concurrence vote."

This despite the growing evidence of the medicinal value of cannabis for PTSD sufferers. NORML points out that a 2014 retrospective review of patients' symptoms published in the Journal of Psychoactive Drugs found a greater than 75% reduction in Clinician Administered Posttraumatic Scale (CAPS) symptom scores following cannabis therapy.

Vets stand up 
John Penley has been a part of the activist effort around this question.

On Veterans’ Day 2018, he was among a group of veterans who camped out at the national offices of the VA to demand access to medical marijuana.

He was also arrested for crossing police lines while protesting lack of action on veteran suicides at the 2012 Democratic National Convention in Charlotte, NC. 

And in July 2014, when the Veterans for Peace national convention was held in his hometown of Asheville, NC, he pushed for a resolution which was adopted, stating that "it is the right of any Veteran to discuss with his/her healthcare provider any and all possible treatment options...including the use of medical cannabis, without the threat to the Veteran or provider of disciplinary action, regulatory loss of privilege and/or or benefits, or criminal sanctions."

As for the bureaucratic response to his own cut-off of painkillers, Penley protests: "They say it's federal policy and they don't have a choice in the mater. But the feds shouldn't be punishing people for using medical marijuana. I should be able to get medical marijuana from the VA. I think the vet suicide rate would go down if they supplied it."

Cross-post to Cannabis Now

Graphic by Veterans and Friends Against War and Nuclear Weapons

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