Amy Rising grinds up medical marijuana before smoking. Rising, an Air Force veteran, has been working on legislation for veterans' freedom to treat PTSD with medical cannabis.Kevin Cook for The Washington Post via Getty Images)
When Lt. Col. Doug Distaso retired from the Air Force in 2017, he left with a laundry list of service-related medical diagnoses – chronic pain, a traumatic brain injury and post-traumatic stress disorder – and a slate of opioids, muscle relaxers and other drugs prescribed to ease his symptoms.
The drug cocktail, he says, left him in a medicated stupor. His wife was worried. He felt like he was at a dead end.
Distaso's situation wasn't unique. Veterans experience chronic pain at rates high above those of the general population and are often prescribed opioids to temper their suffering. Rates of post-traumatic stress disorder in veterans are in the double digits and an average of 20 veterans die each day from suicide.
Across the country, those with chronic pain and mental health diagnoses – as well as a litany of other conditions – are turning to medical marijuana as a viable treatment option. More than three dozen states have legalized medicinal cannabis and new marijuana legislation is being considered by state lawmakers every week.
But for U.S. military veterans accessing health care through the Department of Veterans Affairs health system, obtaining and using medical marijuana is fraught with roadblocks, even in states that have legalized medical or recreational use.
Under current VA policy, VA doctors cannot prescribe or recommend medical marijuana to patients – including in states where medical marijuana is legal – because of the drug's status as a Schedule I controlled substance.
The system has only just, in the last two years, altered its regulations to allow doctors to discuss marijuana use with patients when veterans request information or when it has "clinical relevance," though veterans groups say veterans still frequently encounter doctors who are dismissive or judgemental when the topic is raised.
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The department has also lamented the lack of research into the drug but has not conducted major research on marijuana's potential benefits for veterans battling common service-related ailments, citing federal red tape.
Distaso, who lives in Washington, D.C., was able to wean himself off his prescription drug regimen by using medical marijuana he accessed outside of the VA health system. His experience led him to the Veterans Cannabis Project, an advocacy group that pushes for reform on the issue, where he is now the executive director.
One option for vets who want access to marijuana is seeing a doctor outside of the VA system and footing the bill themselves. But that can be costly. Distaso says he hears from veterans frequently who struggle to afford to do so, especially from those on disability because of their service-related conditions.
Even for those who can shoulder that cost, marijuana use can throw their VA-prescribed medications into jeopardy. Veterans say that patients prescribed opioid painkillers are given semi-routine drug screenings from the VA to check for potentially harmful drug interactions. If veterans test positive for marijuana, their opioid prescriptions could be yanked, they say. (The VA did not respond to requests for comment on its drug testing policies.)
Major veterans groups, including the American Legion, Veterans of Foreign Wars and Iraq and Afghanistan Veterans of America, have advocated for reform for years, arguing that cannabis may help treat the chronic pain and mental health disorders at the root of both the opioid epidemic and the devastating suicide rate among veterans. Research has found that VA patients die of accidental overdoses – largely from opioids and cocaine – at nearly twice the rate of the general population.
"We feel that this is one of those areas where service members are being left behind," says Jeremy Butler, chief executive officer of Iraq and Afghanistan Veterans of America. "There's been an overreliance and over-prescription of opioids, where medical marijuana seems to be one of those areas in which we could make a lot better use of pain management treatments … and get people off opioids."
The issue also bucks traditional partisan lines and reform is overwhelmingly supported by veterans, according to surveys. A poll of veterans and their caregivers conducted by an independent group and publicized by the American Legion found that 92% of veterans support medical marijuana research and 81% support legalizing medical marijuana. The poll also found that 1 in 5 veterans already use cannabis for a medical condition. A survey of members of the Iraq and Afghanistan Veterans of America found similar support for medical marijuana research and legalization, and reported use.
In public comments, VA secretary Robert Wilkie has been unevicocal that the VA's policies will not change until federal laws permit marijuana use. He has also expressed concern at the lack of reliable research about marijuana's potential medical effects.
"Well, it is the federal law, and it's simple," Wilkie said in an interview with Colorado Public Radio.
"We still have no idea the effects of a more potent type of marijuana that we're seeing in the country and I'm not going to be in the position to replace the opioids that we are dispensing with a drug that we still have no idea what kind of effects it has on the brain," Wilkie added. "We are still really in the early stages of determining that impact."
Lawmakers on Capitol Hill have recently reinvigorated a push to address the issue, introducing a handful of bipartisan measures aimed at increasing medical marijuana access for veterans and compelling the VA to conduct research on medical cannabis. Similar legislative pushes in the past have failed, but there is evidence of a burgeoning bipartisan appetite for federal marijuana reform.
A bill dubbed the VA Medicinal Cannabis Research Act of 2019 is at the heart of the renewed reform effort. The measure would require the VA to conduct research on the effects of medicinal cannabis on veterans diagnosed with chronic pain and PTSD. Introduced in the House by Rep. Luis Correa, D-Calif., and Rep. Clay Higgins, R-La., it has more than 60 sponsors, including five Republicans, and is similar to one introduced last year that stalled.
The VA has not undertaken any major research on medical marijuana as a treatment for veterans' chronic pain or PTSD, citing federal requirements and the necessity for the involvement of other federal agencies, like the Food and Drug Administration. It has also in the past declined to participate in FDA-approved private-sector research on medical marijuana and veterans' PTSD.
"The restrictions contained in federal law are clear. Some research is allowed, but must be done in conjunction with the aforementioned federal entities," Susan Carter, director of media relations for the VA, said in an emailed statement. "If Congress wants to facilitate more federal research into Schedule I controlled substances such as marijuana, it can always choose to eliminate these restrictions."
Some proponents of medicinal marijuana research accuse the VA of hiding behind red tape in a bid to mask what they view as a general reluctance to study the drug.
Butler, the head of Iraq and Afghanistan Veterans of America, says the recently introduced research bill would give the VA "top cover" to move forward with research without worrying about being at odds with federal entities or the Trump administration.
"We need to understand where it can be best used, applied, where it's more effective or less effective," Butler says. "I think this can be done in a very expedited fashion, but it needs that government acceleration, I think, to make it happen."
In a recent hearing on Capitol Hill, a representative from the VA reiterated the department's objection to the bill.
It's not clear, however, if such a measure is necessary for the VA to begin comprehensive research into cannabis or if the bill would effectively compel the department to do so.
A handful of bills introduced in Congress are focused on expanding veterans' access to medical marijuana in states where it is legal and face longer odds than the research measure.
The Veterans Equal Access Act, re-introduced in the House by Rep. Earl Blumenauer, D-Ore., would authorize health providers in the VA to give recommendations and opinions on medical marijuana and to fill out forms with such recommendations.
And in April, Reps. Greg Steube, R-Fla., and Gilbert Cisneros Jr., D-Calif., introduced the Veterans Cannabis Use for Safe Healing Act, which would codify an existing directive that would protect veterans from being denied benefits due to participation in medical marijuana programs and would also allow VA staff to help veterans fill out forms to enroll in state marijuana programs.
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Non-veteran specific marijuana reform bills, including a measure that would remove marijuna from the controlled substances list or one that would cede authority over marijuana laws to individual states, could also alter veterans' access to the drug.
But, barring legalization at a federal level, its appears unlikely that the bills introduced on Capitol Hill in recent months will alleviate all of veterans' concerns – or that the VA will change its policies at all.
Even if VA doctors are allowed to recommend or prescribe cannabis, it would still only be an option for veterans living in states with medical marijuana programs, creating uneven treatment plans within a national health system.
Still, given hints that there is growing bipartisan support for national marijuana reform and recent comments by Attorney General Bill Barr indicating he would support a change in federal marijuana law, proponents of recently introduced legislation say they're hopeful the efforts have a shot.
"We think our voices are being heard on the Hill," says Distaso, the head of the Veterans Cannabis Project. "The legislature understands it, they're trying to get this much needed therapy to veterans."
Joshua Littrell, who served in the Air Force for six years and was deployed during Operation Iraqi Freedom, says he has reduced his opioid dependence and gotten sober from alcohol because of medical marijuana. He now leads his own veterans' medical marijuana advocacy group from his home in Georgia.
"We know that this comes from the federal level because [the VA's] hands are covered by the feds. So this is an act of Congress," Littrell says. "It's got to be done. Because every single day veterans die."
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