VA Still Punishes Veterans for Using Medical Cannabis

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 disorder (PTSD) related to his military service in the 1970s. 

He didn’t anticipate that his use of state-legal cannabis could result in the U.S. 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 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 which the VA designates as a “nonservice-connected disability.” The agency has been sending him a codeine-acetaminophen mix to control the pain.

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

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

But after his last test in early Sept., he received a call 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 painkillers 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 1976. Working as an air traffic controller at the Souda Bay base on the Greek island of Crete, he was responsible for aircrafts carrying nuclear weapons. During the 1973 Arab-Israeli war, the base served as a “forward operating airfield” for U.S. operations in support of Israel. 

“I was extremely worried about a nuclear exchange between the U.S. and Russia, which were backing opposite sides in the war,” Penley recalls. “The whole area was swimming with Russian submarines, and Nixon put the U.S. 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

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.

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 said. “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, but 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 Dec. 2017, the VA issued Directive 1315, which states: “Veterans will not be denied VA benefits because of marijuana use.”

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.”

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 despite 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 painkiller 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 Legislative Solution?

In recent years, The Veterans Equal Access Act has repeatedly introduced legislation 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 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 issue.

On Veterans Day 2018, he was among a group of vets 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. 

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 health care 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 benefits, or criminal sanctions.”

As for the response to his own cut-off of painkillers, Penley affirms: “They say it’s federal policy and they don’t have a choice in the matter, but the feds shouldn’t be punishing people for using medical marijuana.” 

“I should be able to get medical marijuana from the VA,” he said. “I think the vet suicide rate would go down if they supplied it.”

The post VA Still Punishes Veterans for Using Medical Cannabis appeared first on Cannabis Now.

Despite Adult-Use Legalization, Veterans Are Awaiting Medical Cannabis

The percentage of military veterans facing challenges from PTSD is staggering — and research shows that medical marijuana can provide relief to people struggling with the illness. However, the Department of Veterans Affairs remains intransigent on allowing veterans access to cannabis within its medical system, and legislators haven’t taken action to override those stubborn officials.

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 the use of cannabis to treat PTSD way back in 2015. Meanwhile, in the United States, there has been little progress on efforts in Congress to remedy the situation.

Legislative Efforts for Veteran Access to Cannabis Stalled

Over the past few years, a few federal lawmakers have proposed a slate of bills that would allow veterans to access cannabis, but they’ve all struggled to see any movement toward becoming law.

A prominent bill to at least allow VA doctors to recommend cannabis, the Veterans Equal Access Act, was reintroduced last March after failing to pass in 2018. The bill was sponsored, once again, by Congressional Cannabis Caucus founder Rep. Earl Blumenauer, a Democrat from Oregon.

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.

The other bills concerning cannabis and veterans currently before Congress include the VA Medicinal Cannabis Research Act, introduced by Rep. Lou Correa — which directs the VA to carry out a clinical trial of the impacts of cannabis on chronic pain and PTSD, and the Veterans Cannabis Use for Safe Healing Act, sponsored by Rep. Greg Steube, which prohibits the VA from denying benefits because a veteran participates in a state-approved medical marijuana program.

In April of last year, 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, according to Stars and Stripes. “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 the 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.

Introduced in 2018 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, 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 year, many veterans were shocked when former VA secretary David Shulkin came out flatly in favor of medical cannabis.

In an interview with military affairs website Task & Purpose ahead of the release of his book, “It Shouldn’t Be This Hard To Serve Your Country,” Shulkin was asked if he thought the VA should be researching medical marijuana, or if he could foresee the agency actually recommending cannabis.

“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.”

PTSD: A Growing Health Crisis

The depth of the crisis facing the nation’s vets could hardly be more apparent. Military.com reported last 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.

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 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.”


Vets’ Experience Overlooked

Cincinnati’s WCPO  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 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.

The post Despite Adult-Use Legalization, Veterans Are Awaiting Medical Cannabis appeared first on Cannabis Now.