The VA’s Contradictory Stance on Medical Marijuana

Cannabis seems to be growing in popularity across the country, with more and more territories breaking from the federal norm and allowing both recreational and medical cannabis usage within their regions. Despite an increasingly positive reception by the public at large, cannabis is still listed as a Schedule I substance as classified by the DEA, joined by heroin, LSD, ecstasy, methaqualone, and peyote because there is “no currently accepted medical use and a high potential for abuse”.

The National Institute on Drug Use (NIDA) states that “researchers haven’t conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it’s meant to treat.” However, what little research actually has been done lead to the development of Cesamet and Marinol, which are essentially legally prescribed cannabinoid pills. They are being prescribed to help manage the type of chronic nausea and vomiting brought on by chemotherapy, as well as to stimulate appetite. Unfortunately, the efficacy of these compounds is up for debate, with different individuals reporting varying levels of relief. Some report no relief at all.

I felt no relief, I didn’t feel ill, I felt nothing,” Jeff Elton, a 56-year-old man from Des Moines told CBS correspondent Brian Monopoli. “It might as well be M&M’s.”

Elton claims that switching to actual marijuana, which he inhales via vaporizer, has helped him manage the symptoms of gastroparesis, which includes chronic nausea and vomiting. In fact, he told Monopoli that using cannabis proper has allowed him to keep his food down and regain some of the weight he lost on Marinol.

 

No research for veterans

The good news for people like Elton is that, if Marinol or Cesamet doesn’t prove effective at managing symptoms, more and more states are legalizing marijuana for both recreational and medical use. While this makes it easier for the average citizen to secure cannabis near states where legalization is occurring, some of the people who need treatment the most are stuck in limbo; military veterans are still unable to be referred to state medical marijuana programs by VA physicians due to federal prohibition.

Katie Zezima, writing for The Washington Post, reports that the Department of Veterans Affairs recently released a statement proclaiming that they will not conduct research into whether cannabis can help vets suffering for PTSD and chronic pain. He quotes the Department of Veterans Affairs Secretary David Shulkin’s response to 10 Democrats on the House Veterans’ Affairs Committee:

VA is committed to researching and developing effective ways to help Veterans cope with post-traumatic stress disorder and chronic pain conditions,” Shulkin wrote in a response to the members of Congress. “However, federal law restricts VA’s ability to conduct research involving medical marijuana, or to refer veterans to such projects.”

Zezima then quotes John Hudak, deputy director of the Center for Effective Public Management at the Brookings Institution, who argues that Shulkin’s response is inadequate:

Obviously, it is federally illegal, but there are no restrictions on doing scientific research on it. Universities do this all the time and there’s a process to go through,” he says to Zezima, noting that the National Institute on Drug Abuse funds cannabis research. “It’s really a cop-out for the VA to say, ‘oh, we’re not doing work on this because of federal law’ when actually federal law allows them to do that.”

 

The VA sending mixed signals…

Shulkin’s response letter controversially follows on the heels of a VA policy rolled out at the end of December. Tom Angell, a contributor to Forbes.com, writes that while doctors with the VA still can’t recommend medical marijuana, they are being encouraged to talk more about it with military veterans. This new directive urges VA doctors to “discuss with the Veteran marijuana use, due to its clinical relevance to patient care, and discuss marijuana use with any Veterans requesting information about marijuana,” writes Angell.

The problem is, however, that the VA’s own internal policy toward medical marijuana still prohibits government assistance toward medical marijuana treatment, as evidenced by Shulkin’s quote above. Instead, the VA continues to fund opioid-based pain treatments amidst the worst drug and heroin epidemic in our country’s history. The oxymoronic nature of this type of treatment leaves vets open to the harms of opioid addiction, something that the experts at The Recovery Village claim cannabis could be used to curb:

What some studies are finding is that the use of prescribed marijuana for some medical conditions, especially for pain issues, can help prevent an opioid addiction from developing in the first place,” they write. “Many addicts begin their addiction with a prescription for painkillers, and medical marijuana might be a suitable and safer substitute.

This statement is representative of how the negative public perception of medical cannabis is fading. Experts at the University of Reno Nevada write, for example, that despite increased reports of the hazards of driving under the influence of marijuana, the dangers of cannabis consumption and driving may be putting the cart before the horse.

Crucially for public health officials looking to make sense of the data, the perception of danger is at odds with the number of accidents that can be attributed to the drug,” they write. “According to the American Public Health Association, the NHTSA stated they were unable to find a causality between legal marijuana and fatal traffic accidents—a finding echoed in the aforementioned Washington Drug Policy Alliance report, which showed that traffic accident fatalities remain flat in states with recreational marijuana.”

It’s an unfortunate reality that those looking to demonize marijuana need do no more than point to outdated studies, or like the VA, hide behind unfounded statements and the hazy federal legal status of cannabis.

Veterans like Michael Krawitz are happy about the small steps being made by the VA and federal government, in reference to the recently revised VA policy, but still, think that these small steps aren’t enough. Krawitz is a disabled Air Force veteran who takes oxycodone as well as marijuana to treat injuries he received in Guam in 1984.

Vets are happy that there’s a policy, but they’re unnerved by that prohibition,” he said in an article with Michelle Andrews. Andrews explains that Krawitz, 55, is the executive director of Veterans for Medical Cannabis Access, an advocacy group.

He has always been open with his VA doctors about his medical marijuana use and hasn’t suffered any negative consequences,” she writes. “But Krawitz said he has worked with veterans who have been kicked out of their VA pain management program after a positive drug test and told they couldn’t continue until they stopped using cannabis.”

Andrews adds that while most of these instances are usually misunderstandings that can be corrected, they generally occur due to unclear guidance from the Veterans Health Administration to its staff. It goes without saying, however, that veterans shouldn’t be penalized by the same agency that’s supposed to help them due to a simple mistake on the agency’s part.

 

Time will tell…

It’s worth noting that cannabis as a solution is not yet perfect. Medical News Today ran a headline last year titled “Marijuana ‘may be worse than cigarettes for cardiovascular health’” written by Honor Whiteman.

The lead researcher and author, Barbara A. Yankey of the School of Public Health at Georgia State University in Atlanta, found that “compared with subjects who had never used marijuana, the results revealed that marijuana users were 3.42 times more likely to die from high blood pressure. For each year of marijuana use, the risk of death from hypertension increased by 1.04 times.”

The good news is that the rise of new types of marijuana-infused products like tinctures and edibles may circumvent the need to inhale or burn cannabis in the first place. These products are also helping to further a more positive view of cannabis and cannabis-based products and could be instrumental in legitimizing both THC and CBD as a medicine.

Only time will tell whether or not veterans will receive much-needed support from the government and Department of Veterans Affairs beyond flimsy policies that Secretary Shulkin has responded to. Veterans, themselves, are turning to advocacy groups like Krawitz’s Veterans for Medical Cannabis Access and are demanding that the country they’ve served and the government that they answer to does more than give them half-answers and bunk solutions. Despite these obstacles, the future looks bright for proponents of medical marijuana—as the public continues to offer their support, the government will eventually have no choice but to follow suit.

Tags: mental health, substance abuse & addiction

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