op-ed

Giving Vets the Freedom to Use MMJ for Pain and PTSD

Photo by Jessica Radanavong on Unsplash
Cindy Kleh
Cindy Kleh 7 Nov 2019

Veterans’ Access To Medical Cannabis May Reduce Dependency On Opiates

NOTE: This Monday, November 11, is Veteran’s Day, and for the second consecutive year, Heady Vermont, in collaboration with the Vermont Cannabis Nurses Association, will be honoring Veterans who have experienced challenges accessing medical cannabis by giving them free cannabis and cannabis products on Sunday November 10 from noon to 4:00 p.m. at their Burlington offices at 250 Battery Street. The cannabis is donated by local growers and makers who care about Veterans suffering from service-related injuries – both visible and invisible. 

Significant numbers of military personnel return from combat suffering from traumatic brain injuries, chronic pain, depression, anxiety, and Post Traumatic Stress Disorder (PTSD). A combination of opioids, muscle relaxants, anti-anxiety meds, and other drugs prescribed to ease multiple symptoms can leave some Vets feeling over-medicated or suffering from side effects such as sleep loss, sexual dysfunction, constipation and weight gain. 

Veterans are twice as likely to die of an opiate overdose than their civilian counterparts, and current suicide rates run at over 20 Vets per day.

Additionally, concurrent mental health issues put Vets at an increased risk for suicide, and opioid use only increases that risk. While in the past 10 years, opioid deaths have increased at a rate of almost 20% a year among the general population, according to a Veterans Affairs study of over 50 million Veteran records in every state from 1979 to 2014, Veterans are twice as likely to die of an opiate overdose than their civilian counterparts, and current suicide rates run at over 20 Vets per day – though it’s often difficult to distinguish between suicide and accidental overdose. 

Invisible Injuries

In some ways, mental health wounds can be more life-threatening to a veteran than the more apparent physical injuries. 

For most civilians, seeking mental health care is hard enough. The process can be embarrassing because of the pervading stigma this type of illness has, and it can be difficult to get started when one is depressed, confused, sleep-deprived and feeling overwhelmed. Veterans, many of whom feel they’ve been trained to be “mentally tough,” are even less likely to seek mental health treatment. 

A study by the Substance Abuse and Mental Health Services Administration revealed that only 50 percent of returning Vets who need veteran mental health treatment actually receive these services.

Many Vets are also hesitant to admit they need help for fear of being seen as weak, or they may also feel guilty knowing that some of their peers have been, physically, more critically injured or have died in combat. Often, Vets haven’t been trained to know that mental health support is an honorable, intelligent, and healthy thing to do, and that it can help prevent broken marriages, domestic violence, social dysfunction, substance abuse, problems holding down a job, legal entanglements, homelessness, and death. 

Unfortunately, for those Vets who do seek help, there are no guarantees that they’ll get it. A study by the Substance Abuse and Mental Health Services Administration revealed that only 50 percent of returning Vets who need veteran mental health treatment actually receive these services.

Because of the chronic pain suffered by many vets, and the subsequent high incidence of opioid-related addiction and death, the VA initiated a multi-faceted approach called the Opioid Safety Initiative (OSI) in 2012 designed “to provide healthcare providers with a framework by which to evaluate, treat, and manage the individual needs and preferences of patients with chronic pain, who are currently on or are being considered for long-term opioid therapy.” 

The VA reports numerical rates of success, such as a 52 percent reduction in patients needing opioids and an 80 percent reduction in patients receiving opioids and benzodiazepines together.

The VA reports numerical rates of success, such as a 52 percent reduction in patients needing opioids and an 80 percent reduction in patients receiving opioids and benzodiazepines together. The results could be viewed as very promising – or troubling, considering the number of Vets who may have been forced to taper down or stop taking opiate meds while still in pain. 

In essence, this program forced the tapering down or end of many vets’ opioid prescriptions, and while their Patient Guide To Opioid Therapy does offer a variety of pain management alternatives ranging from therapy to acupuncture to pain school, cannabis is not on the list.

The Challenge Of Medical Cannabis

A poll of veterans and their caregivers conducted by an independent group found that 1 in 5 veterans already use cannabis for a medical condition.

Medical cannabis has the potential to alleviate much of the pain and suffering experienced by physically and emotionally wounded Vets, and save lives. A National Institute On Drug Abuse study published in 2014 found that “from 1999 to 2010, states with medical cannabis laws experienced slower rates of increase in opioid analgesic overdose death rates compared to states without such laws.”

A poll of veterans and their caregivers conducted by an independent group found that 1 in 5 veterans already use cannabis for a medical condition, and that 92% of veterans support medical cannabis research and 81% support legalizing medical cannabis.

However, thanks to President Richard Nixon’s War On Drugs, the 1970 Controlled Substances Act classified cannabis as a Schedule I drug, with no medical benefit and a high probability of abuse and addiction. In a classic Catch-22 situation, a drug’s medical value needs to be determined by large-scale clinical trials. But, getting funding for clinical trials on a Schedule I substance – much less getting broad access to a Schedule I substance – is almost impossible.

Despite the fact that 33 states have legalized medical cannabis, Veterans get their health care from the Veterans Administration – which is under federal jurisdiction, where cannabis remains illegal.

Nevertheless, the complex process of rescheduling drugs can be undertaken by the DEA, or initiated by the Attorney General. But the agency has ignored repeated petitions for over 40 years, and neither political party has been able to meaningfully address the situation.

Additionally, despite the fact that 33 states have legalized medical cannabis, Veterans get their health care from the Veterans Administration – which is under federal jurisdiction, where cannabis remains illegal. This restricts the VA’s ability to conduct research into the value of medical cannabis, and hinders the ability of VA doctors to prescribe it in states where medical cannabis is legal.

A Roundabout With No Exit

While the VA website encourages veterans to discuss their cannabis use with their VA doctor with assurances they will not lose VA benefits because of it, some are finding that claim to be misleading.

Some Veterans fear that if their urine or blood tests come back “hot,” their opioid prescriptions could be tapered down or discontinued.  

Many rely solely on the VA for medical care, and a medical cannabis license from a legal state is not only risky to obtain, it requires out-of-pocket expenses such as the acquisition of a non-VA doctor to evaluate symptoms and annually prescribe it, annual fees for the license, and cash to buy it from a dispensary.

Even for those who can shoulder that cost, cannabis use can throw their VA-prescribed medications into jeopardy. Veterans prescribed opioid painkillers are given semi-routine drug screenings from the VA to check for potentially harmful drug interactions. Some Veterans fear that if their urine or blood tests come back “hot,” their opioid prescriptions could be tapered down or discontinued.  

Unsuccessful Attempts at Rewriting MMJ Laws 

Currently, legislation is being referred to committees in their respective chambers to amend the Controlled Substances Act so that cannabis is no longer classified as a Schedule I drug.

Three bipartisan VA medical cannabis bills were defeated in Congress this past summer that could have made both research and access easier, as well as provided training for VA doctors to acquire more consultative and pharmaceutical knowledgeable about medical cannabis – though even if VA doctors were allowed to recommend or prescribe cannabis, it would still only be an option for Veterans living in states with medical cannabis programs, creating uneven treatment programs within the country’s second largest health system.

Currently, legislation is being referred to committees in their respective chambers to amend the Controlled Substances Act so that cannabis is no longer classified as a Schedule I drug. HR 715, the Compassionate Access Law, could reschedule cannabis down to Schedule II, respecting states’ laws regarding medical and recreational cannabis. HR 2020 would place cannabis in Schedule III, making it even easier for Veterans to access it for medical purposes. 

These reclassifications would not fully legalize cannabis. THC cannabis would still be a controlled substance, but the new classification would allow the floodgates to open on cannabis research, which would help it become more accepted as a prescribed drug.

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