Should vets be allowed to use medical pot for PTSD? The Trump administration says no
By DAVID S. CLOUD | The Los Angeles Times (Tribune News Service) | Published: February 10, 2018
Frustrated with traditional therapies for chronic pain and post-combat stress disorders, a growing number of military veterans of the Iraq and Afghanistan wars are turning to medical marijuana for their treatment, a move that has put them at sharp odds with the Trump administration.
The White House has resisted calls from Democrats in Congress, pro-reform activists and even the American Legion, the nation's largest wartime veterans service organization, to support research into whether marijuana can help veterans, apparently fearing that any move by the Department of Veterans Affairs to study its effectiveness will be another step toward nationwide legalization.
The VA thus become the latest flash point in the national debate over marijuana legalization, pitting proponents of greater study or medical use against an administration that has tried to halt or roll back a steady movement toward greater tolerance of marijuana.
"We all understand that if the VA is able to prescribe medical cannabis and they determine this is the right way to go, then all of a sudden it is available in all 50 states and territories and the calculus changes dramatically," said Rep, Tim Walz, D-Minn., a 24-year Army veteran who is the top Democrat on the House Veterans Affairs Committee.
In December, VA Secretary David J. Shulkin refused a request by Democrats on the House committee to launch a study of marijuana's effects on chronic pain and post-combat stress, asserting that federal law "restricts VA's ability to conduct research involving medical marijuana or to refer veterans to such projects."
In a letter to the Democrats, Shulkin claimed a review of previous research found links between marijuana use and suicide, mania and psychotic symptoms.
"The VA is saying, 'We don't even want to investigate whether medical marijuana is valid," said Rep. Mark Takano, another member of the House committee. "But veterans continue to suffer in large numbers and we should be exploring all the possible alternatives out there."
Post-traumatic stress disorder, a sometimes severe psychological condition that stems from exposure to combat and other disturbing events, afflicts an estimated 9% of VA patients and at least 20% of Iraq and Afghanistan veterans, according to the VA.
VA doctors treat PTSD, as the disorder is known, with therapy and prescription drugs, as well as yoga, acupuncture, and other nontraditional therapies.
But some soldiers say those treatments are inadequate or produce undesirable side effects. Some former service members move on to abuse alcohol or illegal drugs, and even attempt suicide.
Twenty-six states, including California, offer access to medical marijuana for patients who obtain a physician's recommendation. Neither the VA nor the Defense Department, however, uses marijuana therapy or allows their healthcare providers to recommend it for medical purposes.
Under federal law, marijuana is still classified in the same category as heroin, and repeated efforts since the 1970s to reclassify it have failed.
The American Legion, with about 2 million members, traditionally has been a conservative voice on social and political issues. But it stepped up its push for the VA to undertake research into the medical benefits of marijuana after commissioning a poll last year that found 92 percent of veteran families favor more study.
At the group's national convention last August, it adopted a resolution calling on the VA to allow its physicians and other health providers to discuss the use of medical marijuana with veterans, and to recommend it in states where it is legal — steps that are prohibited at the VA.
Dan Schmink, a 31-year-old former Army infantryman, said he was diagnosed with post-traumatic stress disorder and a herniated disc in his back after a combat tour in Iraq in 2006 and 2007, one of the most violent periods of the war.
After leaving the Army and returning home to Arizona in 2009, Schmink received opioid painkillers from the VA for his back pain. He resisted taking prescription medication for his depression, insomnia and bouts of hyper-alertness, which are frequent symptoms of traumatic stress.
Attending nursing school, he found himself unable to cope with routine daily situations. "I'd sit in the back in class and keep my eyes down to avoid talking with anybody," he said in a telephone interview. "I drank a lot. Sometimes that was the only way to turn it off."
After a friend offered him marijuana — which he says he had never tried before — his back pain eased and he felt less anxious. In 2012, Schmink got a prescription for medical marijuana and began smoking it regularly.
"I didn't have the hyper-awareness. I wasn't having hundreds of thoughts at once," he said. "You got to a really good meditative state."
When he told his VA psychologist he was using marijuana, the reaction was "completely negative," Schmink said. A notation was put in his medical record and he was placed on a watch for possible substance abuse.
Another VA doctor was more receptive, allowing Schmink to ask questions about cannabis use. But when he sought another prescription for medical marijuana, the doctor refused, saying it was against the law.
Now living in San Diego, Schmink says he smokes marijuana every morning, and has figured out the right dose to avoid lethargy and anxiety. "It's allowed me to become more of the person I was before I went into the service and started playing war," he said.
Demonstrating the benefits of marijuana with scientific data has proven more difficult, in part because of the VA's reluctance to participate, researchers say.
The challenge has been clear in Phoenix, where researchers have been unable to complete a $2.1-million clinical trial that was approved by the Food and Drug Administration in 2011. It is the first study to try to determine whether marijuana can effectively treat PTSD.
For the findings to be statistically valid, the researchers needed to enroll 76 combat veterans who had suffered post-traumatic stress symptoms, were resistant to other treatment protocols and were not abusing marijuana. But only 38 — half the total — have agreed to participate so far.
Marcel Bonn-Miller, a researcher at the University of Pennsylvania who is overseeing the study, said the research has been slowed, in part, because the Phoenix VA hospital refused to allow its doctors and therapists to mention the study to patients or let researchers put up fliers seeking participants, citing federal restrictions on marijuana research.
That forced researchers to comb through social media and make telephone cold calls to search for potential participants. The study required the patients to visit a private Phoenix clinic 10 times over 18 weeks, followed by six months of follow-up visits.
Asked about the study, Curt Cashour, a spokesman for the VA in Washington, said that federal law restricts the agency's "ability to conduct research involving medical marijuana, or to refer veterans to such research projects." But researchers, he added, are "free to work with veterans service organizations and state veterans officials who may not face such restrictions."
Bonn-Miller said the VA is confused about federal restrictions on marijuana research. But the Phoenix study is politically explosive because it could establish for the first time whether marijuana has beneficial effects for veterans, he said.
"If [the VA] were to cooperate it would make things easier," said Bonn-Miller. "The VA can't recommend, give or prescribe cannabis for veterans, regardless of whether it's legal in the state or not, but research is a separate thing."
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