Veterans
Military veterans who wish to use cannabis for pain relief sadly remain
caught in the crossfire between state and federal law.
...But the cavalry may be on its way.
Though several states have approved the use of marijuana for
medical and/or recreational use, federal law still classifies it as a
Schedule One Controlled Substance, making it illegal nationally.
As a result, healthcare providers may not recommend nor assist
veterans in obtaining it.
The rub is that Veterans Administration (VA) clinicians can
only prescribe medications that have been approved by the
FDA for medical use. At present, most products containing
tetrahydrocannabinol (THC), cannabidiol (CBD), or other
cannabinoids are not approved for this purpose, according to
the agency. Thus, VA clinicians may not complete paperwork
required for veteran patients to participate in state-approved
marijuana programs, the system’s pharmacies may not fill
prescriptions for medical marijuana, and the VA will not pay
for medical marijuana prescriptions from any source. The
use or possession of marijuana remains prohibited at all VA
medical centers, locations and grounds. At present, 37 states
allow medical cannabis, 83% of U.S. veterans support medical
cannabis programs -- and 0% of Veterans Administration
facilities provide medical cannabis.
It’s a big shame. Over the years, veterans have often reported
using cannabis to treat symptoms of chronic pain and mood
disorders, like post-traumatic stress. Clinical and observational
data supports the use of cannabis treatment for these indications.
Early this year, the journal Frontiers in Psychiatry reported on
a retrospective naturalistic study. “We followed 14 relatively
mature (32-68 years of age), treatment-resistant, chronic combat
post-traumatic patients who remained severely symptomatic
despite treatment with many lines of conventional treatment
prior to receiving medicinal cannabis… After treatment with
cannabis, total sleep score, subjective sleep quality, and sleep
duration significantly improved… Total PTSD symptom score
and its subdomains (intrusiveness, avoidance, and alertness)
showed (also) improvement.”
CAVALRY?
Help may finally be on the way.
In mid-February, members of the U.S. Senate’s Veterans’ Affairs
Committee moved forward with legislation directing the VA to
conduct research evaluating the safety and efficacy of cannabis
products for veterans suffering from chronic pain and posttraumatic stress.
The bipartisan legislation directs the VA’s office to conduct a
large-scale observational trial assessing veterans’ use of cannabis,
and to report on its ability to mitigate pain, improve sleep, and
influence subjects’ intake of prescription medicines or alcohol,
according to norml.org. Identical legislation is also pending in
the House of Representatives.
“Recently conducted observational trials in Israel and the United
Kingdom have documented improved symptoms following the
use of cannabis products among patients with post-traumatic
stress,” the group noted. “These outcomes include statistically
significant changes in sleep quality and anxiety, fewer
nightmares, and improved quality of life.”
Beyond that, dozens of observational studies document patients’
reduction in their use of prescriptions drugs, particularly
opioids, and other controlled substances following the initiation
of cannabis therapy. “Numerous placebo-controlled trials also
document the ability of either inhaled or vaporized herbal
cannabis to significantly mitigate pain in various patient
populations, including those suffering from HIV, diabetes,
spinal cord injury, or with severe treatment-resistant neuropathy
(nerve pain), NORML executives pointed out. “These positive
results have been replicated in clinical trials utilizing relatively
low doses of cannabis, as well as in trials using plant-derived
cannabis extracts.”
The pending legislation further directs the Secretary of the
Veterans Affairs to assess the ability of the office to coordinate
prospective, FDA-approved clinical trials evaluating the safety
and efficacy of cannabis flowers and plant-derived extracts in
veterans.
“Were such trials authorized to go forward, investigators would
be providing participants with cannabis products provided
by federally-licensed producers and comparing the outcomes
associated with those products with a control group,” the
organization explained. “Patients suffering from post-traumatic
stress typically acknowledge consuming cannabis at rates far
greater than those reported by the general population.”
INEFFECTIVE, ILL-PREPARED
The need for such legislation is long overdue.
“America’s prolonged military conflicts over the past 17 years have
exposed an aging and ineffective healthcare system, ill-prepared
for the type and severity of the latest round of war-related injuries,”
according to a group called The Veterans Cannabis Project
(VCP). “Upwards of 20% of the 2.7 million Iraq and Afghanistan
veterans will experience post-traumatic stress or depression,
according to the VA. The VA is not equipped to effectively or
comprehensively treat the complexity of every veteran’s mental
and physical wounds, leaving former service members to cope
with limited and inadequate treatment options. Veterans are often
placated with ‘cocktails’ of prescription drugs, including powerful
and addictive opiates. The current arrangement is not meeting
veterans’ healthcare needs.”
Medical cannabis, on the other hand, is “a proven, safe and
common-sense personal health-management option, free of the
devastating side effects of opiate-based drugs,” VCP explained.
“It… is recognized by experts such as the American College of
Physicians, the American Public Health Association and the
American Nurses Association as a safer alternative to many
federally legal treatments. Medicinal cannabis is an incredibly
effective tool for veterans challenged with managing the
symptoms of their wounds.