Veterans and Marijuana: the Highs and Lows of the VA’s Healthcare

Chris Hondros/Getty Images

Marijuana usage has grown in popularity over the last decade, as individual states have voted to legalize both its medical and recreational use. However, on a national level, the drug remains classified as a Schedule One Controlled Substance, making it illegal in the eyes of the federal government. This means that the use of medical marijuana remains largely inaccessible to our veteran population, as the majority of them depend on the US Department of Veterans Affairs for their prescriptions. How does this impact the quality of our veterans’ healthcare? What is the right course of action regarding marijuana treatment for veterans’ trauma-related disabilities, such as PTSD? While there is much debate over the use of marijuana in treating psychological illnesses, evidence suggests that the drug could provide an effective and safer alternative to the prescriptions that veterans currently have access to today. 

Marijuana in the United States

On a federal level, marijuana is completely illegal. Its Schedule One classification means that, officially, the drug has “no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision” (US Department of Veterans Affairs 2023). However, on the state level, voters have pushed for the drug’s legalization. As of 2023, 38 states and Washington, D.C. have legalized marijuana for use in either medical programs, recreational markets, or both (Matthews and Hickey 2023). As a result, marijuana has become much more common — its daily use has increased by 60% in the past decade (US Department of Veterans Affairs 2023). This trend extends to the American veteran population. An early 2014 survey reported that 9% of all veterans used cannabis within the last 12-month period. In contrast, by 2020, 11.9% of all veterans, and over 20% of veterans aged 18-44, reported using marijuana within the last 6 months. However, despite marijuana’s growing popularity amongst veterans, they remain one of the most under-researched populations when it comes to cannabis use (Cannabis Control Commission 2023).

The VA’s Policy on Marijuana

The US Department of Veterans Affairs, known as the “VA,” is the top healthcare provider for US veterans (Cannabis Control Commission 2023). Their opposition towards marijuana use is not entirely inflexible; they allow veterans to participate in state marijuana programs, and will discuss whether veterans engage with marijuana as part of their “comprehensive care planning” (US Department of Veterans Affairs 2023). However, VA policy dictates that while marijuana has a Schedule One classification, “VA health care providers may not recommend it or assist veterans to obtain it” (US Department of Veterans Affairs 2023). This means that the VA will not prescribe, distribute, insure, or subsidize the use of medical marijuana. They also may not assist veterans in their participation in state-approved marijuana programs. 

Marijuana Treatment’s Potential Pitfalls 

Beyond marijuana’s legal classification, the VA provides additional justifications for its policies. Essentially, they claim that there is not enough scientific evidence to prove the drug is an effective treatment option, and that the substance is dangerous because veterans are at a high risk for cannabis use disorder (CUD). Regarding the research, the VA highlights that there has only been one randomized controlled trial (RCT) that compares cannabis with a placebo for treating PTSD. The research they cite is published in Cannabis and Cannabinoid Research, a peer-reviewed scientific journal. Generally, RCTs are considered imperative to determine a drug’s efficacy, and the RCT phase of this study showed no significant difference between the treatments. The VA claims this research concludes that marijuana does not provide effective PTSD treatment (US Department of Veterans Affairs 2023). Meanwhile, CUD is considered a heightened threat to veterans, especially since individuals with PTSD have particular difficulty quitting drug use. According to the VA, a 2020 survey showed that 12.1% of veterans with PTSD will be diagnosed with CUD within their lifetime, compared to 9.2% of the total veteran population (US Department of Veterans Affairs 2023). Both of these figures are significantly higher than the general population’s CUD rate — which is estimated to be at around 3% (Center for Disease Control 2023). 

Should Marijuana Access be Expanded?

Alternative Research Interpretations

Despite the VA’s hesitancy to accept medical marijuana, others do support the drug as a treatment option. Scientists have found that individuals with PTSD have a greater availability of cannabinoid type 1 receptors in their brains than the average person (US Department of Veterans Affairs 2023). This means that PTSD patients are biologically predisposed to be more receptive to marijuana’s effects. As a result of studies that record positive feedback from veterans who use medical marijuana, the VA itself acknowledges that it is possible marijuana could “produce short-term reductions of PTSD symptoms” (US Department of Veterans Affairs 2023). Referring back to the VA’s own argument against medical marijuana, one could interpret the RCT study that they cite from Cannabis and Cannabinoid Research in a different light. While the RCT results were not statistically significant, the researchers studying the effect of marijuana on PTSD conducted several other rounds of testing in their studies. In another phase of tests, veterans were randomized and received 1 of 3 different combinations of active THC and CBD. These test results showed “a significant reduction in PTSD symptoms in the THC+CBD group” (US Department of Veterans Affairs 2023). In fact, the researchers who published this study officially concluded that their work indicated that marijuana “might hold promise as an alternative treatment for PTSD” (Bonn-Miller et al. 2022). While the VA may use their RCT data to discredit medical marijuana, the scientists themselves believe that the drug has demonstrated promise — it simply needs more testing to be considered officially effective. 

Steven Mandile’s Testimony

Many veterans have provided moving testimony in favor of legalizing and increasing access to medical marijuana. Steven Mandile, a major advocate for medical marijuana, wrote a letter to the Massachusetts Cannabis Control Commission this June describing his experience with marijuana and the VA’s healthcare. After serving in the Iraq War, Mandile was diagnosed with PTSD. To treat his range of symptoms, Mandile was prescribed over 50 different medications in ten years by VA clinicians. Almost all of these drugs were opioids. Mandile described how they were highly addictive and numbing, and made him quick to anger, violent, and suicidal. Once the VA prescribed these pills, Mandile detailed how the VA clinicians would not let him leave the clinic without taking the drugs with him — even if he expressed that he did not want them. Mandile claims that making the switch to marijuana saved his life. The side effects are less severe, and he does not experience the level of numbing or anger that the opioids caused. For the first time in over a decade, Mandile has been a present father, held a job, and worked on his depression. Mandile is also now less “at-risk” for suicide — not only because he is more emotionally stable, but because he can no longer overdose on his medication. However, since marijuana is not covered by his VA health insurance, the drug imposes a large financial burden on his family. Mandile’s story highlights how, while the VA exercises an abundance of caution around marijuana (a substance that is not physically addictive, and can not cause a fatal overdose), it easily overprescribes opioids. Currently, opioids are the leading cause of drug overdose deaths in America (Center for Disease Control 2023). They are also considered one of the most addictive drugs; physical dependence to opioids may develop in as little as 3-5 days, and it is estimated that one in four people receiving prescription opioids long-term will struggle with opioid addiction (Azadfard et al. 2023). Generally, veterans are considered an at-risk demographic for drug addictions, and they record higher opioid addiction rates than the general population (Cannabis Control Commission, 2023). In 2019 alone, approximately 555,000 veterans reported misusing pain medications (Miller 2023). Given the high risk of overdose, physical dependency, and harmful side effects, one could claim that opioids are far more dangerous than medical marijuana. As such, how does it make sense for the VA to continue to promote opioids and block access to marijuana?

Conclusion

As with any drug, marijuana poses both opportunities and risks. Right now, the VA continues to exercise an abundance of caution around the substance — a decision driven by arguably outdated federal drug policies. However, the testimonies of veterans underscore and humanize the scientific conclusion that researchers are increasingly pointing to: marijuana could be the next frontier for veterans’ treatments. As a nation, we should be aiming to make our healthcare safer and more accessible. As the American perspective on marijuana continues to evolve, it will become crucial to bridge the gap between state and federal regulations, and prioritize veterans’ well-being when it comes to drug policies.

References

Azadfard, M., Huecker, M.R., and Leaming, J.M.. 2023. “Opioid Addiction.” July 21, 2023. In StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448203/.

Bonn-Miller, M. O., Brunstetter, M., Simonian, A., Loflin, M. J., Vandrey, R., Babson, K. A., & Wortzel, H. 2022. “The long-term, prospective, therapeutic impact of cannabis on post-traumatic stress disorder.” Cannabis and Cannabinoid Research. April 19, 2022. https://doi.org/10.1089/can.2020.0056. 

Cannabis Control Commission. 2023. “Cannabis Control Commission Public Meeting.” Recorded June 8, 2023. https://masscannabiscontrol.com/events/cannabis-control-commission-public-meeting-june-8-2023/.   

Center for Disease Control and Prevention. 2020. “Addiction (Marijuana or Cannabis Use Disorder).” October 19, 2020. https://www.cdc.gov/marijuana/health-effects/addiction.html.  

Center for Disease Control and Prevention. 2023. “Drug Overdose Deaths.” August 22, 2023. https://www.cdc.gov/drugoverdose/deaths/index.html. 

Hartman, Michael. 2023. “Cannabis Overview.” National Conference of State Legislatures. November 9, 2023. https://www.ncsl.org/civil-and-criminal-justice/cannabis-overview.  

Matthews, A.L., and Hickey, Christopher. 2023. “More US states are regulating marijuana. See where it’s legal across the country.” CNN. November 7, 2023. https://edition.cnn.com/us/us-states-where-marijuana-is-legal-dg/index.html. 

Miller, Jessica. 2023. “U.S. Military Veterans and Addiction.” AddictionHelp.com. June 14, 2023. https://www.addictionhelp.com/addiction/veterans/.  

U.S. Department of Labor. 2023. “Risk Factors for Opioid Misuse, Addiction, and Overdose.” Last accessed November 21, 2023. https://www.dol.gov/agencies/owcp/opioids/riskfactors.  

US Department of Veterans Affairs. 2023. “PTSD: National Center for PTSD.” July 12, 2023. https://www.ptsd.va.gov/professional/treat/cooccurring/marijuana_ptsd_vets.asp.  
US Department of Veterans Affairs. 2023. “Public Health.” August 1, 2023. https://www.publichealth.va.gov/marijuana.asp.