Veterans Groups Push the VA: More Cannabis Research, Please.

At a congressional hearing, the VA refused to support any of the four bills under consideration calling for more research and access. But the advocates see an alternative to opioids.

Jun 21, 2019 6:55AM EDT Congress

Nikitha Sattiraju

Nikitha Sattiraju is a journalist. She previously reported on agriculture, sustainable development, and mental health in India.

Veterans organizations urged the Department of Veterans Affairs to expand medical cannabis research—and access to cannabis for veterans—at a House Committee on Veterans Affairs hearing on Thursday, as the committee prepares to consider legislation to require both those things.

“VA must expand research on the efficacy of non-traditional alternatives to opioids like medical cannabis,” said Carlos Fuentes, director of the National Legislative Service with Veterans of Foreign Wars. “It’s a better alternative than the cocktail of drugs VA provides.” He added that the department’s overreliance on opioids to treat chronic pain and other conditions has contributed to addiction, and in some cases, even death.

The four bills discussed at the hearing (see below for details) would require VA to conduct nationwide surveys on medical cannabis use by veterans, as well as clinical trials on the efficacy of medical cannabis in treating chronic pain and post-traumatic stress disorder. Parts of the legislation would also require training on medical cannabis use for VA physicians and primary care providers, as well as authorize them to write recommendations that would allow them to procure medical cannabis under state programs.

Both Fuentes and Travis Horr, director of government affairs with the Iraq and Afghanistan Veterans of America, noted that their members say medical cannabis works in treating chronic pain and mental health conditions.

“I’ve seen first-hand the positive impact that medicinal cannabis can have,” said Horr, a veteran who said he served in Iraq and Afghanistan. Ninety percent of Iraq and Afghanistan Veterans of America’s 400,000 members support cannabis research for medical purposes, according to the group’s 2019 member survey, and 83 percent support legalization of medical cannabis.

“It’s time for VA to catch up,” Horr said.

But VA’s primary care providers and physicians should not, however, provide recommendations to veterans to participate in state medical cannabis programs—a provision in the Veterans Equal Access Act, one of the four bills—when the department does not cover the costs under VA healthcare, Fuentes said. “We would not like for VA providers and doctors to prescribe a medicine or any type of drug that VA is unable to provide to veterans,” Fuentes said, citing the high costs of healthcare. “Many of them are struggling to meet VA’s copays. We certainly don’t want to put the full cost of any of the medications that their doctor says they need on them.”

Some members of the committee argued that the nature of any research should be up to the VA. Representatives Phil Roe and Andy Barr, committee members and Republicans from Tennessee and Kentucky, respectively, said that Congress shouldn’t dictate how the VA should conduct research on medical cannabis, as proposed by another of the four bills—the VA Medicinal Cannabis Research Act bill. They suggested an alternative that, while requiring VA to conduct the research, leaves it up to the department and its research partners to design it.

Representative Neal Dunn, a Republican from Florida, said Congress should look into rescheduling cannabis from a Schedule I to Schedule II drug, to facilitate “serious scientific research” into the substance.

The VA, however, refused to support any of the four bills. While the VA does not have a problem with its primary care providers and doctors discussing medical cannabis use with patients, these medical professionals cannot recommend participation in state medical cannabis programs, as it is still federally illegal, said Larry Mole, chief consultant with Population Health Services and Patient Care Services at Veterans Health Administration, the healthcare branch of Veterans Affairs. Nor can medical cannabis costs be covered through VA healthcare, he added, for the same reason.

Veterans who use medical cannabis under state programs will not be denied VA services, Mole said. Still, both Horr and Fuentes said that their members continue to fear that denial, with some even sharing with the organizations that the VA “retaliated” against them for using medical cannabis.

As for training primary care providers and doctors in medical cannabis use, Mole argued that such provisions are unnecessary. “We already make available to all providers information sessions on cannabis, including the latest on marijuana use and side-effects, treatment implications for veterans with PTSD, and on caring for patients who use marijuana at the end of life,” Mole said.

And on the research front—Mole said that there is only one VA funded study at the University of California, San Diego into the effectiveness of CBD in treating PTSD. There are also some VA researchers who are getting funding from other sources to investigate medical cannabis use, Mole added. But the scale of research required by the VA Medicinal Cannabis Research Act bill is too wide and “premature,” said Mole. The focus should be on smaller, early-phase clinical trials such as the one mentioned above.

The VA also believes that conducting a nationwide survey of veterans on medical cannabis use is not feasible because veterans and providers would not want to participate, even if the survey is anonymous, Mole added.

The committee was initially supposed to vote on two medical cannabis bills in May but postponed it in favor of holding Thursday’s hearing.

The bills:

VA Survey of Cannabis Use Act—Requires surveys of both veterans and VA primary care providers to find out how many veterans use medical cannabis nationwide, the conditions for which they use it, and its effectiveness in treating them. .
A Bill to Train VA Primary Care Providers in Medical Cannabis Use—Would require all primary care providers with the Department of Veteran Affairs to be trained in the use of medical cannabis.
VA Medicinal Cannabis Research Act—Requires the Secretary of Veterans Affairs to initiate clinical trials on the effectiveness of medical cannabis for veterans experiencing chronic pain and PTSD
Veterans Equal Access Act—Physicians and primary care providers working with the Department of Veterans Affairs would be authorized to provide recommendations to purchase medical cannabis under state programs to veterans.