Key issues within the United States veteran community regarding medical cannabis laws:

● To date, 38 states and 4 territories of the United States have legalized the use of medical cannabis.

Citizens across our country have acknowledged the therapeutic potential of cannabis, as witnessed by their voter initiatives, and state legislation addressing the disparity between law and reality. Even still, not all state medical programs are created equal. In one state, a veteran may have access to a wide array of cannabis products, whereas in others the options are significantly limited in product and methods of administration. What’s more, due to “local control” ordinances in “legal” counties, veterans can still be denied access to their medication despite their compliance with state laws.

● The Patient/Doctor Relationship.

Veterans Health Administration (VHA) Directive 1315, as of December 8, 2017, is in effect and addresses State-approved marijuana programs. Tens of thousands of veterans have voluntarily self-identified as cannabis users after recommendations are received outside of the VHA, and the requirements of their State or Territory of residence are met. The directive outlines the responsibility of the VHA Medical Facility Director to ensure cannabis use reported to clinical staff is charted in a separate section of the veteran’s electronic health record. Further in the directive, it is noted that if the provider discusses medical cannabis, “relevant information” must be documented in the progress notes.

Since the inception of state-run Cannabis programs there has been a disconnect between VHA healthcare providers and their patients. Veterans require the unobstructed ability to engage in open and honest dialogue with their VHA Primary Care Teams about their use of cannabis; where they can then develop proper treatment plans, documenting their experiences, and utilizing the healthcare system designed for them. Veterans are requesting the VHA provide to the public the results of evaluating patients using cannabis therapeutically for the last decade, preferably in an Executive Summary format with all data relevant to this treatment appreciated.

● Added burden to Veterans and their families.

Veterans are being forced to pay out of pocket to access state medical cannabis programs across the country. The cost of these programs vary from state-to-state for credentials that have to be renewed on an annual or bi-annual basis. The cost of cannabis itself varies greatly from store to store, county to county, and state to state. It is not cheap, especially for veterans on fixed incomes choosing between their bills or cannabis. Recommendations for cannabis from our VHA primary care physicians should be the agreed upon treatment plan, rather than going to a state authorized entity. These recommendations can be converted into vouchers to be filled at local dispensaries, as the Canadian medical cannabis program demonstrates.

 ● Criminal or Patient? That depends on which state veterans call their home.

Veterans will violate the law to heal themselves, and the authorities have no trouble enforcing those laws. Idaho for instance, possession of any amount of cannabis is a crime -- punishable by up to one year in jail, and/or a $1,000 maximum fine. Veterans are being victimized by the criminal justice system, simply for attempting to find relief. Our Heroes deserve treatment options that transcend state lines. No matter what state a veteran may call their home, despite being a qualified cannabis patient under a state program, all possession or use of cannabis on VHA property is federally restricted. This means that a veteran can be charged with a federal crime for medicating themselves at their VHA hospital, nursing home, Fisher House, or federal housing.

● Cannabis Use Disorder (CUD).

CUD has become a staple of VHA medical records for veterans choosing to have honest discussions with their primary care teams regarding their cannabis use. Under a diagnosis of PTS, substance abuse is an attributed factor in the further diagnosis of CUD. Through word of mouth, veterans have come to learn that cannabis helps alleviate a majority of symptoms attributed to PTS. They end up with a CUD diagnosis with no contributing factors other than their use of cannabis and a diagnosis of PTS, along with an unwarranted stigma to overcome. To see the blatant bias at play, one need only to look at the budget request from the Department of Veterans Affairs to the ONDCP for FY 2022. The VHA would rather spend a billion dollars on substance use disorder, than research the medical utility of cannabis. Any funding provided to the VHA from the ONDCP should contain provisions mandating research into the efficacy of cannabis when used to treat PTS, TBI, chronic pain, etc.

● Proliferation of opioid prescriptions since the start of the Global War On Terror (G.W.O.T.).

Within the VHA, pharmaceutical narcotics are being prescribed in staggering numbers, putting veterans at the forefront of the opioid epidemic that has swept the country. Many individuals are entering military service in top physical and mental health, only to be thrust into an overwhelmed system relying too heavily on a pharmaceutical approach to healthcare. The VHA has recently taken minor steps to include a more holistic approach to veteran healthcare but has continually denied the inclusion of cannabis regardless of the science. Studies show opioid use/abuse is reduced in states that have legalized medical cannabis, and it is time for VHA primary care teams to act upon this information.

● Suicide rate increase since the start of the G.W.O.T.

In addition to being inundated with pharmaceutical narcotics, the veteran community is struggling with alcohol. For individuals who have lost their identities, careers, professions, and oftentimes spouses, children, and friends, these potentially destructive substances are too easy to abuse. We have lost more troops to suicide than to combat, many more. Death is an ever-present reality in combat environments. Through training, repetition, teamwork and accountability, the warfighter hardens themselves against this fact. To protect what they love, they knowingly enter into the fight. Nobody was ready for the suicide epidemic. There was no preparation, and it is getting worse. Over the years leaders have stated “nothing is off the table” when it comes to curbing the suicide rate within the military community, it is time for them to prove it. The status quo further aggravates hardships for America’s veterans.

● Veterans learning about their medicine is empowering, therapeutic, and is why you’re reading this.

All across the country there are programs geared toward veterans interested in agriculture. Cannabis farming should be no different. There are many benefits to farming, gardening, and generally getting out in nature on a regular basis. The routine of planting, tending to a crop, harvesting, and preparing for the next season is a structure that fits right in line with the military mentality. Farming brings with it a sense of hope, opportunity, and accomplishment. Bringing in any successful crop is an achievement. It keeps the mind and body occupied, focused, and engaged in a productive manner. Self-sustainability is a key component to a happy, healthy lifestyle.

Veterans should have the opportunity to learn more about cannabis, or other medicinal herbs if they are at all interested. Cannabis Centers of Excellence at specified VHA healthcare facilities designed to teach veterans about their medication, how to grow it, and to supply regional VHA facilities are called for. Top performing VHA facilities, along with consideration of state cannabis laws should be identified as the initial qualifications for implementation of this proof of concept. Cannabis cultivation facilities do not have to be on the VHA campus, but can utilize land grant university space, and/or vacant Department of Defense property, in partnership with various community programs. This scenario fosters further community engagement.

● The NIDA/University of Mississippi monopoly must be busted up.

Research into the medicinal properties of cannabis needs to be fast-tracked. Over-reliance on research conducted by the National Institute on Drug Abuse has hindered our overall understanding of the cannabis plant; its safety, efficacy, and potential medical utility. Monopolizing patents, obstructing objective research, and working to subvert patient’s access to the healing properties of cannabis, are all federal themes played out time and again. This is not hyperbole. It is documented in myriad court cases spanning decades, leading right into the present moment.

● Research from allied nations sponsored by the NIH needs to be acknowledged and acted upon.

Since the early 1960’s, the National Institutes of Health have been providing scientists in the state of Israel with grants to research the cannabis plant, its compounds, and its potential for medicinal use. United States taxpayers have paid for research which has led to the state of Israel becoming the world leader in cannabis science. Additionally, due to compulsory service requirements for their citizens, barring medical or other disqualifications, the majority of Israeli citizens are veterans.

Scientific breakthroughs have led to cannabis being introduced as a viable treatment for use within the Israeli healthcare system. Tens of thousands of Israeli veterans use cannabis on a regular basis which is supplied to them by their government. It is time for the United States to treat her veterans with the same respect and compassion.

● Research investigating what Veterans are using in real-world scenarios is required.

Veterans want to participate in objective cannabis research programs. This research will further assist in understanding medical cannabis, and how to best introduce it into treatment regimens. Decades spent attempting to get through to our elected officials that we know the truth about cannabis, engaging in constant struggle with out of control federal agencies, have left us with a significant gap in our healthcare and knowledge base. In the two decades since the G.W.O.T. began, that gap has consumed over one hundred thousand veteran lives, if we are just accounting for those who have committed suicide.