VA Opposes Senate Bill Requiring It to Research Cannabis Use

Research for PTSD, Pain Treatment Backed by VSOs

By Celeste E. Whittaker

WASHINGTON — A bill that would require the U.S. Department of Veterans Affairs to run clinical trials on the potential benefits of cannabis for the treatment of military veterans suffering from post-traumatic stress disorder and chronic pain was again rejected by the VA, even though the legislation—S.1467 VA Medicinal Cannabis Research Act of 2021—is supported by a plethora of veterans groups.

Sponsored by Chairman Jon Tester (D-MT) and Sen. Dan Sullivan (R-AK), the bill was discussed by the Senate Committee on Veterans’ Affairs at a hearing in June, along with a few dozen other veteran-related pending legislation.

U.S. Department of Veterans Affairs (VA) Acting Deputy Under Secretary of Health for Community Care Mark Upton said the agency “does not support this proposed legislation.”

Upton said in written testimony at the hearing that the proposed legislation “is not consistent with VA’s practice of ensuring scientific merit as the basis for a randomized clinical trial. The requirement in the legislation to study at least seven types of cannabis and their effects on symptoms of PSTD and chronic pain is not consistent with the current state of scientific evidence, which suggests that smaller, early phase, controlled clinical trials with a focused set of specific aims are optimal to determine proof of concept for use of cannabis in treating specific conditions”

“VA has and continues to examine the current clinical evidence regarding use of marijuana for medical purposes and agrees that more research is needed,” he wrote. “VA has utilized the scientific peer-review system and is currently supporting a clinical trial of CBD to treat PTSD where CBD is used as an add-on treatment to standard of care psychotherapy. The results from this study should be available next year. Further, the proposed legislation is redundant to the extent that VA is already examining risks and benefits of cannabis in treating PTSD and chronic pain.”

The VA apparently took particular issue with a provision included in the measure that would require it to study “at least seven types of cannabis and their effects on symptoms of PSTD and chronic pain.”

The VA points out on its website that it is required to follow all federal laws including those regarding marijuana. “As long as the Food and Drug Administration classifies marijuana as Schedule I VA health care providers may not recommend it or assist veterans to obtain it.” It also provides the following information: Veterans will not be denied VA benefits because of marijuana use. Veterans are encouraged to discuss marijuana use with their VA providers. VA health care providers will record marijuana use in the Veteran’s VA medical record in order to have the information available in treatment planning. As with all clinical information, this is part of the confidential medical record and protected under patient privacy and confidentiality laws and regulations. VA clinicians may not recommend medical marijuana. VA clinicians may only prescribe medications that have been approved by the U.S. Food and Drug Administration (FDA) for medical use. At present most products containing tetrahydrocannabinol (THC), cannabidiol (CBD), or other cannabinoids are not approved for this purpose by the FDA. VA clinicians may not complete paperwork/forms required for Veteran patients to participate in state-approved marijuana programs. VA pharmacies may not fill prescriptions for medical marijuana. VA will not pay for medical marijuana prescriptions from any source. VA scientists may conduct research on marijuana benefits and risks, and potential for abuse, under regulatory approval. The use or possession of marijuana is prohibited at all VA medical centers, locations and grounds. When you are on VA grounds it is federal law that is in force, not the laws of the state. Veterans who are VA employees are subject to drug testing under the terms of employment.

“VA needs to take its cues from the growing number of veterans who find critical relief through medicinal cannabis in treating the wounds of war,” Tester said on the committee website. “Our bipartisan bill ensures VA takes proactive steps to explore medicinal cannabis as a safe and effective alternative to opioids for veterans suffering from injuries both seen and unseen. This is a necessary step in taking care of the folks who fought and sacrificed on our behalf, and I’m glad to join Senator Sullivan in this effort.”

“The devastating nationwide opioid epidemic has clearly shown we need to find alternatives to these medications for the treatment of pain, and that’s certainly a priority I’ve heard from many of the veterans I represent in Alaska,” added Sullivan. “Medicinal cannabis is already in use by thousands of veterans across the country, but we don’t yet have the data we need to understand the potential benefits and side effects associated with this alternative therapy. I’m glad to reintroduce this legislation with Senator Tester, directing the VA to investigate how cannabis use can affect veterans with PTSD and chronic pain.”

VA officials said the agency isn’t necessarily opposing cannabis research for veterans overall but argued that the proposed legislation is unnecessary, because it is “already dedicating resources and research expertise to study the effects of cannabis on conditions affecting veterans.”

Despite that, a range of veterans’ service organizations are backing the bill. The Disabled American Veterans said in a written testimony to the Senate committee that the group fully supports the bill and “more comprehensive and scientifically rigorous research by the VA into the therapeutic benefits and risks of cannabis and cannabis-derived products as a possible treatment for service-connected disabled veterans.”

Other veterans’ groups also strongly back the bill, including the Veterans of Foreign Wars.

Scientific Studies

“This legislation would require VA to conduct scientific studies on the efficacy of medicinal cannabis,” said Tammy Barlet, deputy director, National Legislative Service, Veterans of Foreign Wars, in a June 23 statement for the Senate Committee on Veterans’ Affairs hearing on pending legislation. “The VFW is proud to support this important bill and thanks this committee for its consideration.”

Barlet shared the information in an email with U.S. Medicine upon request for comment.

“Prescribed use of opioids for chronic pain management has unfortunately led to addiction for many veterans, as well as for many other Americans,” she said. “VA uses evidence-based clinical guidelines to manage pharmacological treatment of PTSD, chronic pain, and substance use disorder because medical trials have found opioids to be effective. To reduce the use of high-dose opioids, VA must expand research on the efficacy of non-traditional medical therapies, such as medicinal cannabis and other holistic approaches. Veterans who use medical cannabis and are also VA patients are doing so without the medical understanding or proper guidance from their coordinators of care at VA.”

The VFW also noted that medicinal cannabis is now legal in 36 states and the District of Columbia and said that means veterans can legally obtain cannabis for medical purposes in more than half the country.

“Paralyzed Veterans of America fully supports investigation into medical marijuana’s ability to relieve veterans’ chronic pain and thanks Senator Tester and Senator Sullivan for introducing the VA Medicinal Cannabis Research Act, which would allow VA to begin researching cannabis’ ability to address symptoms of pain and post-traumatic stress disorder,” said Heather Ansley, associate executive director of government relations, Paralyzed Veterans of America.

The American Legion, meanwhile, said it “supports efforts to enhance medical cannabis research, urges Congress to remove cannabis from the Schedule I controlled substance list and believes the DEA should license privately funded medical marijuana production operations in the U.S.”