Is Medical Marijuana the Solution to the Veteran Opioid Crisis?

Studies suggest that medical cannabis might be an effective PTSD treatment. The VA has come out against bills that would allow for further research.
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When United States Marine Corps Sergeant Brett D'Alessandro returned from a deployment to Afghanistan in 2013, something was wrong. His behavior was erratic and self-destructive. The growing storm in his mind landed him in the hospital after an acute mental-health episode. Sedated and tied to a gurney, D'Alessandro reflected: "I'm like: 'I was going to college, I was sergeant in the Marines, I was not this. You would call this a crazy person.'"

By 2016, still dealing with a prolonged medical retirement process from the Marine Corps, D'Alessandro found himself on the wrong side of America's deadly opioid crisis. Over the course of three years, he was prescribed 15 different medications by the Department of Veterans Affairs (VA) and a Navy hospital in Rhode Island. At one point, D'Alessandro remembers taking seven different pills at the same time, some of which were only prescribed to counteract the side affects of other medications. His girlfriend remembers his constant struggle with the medication cocktail and the resulting weight fluctuations, stomach pains, and mental fog. Prescription opioids opened the door to heroin.

D'Alessandro realized he needed to make drastic changes if he wanted to be healthy again. But going cold turkey from opioids can be deadly, and D'Alessandro—like millions of Americans, and at least 68,000 military veterans—felt trapped.

Then, in 2017, seven years after the state legalized medical marijuana, New Jersey included post-traumatic stress disorder (PTSD) as one of the diagnoses that qualified for the medical marijuana program. Like many Americans, D'Alessandro was skeptical about weed's ability to be helpful medically. "I saw a lot of my buddies using marijuana in high school and I thought, 'Is this going to break my recovery?'" Despite his concerns, D'Alessandro was desperate to get off the last medication he was still being prescribed by the VA. He decided to give medical marijuana a shot.

The process was lengthy and expensive, costing over $500 and requiring in-person appointments with a doctor. The dispensary staff walked D'Alessandro through different recipes for making edibles since he didn't want to smoke. They gave him cannabis that had very little THC and CBD, which gives a non-hallucinatory effect.

During the first few months of using cannabis, D'Alessandro was afraid to share his new treatment with friends and family. The effects weren't instantaneous, but after a few months D'Alessandro realized he did not feel the same intense reaction when he did not have access to cannabis as he had to missing a dose of other medications he'd been prescribed. "I wasn't fiending for it," he remembers. "I could go days without it."

Now, D'Alessandro is gearing himself up for a big step, one that could potentially put him directly in the crossfire between state and federal law: New Jersey legislators recently approved applications for additional marijuana dispensary sites in the state, and D'Alessandro thinks having a veteran-owned and -operated medical dispensary will ensure homeless veterans can get access to medical cannabis.

But despite the growing number of states that have legalized medical and recreational marijuana, America's veterans are still caught in a dangerous limbo when it comes to cannabis use and marijuana affiliation. Because the Department of Veterans Affairs follows federal law, their approach to marijuana, even in states where it's legal, is as hands off as possible. VA doctors are allowed to discuss cannabis use with veterans and tailor VA prescribed medications to their cannabis use, but they cannot recommend or direct a veteran's use of cannabis. According to VA policy, a patient's records are protected by HIPPA, but some veterans I spoke with express concern that this information could one day be used to hurt them. Employment by the federal government is an attractive opportunity for military veterans (thanks in part to a "veteran preference" program which gives veterans an advantage when competing for government jobs), but cannabis use disqualifies anyone from working for the federal government.

There are also reports that working in the cannabis industry has cost some veterans access to VA care or loans because of their association with a federally illegal substance. In April, a former U.S. Army colonel who manages a cannabis business was barred from working part time as a liaison for West Point, preventing him from receiving his military pension despite decades of active duty service. In June, the Boston Globe reported on a veteran who was denied a home loan through the VA due to working in the cannabis industry.

The pace of change at the federal level concerning cannabis has been glacially slow, frustrating medical cannabis proponents. As the VA continues to deal with an opioid crisis that the VA inspector general reported left almost 70,000 veterans addicted to opioids in 2017, proponents of medical cannabis argue that the VA is refusing to research a potentially healthier alternative treatment that could save lives.

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The previous secretary of the VA, David Shulkin, addressed the VA's stance on cannabis in 2018, saying that, while the administration could study medical cannabis, "We have to go through multiple agencies, and it is very challenging to work our way through that process."

Shulkin was replaced last year in a purge of Obama era officials in the VA, and while his successor Robert Wilkie has not spoken directly on the subject of cannabis and veterans, the VA came out against three separate bills proposed in Congress this May that aimed to allow the VA to provide cannabis in legal states, increase research into using cannabis to treat veterans, and protect veterans' benefits from being denied due to cannabis use. Keita Franklin, the VA national director of suicide prevention, claimed that, despite reports of veterans losing VA benefits due to working for legal cannabis companies, further protecting veterans' benefits is unnecessary.

According to Dan Marshall, a former Navy SEAL who is a senior adviser for the National Foundation of Integrative Medicine, which brings experts from the medical and military field together to explore treatment options, getting marijuana use approved by the VA will not be easy. "It's a long process with the federal government to test and evaluate and accept measures of performance, regardless of what it is," Marshall says. "It's never, 'Oh, this works, we're going to try it.' The VA has their process. For them to align their efforts [with medicinal cannabis proponents] and change modalities, it's not part of their strategic initiative."

To date, only one clinical trial testing the use of marijuana to treat PTSD in veterans has been completed. The Multidisciplinary Association for Psychedelic Studies, or MAPS, plans to release their peer-reviewed findings this summer. The trial took place over the course of a few months, but maneuvering through the legal hurdles to conduct the survey was a decade long struggle for Sue Sisley, who led the study.

A 2017 review of over 60 studies into the use of cannabis to treat PTSD, depression, and other mental-health issues in the Clinical Psychology Review concluded that, while the lack of research makes conclusions difficult to reach, "preliminary evidence suggests that CTP [Cannabis for Therapeutic Purposes] may have potential for the treatment of PTSD, and as a substitute for problematic use of other substances." But without more robust evidence in the form of multiple corroborating studies of veterans, it's difficult for proponents to convince skeptics of the value medical cannabis has for treating soldiers when they return home.

When asked how long he thinks it will take for the VA to get onboard with medical cannabis, Marshall says: "I don't have an optimistic answer. The pushback is not performance based. Typically if you want to run a process through the VA, it's an 18-year process. Nobody has 18 years to develop something."

Marshall's frustration with resistance to looking into medical cannabis for veterans is echoed by many, especially veteran service organizations, including the two largest ones in America: the American Legion and Veterans of Foreign Wars. Veterans and VSO staffers suggest that the biggest resistance to medical cannabis is cultural, not scientific. Mike Hoover, a strategic adviser and former U.S. Army command sergeant major, says: "The majority of military installations in our country fall in what is colloquially known as 'bible belt' country. What has happened is organizations like the VA have an over representation from the states that are the most vocally conservative and anti-cannabis. When you talk about changing things, this is not something that a bottoms-up initiative is going to solve. There's a cultural and religious influence that permeates the VA."

While some in Congress, like Representatives Earl Blumenauer (D–Oregon), Lou Correa (D–California), and Phil Roe (R–Tennessee) have proposed and supported legislation to enable studies and to protect veteran's from losing benefits due to cannabis, Republicans in the Senate—specifically Mitch McConnell, the Republican Majority Leader—and former Attorney General Jeff Sessions have been the biggest federal roadblocks so far. The current attorney general, William Barr, indicated that he would prefer cannabis to remain illegal at the federal level, but would tentatively approve legislation that put more control over marijuana laws into the hands of state governments.

Despite the logjam in the VA and Congress and the risks of doing so, a number of veterans are beginning to adopt medical marijuana as a solution for themselves. While it's unknown how many military veterans use cannabis, a poll conducted by the American Legion in 2017 showed overwhelming support for researching and prescribing cannabis to veterans, and researchers have found evidence that veterans have long self-medicated with marijuana to treat PTSD.

David White, the communications director for the Veterans Cannabis Project, an advocacy group, says that protecting benefits for those veterans who do use marijuana is the central priority. He also believes that veterans should feel safe to discuss cannabis use with their VA doctor since cannabis can affect other medications or treatments. While those conversations are protected by law, White notes, "It's understandable why veterans are concerned."

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In the midst of his personal battle with PTSD and opioid addiction, D'Alessandro had a chance encounter that changed his life: On his way to the hospital for yet another appointment, he saw a homeless veteran outside. It was the dead of a brutal New England winter, and D'Alessandro stuffed a backpack in his truck full of cold weather gear he had laying around and gave it to the man. "About three days later I saw him again and he was with a little boy," D'Alessandro says. "The little boy ran up to me and said, 'Thank you so much, I don't have to go to school with my books in my hands,' and his father said, 'Thank you so much for the warming layers, they kept my wife who's sick at the homeless shelter warm.'"

It was a watershed moment for D'Alessandro, and he called his girlfriend, Alexa Modero. Shortly after the encounter, the two founded Backpacks for Life, a non-profit that provides homeless veterans with backpacks stuffed with toiletries and supplies to use while living on the street. The organization also works directly with homeless veterans to navigate the sea of veteran service organizations and VA programs to ensure they get access to the right care they need to turn their lives around.

D'Alessandro is now developing a program to subsidize the cost of acquiring a marijuana card in New Jersey for homeless veterans and help them navigate the medical marijuana process.

Like other advocates for using medical cannabis to treat veterans, D'Alessandro does not think that cannabis alone helped him get his life in order, but he does believe that it's been a component to his rehabilitation. "Absolutely cannabis has been helping me," he says. "I've been using less than one ounce a month, I don't use it at work, sometimes I don't use it for a day or two, on vacation I won't use it. All of these were indications that this was working, that I'm not addicted, that it's helping me get off the medications that have side effects for days."

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