Pubdate: Fri, 09 Feb 2018
Source: Los Angeles Times (CA)
Copyright: 2018 Los Angeles Times
Author: David S. Cloud


Frustrated with traditional therapies for chronic pain and post-combat
stress disorders, a growing number of military veterans of the Iraq
and Afghanistan wars are turning to medical marijuana for their
treatment, a move that has put them at sharp odds with the Trump

The White House has resisted calls from Democrats in Congress,
pro-reform activists and even the American Legion, the nation's
largest wartime veterans service organization, to support research
into whether marijuana can help veterans, apparently fearing that any
move by the Department of Veterans Affairs to study its effectiveness
will be another step toward nationwide legalization.

The VA thus become the latest flash point in the national debate over
marijuana legalization, pitting proponents of greater study or medical
use against an administration that has tried to halt or roll back a
steady movement toward greater tolerance of marijuana.

"We all understand that if the VA is able to prescribe medical
cannabis and they determine this is the right way to go, then all of a
sudden it is available in all 50 states and territories and the
calculus changes dramatically," said Rep, Tim Walz (D-Minn.), a
24-year Army veteran who is the top Democrat on the House Veterans
Affairs Committee.

In December, VA Secretary David J. Shulkin refused a request by
Democrats on the House committee to launch a study of marijuana's
effects on chronic pain and post-combat stress, asserting that federal
law "restricts VA's ability to conduct research involving medical
marijuana or to refer veterans to such projects."

In a letter to the Democrats, Shulkin claimed a review of previous
research found links between marijuana use and suicide, mania and
psychotic symptoms.

"The VA is saying, 'We don't even want to investigate whether medical
marijuana is valid," said Rep. Mark Takano (D-Riverside), another
member of the House committee. "But veterans continue to suffer in
large numbers and we should be exploring all the possible alternatives
out there."

Post-traumatic stress disorder, a sometimes severe psychological
condition that stems from exposure to combat and other disturbing
events, afflicts an estimated 9% of VA patients and at least 20% of
Iraq and Afghanistan veterans, according to the VA.

VA doctors treat PTSD, as the disorder is known, with therapy and
prescription drugs, as well as yoga, acupuncture, and other
nontraditional therapies.

But some soldiers say those treatments are inadequate or produce
undesirable side effects. Some former service members move on to abuse
alcohol or illegal drugs, and even attempt suicide.

Twenty-six states, including California, offer access to medical
marijuana for patients who obtain a physician's recommendation.
Neither the VA nor the Defense Department, however, uses marijuana
therapy or allows their healthcare providers to recommend it for
medical purposes.

Under federal law, marijuana is still classified in the same category
as heroin, and repeated efforts since the 1970s to reclassify it have

The American Legion, with about 2 million members, traditionally has
been a conservative voice on social and political issues. But it
stepped up its push for the VA to undertake research into the medical
benefits of marijuana after commissioning a poll last year that found
92% of veteran families favor more study.

At the group's national convention last August, it adopted a
resolution calling on the VA to allow its physicians and other health
providers to discuss the use of medical marijuana with veterans, and
to recommend it in states where it is legal -- steps that are
prohibited at the VA.

Dan Schmink, a 31-year-old former Army infantryman, said he was
diagnosed with post-traumatic stress disorder and a herniated disc in
his back after a combat tour in Iraq in 2006 and 2007, one of the most
violent periods of the war.

After leaving the Army and returning home to Arizona in 2009, Schmink
received opioid painkillers from the VA for his back pain. He resisted
taking prescription medication for his depression, insomnia and bouts
of hyper-alertness, which are frequent symptoms of traumatic stress.

Attending nursing school, he found himself unable to cope with routine
daily situations. "I'd sit in the back in class and keep my eyes down
to avoid talking with anybody," he said in a telephone interview. "I
drank a lot. Sometimes that was the only way to turn it off."

After a friend offered him marijuana -- which he says he had never
tried before -- his back pain eased and he felt less anxious. In 2012,
Schmink got a prescription for medical marijuana and began smoking it

"I didn't have the hyper-awareness. I wasn't having hundreds of
thoughts at once," he said. "You got to a really good meditative state."

When he told his VA psychologist he was using marijuana, the reaction
was "completely negative," Schmink said. A notation was put in his
medical record and he was placed on a watch for possible substance

Another VA doctor was more receptive, allowing Schmink to ask
questions about cannabis use. But when he sought another prescription
for medical marijuana, the doctor refused, saying it was against the

Now living in San Diego, Schmink says he smokes marijuana every
morning, and has figured out the right dose to avoid lethargy and
anxiety. "It's allowed me to become more of the person I was before I
went into the service and started playing war," he said.

Demonstrating the benefits of marijuana with scientific data has
proven more difficult, in part because of the VA's reluctance to
participate, researchers say.

The challenge has been clear in Phoenix, where researchers have been
unable to complete a $2.1-million clinical trial that was approved by
the Food and Drug Administration in 2011. It is the first study to try
to determine whether marijuana can effectively treat PTSD.

For the findings to be statistically valid, the researchers needed to
enroll 76 combat veterans who had suffered post-traumatic stress
symptoms, were resistant to other treatment protocols and were not
abusing marijuana. But only 38 -- half the total -- have agreed to
participate so far.

Marcel Bonn-Miller, a researcher at the University of Pennsylvania who
is overseeing the study, said the research has been slowed, in part,
because the Phoenix VA hospital refused to allow its doctors and
therapists to mention the study to patients or let researchers put up
fliers seeking participants, citing federal restrictions on marijuana

That forced researchers to comb through social media and make
telephone cold calls to search for potential participants. The study
required the patients to visit a private Phoenix clinic 10 times over
18 weeks, followed by six months of follow-up visits.

Asked about the study, Curt Cashour, a spokesman for the VA in
Washington, said that federal law restricts the agency's "ability to
conduct research involving medical marijuana, or to refer veterans to
such research projects." But researchers, he added, are "free to work
with veterans service organizations and state veterans officials who
may not face such restrictions."

Bonn-Miller said the VA is confused about federal restrictions on
marijuana research. But the Phoenix study is politically explosive
because it could establish for the first time whether marijuana has
beneficial effects for veterans, he said.

"If [the VA] were to cooperate it would make things easier," said
Bonn-Miller. "The VA can't recommend, give or prescribe cannabis for
veterans, regardless of whether it's legal in the state or not, but
research is a separate thing."
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