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Congress should end medical marijuana gag order on VA doctors

U.S. Navy veteran T.J. Thompson recently joined three senators at a press conference to discuss his inability to access proper medical treatment via the Veterans Health Administration.

He wasn’t there to talk about a lack of benefits or long waiting lists.  He has coverage and he can get an appointment with a doctor. The problem is, his doctor is not allowed to help him.

T.J. explained his situation while standing alongside Sens. Kirstin Gillibrand (D-N.Y.), Cory Booker (D-N.J.) and Rand Paul (R-Ky.) as they introduced the CARERS Act, the first comprehensive medical marijuana bill in U.S. Senate history.  

T.J. suffers from post-traumatic stress disorder and would prefer to treat his condition with marijuana rather than prescription anti-depressants. But even if he lives in a state where medical marijuana is legal if a physician recommends it, and even if his doctor at the VA believes medical marijuana would be the most effective treatment, his doctor can’t tell him that.

The problem stems from a Veterans Health Administration directive prohibits VA providers “from completing forms seeking recommendations or opinions regarding a Veteran’s participation in State medical marijuana programs.”

That directive and the policy it espoused are now six years old. They came at a time when medical marijuana was more politically controversial and many were not yet familiar with its efficacy. But views on marijuana have shifted rapidly.

Today, national opinion polls routinely find support for medical marijuana above 80 percent—an unheard of figure in today’s polarized political climate—and respected physicians like CNN’s chief medical correspondent, Dr. Sanjay Gupta, are joining the call for laws that allow seriously ill people to access medical marijuana.

It’s true that we could use more studies on marijuana, and we would have them if government agencies weren’t actively obstructing them, but the fact of the matter is we have enough information to know that medical marijuana can be a safe and effective treatment for a variety of medical conditions. The clinical and anecdotal evidence for marijuana as a treatment for nausea, appetite loss, muscle spasticity, and severe and chronic pain is overwhelming.

It would be cruel to deny access to any medication for any patient when his or her doctor decides the benefits outweigh the risks and recommends it, but that’s particularly true for veterans and medical marijuana. Our men and women in uniform make incredible sacrifices for our country, and the least we could do make every possible treatment option available to them when they come home.

Veterans returning from Iraq and Afghanistan with debilitating injuries are often prescribed highly addictive opioid painkillers with severe side effects, particularly for long-term use. Marijuana poses significantly less risk of dependence, along with fewer and less severe side effects. What’s more, studies have shown marijuana can be an effective supplemental therapy by reducing patients’ reliance on opioids, or even acting as a “reverse gateway” by replacing narcotic painkillers altogether. Other research shows states where medical marijuana is legal have a 25 percent lower rate of fatal overdoses from opioids.

It is not just the wounds we can see that medical marijuana might help treat. No one knows better than our vets that PTSD is a notoriously difficult condition to treat, with the most common current regimen involving some combination of anti-depressants, anti-psychotics and counseling. The success rate with this cocktail is not particularly encouraging. Many vets instead opt to self-medicate with alcohol and other drugs. And the suicide rate for veterans is alarming—22 per day according to a recent VA analysis. Meanwhile, research has shown a 10 percent reduction in suicide rates in states with medical marijuana laws following passage of those laws.

Even those who don’t support the idea of medical marijuana have reason to support changing the VA’s medical marijuana policy.

In order to provide effective treatment, it’s vital that the doctor-patient relationship be one of open, honest communication. A policy that discourages veterans from asking their doctor about medical marijuana use, and prohibits doctors from even expressing their opinion on it, limits doctors’ ability to ensure veterans using or considering it are fully informed of potential dependence and drug interaction issues.

This week, the U.S. House of Representatives will debate a bill funding the Department of Veterans Affairs, and it will have an opportunity to rescind the VA’s gag order. Congress should seize it and end this outdated and discriminatory policy. It’s time to let veterans like T.J. get the treatment they deserve.

Gilman is a board-certified psychiatrist. She retired in 2014 after over 22 years with the VA, including assessing veterans for psychiatric disability and traumatic brain injury.

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