Issue link: https://www.e-digitaleditions.com/i/1488734
32 legislation focus cannabis patient care | vol. 3 no. 4 cannapatientcare.com post-traumatic stress disorder (PTSD), according to the US Department of Veteran Affairs (VA) (1). About 12 out of every 100 Gulf War Veterans have PTSD in a given year. When they seek help from the VA hospital, it usually comes in the form of an opioid cocktail of some kind, which is the generally ac- cepted treatment regimen. That, along with some counseling, is about all they can get. And that can lead to more problems, such as addiction to the opioids that can cause ongoing sui- cidal ideation, or lead to a deeper internal psychosis, as they try to work through all the bad memories from their deployment. Some veterans discovered on their own that cannabis can help them. But soldiers follow orders. Using an illegal drug like cannabis flies in the face of all they have been taught as patriots trained to uphold the rule of law. So, they are left to suffer within a broken health system. They sometimes act on their thoughts of suicide—there were more than 6000 veteran suicides in 2020 alone (2). Or they simply give up on trying to get back into the life they left, and slowly fade into a deep, dark hole of depression. Cannabis Can Help In April 2016, the US Drug Enforcement Administration (DEA) approved a clinical trial (3) for medical marijuana treatment for veterans, which was the first ever randomized controlled trial of whole plant medical marijuana for the treatment of PTSD in US veterans. It was also the first time that a clinical trial intended to develop marijuana into a legal drug that had received full approval from US regulatory agencies. Since then, there have been multiple clinical trials of cannabis to treat PTSD for veterans. Current studies include another clinical trial in the recruit- ment stage to study the functional outcomes of cannabis use (FOCUS) in veterans with PTSD (4). The investigators will eval- uate the relationship between cannabis use and daily func- tioning among cannabis users and heavy cannabis users. Clinical trial researchers noted that emerging observa- tional and early clinical evidence suggest that cannabis may have the potential to reduce or ameliorate a number of symp- toms experienced by those with PTSD, including sleep diffi- culty and anxiety (5). Indeed, some evidence has suggested that delta-9-tetrahydrocannabinol (THC) may serve to reduce nightmares among those with PTSD, while other studies have shown the positive effects of cannabidiol (CBD) for PTSD. Congress and Veterans for Marijuana Legitimizing cannabis for veterans has had its true champions in Congress over the years. There have been a handful of bills written and discussed in Congress related to veterans and cannabis for treatment of PTSD and chronic pain: the VA Me- dicinal Cannabis Research Act of 2018, reintroduced in 2021 (6); the Veterans Medical Marijuana Safe Harbor Act, introduced in April 2021 (7); the VA Medicinal Cannabis Research Act of 2021, introduced April 29, 2021; and the Veterans Equal Access Act, introduced in Congress in March 2017 after a different version of it appeared in 2015 (8). It was subsequently reintroduced in August 2022. Congressman Earl Blumenauer, founder and co-chair of the Congressional Cannabis Caucus, has been a key Congress member actively pushing for discussion and votes on these veteran's bills all along. Blumenauer's advocacy for cannabis for veterans dates back to 2011, when he wrote a book about it called The Path Forward (9). In his book, he wrote about the directive from the VA called the "Access to Clinical Programs for Veterans Partic- ipating in State-Approved Marijuana Programs." This directive specifically prohibited VA medical providers from completing patient forms looking for recommendations or opinions about participating in state marijuana programs. Under this direc- tive, if a veteran wanted to use medical marijuana in a state where it is legal, they would have to get it illegally at their own expense or find a separate recommendation from a doc- tor outside of the VA. Blumenauer said that he is very optimistic about the most recent version of his Veterans Equal Access bill gaining se- rious traction in this Congress during the end-of-2022 lame duck session. "It's been a long slog," he said. "We've been working on this forever. It is something that is overwhelmingly supported by the public. We've heard from veterans and their families about their stories about how medical cannabis has changed their lives." He said that there was an extensive study just released that revealed that, where people have used medical cannabis, there has been a dramatic reduction in use of opioids. "This was a study that included thousands of people," said Blu- menauer. "Now, all of this stuff is coming together." The Veterans Equal Access Act • Introduced by Congressman Earl Blumenauer (D - OR) in the House of Representatives, June 23, 2022. • 24 bipartisan co-sponsors: 18 Democrats, six Republicans. • The bill directs the Department of Veterans Affairs (VA) to authorize VA health care providers to provide veterans with recommendations and opinions regarding participation in their state's marijuana programs, and complete forms reflecting such recommendations and opinions. Source: https://www.congress.gov/bill/117th- congress/house -bill/8197/cosponsors?r=41&s=1