Nina Whorl stood outside the White House gates last Saturday holding a poster board sign that read, "VA pills kill vets!"
Whorl—long blond hair, aviator glasses, and small gold necklace with a marijuana leaf on it—was in town, like several hundred other protesters that day, to demand President Obama remove marijuana from the federal government's list of controlled substances.
Both Whorl and her husband are Marine Corps veterans who did multiple tours in Afghanistan. And like a worrying number of veterans, they struggled with medications, both for pain management and mental health, after returning home.
"My husband was on 19 pills a day, and they had me on 11 pills day," Whorl said. "My husband has had three accidental overdoses, and my best friend's husband overdosed and he is dead now. He'd only been out of the Marine Corps a year."
"I've just seen too many of my friends die from this," Whorl continued. "My brothers are veterans, and we've all been helped by cannabis. All of us. We all have gotten off every single medication except cannabis."
There is no hard evidence showing marijuana is an effective treatment for post-traumatic stress disorder, but there are a small mountain of anecdotal stories like Whorl's. More and more veterans like her are seeking access to marijuana—either through state medical programs or the black market—to deal with pain relief, anxiety, and PTSD.
Of course, medical marijuana isn't legal in North Carolina, where the Whorls live. Nor can they obtain medical marijuana from Veterans Affairs hospitals. The VA bars its doctors from making written recommendations for medical marijuana, and despite a growing number of lawmakers and policy advocates calling on the VA to reverse that policy, the VA doesn't seem likely to budge.
In a letter sent to Congress last month and obtained by VICE, the Department of Veterans Affairs said it will not change its policy, as it would open up VA doctors to federal prosecution.
In January, a bipartisan group of about 20 lawmakers in Congress urged the VA to change the directive, which expired in February, and asked VA Secretary Robert McDonald to ensure that "doctors and patients are allowed to have honest discussions about treatment options."
David Shulkin, VA Under Secretary for Health, wrote in the VA's response: "I wholeheartedly agree that VA should do all it can to foster open communication between Veterans and their VA providers, including discussion about participation in state marijuana programs."
Eleven states currently include PTSD among the conditions that qualify for medical marijuana, and a few other state medical marijuana programs have loose enough language to allow prescriptions for PTSD.
"At the same time, marijuana is classified as a Schedule I substance under the Controlled Substances Act, so it is unlawful to knowingly or intentionally distribute or dispense marijuana as a matter of federal law," Shulkin continued. "VA and its providers are bound by this prohibition."
Although VA doctors still can't make written referrals or recommendations for medical marijuana, Shulkin said in the memo that the next version of the VA policy would clarify that doctors are allowed to speak frankly with patients about it. Those conversations are protected by free speech, a point that's often misunderstood or ignored, according to Michael Krawitz, executive director of Veterans For Medical Cannabis Access.
Krawitz's group has been influential in pushing change on the issue, like in 2010, when the VA eased a policy that denied pain medications to veterans who used illegal drugs, including marijuana. Veterans can now ostensibly participate in state medical marijuana programs without fear of having their other prescriptions cut off.
There have been no controlled clinical trials proving that marijuana is an effective treatment for PTSD, which is necessary under federal law before VA doctors could prescribe it. Sue Sisley, a former VA doctor, is now the principal investigator on one of the only FDA-approved clinical trials for marijuana as a treatment for PTSD. That study is finally getting underway soon after six years of delays (a small saga of its own).
Sisley said the VA's response sounded "like the usually double-speak that they give to elected officials." During her time in the VA, she said "there was a clear environment that there will be no discussion and certainly no endorsement of using cannabis as medicine."
Whorl said she, her husband, and her brothers all talked about marijuana with their VA doctors, "but we were told in the same breath, 'Don't say that I told you.'"
And even if veterans find a doctor who is open to talking about marijuana, they must then go outside the VA—and its benefits system—to find another doctor in order to enroll in the sometimes costly state medical marijuana programs.
"You lose trust in your [Department of Veterans Affairs] doctor," Iraq war veteran Scott Murphy told Boston's WBUR in February. "Because of this directive, or lack of direction from the government, I'm forced to see another doctor that I don't have the same relationship with, just for them to agree with my first doctor that I have these symptoms."
While there are many veterans who have reported positive results, the percentage of PTSD-afflicted veterans diagnosed with marijuana dependence has nearly doubled since 2002, from 13 percent to nearly 23 percent, according to recent VA numbers reported by the AP. The AP story cited Andy Zorn, an Iraq war veteran diagnosed with PTSD, marijuana dependency, bipolar disorder, and depression. Zorn committed suicide in 2014, leaving a note that read: "Marijuana killed my soul and ruined my brain."
Krawitz points out that while marijuana dependency can be a problem, the pharmaceutical prescriptions are no walk in the park either. The two medications prescribed for PTSD, Paxil and Zoloft, both have suicide black box warnings. "For a suicide-prone population, that's just unacceptable," Krawitz said.
Advocates for increased medical marijuana access also point to a 2014 report that found a close to 25 percent reduction in prescription painkiller deaths in states where marijuana is a legal treatment option. That's the sort of statistic that should give pause to policymakers who are trying to address the ongoing opioid epidemic.
At least one state has figured out a workaround to the VA restrictions: Illinois allows veterans who enroll in the state medical marijuana program to forward their VA medical records directly to the state system, which streamlines the process of getting legal weed.
Sisley said that other states should follow suit, but change to the VA policy is ultimately needed.
"It's not enough to say it's OK for physicians to have discussions. Now is the time to allow the physicians to certify these patients," Sisley said. "A certification isn't a prescription. All it's doing is confirming the patient has one of the qualifying conditions."
Until then, veterans like Whorl will continue to protest and to find treatment that works for them, with or without the guidance of a VA doctor.
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