Marijuana and Veterans Issues


Veterans consume cannabis at rates far higher than the general population, and many report using it for medical purposes

  • According to nationwide survey data compiled by the group Iraq and Afghanistan Veterans of America, 75 percent of military veterans “would be interested in using cannabis or cannabinoid products as a treatment option if it were available.”
  • According to nationwide survey data conducted by The American Legion in 2017, 39 percent of respondents affirmed that they “know a veteran” who is using the plant medicinally. Twenty-two percent of respondents said they themselves “use cannabis to treat a mental or physical condition.”
  • Medical marijuana use among veterans would likely be even higher were not VA physicians forbidden under federal law from recommending cannabis therapy in the states that permit it. According to a December 2017 policy guidance update issued by the US Department of Veterans Affairs, doctors may facilitate to discussions with veterans about their cannabis use “due to its clinical relevance to patient care,” but “providers are prohibited from completing forms or registering veterans for participation in state-approved [medical marijuana] program[s].”

Many veterans report substituting medical cannabis for prescription drugs and alcohol

  • “Participants [in the study] were 93 US military veterans and members of the Santa Cruz Veterans’ Alliance (SCVA). … The majority of participants reported that they use cannabis as a substitute for other licit and illicit substances. … [P]articipants reported a high degree of substitution behavior, particularly for alcohol. … [N]early half the sample reported substituting cannabis for prescription medications. … The current study also confirms the findings of previous studies that have documented a trend in substitution behavior, where cannabis is substituted for other drugs, which, if associated with reduced harm, could be beneficial for overall health.”

Veterans often report using cannabis to treat symptoms of chronic pain and mood disorders, like post-traumatic stress. Clinical and observational data supports the use of cannabis treatment for these indications.

  • “In this retrospective naturalistic study, we followed 14 relatively mature (32-68 years of age), treatment-resistant, chronic combat post-traumatic patients who remained severely symptomatic despite treatment with many lines of conventional treatment prior to receiving medicinal cannabis. … To the best of our knowledge, this is the first published study examining long-term cannabis efficacy in chronic combat treatment-resistant PTSD patients. … After treatment with cannabis, total sleep score, subjective sleep quality, and sleep duration significantly improved. … Total PTSD symptom score and its subdomains (intrusiveness, avoidance, and alertness) showed [also] improvement. … Future research should clarify the long-term effects of cannabis on different groups of patients suffering from PTSD.”
  • “This study investigates health-related quality of life (HRQoL) changes and adverse events in patients prescribed CBMPs [cannabis-based medicinal products] for PTSD. Of 162 included patients, 144 were current/previous cannabis users. HRQoL was assessed at 1-, 3-, and 6-months using validated patient reported outcome measures. … This observational study suggests an association between CBMP treatment and improvement in PTSD-specific, HRQoL [health-related quality of life], sleep, and anxiety outcomes at up to 6-month follow-up. CBMPs were well-tolerated and adverse events manageable. … [T]his study can serve to inform future randomized placebo-controlled trials with the aim of confirming these promising effects, whilst informing current clinical practice.”
  • “[Older] veterans reported positive effects of cannabis use for their pain, sleep quality, health conditions, and QOL. … Veterans in our study were more likely to use cannabis [as compared to non-veterans] for mental health conditions. … [T]he results make sense in that Veterans report mental health condi- tions such as PTSD, anxiety, depression, and insomnia at higher rates than the general population. … Our study results suggest older Veterans may be turning to cannabis as a way to cope with mental health conditions such as PTSD, insomnia, depression, and anxiety.”
  • “For this review, four cohort studies, four randomized clinical trials, one case report, and one case series were obtained from PubMed within the last 10 years. Cannabis extracts, tetrahydrocannabinol (THC) and cannabidiol (CBD), and synthetic cannabinoids were used in the studies to target the cannabinoid receptors 1 and 2. Cannabinoids were shown to improve overall PTSD symptoms, including sleep quality and quantity, hyperarousal, and treatment-resistant nightmares. Summary and outlook: Cannabinoids have been shown to be an effective treatment option for patients with PTSD. Besides aiding to relieve the symptoms and enhance extinction training, they also are relatively well tolerated.”
  • In an analysis of over 61,000 patients seeking medical cannabis authorizations in 12 states, nearly ten percent of patients reported seeking cannabis to mitigate symptoms of post-traumatic stress. PTSD was the third most common condition reported among those seeking authorizations, following only chronic pain and anxiety.

In states where medical cannabis is legal, opioid-related mortality has fallen significantly

Studies of pain patients eligible for medical marijuana access find that most subjects significantly reduce or eliminate their use of opioids following cannabis therapy

  • “Between August 1 – December 31, 2016 a total of 2290 patients were enrolled in the program under the qualifying condition of intractable pain; 45 of these patients were previously enrolled in the program under an additional qualifying condition. This report focuses on the 2245 patients who were certified for intractable pain and enrolled in the program for the first time during this interval. … A large proportion (58%) of patients on other pain medications when they started taking medical cannabis were able to reduce their use of these meds according to health care practitioner survey results. Opioid medications were reduced for 38% of patients (nearly 60% of these reduced at least one opioid by ≥50%), benzodiazepines were reduced for 3%, and other pain medications were reduced for 22%. If only the 353 patients (60.2%, based on medication list in first Patient Self-Evaluation) known to be taking opioid medications at baseline are included, 62.6% (221/353) were able to reduce or eliminate opioid usage after six months.”
  • “During the study period, 2736 patients above 65 years of age began cannabis treatment and answered the initial questionnaire. The mean age was 74.5 ± 7.5 years. The most common indications for cannabis treatment were pain (66.6%) and cancer (60.8%). After six months of treatment, 93.7% of the respondents reported improvement in their condition and the reported pain level was reduced from a median of 8 on a scale of 0-10 to a median of 4. … After six months, 18.1% stopped using opioid analgesics or reduced their dose. … Cannabis use may decrease the use of other prescription medicines, including opioids.”