In the early 1980s, Michael Krawitz was serving in the Air Force, stationed on Guam, when he was badly injured in a car crash. His hip and leg were damaged, as was his spleen. During surgery the doctor nicked his pancreas with the knife. He was left with chronic pain and serious stomach troubles that made it impossible for him to take the pills the VA doctors recommended.
Desperate, Krawitz began to do research on his own. He found what he was looking for in an 1890s textbook for medical students.
“[The book] literally talked about a patient like me that had problems tolerating pills. And the textbook said cannabis was helpful” Krawitz told me. He was relieved but angry. “Here I had to find this on my own through my own investigation, and a hundred years ago that was the first thing that would have come to the doctor’s mind. That really infuriated me. That really started me out as an activist.”
Krawitz is now the executive director of the all-volunteer Veterans for Medical Cannabis Access. Like many veterans, he has found cannabis invaluable for treating pain. It helps him reduce the amount of opiates he needs, and also helps him control nausea.
But despite the fact that medical marijuana has become increasingly accepted in states across the country, the VA remains hostile to the treatment. Cannabis is a schedule 1 drug and tightly regulated as such. VA doctors do not prescribe it. Krawitz says that, in his own treatment at the VA more than a decade ago, he was asked to sign a pain contract allowing the VA to drug test him. If they found illegal substances like cannabis, they could terminate his pain treatment.
“The concept of terminating your treatment as a result of ‘violating the rules’ is absolutely unethical,” Krawitz said. If pain treatment is medically necessary, a doctor can’t deny it to you as a means of punishment. Even if someone commits a crime, you’re not supposed to have the right to torture them.
Krawitz refused to sign the contract, and fought it through the VA for 15 years. He finally got the VA to agree that it could not deny treatment to veterans participating in legal state medical marijuana programs. But stigma around marijuana remains severe.
“Out there in the field there’s considerable disconnect between the doctors that are working and the VA policy,” Krawitz told me. Given conflicting signals, doctors often still think they need to police cannabis use and may threaten to deny treatment to veterans who use it.
Federal stubbornness on marijuana policy can make it hard for veterans to get the best pain treatment. In fact, cannabis can be an extremely effective treatment for PTSD. New Mexico psychiatric nurse-practitioner Bryan Krumm says that, “Cannabis is the only thing that in my clinical practice I’ve ever seen that is effective in treating every symptom cluster of PTSD.”
PTSD includes a wide range of symptoms; anxiety, irritability, anger, sleeplessness, depression. At the VA, doctors will prescribe different drugs to treat the symptoms, Krumm says. These could include antidepressants, mood stabilizers and sleep aids. These drugs have side-effects, which may require more medications.
“We end up with this drug cocktail, and these combinations of medication have never been studied for safety or efficacy for treating this,” Krumm says.
Cannabis, on the other hand, helps directly stabilize the endocannabanoid system, which appears to be involved in the regulation of memory and stress. Cannabis has been shown to help with irritability, anxiety, anger and especially with sleeplessness. And it’s very safe—so much so that Krumm says he tells his patients to self regulate and to take it as needed, whether that’s several times a day, once before bed or only once every few days.
Robert Sher is one veteran who has worked with Krumm and seen great benefit from cannabis. Sher served first as an Army paratrooper and sniper in Panama, then in the 1991 Iraq War. When he returned he got a doctorate in psychology, treating other veterans for 15 years. His own PTSD has forced him into retirement, however. His symptoms include nightmares, intrusive thoughts, anxiety and avoidance issues.
For Sher, cannabis allows him to sleep.
“The biggest appeal for me is cessation of dreaming. So if I used cannabis prior to bedtime then I don’t have any nightmares and I don’t have any dreams. I don’t have to worry about this stuff coming back to me during the night,” he said. “That’s probably the biggest benefit I saw for many of the shooters, people who had actually engaged with the enemy and had a form of PTSD.”
Sher had also tried to self-medicate with alcohol but drinking incapacitated him. The VA, he says, “put me on every medication you could think of. None of them worked.” But when he started smoking cannabis, he realized, “'Oh shit. I can function.’”
There are no shortage of stories like Sher’s. He noted that his VA providers looked the other way when he tested positive for cannabis because they were aware of its benefits. But the VA’s website is filled with dire warnings about the effects of marijuana use. “There is no evidence at this time that marijuana is an effective treatment for PTSD,” the site writes. “In fact, research suggests that marijuana can be harmful to individuals with PTSD.”
The truth is that there is plenty of evidence that cannabis helps veterans. But decisive studies are impossible because the government won’t approve them. The DEA has blocked the large clinical trials needed to prove the safety of cannabis, Krumm says. Since no one can legally do the research, the VA can say they don’t have enough evidence to say it is safe for use with PTSD. Federal government attitudes towards marijuana clearly lag behind the general public’s.
The medical marijuana movement has helped with access for those in some parts of the country. And state policy changes may eventually prompt federal ones, as happened with the marriage equality movement. But the movement towards full legalization faces a steep climb. Current Attorney General Jeff Sessions is rabidly anti-cannabis. In the short term, it’s hard to see a more humane medical marijuana policy coming out of the Trump administration.
In the meantime, veterans will have to make do with what access to cannabis they can cobble together. Instead of trying to do everything it can for people who served, the US government sets up barriers, bureaucratic roadblocks, spreads disinformation, and generally makes the lives of veteran’s more difficult.
“In my humble opinion, you can’t see the horror of war and come out unscathed,” Sher told me. “For those of us who do survive some of us go on and have great lives. Others of us, we deal with the human damage, and it follows us to the grave. And cannabis helps.”