Once Arkansas allows medical marijuana sales, veterans in the care of U.S. Department of Veterans Affairs physicians can discuss the drug with their doctors, but that's it.
In the federal government's eyes, marijuana is an illegal, Schedule 1 controlled substance, meaning the VA won't recommend, prescribe or pay for cannabis.
But as Arkansas has been forming its plan to provide the drug, the VA has been tweaking its internal policy, opening a loophole to allow its doctors to "candidly discuss" the medical use of marijuana and incorporate it into treatment plans.
The Central Arkansas Veterans Healthcare System, the largest branch of the federal VA health administration in the state, doesn't anticipate losing patients because medical marijuana is unavailable at its facilities.
"For CAVHS, nothing will change other than some treatment plans may be modified by our clinicians to consider the patient's use of medical marijuana," said Chris Durney, a spokesman for the hospital system. "Our providers are encouraged to maintain a positive provider-patient relationship with the ability to talk with veterans about how using medical marijuana may adversely affect any VA-specific treatment plan."
State officials hope to license medical marijuana dispensaries before next summer ends, but it remains unclear when the drug -- which Arkansans voted to legalize through a 2016 ballot measure -- will be available for sale.
Whenever it is available, there's expected to be demand from the veteran community in Arkansas. The drug has gained popularity locally and nationally among former service members who say it helps treat a variety of ailments, including post-traumatic stress disorder.
The American Legion, the nation's largest veterans service organization, adopted a resolution this year urging the federal government to free VA physicians to recommend medical marijuana in states where it's legal.
Veterans who support the availability of medical marijuana herald it as an alternative to addictive opioids, which VA hospitals, including those in Arkansas, have worked to reduce.
There have been several efforts in Congress in recent years to lift bans on VA doctors related to medical marijuana, and in fact, the U.S. House of Representatives and U.S. Senate passed a measure as part of their respective VA appropriations bills. However, the measure was moved to a conference panel to reconcile differences between the House and Senate versions of the bill.
Identical House and Senate bills "To extend the principle of federalism to State drug policy" have now been introduced and referred to committee. The legislation would authorize VA doctors to recommend medical marijuana in states like Arkansas.
U.S. Sen. John Boozman, R-Ark., opposes such legislation and has voted against similar measures in the past, a spokesman said in an email.
A spokesman for U.S. Sen. Tom Cotton didn't provide the Dardanelle Republican's stance on the issue but said Cotton is monitoring VA research examining the benefits and downsides of medical marijuana.
Spokesmen for Arkansas' four U.S. representatives didn't respond to emailed questions about medical marijuana last week.
Michael Krawitz, executive director of the national Veterans for Medical Cannabis, encouraged Arkansas veterans to proceed with caution if they're interested in using medical marijuana. But Krawitz, whose organization advocates for veterans interested in medical cannabis, also said veterans shouldn't be fearful.
"We've never seen a case where a veteran lost financial benefits because they used legal cannabis," he said.
While the VA's policy is "pretty good," Krawitz said, he still has problems with it. He pointed to a court case out of California that affirmed physicians' rights to recommend medical marijuana without fear of punishment from the federal government. The decision was upheld on appeal to the 9th U.S. Circuit Court of Appeals, and the U.S. Supreme Court later declined to hear it.
Essentially, Krawitz argues that prohibiting doctors from recommending medical marijuana to patients violates free speech that's necessary to the doctor-patient relationship.
The VA also won't pay for its beneficiaries' medical marijuana, which will create a burden for veterans who are dependent on the VA for income and health care.
Under Arkansas' medical marijuana system, patients with qualifying conditions will be issued registration cards signifying that they can legally purchase the drug. Applying for a card will cost $50, as will an annual renewal, according to the Arkansas Department of Health. However, those fees are subject to change.
On top of administrative fees, veterans would have to purchase the drug themselves, which Krawitz said could cost an average user somewhere between $450-$1,000 a month, depending on the quality of cannabis purchased.
Furthermore, veterans would incur costs while seeking doctors outside the VA to establish a "physician-patient relationship" required before a recommendation for medical marijuana can be made, according to the state Department of Health's rules.
It remains illegal to smoke or possess medical marijuana on VA property, and VA workers will still be subject to mandatory drug tests regardless of whether they're prescribed the drug.
Krawitz said veterans who encounter problems discussing medical cannabis with their doctors should run it up the chain of command. Some doctors, like dentists, don't need to know about medical marijuana use, but some, like heart surgeons, should know because of research linking adverse cardiovascular side effects to medical marijuana, Krawitz said.
"We recommend they obey the credo of 'need to know,'" he said. "Ask yourself, 'Does this doctor need to know about my cannabis use?'"
For some Iraq veterans of the Arkansas National Guard's 39th Infantry Brigade, marijuana has become the key to a more normal life free of pills and constant waves of depression. Harsh combat deployments during the thick of Operation Iraqi Freedom left many of them with traumatic brain injuries and PTSD.
Treatment has mostly consisted of counseling, which most find helpful, and pills -- lots of pills. The opioids work for some, but for others, they only exacerbate the problems, sending veterans deeper into the spiral of depression and suicidal thoughts.
"I was taking so many pills that I didn't even know what most of them were. I just swallowed," said one former member of the 39th Brigade, who requested anonymity to discuss his marijuana use candidly.
He started buying marijuana off the street after reading online research about the experiences of other veterans who had used the drug to treat PTSD.
"Game changer," he said.
There was shame in his voice as he discussed the drug. He hates having to break the law to obtain it, he said.
Soon, though, he hopes to buy it legally.
Metro on 12/24/2017