Can veterans be penalized for using pot? Answer is hazy

The sale and consumption of recreational marijuana is now legal in California, but the state’s veteran population is stuck in the uneasy gap between state and federal law.

Veterans who get medical care through the Veterans Health Administration, part of the Department of Veterans Affairs, are interacting with a federal agency that considers cannabis a forbidden schedule one drug. The drug is not allowed on VA grounds, and doctors are prohibited from prescribing medical marijuana, or even filling out forms related to state-sponsored medical cannabis programs. 

The VA runs the largest healthcare network in the country, serving over 9 million veterans annually.

It’s unclear if veterans who use marijuana recreationally in California will face any consequences to their VA care. Veteran's advocates say the disconnect between local and federal laws creates uncertainty and fear.  

“As long as there’s a federal conflict with state laws, any patient has significant reason to be worried,” said David Mangone, legislative counsel for the advocacy group Americans for Safe Access. He added, while the danger of criminal prosecution is low, “any recreational user who receives federal benefits, they do run the risk of being subject to federal prosecution even if they are complying with state law.”

Despite hanging questions about how recreational pot users will be treated, a new directive published last month hints the VA’s position on medical marijuana is softening. 

The updated guidelines allow more honest conversations between doctors and patients about marijuana use, including language encouraging doctors and pharmacists to “discuss with the Veteran marijuana use, due to its clinical relevance to patient care, and discuss marijuana use with any Veterans requesting information about marijuana.”

The new policy also says veterans won’t lose benefits because of their participation in a state-sanctioned medical marijuana program.

Advocates like Mangone see progress. “Before this directive was issue, certainly there were discussions between doctors and patients about the use of cannabis,” he said. “But this is really the first time we’ve seen the language shift slightly to actually encourage providers to have these discussions with patients.”

The directive is mum on the issue of recreational marijuana. KPCC sent multiple requests to the VA asking whether a veteran who tests positive for recreational cannabis could face repercussions impacting their medical care, but the agency did not respond to specific questions on marijuana policy.

A spokesperson did highlight a statement by VA Secretary David Shulkin during a press briefing last May, which indicated he was open to the potential utility of medical marijuana for treatment of certain medical conditions. 

“My opinion is...that some of the states that have put in appropriate controls, there may be some evidence that this is beginning to be helpful. And we're interested in looking at that and learning from that,” Shulkin said. But he went on to say his hands were tied by the current federal prohibition: “Until the time that federal law changes, we are not able to be able to prescribe medical marijuana for conditions that may be helpful."

At the state level, California's Department of Veterans Affairs, or CalVet, prohibits recreational and medical marijuana use in its veterans homes. The agency provides housing and services for close to 2,200 veterans and their spouses in eight residential facilities across the state. If a new resident is involved in a medical cannabis treatment program prior to moving in, CalVet's policy requires clinical staff to find alternative treatments. 

"Possession / use of marijuana by a resident in a CALVET Home is in violation of Federal regulations and is a violation of the Code of Conduct and will subject the resident to immediate discharge from the Home," the policy states.

Many veterans report marijuana helps alleviate symptoms of PTSD, insomnia, and chronic pain related to service in the military. A survey sponsored by The American Legion published in October indicated over 80 percent of veterans and caregivers support legalizing medical marijuana.

California medical dispensaries that serve veterans have been navigating an uneasy gray area for years.

Jason Sweatt, an Army veteran and co-founder of the Santa Cruz Veterans Alliance, a medical dispensary and retail store, said his members haven’t reported any problems at the VA because of their medical cannabis use.

“I’ve spoken openly about it with my primary care physician in Santa Cruz County, and with other VA doctors in Palo Alto and Monterey,” Sweatt said. “My primary care physician was very interested, and asked me questions about cannabis use. It’s been an ongoing conversation.”

In 2016, SCVA members participated in a 6-month study on medical pot, PTSD, and sleep disorders conducted by the VA’s Substance and Anxiety Intervention Laboratory in Menlo Park.

The SCVA’s Veteran Compassion Program provides free medicinal marijuana once a month to local veterans.

“Just last month we had a World War II veteran come to our meeting, and he said he’s pretty much off the VA-prescribed Vicodin,” Sweatt said. “He’s instead using medical cannabis.”