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Why veterans can't discuss cannabis with VA doctors

Why veterans can’t discuss cannabis with VA doctors

Many US military veterans avoid speaking to a doctor before self-medicating with cannabis due to stigma and fear of consequences, potentially putting their health at risk, according to the findings of a new study.

Published in Health Communication in February, the study examined Reddit conversations in which veterans discussed marijuana use, and concluded that “in studying veterans’ open Reddit conversations, one of this study’s most important findings is that the doctor-veteran relationship needs improvement.”

In particular, the study described a sort of cycle in which veterans are concerned about stigma and the legal status of cannabis, so they either self-medicate without any guidance, or they decide to speak to a Veterans Health Administration (VHA) doctor, only to report being treated differently as a result. 

Veteran smoking cannabis
If veterans aren’t speaking to their doctors because they’re concerned about stigma or losing benefits, they’re putting their health in danger. (Shutterstock)

“If veterans who feel stigmatized and are simultaneously concerned with the legal status of medical marijuana, and are not speaking with their VHA doctors, they are putting their health in danger. This issue is compounded when veterans do, on rare occasions, ask their doctors about medical marijuana, only to be treated as if they are mentally unstable or receive no specific health information at all,” the researchers found. 

They argued that their findings suggest that doctors “outside of the VHA system who treat veteran patients may need to take the lead in conversations surrounding medical marijuana as a treatment option.” 

Reddit and the anonymity to talk about cannabis 

The study, entitled “Mediating Medical Marijuana: Exploring How Veterans Discuss Their Stigmatized Substance Use on Reddit,” focused on eight different themes: “Doctor Patient Conversations, Drug Test, Legality, Legal Policy, Prescription Drug Use/Other Substance Use, Point of View, Reasons for Use, and V.A. Findings.”

The study was used the Social Identity Model of Deindividuation Effects (SIDE) theory, which looks at how anonymity and identifiability affect group behavior to see how veterans communicate about their health and medical marijuana. 

veteran soldier on computer
According to the researchers, Reddit, which affords a measure of anonymity, can ‘alleviate the silencing effects of perceived social stigma.’ (Shutterstock)

The authors noted how previous research indicates that veterans are reluctant to address their psychological health care or participate in health stigma research because it is not common in their community, and could cause them to feel more scrutinized and or stigmatized. 

According to the researchers, Reddit, which affords a measure of anonymity, can thus “alleviate the silencing effects of perceived social stigma,” making it easier for some veterans to discuss cannabis. The research team compiled the study by extracting archival data from Reddit’s open source application programming interface between 2008-2018. They used a popular veterans subreddit with tens of thousands of followers and developed a keyword strategy to focus on solely those conversations that involved cannabis. 

Their analysis of the Reddit conversations found “conversations revealed that veterans used Reddit as a platform to openly garner information and social support regarding medical marijuana, without fear of stigmatization, as the SIDE theoretical framework would suggest.”

What are veterans using medical cannabis for?

When it came to “reason for use,” the researchers found that “over a third of the Reddit posts described their use of medical marijuana as an aid for psychological and physical ailments. Veterans collectively discussed how the use of medical marijuana reduced PTSD symptoms, feelings of anxiety, and helped them sleep better. This directly conflicts with past research claiming marijuana increases PTSD symptom severity.”

The researchers found that veterans also mapped their cannabis use along with that of other prescription drugs prescribed by the VHA, and described a sort of uncertainty about the VHA policies on marijuana and its legality. 

veterans doctor therapy
PTSD is by far the most common reason for using cannabis among veterans. (Shutterstock)

“Witnessed in these veteran disclosures and shared informational support is the underlying confusion or misinformation regarding the current VHA policy on medical marijuana’s legality.”

According to the findings of the report, only 9% of the veterans reported using cannabis for entertainment, and only 1% for relaxation. PTSD was by far the most common use reported, at 14.16%, followed by “general coping” at 11.29%. Pain management was mentioned by 7.8% of veterans, and anxiety and sleep issues by 3.79% and 4.62%, respectively. 

The uncertainty around veterans and medical marijuana 

While medical marijuana is a legal treatment option in 33 states and Washington D.C., the legality of its use by veterans can be rather murky, due to the fact that VHA hospitals and clinics adhere to federal guidelines, and cannabis remains illegal under federal law. This means that while the VA states that “veteran participation in state marijuana programs does not affect eligibility for VA care and services,” veterans still cannot receive a prescription for cannabis from a VHA health care provider. 

The VA further states that veterans will not be denied VA benefits because of marijuana use and that they “are encouraged to discuss marijuana use with their VA providers.” That said, they also state that VA health care providers will record marijuana use in the patient’s medical record “in order to have the information available in treatment planning,” which could potentially deter some veterans from reporting their use. In addition, they clearly state on their website that VA clinicians may not recommend medical mairjuana, VA pharmacies cannot fill prescriptions for medical marijuana,and the VA will not pay for cannabis prescriptions from any source. Veterans who are VA employees are also subject to drug testing, they state. 

Research has shown that cannabis has the potential to help people suffering from PTSD, including veterans. A 2015 metareview in the American Journal of Health-System Pharmacy found that “substantial numbers of military veterans with PTSD use cannabis or derivative products to control PTSD symptoms, with some patients reporting benefits in terms of reduced anxiety and insomnia and improved coping ability.”

Another study published in 2014, found that the symptoms of PTSD were reduced by more than 75% among those who used cannabis compared to those who didn’t use cannabis. That study was carried out in New Mexico, which was the first state to list PTSD as a qualifying condition for medical cannabis. As of January, 2021, PTSD was by far the most-listed qualifying condition in the state, with 57,661 out of 107,371 patients. The next closest was severe chronic pain at 33,401, followed by cancer at 5,205. 

It’s worth noting that other research has found that cannabinoids, particularly in high doses, can actually increase anxiety, arguably providing further indication of the importance of doctor-patient consultation on cannabis use and PTSD. 

The study was partly funded with grants from the John Templeton Foundation and the Federal Bureau of Investigation.

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