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Veterans health study seeks to expand awareness, access to medical marijuana

Medical marijuana cigarette and buds in a prescription container. (Public Domain Pictures/Released)

Daniel Stack will never forget being medevaced out of Southeast Asia during the Vietnam War, surrounded by servicemen with far more devastating injuries than his skin condition.

“I saw firsthand the suffering of those guys who were really wounded,” said Mr. Stack, 67, an Uxbridge resident who served in the U.S. Air Force.

He committed himself then to helping his fellow disabled veterans. Now he serves as Massachusetts department adjutant and CEO of Disabled American Veterans, a nonprofit organization that assists and advocates for veterans.

A generation later, another Uxbridge resident, Stephen Mandile, 41, ruptured six disks in a Humvee collision while deployed in Iraq with the Army National Guard in 2005. He suffered traumatic brain injury, radicular nerve damage, post-traumatic stress disorder and depression.

Mr. Mandile’s Veterans Affairs doctors put him on 57 medications, including nine opioids, over the ensuing decade. “It killed my pain but also killed all my feeling for anything good or bad,” he said.

In 2013 he attempted suicide.

An ultimatum from his wife in 2014 caused Mr. Mandile to wean off prescription drugs by using marijuana, which had been legalized for medical use in Massachusetts in 2012, something he accomplished in five months.

Problem was, while medical marijuana is legal in several states, it is still illegal under federal law. And because of that, the VA will not recommend or pay for medical marijuana for disabled veterans.

Mr. Mandile founded a nonprofit in 2016, Veterans Alternative Healing Inc., to support veterans’ access to alternative therapies, including marijuana.

Mr. Stack and Mr. Mandile joined forces last year with another medical cannabis supporter, Marion McNabb, a researcher with a doctorate in public health.

Ms. McNabb co-founded with Randal MacCaffrie a company based in Worcester called Cannabis Community Care and Research Network, known as C3RN, to promote social justice, research and education in the cannabis sphere.

The coalition formed a new nonprofit, Alternative Treatment for Veterans, to gather data on medical marijuana use by veterans and to use that research to push for policy change.

“If you want to deal with the VA, you need a study that just deals with veterans,” Mr. Stack said.

To get the VA to include marijuana as a therapy for PTSD, pain and other conditions, Congress has to change the law, he explained. That’s a high bar for medical marijuana advocates to meet.

“I know a large number of veterans use it,” he said. “They might say it’s recreational, but I see from them they use it for PTSD and the stress. It’s less harmful than alcohol. They’ll drink themselves to sleep.”

Working with C3RN and partners in the cannabis industry, the group launched a veterans health and medical cannabis research study in March. The study is based on a similar survey done last year with University of Massachusetts at Dartmouth researchers, which looked at patient and consumer marijuana use.

Mr. Stack said, “We believe once this study is done, we’ll have concrete information to get Congress to change the law.”

DAV and Revolutionary Clinics, medical marijuana dispensaries in the Boston area, each provided $6,000 as seed money for the ongoing survey. Ms. McNabb serves as principal investigator.

Preliminary results of the anonymous survey will be released at a Cannabis Advancement Series forum from 5:30 p.m. to 9 p.m. June 20 at Bull Mansion, 55 Pearl St., Worcester.

The forum, “Medical Cannabis, Veterans Health and the Opioid Epidemic: What Are Models We Can Embrace?” will feature a keynote video by U.S. Senator and Democratic presidential candidate Elizabeth Warren, a keynote speech from state Cannabis Control Commissioner Kay Doyle and a panel discussion. The program is free. Information is available at

There’s a lot of anecdotal evidence but not a lot of solid research on marijuana because research institutions risk losing federal funding, the source of most grants, for work on the federally illegal substance.

Ms. McNabb said the study’s goal was to document how cannabis is used by veterans and how it helps them.

“The study highlights how cannabis can be a harm reduction to many medications people are on that they don’t want to be on,” she said.

Last year’s study on Massachusetts marijuana consumers and patients found 59% were using cannabis to reduce prescription medication use. Among veterans, the proportion is even higher, 67%, or two-thirds of marijuana users, according to early results from the current study.

Marijuana is most frequently used by general consumers to substitute for antidepressants (42%), nonopioid painkillers such as ibuprofen (32%), and narcotics/opioids (28%).

But veterans who opt for medical marijuana instead of prescription drugs do so at a cost. The study has found that veterans pay an average of $39 a week, compared to $112 a week for marijuana.

One in five veteran respondents reported that money to purchase products was a barrier to using medical marijuana.

The cost of marijuana comes on top of veterans having to pay $200 to $300 for a civilian physician to qualify them for a medical marijuana card, even if their VA paperwork describes their condition as one that would meet state medical marijuana requirements.

That information supported a state Senate budget amendment that would have allowed VA diagnoses to be used to qualify a veteran for medical marijuana. The amendment was rejected, but Ms. McNabb said her group will keep trying.

Ms. McNabb said that from a public health perspective, she wants to make sure veterans not only have better access but also better information about marijuana, especially when they’re using other medications too.

“On their own, they’re trying to substitute and their (VA) provider is not allowed to talk about it with them,” she said.

Mr. Mandile said there was a lot of misunderstanding among veterans – and providers – about VA policy.

A VHA directive says providers should discuss with their patients use of state-approved medical marijuana to treat medical or psychiatric symptoms, including “how marijuana may impact other aspects of the overall care of the veteran.”

Veterans won’t lose benefits, but the impact on other aspects of care often results in having physicians cut off the veteran’s medication, Mr. Mandile said.

“Without a solid policy, physicians are still able to use how they feel about cannabis as part of their decision process,” he said.

The veterans health and cannabis study has found so far that only 62% said their VA or other health care provider was aware of their medical cannabis use. Another 9% weren’t sure. Nearly one-third, 29%, said their provider was not aware they used cannabis.

Veterans are three times more likely to die from an opioid overdose, with many addictions taking root in prescribed painkillers, according to Ms. McNabb. She’s frustrated that safer alternatives including marijuana aren’t being fully considered.

“They are really missing one large harm-reduction strategy that I think can be beneficial,” she said.

Despite cost barriers, “a good 20%” of patients that come to Canna Care Docs, a group of physicians who provide medical marijuana certification, are veterans, according to Kathleen McKinnon, vice president of operations.

“We see a lot of PTSD with veterans,” she said.

Canna Care Docs, which has an office in Worcester as well as other locations in Massachusetts and 11 other states, works with veterans to educate them so they’re using the right strain. Too much THC, the hallucinogenic component of marijuana, could cause anxiety and exacerbate symptoms.

The company started holding events with veterans in 2014, including offering free evaluations on Cape Cod, where more than 70 veterans received services in one day.

Veterans typically receive a 10% discount off the $200 standard fee, Ms. McKinnon said.

The company was offering a Memorial Day special price of $100 for veterans, something Canna Care is considering offering year-round.

Canna Care Docs also gives out vouchers, called scholarships, for free or reduced price certification visits. Mr. Mandile’s organization, Veterans for Alternative Healing, distributes $2,000 worth of scholarships a month.

“Our goal is to bring cannabis into mainstream medicine,” said Ms. McKinnon. “We see veterans as a group that has done a lot for us and our country. It is saving lives. We see that day in and day out.”

A number of dispensaries are also working with veterans to make medical marijuana more affordable.

The Botanist in Worcester has become a partner of C3RN.

“We fell in love with their program,” said Ross Riley, outreach manager.

The Botanist gives 40% discounts every day to veterans who are deemed 100% disabled, a program called the Veteran Care Program. Ten medical marijuana dispensaries in the state participate in VCP, according to Mr. Mandile.

The Botanist donated a percent of profits May 22-25 to DAV and is looking at other ways to offer support.

Matthew Huron, CEO of Good Chemistry in Worcester, wrote in an email: “We provide an ongoing daily discount for veteran medical patients, and we also offer special holiday discounts for medical patient veterans around Memorial Day and Veterans Day. This Memorial Day, we’re offering our veteran medical patients 25% off their purchase. We’re also in ongoing discussions with Veterans Alternative Healing and C3RN/UMass Dartmouth about how to best support their Cannabis Advancement Event Series. We’re incredibly grateful for veterans and their service to our nation. We’re proud to hire veterans and we are proud to serve them every day.”

Besides making an argument for veterans health policy to include medical marijuana as a harm-reduction strategy, advocates hope that more research and education will reduce the stigma many veterans feel.

“There are a lot of veterans that won’t even put they’re a veteran on applications for work,” said Mr. Mandile. “They’re ashamed; they’ll think, ‘Oh, you’re a veteran, you have PTSD, you’re crazy.’ “

“We want to increase the access, create a sustainable pathway to using medical cannabis,” he continued. “Whatever pathway to healing should never be stigmatized.”


© 2019 Telegram & Gazette, Worcester, Mass.

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