Health

Vets with PTSD victims of VA policy on pot

Federal and state laws on marijuana collide, forcing veterans to self-medicate on the sly

Sean Azzariti, a veteran of the Iraq war, prepares to make the first legal recreational marijuana purchase in Colorado from advocate Betty Aldworth at the 3-D Denver Discrete Dispensary on Jan. 1, 2014 in Denver, Colorado.
Sean Azzariti, a veteran of the Iraq war, prepares to make the first legal recreational marijuana purchase in Colorado from advocate Betty Aldworth at the 3-D Denver Discrete Dispensary on Jan. 1, 2014 in Denver, Colorado.
Theo Stroomer / Getty Images

Duane Patrick Seifert, a U.S. Marine Corps veteran, owns and operates a medical marijuana dispensary in Olympia, Washington, called Rainier Xpress (Rx), where he caters to a large number of veterans. A “Wall of Honor” displays photographs of his customers in their military uniforms, and he offers fellow vets a free one-gram pre-roll (or joint) every day they visit. For veterans on fixed or limited incomes, that means a lot.

Seifert estimates that he gives away about 1.5 ounces of medicine a day, which costs him about $5,000 per month. He also helps homeless veterans get legal access to medical marijuana by taking them to see the doctor and get their medical marijuana card so that Seifert can serve them the medicine they need.

Like many of his customers, Seifert suffers from post-traumatic stress disorder (PTSD) and uses marijuana to tone down symptoms like high anxiety levels, insomnia and nightmares.

“As the word gets out about how Rx helps patients and veterans, the more they come daily,” Seifert says. “They leave with smiles on their faces.”

Although medical and recreational marijuana are legal in Washington, PTSD is not a qualifying condition under state law for a prescription, forcing veterans who suffer from post-combat stress either to lie to their doctors about why they need medical marijuana or to pay higher costs for recreational pot. In Colorado, for example, a vet suffering from PTSD would have to buy recreational marijuana, which is taxed at 25 percent, as opposed to medical marijuana, taxed at 2.9 percent, because PTSD is not a qualifying condition in that state either.

However, in Oregon, while recreational pot is not yet legal, PTSD can qualify a patient for medical marijuana, as it can in eight other states: California, Connecticut, Delaware, Maine, Massachusetts, Michigan, New Mexico and Nevada. 

PTSD is a big issue, and we know medical cannabis has been effective for patients. I see veterans because the VA will not prescribe the cannabis.

Dr. Darryl George

Doctor in Oregon, where medical marijuana is legal

“PTSD is a big issue, and we know medical cannabis has been effective for patients,” says Dr. Darryl George, a general practitioner in Roseburg, Oregon. “I see veterans because the VA [Veterans Administration] will not prescribe the cannabis. I’ve been seeing veterans ever since I got started in 2004.”

Despite the challenges of getting marijuana in Washington, Seifert and his customers are still among the lucky ones, because they live in one of the 21 states (plus the District of Columbia) where medical marijuana is legal, which means that the VA mostly turns a blind eye to patients who self-medicate with pot, vets say.

For veterans in the other 29 states, however, the VA tries to police marijuana out of the system by treating veterans who have turned to the drug as criminals, veterans say, suggesting their PTSD symptoms are a result of their pot use and forcing them to live in fear of being denied the treatment they need. And as long as marijuana remains a Schedule I drug under the Controlled Substances Act, this schizophrenic behavior is likely to remain

A cocktail of drugs for pot

In early 2007, 21-year-old Matthew Coomer deployed to Iraq as part of the Kentucky National Guard with military training in high-tech targeting systems. There he spent a year guarding the perimeter of Camp Cropper, a prison facility near the Baghdad airport notorious for detainee abuse, and returned home to Columbia, Kentucky, the following year, traumatized by the experience. Coomer passed every random drug screening during his deployment, but after a suicide attempt in 2008 that left him in in-patient care at the Dupont VA center in Louisville for nearly a week, he was desperate. So he turned to marijuana — illegal in Kentucky, but plentiful on the black market.

When his post-suicide-attempt drug screenings tested positive for marijuana, Coomer was discharged for “rehabilitation failure,” a designation that would follow him in his subsequent visits to the Louisville VA center, where he was forced to take a drug test every time he visited. He was afraid he was going to lose his benefits.

“When they saw that I had a history, they would suggest, instead of my illness being from traumatic war exposure, it was from using pot,” he says.

So he tried to cope without marijuana and take the Valium that was prescribed to him instead, “but Valium just made everything worse,” Coomer says, as it increased his anxiety. So he stopped.

Last March, the VA doctors prescribed him a cocktail of drugs — Valium, risperidone (an anti-psychotic), divalproex (an anti-convulsant) and duloxetine (a drug to treat depression and anxiety). But the drugs didn’t work for him as well as the marijuana and gave him all sorts of negative side effects.

I take the anti-convulsant to keep my aggression away. I wouldn’t have to [take it] if I lived in a medical marijuana state with safe access. I hate to take it.

Matthew Coomer of his PTSD symptoms

Iraq War veteran

“There are numerous potential interactions,” says George, “from affecting their quality of sleep and mood to increased anxiety, and nausea is always the big one. And typically these vets are poly-pharmaceuticals [patients being treated for multiple conditions], and then you’re adding these side effects on top of that.”

“It bothers me on a daily basis,” Coomer says of his PTSD symptoms. “I take the anti-convulsant to keep my aggression away. I wouldn’t have to [take it] if I lived in a medical marijuana state with safe access. I hate to take it.”

Coomer is so desperate to get pot to treat his PTSD that he has considered moving to a state where it’s legal, but can’t because he and his wife owe a mortgage on their house, and his wife works seven days a week as a nurse to make ends meet.

He was trained to operate the targeting computer for a missile launch system, but since his return he can’t sit in front of a computer monitor for very long “because of the way I am,” making it impossible for him to work. He is applying for disability benefits.

A VA spokeswoman said via email, “As marijuana use is still a federal offense VA will not provide for use regardless of state laws,” even when it is “characterized as medicine … However, patients who participate in a non-VA marijuana program will not be denied access to care for most clinical programs but should be assessed for misuse, adverse effects, and withdrawal.”

Pain contracts

Pedestrians walk past the U.S. Department of Veterans Affairs headquarters in Washington, D.C.
Pedestrians walk past the U.S. Department of Veterans Affairs headquarters in Washington, D.C.
Andrew Harrar / Bloomberg / Getty Images

Michael Krawitz, the executive director of Veterans for Medical Cannabis Access, is a longtime advocate of the benefits of marijuana. He speaks from personal experience: He uses medical marijuana to treat a physical injury he suffered while serving in Guam in the 1980s, from working on avionics equipment on board a B-52 bomber. But his activities as an advocate for vets in need of medical marijuana have also put him in touch with many like Coomer and Seifert who need cannabis to treat their PTSD.

In addition, because of his chronic pain, Krawitz became aware of another problem marijuana-using veterans face when dealing with the VA: “pain contracts,” officially called patient care agreements (PCAs).

To receive controlled medication such as opioids from the VA, a veteran needs to sign a PCA, Krawitz says, a nonlegal agreement requiring that the vet submit to regular drug screenings for illegal drugs, including marijuana. The VA says these contracts are its “standard approach” to ensure that both the patient and the doctor understand “their respective responsibilities in managing the risks and benefits of opioid analgesia.”

Krawitz, knowing he would test positive for marijuana, refused to sign.

“I lost my access to pain treatment as punishment for not signing a pain contract,” Krawitz says. He lives in Virginia, which is not a medical marijuana state. “I have seen an outside doctor for my pain treatment for many years as a result of our standoff,” he adds.

The VA continues to act as if marijuana has no medicinal value, despite increasing indications to the contrary coming from the 21 medical marijuana states and countries such as Israel, which has become a surprising leader in the field, distributing 880 pounds of medical marijuana per month. (By comparison, the Netherlands, long associated with lax drug laws, distributes a mere 330 pounds per year.)

Despite the evidence that marijuana has legitimate medical value, especially to those suffering from PTSD, the VA considers its use a criminal act, further complicating the treatment of those veterans who say they need both marijuana and pain medication to cope with their injuries.

A VA spokeswoman says, “Pain management agreements are established between the provider and patient as a means to ensure the safest use possible of prescription narcotics.  Providers can suspend or reduce prescriptions should they be concerned with improper use, or possible conflicts with other drugs.” 

“Other drugs,” of course, includes marijuana.

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