A federal commission tasked with developing recommendations to
improve mental health treatment for military veterans has reached a
surprising conclusion: Congress and the executive branch need to promote
research into the therapeutic potential of marijuana and psychedelics
such as psilocybin mushrooms and MDMA.
Following months of meetings, the Creating Options for Veterans
Expedited Recovery (COVER) Commission released its report in January.
But despite the novelty of its drug policy findings, the document has
gone largely unnoticed by reform advocates and the media. Chaired by
presidential appointee Jake Leinenkugel, the panel determined that
cannabis and psychedelics represent promising mental health treatment
options for veterans that should be fully explored.
“Medical cannabis and psychedelic drugs may have uses in treating
mental health issues among veterans; however, these substances are
currently classified as Schedule 1 under the Controlled Substances Act,
which precludes VA from conducting research on their efficacy,” the
panel said.
The scheduling status of these substances has meant that the process
of obtaining approval to research them is needlessly burdensome and that
the supply of marijuana and other controlled drugs that’s available for
studies is inadequate, the commission, members of which were appointed
by congressional leaders and the president, found.
“The U.S. federal government’s policies have blocked externally
valid, randomized clinical trials on the effects of cannabis,” the
report says. “Scientists seeking to conduct research on cannabis must
submit to an arduous application process that may last years. The
research requires approval from multiple government agencies, including
some with stated opposition to any therapeutic uses of cannabis.”
The panel further asserted that the Schedule I status of the drugs
has effectively blocked VA from researching them at all, though that
point has been disputed by advocates.
“Because VA is unable to conduct research
into issues that are actively affecting veterans’ health care (medical
cannabis) or issues that could dramatically affect veterans’ health care
(medical psychedelics), VA is unable to explore possibilities such as
whether medical psilocybin is effective in decreasing anxiety and
depression in patients with life-threatening cancer. The opioid epidemic
highlighted the need for third-party research into negative effects of
treatment interventions and underscored that FDA approval alone does not
reveal all of the potential negative consequences that can come about
when a prescription treatment is made available to the public.”
Veterans across the U.S. are already using cannabis in compliance
with state laws to treat a host of mental health conditions, the report
states, and that “necessitates that VA better understand medical
marijuana, and how it can benefit and harm patients who use it, so VA
providers can better care for these veterans.”
Reform advocates and a growing group of bipartisan lawmakers have
long argued that expanding research into the medical value of cannabis
for veterans is an imperative—but what’s particularly striking about
this commission’s report is that it explicitly acknowledges the
potential of specific psychedelics as well. It notes that the
“psychedelic research movement is gathering momentum” with
investigations into how psilocybin and MDMA can impact conditions such
as post-traumatic stress disorder being carried out privately by
universities and research institutes.
“Although the findings have limited generalizability due to sample
size and homogeneity issues, studies have shown some promise for
treating disorders for which available treatments are insufficient—mood,
substance, anxiety disorders, post-traumatic stress disorder—using
psychedelics, including MDMA,” the COVER Commission report says.
To that end, the commission issued a recommendation: VA should
“engage with other federal agencies, as appropriate, to research the
potential short- and long-term risks, as well as benefits, of medical
cannabis and psychedelic drugs.”
It also recommends that the executive and legislative branches
require the National Institute On Drug Abuse to develop “strains of
cannabis with THC levels equivalent to those being used by medical
cannabis users in the states where medical cannabis is legal to ensure
that research on medical cannabis use generates meaningful information
on the related risks and benefits.”
That would address the fact that studies have shown that the
marijuana that’s produced at the only federally authorized manufacturing
facility is chemically more similar to hemp than cannabis sold in state-legal markets.
Further, VA physicians should be given “up-to-date information on
research related to use of medical cannabis and psychedelics, including
MDMA” and be better educated about “their ability to discuss the
benefits and possible negative effects of medical cannabis with veterans
in their care,” the report continues.
The panel
said
that there “are significant questions about the benefits and costs of
using cannabis and psychedelics in treating mental health issues. The
efficacy and safety of these types of treatments are unclear, but it is
essential that VA engage in research to better understand them.”
“VA should engage with other federal agencies to conduct research
into the positive and negative effects on veterans’ mental health of
medical cannabis and psychedelics, including
methylenedioxymethamphetamine (MDMA),” a summary of the report states.
Rep. Lou Correa (D-CA), a longtime advocate for marijuana research for veterans who is sponsoring the VA Medicinal Cannabis Research Act, told Marijuana Moment that the commission’s report “shows exactly why my bill is so important.”
“The Department of Veterans Affairs acknowledges cannabis can be a
valuable medical tool for our veterans,” he said. “We must pass the
Medicinal Cannabis Research Act so the VA can finally conduct this
critical research and get veterans the medicine they need.”
Correa’s medical marijuana research bill was approved by a House committee in March but has not yet been scheduled for floor action by Democratic leaders.
Based on testimony in past hearings, it’s unclear whether VA will be
inclined to embrace the COVER Commission’s recommendations, as
department officials have stood opposed to several modest marijuana reform bills
that were discussed in committee last year. That included legislation
to protect VA benefits for veterans who use marijuana, allow the
department’s doctors to recommend medical cannabis and expand research
into the plant’s therapeutic potential.
In any case, the commission’s report seems to reflect an evolved
understanding of the policy changes that would be necessary to
effectively investigate whether marijuana or certain psychedelics would
be able to provide relief to veterans suffering from a wide range of
mental health conditions. It was released three years after the panel
was established as part of the 2016 Comprehensive Addiction and Recovery
Act.
Transcripts of commission meetings leading up to the report’s
publication showed that members routinely participated in conversations
about the limitations of mental health research opportunities for
controlled substances under prohibition.
For example, Leinenkugel, the chairman, who has previously expressed interest in advancing VA studies into the medical benefits of marijuana for veterans,
said
during a hearing in July 2018 that he was “blown away” by the amount of
research that’s been conducted on the subject in other countries such
as the Canada and Israel.
“They, for some reason, found much more reason to take cannabis and
cannabinoid oils to a further legal way for their veterans, not for
recreation but for usage of the veterans,” he said. “It was a wake-up
call for me personally.”
Col. Matthew Amidon, a member of the commission, told the chair that
the panel “should remember also that there’s H.R. 5520, which is the
2017 Cannabis Research Act, which is a bill right now which we might
want to refer to as we articulate a vision with cannabis bills.”
At another meeting, Leinenkugel
said
that “I think that our largest [veterans service organizations] have
stated through their membership that over 90 percent of American Legion,
which is two million strong, veterans are advocating that we at least
take a look at research within the VA, which I don’t think we’re doing.”
“To me, that makes no sense. It’s a plant, it’s an herb. I’m not
advocating for recreational use at all, but from this commission, we
need to look at every variation of complementary type of care under what
we had yesterday, whole health,” he said. “I know I’m editorializing a
little bit, but I want to at least get it on the public record that
these are things that I think we need to start taking a look at.”
All told, the conversations reflect a growing recognition
that—despite ongoing federal prohibitions—there’s a need to promote
research into controlled substances that hold therapeutic potential. And
that’s not just coming from advocates, it’s coming from Trump
appointees and military brass alike.
Now it’s up to Congress and the White House to follow through with
the recommendations of the panel that the two branches created and
appointed.