Vermont's Medical Marijuana Law Leaves Disabled Veterans Dry — Not High

Thirty-five years ago, Paul Shannon ventured to a place most people will never go: the Korean Demilitarized Zone, or DMZ, separating North and South Korea. He remembers the experience vividly, though he’s spent much of his life trying to forget it, often by using drugs and alcohol.

On May 13, 1975, Shannon, then an Army MP, was on an “infiltration-intercept mission” into the DMZ when he was shot three times — twice in the chest and once in the right arm. While being evacuated to a military hospital, Shannon was given a shot of morphine, the first of countless doses he’s received over the last three and a half decades to ease his pain.

That pain hasn’t ceased. In fact, it’s gotten worse, despite ever-increasing doses of opiates, which Shannon gets for free and in huge quantities from the Department of Veterans Affairs [1], better known as the VA. Currently, Shannon takes 120 milligrams of morphine sulfate and twelve, 5-milligram doses of oxycodone per day for the pain resulting from his combat wounds, degenerative arthritis and severely herniated discs.

As a clinician familiar with Shannon’s case puts it, “He’s on a boatload of pain meds that no longer do anything but keep him addicted.”

Shannon has been through drug rehab four times, the last, in 2001, after he nearly died of an overdose because he was following the orders of two doctors who were unaware of each other.

“If I showed you a list of all the drugs they gave me from ’97 to 2001, and you gave it to a doctor or psychiatrist, they’d look at you and say, ‘So when did they bury this guy?’” says Shannon, 55, who’s divorced and lives in a cabin that he built in the woods outside Sheffield.

There’s one drug Shannon believes would help him cope more effectively with his chronic pain, as well as with the insomnia, flashbacks, cold sweats and mood swings associated with his post-traumatic stress disorder [2]: marijuana. Some doctors have told Shannon that medicinal cannabis could help him wean himself off all those opiates.

But Shannon’s doctor, who works at the VA Medical Center in White River Junction [3], is prohibited under federal law from recommending medical marijuana to his patients. Even with a signed release from Shannon, he won’t discuss the matter with a journalist for fear of being reprimanded or losing his job.

Thousands of disabled veterans across the country are caught in this crossfire of conflicting state and federal drug laws. Many of them receive all their medical and psychiatric care through the VA, which doesn’t permit its medical professionals to participate in the medical marijuana programs that are now legal in 14 states, including Vermont.

In 2004 [4], the Vermont legislature set up a medical marijuana registry [5] for patients who suffer from end-stage cancer, HIV/AIDS or multiple sclerosis. In 2007, the law was expanded [6] to include any medical condition that results in persistent or severe pain, chronic wasting, nausea or seizures. Currently, 204 Vermonters are on the registry.

To qualify, a patient must spend at least six months under the continuous care of a licensed physician who must sign a medical marijuana recommendation form. That recommendation — it’s not considered a “prescription” — must be renewed annually. But Shannon says he can’t afford duplicative medical care for six months a year.

Shannon also says he worried that if he does get on the registry and tests positive for pot, he could lose his VA benefits, including access to his pain meds.

“Unfortunately, that problem is widespread across the country,” says Kris Hermes of Americans for Safe Access [7], the nation’s largest advocacy group for legalized marijuana treatment, therapy and research. “We’ve received dozens of reports from patients across the country, in both medical [marijuana] states and non-medical states, that they’re being denied pain meds unless they can show they will abstain from using marijuana.”

Vets such as Shannon who receive prescription narcotics through the VA must sign a pain-management contract that says they won’t abuse or divert those drugs for illicit use. (The estimated street value of the drugs Shannon gets from the VA each year exceeds $65,000.) One provision common in those contracts, which until recently differed from state to state, requires vets to agree to drug testing at the discretion of their VA doctor.

According to Andy LaCosse, staff assistant to the director of the VA Hospital in White River Junction, “VA patients will not be denied VA services because of their participation in state medical marijuana programs.”

Despite such official pronouncements, the attitudes of some VA doctors elsewhere can be markedly different from those in Vermont. “In states that have medical marijuana, occasionally there’ll be a doctor who feels more like he works for the DEA than the VA,” says Michael Krawitz of the advocacy group Veterans for Medical Marijuana Access [8] in southwestern Virginia. Krawitz, 47, is a retired Air Force veteran who was injured in an accident in Guam about 20 years ago that cost him his spleen, pancreas and part of his intestine. When Krawitz refused to agree with the drug-testing provision in his contract, he was denied his pain meds.

Today, Krawitz is working with a group of vets in Sacramento, Calif. Some were denied narcotic painkillers by the VA because they tested positive for cannabis; others agreed to discontinue their legally sanctioned medical marijuana use to get their pain-med prescriptions restored.

“The vets who took that [latter] option were forced into rehab,” Krawitz adds, “which is pretty darned inappropriate for someone who’s using a substance based on a doctor’s orders.”

The irony of the VA’s seemingly conflicted attitude toward medical marijuana isn’t lost on vets such as Shannon. For years, one oft-cited rationale for keeping marijuana illegal has been that it’s a “gateway drug” to more addictive substances, particularly opiates.

However, a growing body of evidence suggests that gate swings both ways. New research shows that vets like Shannon who suffer from chronic pain, PTSD and even opiate addiction may find a pathway back to normalcy through medical marijuana — provided their doctors are allowed to recommend it.

MaryLynn Mathre is a registered nurse and cofounder of the Virginia group Patients Out of Time [9], which advocates for the rights of patients seeking access to medicinal cannabis. In the 1970s, Mathre worked as a Navy nurse at the Portsmouth Naval Hospital in Virginia, then at the Roosevelt Roads Naval Station in Puerto Rico, where she helped Vietnam vets recover from their physical and psychological wounds. Later, she spent years working in a methadone clinic with drug-addicted vets.

“What your veteran is saying is not off the mark,” she says, referring to Shannon. “I’ve personally known a lot of people who’ve gotten off IV opiates by using methadone, then using cannabis to kick the methadone.”

According to Mathre, the human body has its own endocannabinoid system that produces chemicals almost identical to the active ingredients in marijuana. These chemicals are vital to helping us eat, sleep, relax, cope with stress and forget traumatic experiences, such as the pain of childbirth.

“People think of short-term memory loss [from marijuana] as a negative, but this is actually a protective factor,” she explains. “It can really help veterans to forget these horrific experiences they’ve had so they can get on with their lives as opposed to being plagued by them.”

In fact, Krawitz of Veterans for Medical Marijuana Access points out that, ever since New Mexico made PTSD one of its 15 qualifying conditions for inclusion on its medical marijuana registry, the largest number of incoming patients have been those suffering from PTSD. Needless to say, many of them are combat veterans.

Such numbers are only expected to grow. In 2008, the RAND Corporation [10] estimated that 300,000 military personnel, or one in five soldiers returning from Iraq and Afghanistan, will suffer from PTSD or major depression. An equal number will experience comparable symptoms due to traumatic brain injuries incurred in combat.

Vermont is currently home to more than 55,000 veterans, including 35,000 to 40,000 who served during wartime, according to the state’s Office of Veterans Affairs [11]. Nearly 4000 Vermont National Guard members have been deployed to Iraq or Afghanistan since 2003, including the 1500 currently overseas. While the Vermont National Guard doesn’t release statistics on the number of its members suffering from PTSD, there’s no reason to suspect their experiences will be any different from those of other vets returning from war.

For his part, Shannon says it’s grossly unfair that the roughly one in six Vermonters who served his or her country and receives medical and psychiatric care through the VA is not eligible for the state’s medical marijuana registry.

Earlier this year, he sent letters to every member of the legislature spelling out his recommendation for revising the medical marijuana law to provide equal access to disabled veterans. Among his suggestions was to establish a system that allows a civilian doctor to review veterans’ medical records and determine if they qualify for the registry.

The response to Shannon’s massive letter-writing campaign was underwhelming, to say the least. “I haven’t heard a fucking word from any of them,” he says.

Rep. Dave Zuckerman (P–Burlington), who was instrumental in the passage of Vermont first medical marijuana law, has spoken to Shannon and says he’s sympathetic to his plight. Nevertheless, he points out that the medical marijuana dispensary bill wasn’t a priority this year, especially since the House and Senate judiciary committees were wrestling with more pressing issues, such as an overhaul of the state’s court system.

“He’s got incredible points that he makes,” Zuckerman says of Shannon. “What’s difficult here is we’re trying to shoehorn in a bunch of exemptions to what is already a bad law: to have marijuana be illegal.”

For his part, Shannon suggests more sinister forces are at work keeping him hooked on the pain meds.

“[Are] the government and the pharmaceutical industry conspiring to keep me addicted?” Shannon asks. “The only answer I can come up with is yes.”