A new report from the Congressional Budget Office (CBO) on federal legislation intended to expand research into using cannabis to treat PTSD and chronic pain in military veterans says the proposal would result in negligible costs to the government but may also fail at its goal of ushering in additional studies.
Ben Adlin March 6 2023
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The CBO report, published on Thursday, consists of a short analysis of the Senate bill, S.326, which would mandate the U.S. Department of Veterans Affairs (VA) research and report to Congress on the therapeutic potential of cannabis for veterans. It would also authorize, but not require, VA to conduct clinical trials involving marijuana.
Satisfying the reporting requirement to Congress, CBO estimates, “would cost less than $500,000 over the 2023-2028 period,” subject to appropriations by federal lawmakers.
But as for further research, the report notes that VA studies “conducted under current laws governing cannabis prescription and use” are already examining marijuana’s risks and benefits for veterans with PTSD and chronic pain.
The office says it doubts the pending legislation would lead to further hands-on research.
“One study that began in 2019 is evaluating the effects of medical cannabis treatment among 136 participants with PTSD and other health conditions. Another interventional study focused on cannabis treatment for chronic diabetic neuropathic pain,” the office says. “CBO expects that the department would not expand those efforts as a result of the bill.”
While the report alludes to VA’s operation “within the restriction of other laws governing [cannabis’s] use and prescription,” it does not state explicitly why it expects the bill would not expand the agency’s clinical studies.
Earlier versions of the legislation, which cleared committee votes in the House in 2018 and 2020, would have mandated that VA launch a series of clinical trials on using medical marijuana to treat PTSD and chronic pain. The current version merely says the department may choose to proceed with clinical trials after conducting more a limited retroactive observation study that is mandated under the bill, but that it is completely within officials’ discretion to do so.
Within 90 days of completion of the observational study on the effects of cannabis on PTSD and chronic pain, VA would be required to submit a report to Congress on whether it’s capable of carrying out the more robust clinical trials that were at the center of earlier forms of the legislation.
VA leadership has historically balked at conducting those trials. In 2021, David Carroll, the agency’s executive director of mental health and suicide prevention, told the House Veterans’ Affairs Committee that the proposal was “not consistent with VA’s practice of ensuring scientific merit as the basis for a randomized clinical trial.”
Some effects of marijuana, Carroll added, “are not known, thus a circumscribed approach to determine dose, administration modality and best outcome measure must be shown in a proof-of-concept approach to ensure the validity of the research.”
Subcommittee Chair Rep. Julia Brownley (D-CA) said at the hearing, “If the VA is not going to do the research on the veteran population, then, really, who is? I feel like the buck sort of stops with us.”
One of the proposal’s champions on the House side, Rep. Lou Correa (D-CA), told Politico at the time: “The VA keeps saying, ‘We have the authority, we don’t need you to micromanage us.’ But we do—because they’re not doing their job.”
A coalition of more than 20 veterans service organizations (VSOs) sent a letter to congressional leaders late last year urging the legislation be passed before the close of last legislative session.
The revised bill is advancing through the new Congress. Last month, the Senate Veterans’ Affairs Committee approved the bipartisan bill, sponsored by panel Chairman Jon Tester (D-MT) and Sen. Dan Sullivan (R-AK), making it the first piece of standalone cannabis legislation to ever advance through a Senate committee.
The Senate committee development came two days after a House companion version was filed by Reps. Lou Correa (D-CA) and Jack Bergman (R-MI). Correa and Bergman also recently announced the relaunch of a bipartisan congressional caucus focused on expanding access to evidence-based research into psychedelic-assisted therapy, hoping to spur more investment into trials around veterans’ mental health.
“The issue before us as a society is mental health: drug addiction, alcoholism, PTSD, veterans afflicted by those invisible wounds,” Correa told Marijuana Moment about the caucus. “We owe it to our taxpayers, to our loved ones, to our veterans to explore this very promising therapy.”
Correa had a conversation with VA Secretary Denis McDonough about the issue of marijuana and veterans last year, and there have been heightened expectations that the department might reverse course on the legislation. But so far that hasn’t happened.
Meanwhile, a large-scale defense spending bill that was enacted at the end of the last session excluded language from a previously House-passed version that would have authorized VA doctors to recommend medical cannabis to veterans living in legal states.
In January, VA officials signaled they’re keeping a close eye on psychedelics as the next step in exploring alternative therapies. Ilse Wiechers, deputy executive director of VA’s Office of Mental Health and Suicide Prevention, cited a need for more research and administrative guidance. The agency, Wiechers said, has been having meetings with stakeholders and “working together on thoughtful plans around how to move things forward in terms of both our policy and ongoing research.”