VA Asks Congress To Amend Medical Marijuana Bill For Veterans While Opposing Psychedelics Measure At Hearing

A congressional committee met on Thursday to take up a series of bills, including two GOP-led veterans-focused measures concerning medical marijuana and psychedelics. The U.S. Department of Veterans Affairs (VA) is supporting the cannabis legislation if it undergoes “extensive amendments,” and it opposes the psychedelics measure, describing it as “unnecessary.”

The House Veterans’ Affairs Health Subcommittee—which made history last November by holding a first-ever congressional hearing focused on psychedelics-assisted therapy for veterans—also heard from a number of veterans service organizations (VSOs) that are advocating for the reforms.

One of the bills that was on the agenda, sponsored by the subcommittee chair Rep. Mariannette Miller-Meeks (R-IA), is titled the Veterans Cannabis Analysis, Research, and Effectiveness (CARE) Act.

It would require the U.S. Department of Veterans Affairs (VA) to “conduct and support research relating to the efficacy and safety of forms of cannabis” for chronic pain, post-traumatic stress disorder (PTSD) and “other conditions the Secretary determines appropriate.”

“For years we’ve heard anecdotal firsthand accounts from veterans who have experienced decreased PTSD symptoms and pain through medical cannabis,” Miller-Meeks said at the hearing. “It’s important not to let stigmas interfere with the health care treatment veterans are receiving if it therapy is proven to be safe, effective and improves veterans quality of life.”

“I’m proud to introduce this bill so that we can gain insight into new therapies that could help those who need it most,” the congresswoman said.

The legislation specifies that the VA studies must involve plants and extracts, at least three varieties of cannabis with different concentrations of THC and CBD and “varying methods of cannabis delivery, including topical application, combustable and non-combustable inhalation, and ingestion.”

VA would first have to submit a research plan to House and Senate Veterans’ Affairs Committees and make any requests to support the studies. Over the course of five years after the bill is enacted, VA would need to send annual reports on its progress to the panels.

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VA’s Ajit Pai told the committee that the department supports the bill ” if amended, and subject to the availability of appropriations,” laying out a number of concerns that they wants lawmakers to address.

That includes concerns that, “as drafted, the bill is too prescriptive in its design,” specifically as it relates to the required study of whole-plant cannabis products with THC concentrations that have “undetermined therapeutic benefit or harmful effects.”

“VA generally supports efforts to study the effects of cannabis products on the health outcomes of users of such products to determine whether the use of such products can benefit Veterans who have been diagnosed with PTSD and who are experiencing chronic pain or other conditions as deemed appropriate by VA. We recommend extensive amendments to this bill, though, to ensure that its requirements would yield scientifically and clinically valid results.”

The department offered a series of recommendations to revise the measure, including inter-agency coordination to develop a plan for the studies, a required feasibility analysis for proposed patient registries, authorization to conduct additional clinical trials and more.

“VA would be happy to provide specific amendments to the bill text and to discuss our recommendations further with the Committee,” Pai said.

Miller-Meeks pressed another VA official, Wendy Tenhula, about the department’s suggestion that her legislation is overly prescriptive, pointing out that it was specifically crafted to ensure flexibility. She asked for clarification on VA’s recommendation for inter-agency coordination.

Tenhula said VA is “interested in working with other federal agencies in developing a plan for an observational study that would allow us to understand cannabis use among not only veterans, but a broader population and not only veterans that seek care in the VA Health Care System.”

“So allowing us to work with other federal agencies on those efforts would allow for more unbiased data collection and would provide data that could influence clinical trials that you mentioned and advise us in what direction to go with those trials,” she said.

The VSOs Disabled American Veterans (DAV), Wounded Warrior Project (WWP) and Paralyzed Veterans of America (PVA) submitted testimony in support of the proposal.

“Many veterans are currently using cannabis, and it is important for medical research to continue exploring the safety and efficacy of cannabis usage for medical purposes,” DAV said. “It is crucial for clinicians to be able to offer veterans with PTSD and chronic pain appropriate guidance on the potential impacts, harms, and benefits of cannabis use to provide comprehensive support.”

WWP said it “believes that choosing an alternative treatment is a personal decision that should be made between a warrior, his or her family, and his or her medical team.”

“We also support warriors having access to evidence-based and evidence-informed therapies, as well as complementary and alternative therapies, that have proven to be effective in rehabilitation and recovery,” the group said. “As several early studies have shown promising results for veterans using cannabis to treat conditions like chronic pain, WWP supports continued research in this field and the passage of the Veterans CARE Act.”

PVA said that there’s a “growing body of evidence that cannabinoids are effective for treating conditions like chronic pain, chemotherapy induced nausea and vomiting, sleep disturbances related to obstructive sleep apnea, multiple sclerosis spasticity symptoms, and fibromyalgia.”

“PVA supports evidence-based alternative treatments, including research into the efficacy of medical cannabis,” it said. “A series of clinical trials on the use of medicinal cannabis may help determine if it could provide any medical benefits for veterans.”

The measure as drafted is identical to an earlier measure Miller-Meeks sponsored last Congress. On the Senate side, a committee approved a separate bill last February to promote research into the therapeutic effects of marijuana for military veterans with certain conditions. However, Senate Republicans blocked a procedural motion to advance it to the floor.

The other bill that was taken up in the House subcommittee hearing on Thursday, sponsored by Rep. Derrick Van Orden (R-WI), would instruct VA to notify Congress if any psychedelics are added to its formulary of covered prescription drugs.

At the hearing, Van Orden discussed the suicide epidemic among veterans and stressed that “we have to try something different—we simply do.”

“I’ll tell you what, honestly, I’m not 100 percent sold on this. I am not,” he said, referencing psychedelics treatment. “But you know what? It works for some of our veterans. It does. Some of our veterans on this committee actually have done psychedelic treatment to prevent or to help them deal with PTSD, and it worked for them.”

“I’m asking you all to vote for this, understanding that it’s not a do-all, fix-all for everybody,” Van Orden said. “But it’s gonna help at least save one veteran’s life so that I don’t have to go to their funeral and get on my knees one more time and speak to these fatherless children and look at their widow and try to explain to them why we didn’t do everything we possibly can to prevent their husband from committing suicide.”

The bill states that VA must report to Congress on the addition of any psychedelic medicines to its formulary within 180 days of their federal approval by Food and Drug Administration (FDA).

The report would need to include “the determination of the Secretary whether to include such drug in the formulary of the Department,” as well as “the justification of the Secretary for such determination,” the bill text says.

Rep. Greg Murphy (R-NC) also voiced support for the legislation, echoing Van Orden’s comments about the urgency of exploring novel solutions to the veterans suicide epidemic.

“We’re gonna get back to where this is literally the end of the road for individuals,” he said. “I was very skeptical of psychedelics. I read the literature and I’m very much a proponent of this.”

“I am not a fan of marijuana in a general sense,” he added, referencing the other legislation being considered at the hearing. “But if it’s going to help our veterans and it’s very restricted,” he said he’s in favor.

The congressman also pointed out that veterans “may have to travel” out of the country for psychedelics treatment. “Well, if the option is traveling to a cemetery or traveling to a VA to go get this, by God, we ought to be knocking down the doors of hell to do it. It’s critical.”

Currently, there are no psychedelic drugs that are federally approved to prescribe as medicine. But that could soon change, as FDA recently agreed to review a new drug application for MDMA-assisted therapy on an expedited basis. The agency has also designated psilocybin, and more recently an LSD-like compound, as “breakthrough therapies.”

In January, VA separately issued a request for applications to conduct in-depth research on the use of psychedelics to treat PTSD and depression.

In testimony, VA said that it opposes the proposal because the department views it as “unnecessary.”

“VA already has processes in place where formulary decisions regarding inclusion or exclusion of a drug are released publicly,” it said. “In this context, the bill would include additional administrative burden without any increase in transparency or accountability.”

“We are also concerned about the precedent this could set; further reporting would only delay actions that would improve Veterans’ access to new drugs and treatments,” it said. “VA makes decisions regarding which drugs to include in the formulary in consideration of the best clinical outcomes of Veterans; if the FDA approves any psychedelic drugs, VA will review these drugs using the same process as any other drug or medication.”

“These concerns are hypothetical at this point, though, as no psychedelic drugs have been approved by FDA yet. VA is developing plans to respond in the event such drugs are approved. All drugs that are approved by the FDA are available to Veterans with clinical need, regardless of whether the drug is available on the formulary.”

DAV, meanwhile, testified in favor of the legislation, saying it supports “research to develop new, safe, and effective treatments and therapies for veterans, particularly when seeking relief from hard-to-treat injuries and illnesses.”

“Our nation’s veterans deserve access to the most effective treatments and therapies available, including alternative options available under the law,” it said. “It is important that Congress and VA support safe and effective innovations in delivering evidence-based treatments to improve veterans’ health and quality of life.”

Van Orden, who filed the psychedelics bill, is also a co-sponsor of a bipartisan measure to provide funding to the Department of Defense (DOD) to conduct clinical trials into the therapeutic potential of certain psychedelics for active duty military members. That reform was signed into law by President Joe Biden under an amendment attached to the 2024 National Defense Authorization Act (NDAA).

On Wednesday, congressional appropriations leaders also unveiled a spending package that contains language providing $10 million to facilitate the psychedelics studies.

Meanwhile, in a floor speech last year, the Miller-Meeks, the subcommittee chair, talked about the need to support “novel forms of research” to unlock the potential of psychedelics and cannabis for the treatment of conditions like PTSD that commonly afflict veterans.

She also touted first-ever FDA guidance on psychedelics research that she separately requested in a bill filed last year alongside Reps. Dan Crenshaw (R-TX) and Ro Khanna (D-CA).

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During joint U.S. House and Senate committee meetings earlier this month, VSOs also pressed members of Congress to more urgently pursue the potential benefits of psychedelic-assisted therapy and medical marijuana.

The requests from groups like the Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars of the United States, Disabled American Veterans and the Wounded Warrior Project came on the heels of organizations at last year’s set of annual VSO hearings criticizing VA for “dragging their feet” on medical marijuana research.

In October, VA separately launched a new podcast about the future of veteran health care, and the first episode of the series focuses on the healing potential of psychedelics.

FDA officials also recently joined scientists at a public meeting on next steps for conducting research to develop psychedelic medicines.

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Image element courtesy of Kristie Gianopulos.