Every morning, former Air Force senior airman Amy Rising makes breakfast for her second-grader, drives him to school and returns home to prepare what she calls her medicine.
She suffers from severe anxiety after four years working in the frenetic global command center at Scott Air Force Base in Illinois, providing logistical and support services for bombings and other missions in Iraq and Afghanistan.
Rising says she has found a treatment that helps her cope. But her local Veterans Affairs hospital does not provide it — because her medicine is a joint.
At a time when the legalized use of marijuana is gaining greater acceptance across the country, Rising is among a growing number of veterans who are coming out of the “cannabis closet” and pressing the government to recognize pot as a legitimate treatment for the wounds of war. They say it is effective for addressing various physical and psychological conditions related to military service — from chronic back pain and neuropathic issues to panic attacks and insomnia — and often preferable to widely prescribed opioid painkillers and other drugs.
Researchers in the United States and several other countries have found evidence that cannabis can help treat post-traumatic stress disorder (PTSD) and pain, although studies — for instance, looking into the best strains and proper dosages — remain in the early stages.
Veterans are lobbying for more states to legalize cannabis for medical use — 23 states and the District allow this — but the primary target is the federal government and, in particular, the Department of Veterans Affairs.
The federal government classifies marijuana as a Schedule I drug, the same as heroin and LSD, deeming that it has no accepted medical use and a high potential for abuse. That means that VA, which runs the largest network of hospitals and health clinics in the country, cannot prescribe pot as a treatment, even for veterans who live in a state where medical marijuana is legal.
VA says that its physicians and chronic-pain specialists “are prohibited from recommending and prescribing medical marijuana for PTSD or other pain-related issues.” Medical staff are also prohibited from completing paperwork required to enroll in state marijuana programs because they are “federal employees who must comply with federal law,” said Gina Jackson, a VA spokeswoman.
The swelling chorus of veterans who want to take advantage of marijuana but can’t reflects the growing disconnect between more tolerant state policies and the federal government’s unwillingness to budge.
Advocates such as Rising say it is urgent that the federal government recognizes marijuana as a treatment because there are so many veterans of recent wars.
Although Rising did not serve in Afghanistan or Iraq, she said the pressure of her work was intense. “What was really hard about working in command was never being able to see the damage you did on the ground,” she said. “You start to think about all the orphans and widows you created, and that you do hit civilians.”
Without marijuana to treat what she says is PTSD, Rising said she feels “like the Incredible Hulk and that danger is around every corner and that my nerves could explode.”
After dropping off her son at school on a recent morning, she prepared a pair of blunts. She took some pot out of a jar, dumped the guts of two Dutch Masters cigars and re-rolled them with the marijuana. Then she slipped her blue Air Force jacket over her blue and white flower-print dress and went into her suburban back yard to smoke, putting her long, blond curls behind her ears.
Medical marijuana is legal for treating some conditions where Rising lives. She declined to identify her home state except to say it is in the Mid-Atlantic.
“It’s not about getting stoned. It’s about getting help,” she said. “The VA doesn’t have any problem giving us addictive pharmaceutical drugs by the bagful.”
Winning acceptance for medical marijuana, she said, involves convincing the government that there is more to the movement than “Cheech and Chong, a stoned vet burning one down to Bob Marley tunes.”
If veterans report their use of marijuana to VA, they could face criminal charges if they live in a state where it is illegal. And though few have indeed been charged, the mere possibility has spawned a culture of “don’t ask, don’t tell,” said Michael Krawitz, a former Air Force staff sergeant and the director of Veterans for Medical Cannabis Access.
VA medical staff have warned that this culture is making for a dangerous situation, especially as more states legalize medical marijuana, because doctors do not know about all of the medications their patients are using. Patients are not routinely given drug tests, but those who are prescribed large amounts of opiates and risk overdosing can be asked to undergo screenings, which can turn up marijuana use.
In 2011, VA issued a directive that said patients who were participating in state marijuana programs for pain cannot lose their VA benefits. VA added that it is up to individual patients to craft their “treatment plans” in consultation with their doctors.
Some patients say their VA doctors are making them choose between their prescription drugs and marijuana. “Doctors and administrators wrongly assume that the use of marijuana along with opiates is unsafe,” Krawitz said.
A study published last month in the journal JAMA Internal Medicine reported that “people already taking opioids for pain may supplement with medical marijuana and be able to lower their painkiller dose, thus lowering their risk of overdose.” The study, written by Marcus A. Bachhuber, a researcher at the Philadelphia Veterans Affairs Medical Center, and several colleagues, found that “medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates.”
Scott Murphy, a retired Army specialist who is the head of Veterans for Safe Access and Compassionate Care, has been compiling a petition asking that marijuana no longer be classified as a Schedule I drug. “Veterans in states without medical marijuana laws feel they need to lie to their physicians for the justifiable fear of losing their earned benefits,” Murphy writes in the petition.
To counter widespread perceptions about pot users, Murphy makes sure to wear a suit when he lobbies on Capitol Hill and in his home state of Massachusetts, where medical marijuana is legal for some uses. “I won’t wear a tie-dyed shirt with a marijuana leaf,” he said.
Murphy served in Iraq for more than a year, working in field artillery and training Iraqi police officers. He said the physical stress of lugging heavy military equipment contributed to degenerative arthritis and bone pain in his leg, hip and wrist, and he began taking morphine, muscle relaxers and Oxycontin.
“It never took away the pain,” he said. “I was at the point where I just wanted my leg to be taken off.”
Then, two years ago, he started using a liquid form of cannabis that he puts under his tongue. “I was able to go eight hours without taking my medication,” he said.
Several VA doctors who specialize in pain management and PTSD said in interviews that they are eager for more research on the medical benefits of marijuana. The doctors, who spoke on the condition of anonymity because they do not have permission from VA to discuss marijuana with the news media, said they feel frustrated because prescription drugs are not helping patients who are suffering.
“Anecdotally we know it works, and more and more studies are saying this,” said one VA doctor, a PTSD expert who leads a large East Coast VA pain center. “But we aren’t allowed to study it.”
Researchers at New York University’s Langone Medical Center are developing the first generation of cannabis-related medications targeted for PTSD, according to Alexander Neumeister, an NYU professor who supervised three drug trials. He said research has found that people with PTSD have lower levels of unregulated receptors in the brain. These receptors, called CB1, are activated when a person uses marijuana.
“We are throwing the wrong pills at the problem and keep doing it,” Neumeister said. “It’s upsetting. It’s heart-breaking and it’s just wrong.”
He warned that marijuana for PTSD and pain is “not ready for prime time yet,” because there must be more research into the proper doses and the most effective strains.
“We don't know enough about the side affects and long term negative effects," he said.
Some veterans are not waiting for the studies to be finished.
Mark DiPasquale, a 39-year-old retired Marine staff sergeant who served in Iraq from 2005 to 2007, said marijuana was his “exit drug.”
To treat back and bone injuries as well as PTSD, he said he had gone on 22 medications, including opioids and anti-anxiety medication. “I realized none of these were working and I was about to be a father. I was so jacked up on every pharmaceutical,” he said.
DiPasquale looked for alternatives. He decided to use marijuana, inhaling it with a vaporizer, to stop drinking alcohol and to adopt a largely vegan diet (he occasionally eats fish). The regimen has worked, he said. But he added that he has to spend a lot of money and time buying marijuana “from people I trust or seeing if a random cousin has some.” DiPasquale, who lives in New York — where voters have approved medical marijuana — wishes VA would consider dispensing pot.
“It’s not like, ‘Let’s smoke a joint and feel better,’ ” he said. “We want to do it the right way.”