In this article, let us examine the state of health care for veterans, both in the United States and in Canada, with emphasis on mental health issues. We will also talk about their ability to access alternative mental health treatment, particularly medical cannabis.
U.S. veterans and its veteran health care system
According to the United States Department of Veterans Affairs, there are more than 21 million veterans in the country. The Veterans Health Administration is the country’s largest integrated health care system, with 1,243 health care facilities, medical centers, and outpatient sites providing care and health services to enrolled veterans each year.
While most people assume that the Veterans Health Administration automatically provides health care coverage to all veterans, that is not exactly how the system works. A 2014 study from The Lancet showed that over 1.2 million U.S. military veterans lack health insurance coverage.
The study pointed out that only 8.9 million of the total number of veterans in the U.S. are enrolled in VHA’s health benefits, which are reserved for men and women who have been disabled while rendering military service or those who are very low-income. Other veterans, meanwhile, obtain insurance through the private market.
Moreover, the researchers found that most of the veterans who are uninsured live in states that have chosen not to accept federal funding to expand Medicaid, which is the American government’s insurance program for people belonging to the low-income bracket.
A previous study from the National Institute of Health suggested that veterans have a problem obtaining health insurance and highlighted that there are many veterans who did not even know they were qualified for VA care.
American veterans’ unique health issues
Veterans experience a range of mental health problems, post-traumatic stress disorder (PTSD) and depression being the most common. And they suffer from these mental disorders at higher rates compared to their non-military counterparts.
In fact, citing veteran medical records, a study published in 2015 revealed that one in three veteran patients get diagnosed with at least one mental health disorder. The same study also noted that 18 to 22 U.S. veterans commit suicide every day, with younger vets (18 to 44 years old) being most at risk. This suggests that while modern medical advancements have allowed soldiers and military personnel to survive war-related physical injuries, they are still left vulnerable to PTSD, depression, traumatic brain injury (TBI), substance use disorders, and other mental illnesses.
The study specifically identified veteran issues which include separation from military service and those that are related to complex multiple deployments. Then there’s PTSD which was previously known as “combat fatigue” or “shell shock,” often resulting from veterans experiencing or witnessing a traumatic event. While PTSD affects about 8 million American adults, the problem is especially prevalent among war veterans and active duty military personnel.
PTSD often results from TBI, military sexual trauma (MST), often causing difficulty sleeping, chronic pain, and other psychiatric disorders like depression, agitation, anxiety, and suicidal ideation. Treatment of PTSD is aimed at social support, therapy, and medication such as antidepressants.
In fact, more than a decade of war in Iraq and Afghanistan has pushed PTSD to the forefront of veteran mental health concerns. And an increasing number of war veterans who have served in the Middle East are seeking treatment for this debilitating condition in the last several years.
Available mental health treatment for veterans in the U.S.
It is essential that veterans be given mental health services to help them recover from their military service- and combat-related mental health issues, especially PTSD. However, according to a Substance Abuse and Mental Health Services Administration study, only 50 per cent of returning veterans who need mental health treatment will be given these services.
The whole veteran mental health picture has raised many questions regarding the appropriate mental health options made available to the vets and the various barriers to treatment.
The U.S. Government Accountability Office, as well as other sources, has identified the barriers faced by veterans when it comes to getting treatment. These barriers include long wait times to receive mental health treatment, a lack of awareness and understanding of mental health issues and their treatment options, and concerns over VA-offered mental health treatment.
Now let’s talk veteran access to medical cannabis in the U.S.
Recently, the veterans group American Legion has urged the federal government to allow soldiers and veterans to access medical marijuana for treatment. This, the group said, could help reduce suicide rates and ease the physical and mental suffering that comes as a result of experiencing the horrors of war, as well as provide an alternative to opioids to treat chronic pain and reduce addiction. The American Legion has been adamant about this subject, and is going to great lengths to forward the discussion (VIDEO).
The American Legion released a national survey among veterans showing that a vast majority of them support the federal legalization of medical cannabis. The survey showed that more than 80 percent of veterans want to see medical cannabis become a federally legal option for the treatment of physical and mental conditions they suffer from.
The American Legion stated that a significant number of veterans who have PTSD and TBI and have used medical cannabis would attest that it works in treating their mental condition. The group stated that many veterans have turned to cannabis as an alternative to opioids and antidepressants, which could adversely affect mood and personality and which, in turn, gives veterans thoughts of suicide.
However, the problem lies with the U.S. Drug Enforcement Administration classifying marijuana and all its derivatives as Schedule I substances under the Controlled Substances Act. This means that cannabis is illegal under federal law and considered to be of no therapeutic value, with a high potential for abuse. This also means that in many states where medical cannabis has not yet been legalized, veterans who want to use it in the treatment of PTSD, as well as chronic pain, cannot get a prescription.
The Schedule I classification also impedes more research and clinical trials on cannabis and its effects on health. What’s more, this classification means that veterans and those who are still serving the military cannot avail of medical cannabis as part of their VA health care coverage.
Most recently, the VHA has changed its policies to allow its physicians to speak to veterans about cannabis. However, VA doctors are woefully under-educated on cannabis and the new policy still prevents physicians from recommending cannabis or filling out costly and often complex paperwork to obtain a medical cannabis card in states where the option is legal. The directive urges government doctors to “discuss with the Veteran marijuana use, due to its clinical relevance to patient care, and discuss marijuana use with any Veterans requesting information about marijuana.”
However, the policy reiterates the department’s long-held position that “to comply with Federal laws such as the Controlled Substances Act…providers are prohibited from completing forms or registering Veterans for participation in a State-approved marijuana program.”
According to recently retired U.S. Army Lieutenant Colonel Todd Scattini, now the CEO of Harvest 360 and veteran outreach coordinator for CW Hemp, we are doing a great disservice to military veterans and active military personnel by not fully exploring the military applications of cannabis. He told us that he “sees numerous applications of the cannabis plant to include the mitigation and treatment of PTSD, TBI, and chronic pain”. He said that “when soldiers return from ‘downrange’ in combat, they are regularly prescribed drugs with serious side effects to treat the issues and ailments that result from service to nation”. He told us that side effects of many drugs prescribed to treat mental health issues can result in increased suicidal ideation, increased potential for depression, and he feels that these can often lead to the discharge of good soldiers and contribute to the high rate of suicides among veterans and active duty military personnel. Additionally, the medications prescribed for pain are often addictive opioids, which can easily result in death, or damage to the liver from over prescription of NSAIDs such as Motrin (often called ‘Ranger Candy’ in the Army). He says that he is committed to educating military leaders about the efficacy of cannabis and cannabinoid therapies. He told us that “we (soldiers) have skin in the game on this particular issue. If the Drug Enforcement Agency and the Food and Drug Administration continue to prevent studies on this plant that has so much promise, the Department of Defense should take action and begin studies on their own”. He added that his company, in cooperation with numerous industry experts and medical professionals, has developed The Athena Protocol, which is an attempt to mitigate and treat TBI using non-psychoactive cannabinoids. Since the U.S. government is unlikely to allow clinical trials of these products due to the Schedule I status of cannabis and its byproducts on the Controlled Substances Act, his company plans to conduct clinical trials in the Czech Republic.
Canadian veterans and its veteran health care system
As of March 2017, the total estimated veteran population in Canada, both war service veterans and Canadian Armed Forces veterans, is 658,400.
Veterans Affairs Canada provides a wide range of services for the country’s veterans and for their families, including financial support and health and well-being programs. VAC has also partnered with Medavie Blue Cross, which is in charge of registering health care service providers and processing claims for payment to these providers.
According to studies on the mental health of veterans in Canada, while a majority of them are doing well, a number are still affected by mental problems such as PTSD, depression, and operational stress injuries.
To help with this problem, the VAC and the Mental Health Commission of Canada teamed up to provide the veteran community with mental health first aid courses.
Veteran access to medical cannabis in Canada
What’s more, the VAC also established an exceptional approval process for those veterans who have been authorized to consume more than 3 grams of cannabis per day. The department has also fixed a reimbursement rate of up to C$8.50 per gram of cannabis in order to ensure that the amount veterans are charged as well as the amount the VAC reimburses is fair market value price.
Just recently, the government held a month-long series of consultations with veterans on how the excise duty is going to be applied to cannabis.
Comparison between U.S. and Canada
Many people tend to compare the state of health care services for veterans in the U.S. and veterans in Canada, especially in terms of their ability to access medical cannabis as an alternative treatment option. But, really, there is no point of comparison. The numbers alone do not warrant this. Canada’s veterans make up only around 3 – 4 per cent of the United States’ total number of vets. A smaller number of veterans means less funding needed for health care and other veteran services.
Moreover, the two countries have different approaches to war. So the experiences between U.S. vets and Canadian vets are different. These varying experiences also mean varying factors that affect mental health. And it is not something that people outside the scientific community have the authority and the know-how to discuss.
Additionally, the U.S. and Canada have different cannabis policies, and this definitely adds another layer to the complexities of their respective health care system.
To put things simply, comparing the state of veteran health care in the two countries is more complicated than saying which one is better than the other. It goes beyond seeing which country takes better care of its veterans. There are so many factors to consider and it should be looked at in a more comprehensive manner, where scientific methodology is applied.