New records from the Department of Veterans Affairs show physicians are diagnosing veterans with cannabis use disorder without consistently considering whether patients are using state-authorized medical marijuana, according to an analysis by the Veterans Action Council.
The issue stems from the 2013 release of the DSM-5, which replaced separate categories for cannabis abuse and dependence with a single "cannabis use disorder" diagnosis. Etienne Fontan of the Veterans Action Council says the change has created complications for veterans using cannabis legally under state medical programs.
"Diagnoses are sometimes entered into medical records without meaningful consideration of medically authorized cannabis use," Fontan wrote in an analysis of the newly released VA records.
The Medical Records Problem
The DSM-5 criteria for cannabis use disorder include symptoms like using larger amounts over time, unsuccessful attempts to cut down, and continued use despite social or interpersonal problems. But veterans advocates argue these criteria don't adequately distinguish between problematic use and therapeutic use prescribed by state-licensed physicians.
The VA operates under federal law, which still classifies marijuana as a Schedule I controlled substance. This creates a jurisdictional gray area: veterans can legally obtain medical cannabis cards in 38 states and Washington D.C., but VA physicians cannot recommend or prescribe cannabis. The department's policy allows doctors to discuss cannabis use with patients but prohibits them from completing forms required for state medical marijuana programs.
Research indicates veterans use cannabis at higher rates than the general population, often to manage PTSD, chronic pain, and other service-connected conditions. A 2020 study in the Journal of Psychoactive Drugs found that 90% of veterans using cannabis reported it helped with PTSD symptoms.
Impact on Benefits and Care
A CUD diagnosis in a veteran's medical record can have cascading effects. The diagnosis may influence disability compensation decisions, affect eligibility for certain treatments, or complicate pain management plans. Veterans receiving VA care who test positive for THC are sometimes flagged in ways that trigger automatic CUD diagnoses, according to the Veterans Action Council analysis.
The organization obtained the records through Freedom of Information Act requests, though the specific number of affected veterans was not disclosed in the initial release.
Clinical evidence shows that diagnostic criteria developed for substance use disorders don't always translate well to medical use contexts. The American Psychiatric Association's DSM-5 includes a note that diagnoses should account for "appropriate prescribed use," but this guidance becomes murky when the prescribing happens outside the VA system.
What Advocates Want
Veterans groups are calling for the VA to update its diagnostic protocols to better distinguish between medical use and problematic use. The Veterans Action Council recommends that VA physicians document whether cannabis use is authorized under state law before entering a CUD diagnosis.
The issue gained urgency after the VA announced in 2021 that it would not deny benefits solely because of cannabis use. But advocates say CUD diagnoses can still negatively affect veterans even without explicit benefit denials.
Several bills in Congress would address the federal-state conflict, including measures to allow VA doctors to recommend medical cannabis in legal states. None have advanced to floor votes in the current session.
The VA did not immediately respond to requests for comment on its diagnostic practices or the newly released records.
This article is based on original reporting by www.marijuanamoment.net.
