When he was deployed to Iraq in 2005, Army Sgt. E-5 Steven Acheson was assigned to the security detail of a high-ranking officer, driving a Humvee over IED-infested roads on more than 400 missions, as the violent insurgency tore the country apart.
During his deployment, he suffered an accident that left him with a herniated disc. He had also begun experiencing symptoms of post traumatic stress disorder (PTSD).
"Nightmares and strange things would happen in the middle of the night. I'd gouge the side of my face with my fingernails, and all kinds of interesting things were going on," Acheson, now 33, said.
His back injury went untreated, eventually requiring two surgeries. His doctors prescribed pain medication to help with his recovery.
"They just almost overnight filled me up with pills," Acheson said. "I remember getting bags of pills mailed to my front door. I didn't even have to leave my house to become a drug addict."
He left active duty in 2008 and began pursuing an engineering degree, transitioning to the Department of Veterans Affairs (VA) health system. But Acheson said he found it "almost impossible" to function while taking OxyContin, a powerful opioid.
Then he found something else that helped: marijuana. A friend on campus offered it to him, and it was like a "lightswitch going off." Eventually he was able to stop taking pain pills entirely.
But medical marijuana was and remains illegal in his home state of Wisconsin, and even in the 33 states where it is legal, patients in the VA system don't have access to it. The Food and Drug Administration classifies marijuana as a Schedule I controlled substance, the same category as heroin and ecstasy. While VA doctors can discuss marijuana use with patients, they can't recommend patients use it or help them obtain it.
The VA also won't reimburse veterans if they obtain marijuana through other means. Acheson wants that changed, arguing the VA should consider medical marijuana no different than other forms of treatment veterans obtain through private providers.
"They do it already with acupuncture. They do it already with chiropractic work. They do it already with a number of things health care related that the VA just can't provide. I don't see any reason why on a state by state basis, we can't be doing the same thing with cannabis," Acheson said.
Acheson is now the co-founder and director of the group High Ground Veterans Advocacy, and co-founder of Wisconsin Veterans for Compassionate Care. He has also become an advocate for medical marijuana in Wisconsin, where the new Democratic governor supports medical marijuana legalization and decriminalization of small amounts for recreational use.
On the federal level, there are signs that support for expanding access to medical marijuana for veterans is growing. In February, Democratic Sens. Tim Kaine of Virginia and Brian Schatz of Hawaii introduced the Veterans Medical Marijuana Safe Harbor Act to allow VA doctors to discuss and recommend medical marijuana to veterans in states where it is already legal.
In 2018, the group Iraq and Afghanistan Veterans for America (IAVA) surveyed 4,600 of its veteran members and found 55 percent of respondents said they want greater access to medical marijuana. Eighty-three percent said cannabis should be legal for medicinal purposes. About a quarter said they had used marijuana for medicinal purposes.
"Our veterans want access to the same care and options as their civilian counterparts. It is frustrating that the VA would prefer a world where those who have served their country have access to fewer treatment options than those who have not," IAVA CEO Jeremy Butler said in a statement.
A need for more research
Advocates for expanding access to medicinal marijuana say allowing and supporting research into marijuana's medicinal properties is just as important. In the IAVA survey, 72 percent of respondents said cannabis should be researched for medicinal uses, and 68 percent strongly agreed the VA should allow for cannabis research as a treatment option.
As a Schedule I drug, federal law imposes strict controls on researchers hoping to study the effects of marijuana. But there is a growing bipartisan push on Capitol Hill to expand studies into whether and how cannabis could be used by veterans to treat PTSD.
In January, Democratic Sen. Jon Tester of Montana and Republican Sen. Dan Sullivan of Arkansas introduced the VA Medicinal Cannabis Research Act of 2019, which would direct the VA to perform clinical research on the safety and efficacy of medical marijuana in treating both PTSD and chronic pain. Reps. Lou Correa, a Democrat from California, and Clay Higgins, a Republican from Louisiana, filed identical legislation in the House.
Rep. Phil Roe, the top Republican on the House Committee on Veterans Affairs, also introduced his own bill directing the VA to research the drug.
"As a doctor myself, I am a firm believer in the importance of medical research to assure that a treatment is safe and effective," Roe said. "If research on the usage of medical cannabis is favorable, I am confident that it could become another option to help improve the lives of veterans and other Americans."
Researchers say they could be close to uncovering valuable information about the efficacy of cannabis to treat PTSD. Between 11 and 20 percent of veterans who served in Iraq or Afghanistan experience PTSD symptoms in a given year, according to the VA. PTSD is linked to other mental health issues like depression, and are at higher risk for drug and alcohol abuse.
Last week, the Multidisciplinary Association for Psychedelic Studies announced the completion of the first randomized controlled trial of "whole plant" marijuana used in treating PTSD. A total of 76 veterans took part in the study, smoking four different types of marijuana to test the effect on their symptoms. Dr. Sue Sisley, the study's principal investigator, said data collected during the triple-blind study still needs to be analyzed, but said she hopes the results will be published in the coming months.
Among those awaiting the results is Dr. Marilyn Huestis, a member of the steering committee for the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia.
Huestis, a former researcher at the National Institute on Drug Abuse, said there is already evidence that medical marijuana can help with pain management. But plenty of questions remain about how and whether it can consistently help patients suffering from PTSD.
"We don't have a lot of good choices for PTSD. So finding something that would help these individuals would be tremendous," Huestis said.