As part of the VA’s Systematically Testing the Evidence of Marijuana project, the Department of Veterans Affairs is seeking contractors who can analyze and communicate scientific evidence about medical marijuana with clinicians and the public.
This work aims at evaluating and communicating cannabis’ potential benefits to conditions such as PTSD, as well as its potential risks.
The federal agency posted a “prices sought” request for qualified contractors on the website of the U.S. General Services Administration on Thursday. This follows a previous notice that VA had published in the last month regarding the planned review on marijuana science. This latest submission provides more details on the scope of the work, and establishes a deadline of May 15, for contractors to respond.
VA states that the STEM Project has three major goals.
- To facilitate conversations with patients, clinicians should be educated about cannabis and the quality of the available evidence.
- Researchers can design studies with high yields by identifying specific research gaps.
- Patients and the public can be provided with resources about marijuana-related evidence
Over a yearlong period—which could optionally be extended to two years—the contractor would conduct “literature surveillance” with the goal of creating “living systematic reviews” on five topics, including PTSD, cannabis use during pregnancy, cannabis use disorder, the treatment of cannabis use disorder and cannabis for mood disorders.
The new job posting states that the contractor will “work with a Medical Librarian to implement a search to identify any newly eligible studies on the topics.” After that, two researchers will “independently” screen the titles, abstracts and full texts.
The researchers will summarize and evaluate the findings and methods of all eligible studies, assessing them on the basis of quality evidence and bias risk.
These findings would be combined with separate analyses of only random controlled trials on a particular topic and put in a report that would be peer reviewed at least by two other independent researches from the field. On the basis of feedback received, “this review then turns into a live review in which Contractor develops methods to ensure that it is quickly updated when needed”.
According to the announcement, work would start in July this year and last until June next. The option would last from July 1, 2016 through June 30 2027.
The new application states that contractors must “show 10+ years of robust experience” in the areas of information technology, systematic surveillance of literature, systematic review methodologies, meta-analysis and the synthesis or evidence when working on similar government research projects.
Devan Kansagara serves as the primary investigator on the project. Kansagara teaches medicine at Oregon Health and Science University and is an internist in the VA Portland Health Care System.
VA’s earlier document explained that approximately 9 percent (of veterans) reported having used cannabis within the last year. About 40 percent said that they had used it to treat medical problems. When veterans attempt to speak to VA doctors regarding their use of marijuana, they run into trouble.
This notice warns that clinicians may encounter patients using marijuana or with questions about cannabis use. The notice says that discussions about cannabis can be difficult because the evidence on the harms and benefits of cannabis changes rapidly and is constantly growing.
The report states that there are no updated, comprehensive and independent cannabis resources for the healthcare sector. This is because “there’s nothing to synthesize what has been learned from research, or what still needs to be discovered.”
VA’s existing STEM website is a collaborative project between the federal agency and Oregon Health & Science University’s Center for Evidence-Based Policy. The VA Office of Rural Health funds it.
VA points out that 25% of U.S. Veterans reside in rural areas. This means, “the number is considerable of rural Veterans who are using cannabis.” The new request says the most commonly cited clinical reasons for cannabis use “are highly relevant to care of rural Veterans and Veterans in general, and include pain, PTSD, anxiety, and insomnia.”
A separate study funded by the federal government found earlier this year that 40% of veterans with chronic pain used marijuana to relieve their symptoms.
Majority of participants said cannabis helped with mobility, sleep and pain issues. A significant number also stated that it was used to relieve PTSD and anxiety. Nearly 100% of participants said that healthcare providers should talk to their patients about natural products.
The authors from Yale University and the University of California San Francisco noted that the number of respondents who reported cannabis use may be an underreporting due to VA’s prohibition of cannabis prescriptions as part of its federal health system.
Fewer than half of the respondents reported having discussed their natural products use with healthcare professionals. However, the authors note that pharmacists and doctors are often unaware of NPs. That is why many avoid discussing NPs with patients.
At a joint hearing earlier this year, meanwhile, two veterans service organizations submitted testimony voicing support for expanded access to plant-based medicines, including marijuana and psychedelics.
Allison Jaslow is the CEO of Iraq and Afghanistan Veterans of America. She said that veterans who reside in states with legal cannabis are not able to get cannabis prescribed by their doctors for medical purposes at the VA.
Jaslow said IAVA is “looking forward” to the reintroduction of a bipartisan bill—the Marijuana Safe Harbor Act—that would temporarily allow veterans to legally possess and use cannabis under federal law, as recommended by doctors in accordance with state law. VA physicians will also have the opportunity to give such recommendations, for the first.
In addition to that bill, cannabis-related measures for veterans have already been filed during the 119th Congress. That includes a bill sponsored by Rep. Brian Mast (R-FL), co-chair of the Congressional Cannabis Caucus, whose Veterans Equal Access Act would similarly allow VA doctors to recommend medical marijuana to their patients in states where it’s legal.
Other VSOs also addressed marijuana and psychedelics policy with the bicameral committees at previous hearings in February, urging lawmakers to continue to explore the alternative therapeutic options and expedite access if they’re proven to be efficacious.
Research published in 2023 found that more than 90 percent of U.S. military veterans who use medical marijuana reported that it improved their quality of life, with many using cannabis as an alternative to over-the-counter and prescription medications.
In July of last year, a Senate committee urged the VA to explore medical marijuana as an alternative to opioids for veterans, also asking the agency to consider allowing its doctors to formally recommend cannabis to their patients.
As for marijuana and chronic pain, a recently published scientific review concluded that cannabinoids may be useful treatments for various types of chronic pain, in some cases helping to reduce the use of other medications. A recent scientific review concluded that cannabinoids are useful treatments for chronic pain, and in some cases may reduce the need to use other medications.
The paper was published by Penn State College of Medicine and reviewed “the latest evidence to support the use of marijuana in the treatment of chronic disorders such as chronic neuropathic, cancer-induced, musculoskeletal, and headaches and migraines.”
Research published earlier this year in the journal Pain also found that marijuana was “comparatively more effective than prescription medications” for treating chronic pain after a three-month period, and that many patients reduced their use of opioid painkillers while using cannabis.
According to the authors of the National Cancer Institute, Harvard Medical School, and University of Pittsburgh report, the analysis was able “to determine using causal inference methods that the use of medical cannabis for chronic pain is at least equally effective, and possibly more effective, in relation to patients who have chronic pain and are treated with prescription medication (nonopioid and opioid).
A separate federally funded study found that legalization of marijuana in U.S. states is associated with reduced prescriptions for opioid pain medications among commercially insured adults—indicating a possible substitution effect where patients are choosing to use cannabis instead of prescription drugs to treat pain.
The authors wrote that “these results indicate that the substitution of marijuana for pain medication increases with increased availability of recreational cannabis.” They noted that “there appears to be a slight shift when recreational cannabis is legalized, but that we see better results after users are able to purchase cannabis from recreational dispensaries.”
Recent research has also shown a drop in the number of fatal opioid overdoses among jurisdictions that have legalized marijuana for adults. That study found a “consistent negative relationship” between legalization and fatal overdoses, with more significant effects in states that legalized cannabis earlier in the opioid crisis. According to the authors, recreational marijuana legalization is “associated with an approximate 3.5 death reduction per 100,000 persons.”
Another recently published report into prescription opioid use in Utah following the state’s legalization of medical marijuana found that the availability of legal cannabis both reduced opioid use by patients with chronic pain and helped drive down prescription overdose deaths statewide. The study concluded that cannabis has an important role in the management of pain and reduction of opioid usage.
Yet another study, published in 2023, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. And another, published by the American Medical Association (AMA) last February, found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.
About one in three chronic pain patients reported using cannabis as a treatment option, according to a 2023 AMA-published report. A majority of this group claimed to have used cannabis in place of other pain medicines, including opioids.
Other research published that year found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
A 2022 research paper that analyzed Medicaid data on prescription drugs, meanwhile, found that legalizing marijuana for adult use was associated with “significant reductions” in the use of prescription drugs for the treatment of multiple conditions.
A 2023 report linked state-level medical marijuana legalization to reduced opioid payouts to doctors—another datapoint suggesting that patients use cannabis as an alternative to prescription drugs when given legal access.
Researchers in another study, published last year, looked at opioid prescription and mortality rates in Oregon, finding that nearby access to retail marijuana moderately reduced opioid prescriptions, though they observed no corresponding drop in opioid-related deaths.
Cannabis may also be used as an effective alternative for opioids to manage pain, according to other recent studies.
A report published recently in the journal BMJ Open, for instance, compared medical marijuana and opioids for chronic non-cancer pain and found that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” potentially offering comparable relief with a lower likelihood of adverse effects.
Separate research published found that more than half (57 percent) of patients with chronic musculoskeletal pain said cannabis was more effective than other analgesic medications, while 40 percent reported reducing their use of other painkillers since they began using marijuana.
In Minnesota, meanwhile, a state government report this year on chronic pain patients enrolled in the state’s medical marijuana program said recently that participants “are finding a noticeable change in pain relief” within a few months of starting cannabis treatment.
In a large-scale, nearly 10,000 patient study, nearly a quarter of patients who previously took painkillers reduced their usage after using medical cannabis.
Another new study on the use of medical marijuana by older patients—age 50 and above—concluded that “cannabis seemed to be a safe and effective treatment” for pain and other conditions.
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