REPUBLICANS DEMOCRATS DAVID P. ROE, TENNESSEE, CHAIRMAN TIM WALZ, MINNESOTA, RANKING GUS BILIRAKIS, FLORIDA MARK TAKANO, CALIFORNIA MIKE COFFMAN, COLORADO JULIA BROWNLEY, CALIFORNIA BRAD WENSTRUP, OHIO ANN KUSTER, NEW HAMPSHIRE AMATA RADEWAGEN, AMERICAN SAMOA BETO TEXAS MIKE BOST, ILLINOIS ?og. 1901159 Uf Repregentatlh BE KATHLEEN RICE. NEW YORK BRUCE POLIOUIN, MAINE J. LUIS CORREA, CALIFORNIA NEAL DUNN, FLORIDA JODEY ARRINGTON, TEXAS COMMITTEE ON AFFAIRS ISLANDS JOHN RUTHERFORD, FLORIDA PETERS, CALIFORNIA CL GINS, IANA AV ONE HUNDRED FIFTEENTH CONGRESS JACK BERGMAN, MICHIGAN JIM BANKS, INDIANA JENNIFFER GONZALEZ-COLON, PUERTO RICO 335 CANNON HOUSE OFFICE BUILDING RAY KELLEY WASHINGTON, DC 20515 October 26, 2017 JON. TOWERS, STAFF DIRECTOR The Honorable David Shulkin Secretary Department of Veterans Affairs 810 Vermont Avenue, Northwest Washington, DC 20240 Dear Secretary Shulkin, In 1925, Congress established the Veterans Health Administration Of?ce of Research and Development (0RD), in order to facilitate the Department of Veterans Affairs? (VA) ful?llment of its research and development program?s mission ?to discover knowledge and create innovations that advance health care for Veterans and the Nation.?' This letter is a request for 0RD to ful?ll its stated mission by conducting and examining research on medical marijuana?s effects on veterans suffering from chronic pain and post-traumatic stress disorder (PTSD). According to a 2014 report by Of?ce of Inspector General (VAOIG), in 2012, opioid based treatments were provided to 7.7 percent of patient population, and of patient population prescribed opioids for the treatment of chronic pain, 1 out of every 5 patients had been diagnosed with PTSD. VAOIG also found approximately 13 percent of veterans prescribed opioids have formed an addiction to the drug.ll As a response to the opioid epidemic, Congress passed The Comprehensive Addiction and Recovery Act (CARA) which directed VHA to continue its efforts to reduce VHA reliance on opioid medication for pain management by implementing safer prescribing and monitoring practices. In July of 2017, the House Committee on Veterans? Affairs held a roundtable to discuss the impact of CARA on the veteran population and whether resulting actions were suf?cient to reduce opioid reliance and addiction. Attendees of that roundtable, including Members of Congress and representatives from Veteran Service Organizations (VSOs), expressed concerns regarding veterans? lack of access to alternatives to opioid-based treatments such as complementary and alternative medicine including medical marijuana and its cannabinoids. VA is uniquely situated to pursue research on the impact of medical marijuana on veterans suffering from chronic pain and PTSD given its access to world class researchers, the population it serves, and its history of overseeing and producing research resulting in cutting-edge medical treatments. Currently, 26 states and the District of Columbia, Guam, and Puerto Rico offer access to medical marijuana for those with physician recommendations. While data is limited, it has been reported that an estimated 9% of the veteran population currently use marijuana and 41% of those veteran users reported having used marijuana medically. This is more than double DEMOCRATIC STAFF DIRECTOR the percentage of civilians using marijuana for medicinal pursuit of research into the impact of medical marijuana on the treatment of veterans diagnosed with PTSD who are also experiencing chronic pain is integral to the advancement of health care for veterans and the Nation We ask VA to respond, in kind, with a commitment to the development of VHA-led research into this issue. If VA is unable to make this commitment, we ask VA to outline any and all external and internal barriers to the pursuit of the research to the House Committee on Veterans? Affairs by November 2017. Thank you for your consideration of this request, if you have any questions please email Megan Bland at megan.bland@n1ail.house.gov. Tim Walz ark Takano United States United States auliaI;rtrtilmley1 Ann McLane Kust?r Umted States House of Representatives United tates House of Representatives O?Qowkg. Beto O?Rourke ouse of Representatives 1: of Representatives I Kathleen Rice United States House of Representatives nited es Hou of Representatives - doe. Luis?Con?ea United States House of Representatives RWAM Elizab sty a? Unite tates House of Represen ves Gregorio Kilili C?naeho Sablan United States He of Re esentatives Scott Peters United States House of Representatives Department of Veterans Affairs, Veterans Health Administration, Research and Development Program, VHA DIRECTIVE 1200, May 13, 2016, p.1. ii Of?ce of Healthcare Inspections, Department of Veterans Affairs Of?ce of Inspector General, Healthcare Inspection VA Patterns of Dispensing Take-Home Opioids and Monitoring Patients on Opioid Therapy, May 14, 2014. Davis, Lin, IIgen, and Bohnert (2017). Recent cannabis use among Veterans in the United States: Results from a national sample. Addictive Behaviors, Abstract retrieved from ScienceDirect Abstract database.