“They cannot currently help a veteran access cannabis through official channels. This is not a gray area. It is a bright line that shapes every clinical interaction.”
By Mike Davis, Veterans Action Council
What happens when a veteran sits down with a clinician in a U.S. Department of Veterans Affairs (VA) medical center and mentions cannabis?
For years, that moment carried uncertainty, even fear. Veterans worried about losing benefits, being arbitrarily labeled or having their medical care restricted and their needed pain medicine denied. Providers, in turn, often navigated a gray zone between federal law, seemingly conflicting policies, evolving science and patient reality.
This article is the second installment in an ongoing Veterans Action Council (VAC) series examining internal VA cannabis policies obtained through Freedom of Information Act (FOIA) requests and what those documents reveal about veterans’ access to medical cannabis.
Today, cannabis-related interactions between veterans and VA providers are more defined, not because policy has liberalized within the department, but because it has been formalized, the documents show.
At the center of that structure is Veterans Health Administration (VHA) Directive 1315, which governs how providers interact with veterans about cannabis. It is supported by internal educational materials, including a Cannabis Provider Education Packet and policy slide decks obtained through VAC FOIA disclosures.
These documents do not change the law, but they do reveal different perspectives of what the law actually requires. The first medical cannabis state initiative, California’s Proposition 215, passed in 1996, inspired many doctors inside VA to seek guidance from the department’s Office of General Counsel (OGC) about medical cannabis.
A 2008 opinion from VA OGC cites an informal communication from the Department of Justice (DOJ) that warned that it “may seek civil or criminal penalties for federal physicians and practitioners who completed forms that either recommend the use of medical marijuana or forms that describe the patient’s physical condition in order to facilitate the patient’s procurement of medical marijuana pursuant to state law.”
The VA operationalized this DOJ interpretation, records show. And in doing so, it shapes exactly what veterans experience in the exam room every day.
The Script Behind The Conversation
The VA’s guidance to providers can be distilled into four core directives:
- Discuss cannabis use openly
- Document it in the medical record
- Do not fill out the needed recommendation for veterans’ access in state medical cannabis programs
- Remind veterans they are subject to arrest for cannabis possession while on federal VA medical center property
At the same time, the policy is explicit on a fifth point: Veterans are not to be denied VA care solely for cannabis use.
On paper, this appears balanced. In practice, it creates a very specific tone within the clinic, one that VAC believes veterans should clearly understand.
When a veteran discloses cannabis use, providers are trained to respond in a structured, clinical manner. The emphasis is on screening: frequency, quantity, method of use and potential signs of Cannabis Use Disorder (CUD). Providers are encouraged to assess interactions with other medications, mental health conditions and overall functioning.
This is not a casual conversation. From VA’s perspective, this is about safety and continuity of care. From the veteran’s perspective, it can feel like being interrogated rather than being heard.
What Providers Are Told Not to Do
The most rigid boundary in VA’s cannabis policy remains unchanged: providers cannot complete paperwork to recommend cannabis for state medical cannabis programs. This prohibition is rooted in cannabis’s status as a Schedule I controlled substance and dates back to when DOJ warned VA physicians that recommending cannabis could be viewed as effectively aiding and abetting illegal activity.
The landmark federal case Conant v. McCaffrey later established that physician recommendations are protected speech and an integral part of the doctor-patient relationship. Yet VA physicians were never formally informed of the implications of the case, nor has DOJ ever publicly withdrawn its original threat.
As discussed in the first article in this series, a move of cannabis from Schedule I to Schedule III could significantly alter the legal foundation for VA’s current prohibition. Internal VA documents obtained by VAC indicate that department officials have already acknowledged that rescheduling may enable VA providers to complete state medical cannabis recommendation forms.
At the same time, those documents suggest that the department’s broader clinical posture toward cannabis, particularly within mental health settings, would not automatically shift simply because of rescheduling.
For veterans, this creates a disconnect that is difficult to ignore. In many states, cannabis is a legal therapeutic option. Outside the VA system, physicians can recommend it, guide its use and integrate it into treatment plans. Inside VA, providers must stop short of that line.
They can discuss cannabis up to a point where such a discussion might be interpreted as a recommendation. They can document cannabis use. But they cannot currently help a veteran access cannabis through official channels. This is not a gray area. It is a bright line that shapes every clinical interaction.
The “Do Not Deny Care” Clause And Its Limits
One of the most important protections in Directive 1315 is the prohibition against denying care based solely on cannabis use. This provision did not emerge in a vacuum. It reflects years of advocacy by veterans, including leaders within the VAC, who fought to ensure that honesty about cannabis would not come at the cost of treatment.
Before this policy existed, the reality was far harsher. Veterans were removed from pain management programs, flagged in ways that affected prescribing decisions or discouraged from discussing cannabis at all. The culture was punitive.
Directive 1315 changed that.
If a doctor is told by policy that they can freely discuss cannabis use as long as the doctor’s words, or printed clinical notes, cannot be interpreted as a recommendation, how does the doctor handle this?
It is the experience of many veterans that when they discussed medical cannabis under Directive 1315, only negative things about cannabis would be documented in their files. Absolutely no positives, which can then lead to veterans being labeled as having CUD and being denied access to pain medication or facing other implications.
One outcome of this lack of clear systemic medical guidance for physicians is that it leaves room for doctors to act inappropriately by injecting their own beliefs. This outcome varies for veterans depending on the VA facility they visit. Treatment by geography does not work.
Education Packets And The Framing Of Risk
The Cannabis Provider Education Packet that VAC obtained via FOIA plays a critical role in shaping how providers interpret and communicate about cannabis. These materials rely heavily on evidence synthesis, meta-analyses, systematic reviews and position statements from organizations such as the American Psychiatric Association. The framing is consistent: cannabis carries risks, particularly in mental health contexts.
Providers are taught to focus on potential harms, including dependency, cognitive effects and exacerbation of psychiatric conditions. What is less emphasized, and often absent, is any real-world clinical nuance. Many veterans report using cannabis to manage chronic pain, PTSD symptoms or sleep disturbances—but acknowledging any of these motivations starts looking like a recommendation.
These lived experiences do not fit neatly into the risk-focused framework presented in VA materials. As a result, the conversation inside the clinic can feel very one-sided. A veteran may describe relief. A provider, following guidance, responds with caution. Both perspectives are real. But only one is institutionally reinforced.
Humanizing The Policy
Policy documents are sterile by design. They speak in directives, not dialogue. But their impact is deeply human.
Imagine a veteran sitting across from a VA clinician: They mention cannabis use, perhaps hesitantly. The provider asks structured questions and documents responses. They explain that they cannot recommend cannabis or assist with state certification. They may discuss risks, particularly related to mental health. They reassure the veteran that care will continue regardless.
This is the interaction Directive 1315 was built to standardize. It is safer than in the past. It is clearer than the past, but it is not fully aligned with the reality that many veterans live in today.
There is also a disconnect within VA where the top administrators in Washington, D.C. expect doctors in the field to take their guidance with a grain of salt, focus on the medical standards of care and their medical training and not defer to “some memo.”
Still, medical professionals working in VA hospitals, all too often, act like these memos are the law and must be followed even at the detriment of patient care.
The VAC Perspective
From the Veterans Action Council’s standpoint, the issue is not whether the VA should ignore risks or abandon clinical rigor. It is whether the system can evolve to meet veterans where they actually are.
Right now, VA’s approach is rooted in caution, liability and federal constraint. It relies heavily on synthesized evidence rather than VA-driven clinical trials. It prioritizes documentation over integration. And it draws a hard line at recommendation.
VAC believes that the line deserves reexamination. Veterans are not asking for reckless endorsement. They are asking for informed, honest and collaborative care—care that acknowledges both risks and benefits, and that does not artificially separate VA from the broader medical landscape.
What Veterans Should Know
If you are a veteran receiving care through VA, here is the reality of the current system:
- You can and should discuss cannabis use openly with your provider
- Your use will be documented as part of your medical record
- Your provider cannot complete the recommendation forms for cannabis under the state program
- You will not be denied VA care solely for using cannabis
Understanding this framework removes uncertainty. It allows veterans to walk into appointments informed, rather than fearful.
The Path Forward
Directive 1315 was a step forward. It replaced silence with structure and fear with defined boundaries. But it is not the final word. As cannabis policy continues to evolve nationally, the gap between federal systems and state-level realities will only become more pronounced.
VA cannot remain static in a dynamic landscape. Inside the clinic, the conversation has already changed. Veterans are speaking more openly. Providers are listening. The next step is to decide whether those limits still serve the people the system was built to care for.
Congress has taken up our effort to educate veterans and the public that the recommendation of cannabis needed to participate in state medical cannabis programs is a necessary part of the doctor-patient relationship and considered to be free speech that is being denied to our veterans.
VAC appreciates Congress’s effort to codify this reality by attempting to pass a federal law to protect VA doctors from punishment for recommending medical cannabis. However, we don’t know of any doctors who have ever been punished for it, and, in fact, the prohibition on free speech is at the core of the veterans system of care.
The issue is not whether VA physicians have free speech rights identical to those of private citizens. The issue is that veterans receiving care through VA are subject to a healthcare system in which physicians face restrictions that private-sector doctors do not. Veterans should not lose access to open and informed medical discussions simply because their healthcare provider works for the federal government.
The Conant v. McCaffrey ruling on the right of providers to recommend medical cannabis held that: “An integral component of the practice of medicine is the communication between a doctor and a patient. Physicians must be able to speak frankly and openly to patients. That need has been recognized by the courts through the application of the common law doctor-patient privilege.”
VAC asks: If VA doctors are not allowed to speak freely with their patients about matters affecting their health, should VA continue to hold primary responsibility for treating those patients at all?
At this point, we would prefer that the Veterans Equal Access Act, the legislation focused on allowing VA providers to recommend medical cannabis, be withdrawn. It has served its function of educating everyone as to the detriment of the veterans’ healthcare caused by this lack of free speech within the doctor/patient relationship.
We worry the bill could backfire. Rather than leading VA to loosen restrictions on what its doctors can say about cannabis, it might cause VA and DOJ to join forces and defend the current rules.
Mike Davis is a medically retired Army combat veteran and disabled veteran with 15 years of active-duty service and a member of the Veterans Action Council. He focuses on veterans’ access to medical cannabis, federal policy reform and government transparency. His advocacy includes Freedom of Information Act investigations, regulatory analysis and participation in international discussions on drug policy and veteran healthcare.
Read VA’s Cannabis Provider Education Packet obtained via FOIA below:
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