Newly Released VA Records Raise Questions About How Cannabis Use Disorder Diagnoses Are Affecting Veterans

Newly released Department of Veterans Affairs records obtained through a Freedom of Information Act request are raising questions about how cannabis use disorder diagnoses are applied to veterans. The documents show that in 2022, the VA reported 139,336 veterans identified as having cannabis use disorder, while national survey data cited in the same records found only 1.8 percent of veterans who used cannabis met diagnostic criteria. Veterans advocates argue that diagnoses are sometimes entered into medical records without comprehensive clinical evaluation or meaningful consideration of medically authorized cannabis use.

Newly released Department of Veterans Affairs records obtained through a Freedom of Information Act request by the Veterans Action Council are raising questions about how cannabis use disorder diagnoses are being applied to veterans within the Veterans Health Administration. The documents, detailed in an op-ed by Etienne Fontan of the Veterans Action Council, suggest that some veterans may be receiving cannabis use disorder diagnoses without the comprehensive clinical evaluation required by the Diagnostic and Statistical Manual of Mental Disorders.

The 2013 release of the DSM-5 introduced cannabis use disorder as a new diagnosis, replacing the DSM-4 categories of Cannabis Abuse and Cannabis Dependence with a single, severity-based unified diagnosis. According to the op-ed, this consolidation widened the diagnostic net, capturing a broader range of individuals under a single label and creating circumstances in which individuals who previously would not have received a diagnosis could now be classified as having a disorder.

Internal VA records obtained through the FOIA request show that in 2022, VA correspondence reported 134,790 veterans with cannabis-positive urine drug screens and 139,336 veterans identified as having cannabis use disorder. Research cited within the same FOIA records from the National Epidemiologic Survey on Alcohol and Related Conditions found that 7.3 percent of U.S. veterans reported cannabis use in the previous year, but only 1.8 percent met DSM criteria for cannabis use disorder.

The FOIA records also reveal that VA officials recognized the complexity of the issue. In one email, VA Office of Research and Development Media Branch Chief Bruce I. Friedland acknowledged the need to thread a needle between addressing genuine cannabis-related substance use disorders and supporting research into cannabis as a potential therapeutic treatment. Additional correspondence from UCSF physician Dr. Salomeh Keyhani recommended that veterans identified through urine drug screening be individually assessed for high-risk cannabis use and offered treatment when appropriate.

VA research contained in the FOIA materials also found that nearly one third of reviewed patient records contained no documented discussion of cannabis between providers and patients. Of those that did, nearly half involved medical cannabis use rather than discussions of risks or harm reduction. These findings reinforce the importance of patient-provider dialogue and individualized clinical judgment before assigning a psychiatric diagnosis, according to the op-ed.