The U.S. Department of Veterans Affairs (VA) is looking for contractors to analyze and explain scientific evidence on medical marijuana to clinicians and the general public as part of VA’s Systematically Testing the Evidence of Marijuana (STEM) project.

The work aims to evaluate and allow VA to more clearly communicate cannabis’s potential benefits for conditions like PTSD as well as potential risks around cannabis use disorder and consumption during pregnancy.

On Thursday, the federal agency filed a request on a U.S. General Services Administration website for price quotes from qualified contractors, which follows an initial “sources sought” notice on the planned marijuana science review that VA published last month. The latest filing provides additional details about the scope of work and sets a May 15 deadline for responses.

VA says there are three main goals of the STEM project

1. Educate clinicians about the evidence, and its quality, regarding the benefits and harms of cannabis in order to facilitate discussions with their patients
2. Identify specific research gaps to help researchers design high-yield studies that will advance the field
3. Provide resources for patients and the general public about cannabis-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.

For each of those topics, the new posting says, the contractor “will work with a medical librarian to execute a search strategy to identify all newly eligible studies for the topic.” Two researchers will then “independently screen all titles and abstracts” as well as the full text of the documents.

Researchers will then summarize the methods and findings of the eligible studies as well as evaluate them based on quality of evidence and risk of bias.

Those findings, combined with an separate analysis of only randomized controlled trials a topic, would be put into a report, which would be peer reviewed by at least two other independent researchers from that field. Based on feedback, “this review will then turn into a living review, in which the Contractor will develop methods to ensure it is rapidly updated, when needed.”

Work on the project would begin in July of this year, the posting says, and run through the end of next June. The option year would run from July 1, 2026 through June 30, 2027.

Contractors need to “demonstrate 10+ of years’ robust experience in information technology, systematic literature surveillance, systematic review methodology, meta-analysis, and the synthesis of evidence working on government research projects similar in scope,” the new filing says.

The principal investigator for the project is Devan Kansagara, a professor of medicine at Oregon Health and Science University and an internal medicine doctor in the VA Portland Health Care System.

As VA explained in its earlier filing, the new document notes that about 9 percent of military veterans reported using cannabis in the past year, and about 40 percent of those said they used marijuana to treat medical conditions. The trouble comes when veterans try to talk to VA doctors about use of the drug.

“In short, clinicians will encounter patients who are using cannabis or who have questions about using cannabis,” the notice says. “Discussions about cannabis are challenging in part because evidence examining the benefits and harms of cannabis is growing and changing rapidly, and because of the variability in the way the existing evidence base has been interpreted.”

“Currently,” it adds, “there is no comprehensive, independent, updated cannabis evidence resource for the health care sector that synthesizes what is known from research and what is left to learn.”

VA’s existing STEM website is a collaborative project between the federal agency and Oregon Health & Science University’s Center for Evidence-Based Policy. It’s funded by VA’s Office of Rural Health.

VA notes that a quarter of U.S. veterans live in rural areas, meaning “the number of rural Veterans using cannabis is substantial.” 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.”

Earlier this year, a separate federally funded study found that 40 percent of military veterans suffering from chronic pain reported using marijuana to treat symptoms.

Most said it helped them deal with pain, mobility and sleep issues, while substantial numbers of veterans also say they used cannabis for PTSD, anxiety and stress. Nearly all participants (98 percent) said healthcare providers should discuss the use of natural products with their patients.

Authors from the University of California, San Francisco, and Yale University noted that the percentage of respondents reporting cannabis use “may represent under-reporting related to the prohibition on cannabis prescribing in the VA as a federal health care system.”

Notably, only about half of respondents overall said they’d discussed natural product use with their healthcare providers. Authors noted, however, that “clinicians and pharmacists generally lack knowledge about NPs, which explains why they may avoid discussions about NPs with their 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.

“Currently,” said Allison Jaslow, CEO of Iraq and Afghanistan Veterans of America (IAVA), “veterans who live in states where cannabis has been legalized completely are unable to even be prescribed cannabis for medicinal purposes by their doctor” 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 would also be allowed for the first time to issue such recommendations.

Aside from that legislation, there have been veterans-focused cannabis measures already filed in 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. The paper also said select mixtures of cannabinoids could help minimize undesirable effects of cannabis, such as the psychoactivity of THC.

Published in the journal Medical Cannabis and Cannabinoids and authored by researchers at Penn State College of Medicine, that paper reviewed “the most recent evidence supporting the use of cannabis in the treatment of chronic pain disorders including chronic neuropathic pain, cancer-induced neuropathic pain, chronic musculoskeletal pain, and chronic 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.

The analysis “was able to determine, using causal inference techniques, that use of medical marijuana for chronic pain under medical supervision is at least as effective and potentially more effective in relationship to patients with chronic pain treated by prescription medications (nonopioid or opioid),” said the report, by authors at the University of Pittsburgh, Harvard Medical School and the National Cancer Institute.

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.

“These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases,” authors of that report wrote, noting that there “appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries.”

Other recent research also showed a decline in fatal opioid overdoses in jurisdictions where marijuana was legalized 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. Authors estimated that recreational marijuana legalization “is associated with a decrease of approximately 3.5 deaths per 100,000 individuals.”

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. Overall, results of the study indicated that “cannabis has a substantial role to play in pain management and the reduction of opioid use,” it said.

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. Most of that group said they used cannabis as a substitute for other pain medications, 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.

Other recent research also indicates that cannabis may be an effective substitute for opioids in terms of pain management.

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.

The large-scale study of nearly 10,000 patients also shows that nearly a quarter who were taking other pain relievers reduced the use of those drugs after using medical marijuana.

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.

VA Secretary Tells Trump About Psychedelics’ Potential To Combat Military Veteran Suicide Crisis At Cabinet Meeting

Delaware’s plan to commence adult-use cannabis sales is moving forward once again after getting sidetracked by a federal-state misalignment, yet a technical issue still exists.

The state’s Office of the Marijuana Commissioner (OMC) announced May 5 that it received a fingerprint service code from the Federal Bureau of Investigation (FBI) to perform required background checks on those applying for adult-use business licenses.

In late March, the OMC had informed the public that the FBI had rejected its revised application for the services code to initiate Delaware’s statutorily required criminal history reports on individuals aspiring to enter the forthcoming marketplace. The FBI had notified state cannabis regulators that Title 4 of the Delaware Code was too vague regarding who would be required to obtain the background checks.

Delaware lawmakers filed a legislative fix, House Bill 110, on April 3 to align the state code with FBI standards. Gov. Matt Meyer signed the bill on April 24, allowing the OMC to return to the FBI with revised language for the service code.

The OMC announced Monday that the FBI partially approved the revised language and issued the fingerprinting code for selected applicants.

“Fingerprint-based background checks are a vital part of ensuring public safety and maintaining the integrity of the program,” OMC Acting Marijuana Commissioner Paul Hyland said. “We appreciate the FBI’s collaboration and are excited that selected applicants can continue moving forward.”

While the OMC will contact selected applicants this week with the next steps in the process, the state’s cannabis regulators also have to return to the General Assembly to resolve a still existing “technical” issue. The FBI rejected the term “agent” as being overly broad in the Title 4 code’s revised language.

Those required to complete the background checks include:

1. An applicant for a cannabis establishment license;
2. A person who performs work at or for a cannabis establishment, whether classified as a contractor, employee or volunteer, with or without compensation, and prior to beginning work;
3. A person who is or seeks to become a director, officer, board member or agent of a licensed cannabis establishment or a business entity that is an applicant for a cannabis establishment license; and
4. A person who holds an ownership interest of 10% or more in a licensed cannabis establishment or a business entity that is an applicant for a cannabis establishment license.

Delaware Rep. Ed Osienski, D-Newark, who sponsored the state’s push for adult-use legalization as well as H.B. 110, said in a public statement May 5 that he appreciated his fellow lawmakers and the governor for working expeditiously to support his legislative fix for the service code.

“This means we’re one step closer to getting the legal adult-use cannabis industry up and running,” he said. “Delawareans have waited long enough for a safe, legal adult-use market, and I’m glad to see that implementation is getting back on track.

“I also want to recognize the many entrepreneurs, especially from communities that have long been left behind, who have already invested a significant amount of time and resources into the industry. They’ve waited patiently, and I’m hopeful they’ll soon be able to open their doors, create jobs, and help build a strong, well-regulated market.”

The setback from the FBI came two years after former Gov. John Carney allowed complementary adult-use legalization bills to go into effect without his signature in April 2023.

The OMC had tentatively planned to commence the adult-use marketplace in March 2025 under former Marijuana Commissioner Rob Coupe, who resigned in January after the office held lotteries to award 125 conditional adult-use licenses in late 2024.

State regulators can’t formally issue those licenses—to 60 cultivators, 30 manufacturers, 30 retailers and five testing laboratories—until the background checks are performed.

“Delaware’s recreational cannabis industry is going to create good-paying jobs and provide critical revenue for the state to help pay for schools, housing and health care,” Meyer said last month when he signed H.B. 110 into law.

The state expects tens of millions of dollars in annual revenue from a 15% excise tax imposed on adult-use cannabis sales, with part of that revenue going toward funding justice reinvestment initiatives.

Nebraska lawmakers are set to reconsider a bill to implement the voter-approved medical cannabis program, WOWT reports. The move comes two weeks after the General Affairs Committee voted against advancing the legislation.  

Lawmakers will consider the new proposal after reaching a compromise to allow medical cannabis obtained through the state program to be only vaporized and not smoked, and retain the current state law for smoking cannabis flower. The compromise also keeps post-traumatic stress disorder off the list of qualifying conditions for program access.

In a statement, Crista Eggers with Nebraskans for Medical Marijuana called the development “a huge win.”

“As advocates we believe today was a huge win that shows lawmakers are recognizing the important of listening to the vote of the people, and being willing to engage in dialog on the issue. We do not know what the path forward will look like, however after fighting for over a decade, seeing the day that a strong bill that adheres to the will of the people, while also ensuing safeguards and regulations to support a good medical program for the state as a whole, is a huge step forward.” — Eggers, in a statement, via WOWT

Last November, 67% of Nebraska voted in favor of the reforms. Lawmakers are planning a series of public meetings on implementing the law.

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