For many U.S. veterans, chronic musculoskeletal pain, neuropathic pain, and the lingering effects of trauma collide with the risks of long-term opioid therapy. As overdose deaths and dependency concerns mounted over the last decade, interest grew in whether medical cannabis could substitute for—or at least reduce—opioid exposure. Emerging evidence suggests potential, but the picture is nuanced and policy constraints remain.

First, there is credible evidence that cannabinoids can relieve certain kinds of chronic pain in adults. The National Academies’ landmark review concluded there is “conclusive or substantial” evidence for cannabis or cannabinoid efficacy in chronic pain, forming a scientific basis for trialing cannabis when standard therapies fail or cause harm; the same report urged stronger studies on dose, formulations, and long-term safety.

Among veterans specifically, the data are mixed. A national Veterans Health Administration (VHA) study found that cannabis use among veterans already prescribed opioids varied sharply by state legalization status; veterans with PTSD or substance use disorders were more likely to test positive for cannabis—signaling both demand and clinical complexity. Meanwhile, a JAMA Network Open cohort of veterans receiving opioid therapy found that cannabis use was not associated with reduced mortality or acute care utilization, underscoring that “substitution” is not automatically protective and should be clinically supervised.

Policy is another brake and accelerator. Because cannabis remains Schedule I federally, VA clinicians cannot prescribe it, and the VA does not pay for it. Veterans, however, will not lose benefits for state-legal use and are encouraged to discuss cannabis openly so care plans can be adjusted. In July 2025, the House approved language that would allow VA doctors to recommend cannabis in legal states, but as of October 14, 2025, that measure is not final law; veterans should verify current policy before making care decisions.

So where does this leave substitution? Pragmatically, medical cannabis may help some veterans taper from high-risk opioid regimens or avoid dose escalation—particularly for neuropathic pain, sleep disruption, and anxiety that can amplify pain. Qualitative work with people who use opioids describes cannabis easing withdrawal symptoms, cravings, and anxiety, which may support patient-led “opioid-sparing” strategies; at the same time, population-level analyses remain mixed, and one recent analysis associated legalization with increased prevalence of opioid use disorder—an important caution against broad claims.

A careful path forward combines harm reduction with shared decision-making:

• Screen for PTSD, depression, and substance use disorder; integrate behavioral therapies.
• If trialing cannabis, start with low-THC or balanced THC:CBD products, go slow, favor non-inhaled routes for older adults, and set functional goals (sleep, activity, pain-interference scores).
• Review opioid risks, naloxone access, and taper plans; monitor for sedation, falls, and drug–drug interactions.
• Watch for cannabis use disorder—rates can be meaningful among older veterans who use frequently—and adjust potency and frequency accordingly.

Finally, context matters: within the VHA, diagnosed opioid use disorder peaked in 2017 and has declined modestly since, reminding us that multiple levers—prescribing reforms, medication-assisted treatment, and mental-health care—shape outcomes. Cannabis may be one more tool, best deployed within coordinated pain programs rather than as a standalone cure.

Bottom line: cannabis is not a universal replacement for opioids, but for select veteran subgroups it can be a viable adjunct—or, for some, a substitute—inside a monitored, multidisciplinary plan. Precision (right patient, right product, right dose), clear goals, and honest risk-benefit conversations are as vital as policy progress and monitoring.