```

[House Report 115-690]
[From the U.S. Government Publishing Office]

115th Congress    }                                     {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                     {     115-690

======================================================================

 
               VA MEDICINAL CANNABIS RESEARCH ACT OF 2018

                                _______
                                

  May 18, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 5520) to authorize the Secretary of Veterans 
Affairs to use the authority of the Secretary to conduct and 
support research on the efficacy and safety of medicinal 
cannabis, and for other purposes, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill as Reported.............     7

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``VA Medicinal Cannabis Research Act of 
2018''.

SEC. 2. CONDUCT OF RESEARCH INTO EFFECTS OF CANNABIS ON HEALTH OUTCOMES 
                    OF CERTAIN VETERANS.

  (a) Research.--In carrying out the responsibilities of the Secretary 
of Veterans Affairs under section 7303 of title 38, United States Code, 
the Secretary may conduct and support research relating to the efficacy 
and safety of forms of cannabis described in subsection (c) on the 
health outcomes of covered veterans diagnosed with chronic pain, post-
traumatic stress disorder, and other conditions the Secretary 
determines appropriate. The Secretary shall ensure that such research 
is conducted in accordance with applicable regulations relating to the 
oversight of research, including such regulations prescribed by the 
Office of Research and Development of the Department of Veterans 
Affairs, the Department of Health and Human Services (including through 
the National Institute on Drug Abuse), the Food and Drug 
Administration, the Drug Enforcement Administration, and the National 
Institutes of Health.
  (b) Data Preservation.--Research conducted pursuant to subsection (a) 
shall include a mechanism to ensure the preservation of all data, 
including all data sets, collected or used for purposes of the research 
required by subsection (a) in a manner that will facilitate further 
research.
  (c) Forms of Cannabis To Be Researched.--The forms of cannabis 
described in this subsection are--
          (1) varying forms of cannabis, including--
                  (A) full plants and extracts;
                  (B) at least three different strains of cannabis with 
                significant variants in phenotypic traits and various 
                ratios of tetrahydrocannabinol and cannabidiol in 
                chemical composition; and
                  (C) other chemical analogs of tetrahydrocannabinol; 
                and
          (2) varying methods of cannabis delivery, including topical 
        application, combustible and non-combustible inhalation, and 
        ingestion.
  (d) Implementation.--If the Secretary conducts and supports research 
under subsection (a), the Secretary shall--
          (1) before conducting and supporting such research, develop a 
        plan to implement this section and submit such plan to the 
        Committees on Veterans' Affairs of the House of Representatives 
        and the Senate; and
          (2) issue any requests for proposals the Secretary determines 
        appropriate for such implementation.
  (e) Reports.--During the five-year period beginning on the date of 
the enactment of this Act, the Secretary shall submit periodically, but 
not less frequently than annually, to the Committees on Veterans' 
Affairs of the House of Representatives and the Senate reports on--
          (1) the implementation of this section; or
          (2) the rationale of the Secretary with respect to 
        determining not to implement this section.
  (f) Covered Veteran Defined.--In this section, the term ``covered 
veteran'' means a veteran who is enrolled in the patient enrollment 
system of the Department of Veterans Affairs under section 1705 of 
title 38, United States Code.

         AMENDMENT TO H.R. 5520 OFFERED BY MR. WENSTRUP OF OHIO

  Page 2, line 4, strike the subparagraph heading and insert 
``Research.--''.
  Page 2, line 11, after the period insert the following new 
sentence: ``The Secretary shall ensure that such research is 
conducted in accordance with applicable regulations relating to 
the oversight of research, including such regulations 
prescribed by the Office of Research and Development of the 
Department of Veterans Affairs, the Department of Health and 
Human Services (including through the National Institute on 
Drug Abuse), the Food and Drug Administration, the Drug 
Enforcement Administration, and the National Institutes of 
Health.''.
  Page 3, strike lines 6 through 21 and insert the following 
new subsections:
  (d) Implementation.--If the Secretary conducts and supports 
research under subsection (a), the Secretary shall--
          (1) before conducting and supporting such research, 
        develop a plan to implement this section and submit 
        such plan to the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate; and
          (2) issue any requests for proposals the Secretary 
        determines appropriate for such implementation.
  (e) Reports.--During the five-year period beginning on the 
date of the enactment of this Act, the Secretary shall submit 
periodically, but not less frequently than annually, to the 
Committees on Veterans' Affairs of the House of Representatives 
and the Senate reports on--
          (1) the implementation of this section; or
          (2) the rationale of the Secretary with respect to 
        determining not to implement this section.

                          PURPOSE AND SUMMARY

    H.R. 5520, as amended, the ``VA Medicinal Cannabis Research 
Act of 2018,'' would (1) make it clear that VA is authorized to 
conduct and support research into medicinal cannabis, (2) 
require VA to report to Congress on how it intends to exercise 
such authority, and (3) require VA to preserve all data 
collected or used for research in a manner that could 
facilitate further research. H.R. 5520, was introduced by 
Representative Timothy Walz of Minnesota on April 16, 2018.

                  BACKGROUND AND NEED FOR LEGISLATION

    In 2017, The American Legion, the nation's largest Veteran 
Service Organization, contracted with an independent public 
opinion research company to conduct a nationwide survey 
regarding veteran use and access to medical cannabis. The 
survey, conducted over two days with over 1,300 respondents and 
a +/- 3.5 percent margin of error, determined that 92 percent 
of veteran households support research into the efficacy of 
medical cannabis for mental and physical conditions and that 22 
percent of veterans are currently using cannabis to treat a 
mental condition.\1\
---------------------------------------------------------------------------
    \1\https://www.legion.org/veteranshealthcare/239814/survey-shows-
veteran-households-support-research-medical-cannabis
---------------------------------------------------------------------------
    These survey results highlight a large and growing need for 
valid scientific data and research into the safety and efficacy 
of cannabis as a medical treatment for veterans suffering 
chronic mental and physical conditions, especially as an 
alternative to treatment with opiate or other addictive or 
otherwise dangerous medications.
    As a substance listed as Schedule 1 by the Drug Enforcement 
Agency, cannabis is determined to have ``no current accepted 
medical use and a high potential for abuse.''\2\ However, there 
is no clear guidance on VA's legal authority to conduct 
research and study the possibility of an ``accepted medical 
use'' for medical cannabis.
---------------------------------------------------------------------------
    \2\United States Drug Enforcement Agency. (n.d.). Drug Fact Sheet: 
Marijuana. [PDF File].
---------------------------------------------------------------------------
    Section 2 of the bill would clarify that the Secretary of 
the Department of Veterans Affairs may conduct research on the 
medical efficacy of cannabis on veterans, requires the 
Secretary to submit annual reports to Congress on the findings 
of any research conducted using this authority, and to preserve 
all data collected using this authority for use in future 
research opportunities.

                                HEARINGS

    On April 17, 2018, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 5520.
    The following witnesses testified:
          The Honorable Beto O'Rourke, U.S. House of 
        Representatives, 16th District, Texas; The Honorable 
        Tim Walberg, U.S. House of Representatives,7th 
        District, Michigan; The Honorable Neal Dunn, U.S. House 
        of Representatives, 2nd District; Florida; The 
        Honorable Luis Correa, U.S. House of Representatives, 
        46th District, California; The Honorable Mike Coffman, 
        U.S. House of Representatives, 6th District, Colorado; 
        Louis J. Celli, Director, National Veterans Affairs and 
        Rehabilitation Division, The American Legion; Adrian M. 
        Atizado, Deputy National Legislative Director, Disabled 
        American Veterans; Sarah S. Dean, Associate Legislative 
        Director, Paralyzed Veterans of America; and Kayda 
        Keleher, Associate Director, National Legislative 
        Service, Veterans of Foreign Wars of the United States.
    Statements for the record were submitted by:
          The Elizabeth Dole Foundation; The Independence Fund; 
        Veteran Cannabis Project; Wounded Warrior Project; and 
        Iraq and Afghanistan Veterans of America.

                       SUBCOMMITTEE CONSIDERATION

    There was no subcommittee consideration of H.R. 5520.

                        COMMITTEE CONSIDERATION

    On May 8, 2018, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 5520, as 
amended, favorably reported to the House of Representatives by 
voice vote. During consideration of the bill, the following 
amendment was considered and agreed to by voice vote:
          An Amendment to H.R. 5520 offered by Representative 
        Brad Wenstrup of Ohio, the Chairman of the Subcommittee 
        on Health.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 5520, 
as amended, reported to the House.

                      COMMITTEE OVERSIGHT FINDINGS

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to permit the federally-regulated 
study into the safety and efficacy of medical cannabis for 
treatment in veterans with mental and physical conditions, 
while ensuring VA is required to follow established federal, 
clinical and scientific guidelines.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 5520, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
5520, as amended, prepared by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 5520, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                       Washington, DC, May 9, 2018.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 5520, the VA 
Medicinal Cannabis Research Act of 2018.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

H.R. 5520--VA Medicinal Cannabis Research Act of 2018

    H.R. 5520 would allow the Department of Veterans Affairs 
(VA) to conduct and support research related to the use of 
medical cannabis in the treatment of veterans with chronic 
pain, post-traumatic stress disorder, and other health 
conditions. The bill would codify VA's existing authority to 
conduct such research. On that basis, CBO estimates that 
implementing H.R. 5520 would cost less than $500,000 over the 
2019-2023 period, primarily to prepare and submit the necessary 
reports to the Congress. That spending would be subject to the 
availability of appropriated funds.
    Enacting H.R. 5520 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 5520 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    H.R. 5520 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Leo Lex, Deputy Assistant Director 
for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 5520, as amended, prepared by the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
5520, as amended.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 5520, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 5520, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act of 1995.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 5520, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                   DISCLOSURE OF DIRECTED RULEMAKING

    Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), 
the Committee estimates that H.R. 5520, as amended, contains no 
directed rulemaking that would require the Secretary to 
prescribe regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill would provide the short title for 
H.R. 5520, as amended, as the ``VA Medicinal Cannabis Research 
Act of 2018.''

Section 2. Conduct of research into effects of cannabis on health 
        outcomes of certain veterans

    Section 2(a) of the bill would provide the authority for 
the Secretary of Veterans Affairs to conduct and support 
research into the efficacy and safety of cannabis on the health 
outcomes of covered veterans diagnosed with chronic pain, PTSD, 
and other conditions the Secretary may deem appropriate. This 
section also requires authorized research to comply with all 
established federal guidelines and regulations.
    Section 2(b) of the bill would require all research data 
authorized and conducted under section 2(a) to be preserved in 
a manner that will facilitate further research.
    Section 2(c) of the bill outlines which forms of cannabis 
are eligible for research, including (1) full plants and 
extracts; (2) at least three different strains of cannabis with 
significant variations of phenotypic traits and various rations 
of THC and CBD (the active ingredients in cannabis); and, (3) 
other chemical analogs of THC. This section also outlines the 
methods of delivery for research, including topical 
application, combustible and non-combustible inhalation, and 
ingestion.
    Section 2(d) of the bill requires the VA, prior to 
conducting any research authorized by this section, to inform 
Congress of its plan to conduct such research and issue any 
requests for proposals the Secretary deems appropriate.
    Section 2(e) of the bill requires VA to submit periodic 
reports to Congress on (1) the implementation of this section 
and (2) the rationale of the Secretary with respect to 
determining not to implement this section.
    Section 2(f) defines the term ``covered veteran.''

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]
```