“Don’t ask, don’t tell” is how many veterans have approached health care conversations about marijuana use with the doctors they see from the Department of Veterans Affairs.

Worried that owning up to using the drug could jeopardize their VA benefits — even if they’re participating in a medical marijuana program approved by their state — veterans have often kept mum. That may be changing under a new directive from the Veterans Health Administration urging vets and their physicians to open up on the subject.

The new guidance directs VA clinical staff and pharmacists to discuss with veterans how medical marijuana could interact with other medications or aspects of their care, including treatment for pain management or post-traumatic stress disorder.

The directive leaves in place a key prohibition: VA providers are still not permitted to suggest veterans try state-approved medical marijuana programs, because the drug is illegal under federal law.

Veterans wary

That disconnect makes veterans wary, said Michael Krawitz, a disabled Air Force veteran in Ironto, Va., who takes oxycodone and marijuana to treat extensive injuries he suffered in a motorcycle accident while stationed in Guam in 1984.

“Vets are happy that there’s a policy, but they’re unnerved by that prohibition,” he said.

Krawitz, 55, is the executive director of Veterans for Medical Cannabis Access, an advocacy group. He has always been open with his VA doctors about his medical marijuana use and hasn’t suffered any negative consequences. But Krawitz said he has worked with veterans who have been kicked out of their VA pain management program after a positive drug test and told they couldn’t continue until they stopped using cannabis.

Such actions are usually misunderstandings that can be corrected, he said, but he suggests that the Veterans Health Administration should provide clear guidance to its staff about the new directive so veterans aren’t harmed if they admit to using marijuana.

Although the new guidance encourages communication about veterans’ use of marijuana, the agency’s position on the drug hasn’t changed, said Curtis Cashour, a VA spokesman.

Cashour referred to a quote from Veterans Affairs Secretary David Shulkin, who said at a White House briefing in May that he thought that among “some of the states that have put in appropriate controls [on the use of medical marijuana], there may be some evidence that this is beginning to be helpful. And we’re interested in looking at that and learning from that.” But until federal law changes, the secretary said, the VA is not “able to prescribe medical marijuana.”

Cashour declined to provide further information about the new directive.