JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas —
(Editor’s Note: The information that follows is based on Army policies and applies to Soldiers. Military members from other services should consult a judge advocate for analogous service-specific information).
The list of drugs available for doctors to prescribe continues to grow, and now includes Dronabinol, an FDA-approved synthetic THC, or tetrahydrocannabinol, the chemical responsible for most of marijuana’s psychological effects.
Dronabinol, known by the brand names Marinol or Syndros, is approved to treat or prevent nausea and vomiting caused by cancer medication or HIV/AIDS-induced anorexia. Some healthcare professionals, including those who work at Department of Defense healthcare facilities, have also prescribed Dronabinol to treat chronic pain.
The problem? Dronabinol shares the same psychoactive component found in marijuana, so if a Soldier ingests Dronabinol and then undergoes a urinalysis, he or she will test positive for THC.
Normally, if a Soldier tests positive for a prescription drug, a medical review officer, or MRO, will review the matter to see if the use was legitimate. If the use was not legitimate – meaning an authorized health care provider did not prescribe the medication – then the matter will be referred to the Army’s Criminal Investigation Command for investigation.
However, when a Soldier tests positive for THC, the current default position in the Army is that the use was illegitimate, so a MRO evaluation is not conducted prior to the test result being reported to the chain of command as evidence of illegal drug use. This is because the vast majority of THC positive test results in the services are, in fact, due to the use of marijuana, as opposed to Dronabinol.
The positive test result for THC is referred to CID and the Soldier is “flagged,” which suspends the Soldier from receiving any favorable personnel actions such as awards, promotions, attendance at schools, etc.
In addition, there will likely be a report of derogatory information to the DOD Consolidated Adjudication Facility, or CAF, which is the agency that evaluates personnel for access to classified information. Soldiers who test positive for THC will likely be subject to a security clearance revocation procedure, which can lead to a Soldier’s administrative separation from the Army.
So what can a Soldier do when a healthcare professional recommends a medication like Dronabinol (Marinol or Syndros)? The answer is to be informed and proactive.
Soldiers should begin by considering the risks associated with taking Dronabinol and the potential consequences to their careers.
Even when legitimately prescribed, Dronabinol will likely make a Soldier non-deployable. In addition, chronic use of Dronabinol or a prolonged non-deployable status may lead to a Soldier being referred to a medical evaluation board for possible separation from the Army.
Finally, understand that Dronabinol can cause effects such as dizziness, drowsiness and thinking problems. Like many states, Texas has a driving while intoxicated, or DWI, statute, which prohibits operating a vehicle while under the influence of any substance (including illegal and prescription drugs) that impairs the normal use of mental or physical faculties.
In addition to being charged by Texas authorities, Soldiers who drive while intoxicated could face adverse actions by the Army, such as nonjudicial punishment, a General Officer Memorandum of Reprimand, and separation from the Army.
Soldiers should avoid seeking Dronabinol from non-DOD civilian healthcare providers, and instead should discuss the risks and benefits with their military medical provider, including whether other forms of therapy would be more effective.
If a Soldier and military medical provider feel that Dronabinol is an appropriate medical option, the Soldier should notify his or her commander and provide a copy of the prescription. When providing a urine sample during a drug test, the Unit Prevention Leader, or UPL, should be notified as well.
If a commander knows that a Soldier who tests positive for THC has a prescription for Dronabinol, the commander should promptly notify the Drug Testing Coordinator, provide a copy of the prescription, and request a MRO review. Failure to act quickly may lead to a CID investigation and other consequences.
Healthcare providers can assist with this process. Providers who prescribe Dronabinol should document the duty limiting condition for which they are prescribing the medication on the Soldier’s Physical Profile, or DA Form 3349.
The physical profile should also include information for the unit commander that the Soldier is on a prescription that will cause him or her to have a positive urinalysis for THC during unit level testing, and that the chain of command should inform the installation Alcohol and Drug Control Officer, who can then reset the urinalysis to allow for MRO review of the results. When this happens properly, the system of record will be changed from “illegitimate use” to “evaluation complete-authorized use.”
Finally, Soldiers should not be fooled into thinking that a prescription for Dronabinol (Marinol or Syndros) then gives them the opportunity to smoke pot, seeing as both will result in an initial positive urinalysis for THC. If there is any doubt, the drug labs used by the DOD are able to conduct additional tests to determine whether a Soldier’s positive test is from an FDA-approved synthetic THC or from plain old marijuana.
Commanders and military medical providers should consult with their assigned judge advocate if they have questions on any of the matters discussed in this article.
(JBSA Legal News for Soldiers is a provided by Soldier Legal Services at Joint Base San Antonio-Fort Sam Houston, 2422 Stanley Road, building 134, and can be reached at 210-221-2282.)