Cannabis, Sickle Cell, Veterans, and the Tax Code That Threatens All Three

What Is Sickle Cell Disease?

Sickle cell disease is a genetic blood disorder affecting approximately 100,000 Americans, disproportionately Black Americans. It causes red blood cells to become rigid, crescent-shaped, and sticky. These misshapen cells block blood flow, leading to excruciating pain, organ damage, stroke risk, and early death.

Under a microscope, it looks like thousands of tiny knives moving through blood vessels. The pain is exactly as brutal as that image suggests.

There is no universal cure. Patients live on daily medication, endure frequent hospitalizations, and carry the psychological weight of never knowing when the next crisis will strike.

For decades, treatment options were limited. Hydroxyurea, a chemotherapy drug repurposed for sickle cell, became a standard tool to reduce pain crises and extend life expectancy. It is not a cure. It is management.

Today, we are on the edge of breakthroughs. Gene therapy, improved transplant protocols, and new medications are expanding options. But breakthroughs require research. Research requires funding. Funding requires industries that survive.

Why Cannabis Matters for Sickle Cell Patients

Cannabis research for sickle cell disease is still developing, with evidence that remains limited and sometimes conflicting. While some studies suggest potential benefits in chronic pain management and quality of life, controlled clinical trials have not consistently shown significant reductions in pain (JAMA Network Open, 2020; Clinical Hematology International, 2023).

That said, the direction of research is evolving. Newer studies are beginning to focus on inflammation and long-term outcomes, exploring how cannabinoids may impact the underlying drivers of vaso-occlusive crises, when sickled red blood cells block blood flow, cut off oxygen, and cause severe pain that can also damage tissue and organs over time.

Cannabinoids may influence inflammation, a key driver of sickle cell pain, although these mechanisms are still being studied in clinical settings (NIH/NLM; Clinical Hematology International, 2023). The endocannabinoid system (ECS) plays a role in regulating pain, inflammation, and immune response, all of which are directly relevant to sickle cell disease.

Cannabis may still have a role as a complementary option. It is being studied as an opioid-sparing approach, meaning it may help support pain management at lower, safer opioid doses, while opioids remain the standard treatment during acute crises (American Society of Hematology).

Some patients report improvements in sleep, mood, and overall quality of life, although clinical evidence in sickle cell populations remains limited and mixed (JAMA Network Open, 2020).

For many patients, interest in cannabis is growing, and that shift is showing up in both patient demand and evolving state-level access across the country.

However, access without infrastructure creates its own problem.

When cannabis businesses struggle to survive, it limits the consistency, quality, and investment needed to support long-term research and patient outcomes.

Cannabis is not a cure. But it represents possibility. Possibility requires research. Research requires standardized dosing, pharmaceutical-grade consistency, and the ability to replicate results in clinical settings. All of that requires businesses that survive long enough to support it.

Jasmine’s Story: Why Cannabis Accounting Became My Mission

Jasmine was born in 2009 in Okinawa, Japan. From the moment she came home, she was in pain. Not discomfort. Not fussiness. Real, excruciating pain.

Doctors prescribed penicillin from birth and framed it as protection. What they did not tell us was that there were better treatment options that existed. We could not stay in Okinawa. The lack of medical infrastructure forced us to leave. We moved to New Orleans, Louisiana, where there was at least a system capable of treating her.

Even there, we lived through a cycle of complications. A routine checkup after her 2nd birthday turned into hospitalization. Medications meant to help triggered allergic reactions and cascading crises. One wrong decision led to another emergency.

It was not until 2016, after I resigned from my Commission in the Marine Corps and we moved to Virginia, that things changed. A new doctor. A new plan. Hydroxyurea dramatically reduced Jasmine’s crises. She could sleep. She could play. She could be a child. She was finally able to gain weight.

Jalissa and Jackson were born after we moved to Virginia. They began treatment early and never experienced the level of suffering Jasmine endured. But hydroxyurea is still management, not a cure. I refuse to accept lifelong dependency as the only option. Just recently, Jalissa experienced a pain crisis. We are thankful that she understands when a pain crisis is coming, and she is very transparent about that. Jalissa is our future attorney and knows more about sickle cell than anybody in the house. She will state her premise and defend it with every bit of 9 years she has on earth.

The Night That Changed Everything

Afghanistan, 2011. Camp Leatherneck. I was on night shift finishing my accounting homework when someone knocked on my office door.

A Marine needed emergency travel orders approved. His wife and daughter were in a serious car accident. They were on life support. After receiving the Red Cross message, I processed those orders, I realized something profound. For an accountant, this was paperwork. For that Marine, it was a final chance.

He got home.

That same night, about 10 or 15 minutes later, my office phone rang. My wife was screaming. I heard the word died. I thought it was my daughter. I couldn’t make out the words as I was trying to keep her calm. My daughter needed a blood transfusion, and it went wrong, and Jasmine was having complications, and she kept saying someone died… and it was the most chaotic 10-15 seconds I had in a while that felt like forever.

She was telling me that a fellow Marine and neighbor, an IED survivor from Iraq, had died in his sleep while on VA-prescribed medications. His young son was in bed with him and woke up next to his father’s body.

3 families. 3 crises. 1 night. 1 knock. 1 phone call.

At the time, I had just submitted my Warrant Officer package. I had recently re-enlisted and was selected for promotion to Staff Sergeant. On paper, my career was moving forward.

But standing in the middle of that night, I realized something had shifted.

I had seen too many Red Cross messages in my lifetime. Too many notifications that meant someone’s world had just collapsed. Too many reminders that life can change with a single knock on a door or a single phone call in the middle of the night.

I knew then that I wanted to make a real difference in the world, not just advance in rank. I wanted my work to mean something beyond titles, promotions, or timelines that assume tomorrow is guaranteed.

That night, cannabis came back into focus for me, not as a political issue or a business trend, but as a way to support life. Because I realized something simple and profound. When cannabis businesses survive, patients have more pathways to survive.

My Medication Reality: Why Veterans Need Cannabis Research

I am a 100% permanently and totally disabled veteran with service-connected PTSD. The VA currently prescribes me multiple medications to manage PTSD, anxiety, and sleep.

These medications work, but the tradeoffs are real. Fatigue. Cognitive fog. Emotional blunting. Weight gain. Withdrawal symptoms. Blood pressure changes. Sedation. The effects compound when medications are stacked together.

This is common for veterans. One medication treats one symptom. The side effects create another problem. Another prescription is added. Over time, the treatment plan becomes a balancing act that requires constant monitoring just to remain functional.

Polypharmacy increases the risk of adverse reactions, dangerous interactions, and accidental overdose. Many commonly prescribed psychiatric and sleep medications suppress respiration, lower blood pressure, or interfere with heart rhythm, especially when combined.

I do not want to die from the treatment plan meant to keep me alive.

Cannabis operates differently.

Cannabis interacts with the body’s endocannabinoid system (ECS), which regulates mood, pain, inflammation, sleep, and stress response. Unlike opioids or many sleep medications, cannabis does not suppress the brain’s respiratory center. There is no lethal overdose threshold from cannabis alone.

This does not mean cannabis is risk-free. It means the risk profile is fundamentally different and, from an overdose standpoint, significantly safer than many medications routinely prescribed to veterans.

That difference matters. And it is worth researching.

Research requires funding. Funding requires that businesses survive.

The Section 280E Crisis: Why Cannabis Businesses Are Dying

Most cannabis businesses do not survive long enough to invest in research, stability, and growth. One of the primary reasons is Section 280E.

Internal Revenue Code (IRC) §280E disallows any deduction or credit for amounts paid or incurred in carrying on a trade or business that consists of trafficking in controlled substances (Schedule I or Schedule II) prohibited under federal law. Because cannabis remains classified as a Schedule I substance at the federal level, this rule applies directly to state-legal cannabis businesses.

In plain language, it prevents  cannabis operators from deducting ordinary and necessary business expenses. No deductions for rent, payroll, utilities, marketing, or professional services. The only relief comes through the cost of goods sold (COGS), which is treated as an adjustment to gross receipts rather than a deduction.

This is where accounting stops being optional.

Under IRC §471, inventory accounting determines what can be included in COGS. That means structure, accrual accounting, and proper cost allocation are not just technical decisions. They directly impact how much income is exposed to tax.

When this is done wrong, businesses overpay. When it is done right, they protect what they are legally allowed to keep.

Even then, the burden remains.

This creates phantom income. Income that does not actually exist after operating expenses are paid.

A business with $1,000,000 in revenue, $300,000 in COGS, and $400,000 in operating expenses is taxed on $700,000, not $300,000 it actually keeps. At federal rates alone, that can result in an effective tax rate approaching 80%.

That kind of burden does more than reduce profit. It limits survival.

When businesses close, jobs disappear. When jobs disappear, investments disappear. When investment disappears, research slows down. When research slows down, patients lose access to better options.

This is not just a tax issue. It is a systems issue.

Until federal law changes in a meaningful and enforceable way, cannabis businesses are forced to operate under conditions that make long-term stability difficult.

And without stability, the infrastructure needed to support research, innovation, and patient care cannot fully develop.