By Sandra Basu
WASHINGTON – Should VA healthcare providers have more leeway in providing recommendations and options to veterans regarding participation in a state marijuana programs, even though possession of the drug remains a federal offense?
A bipartisan House bill suggests they should. Introduced recently by Reps. Earl Blumenauer (D-OR) and Dana Rohrabacher (R-CA), the bill would authorize VA clinicians to provide recommendations and opinions to veterans who are residents of states with state marijuana programs regarding participation in their state marijuana programs and allow them to complete forms reflecting such recommendations and opinions.
Currently, VA medical providers are not legally allowed to complete forms brought by their patients to enroll them in state medical marijuana programs.
“Our antiquated drug laws must catch up with the real suffering of so many of our veterans,” Blumenauer said in a statement. “This is now a moral cause and a matter of supreme urgency. It is unconscionable that a VA doctor cannot offer a full range of treatments, including medical marijuana, which in many cases has been shown to have worked, to an American veteran who fought valiantly for our country.”
In explaining the need for the bill, Blumenauer noted that more than 20% of the 2.8 million American veterans who served in Iraq and Afghanistan suffer from PTSD and depression. In addition, he cited a recent study finding that, of the nearly one million veterans who receive opioids to treat painful conditions, more than half continue to consume chronically or beyond 90 days.
“In states where patients can legally access medical marijuana for painful conditions, often as a less addictive alternative, the hands of VA physicians should not be tied,” he added.
Medical Marijuana Controversy
The new bill comes as 23 U.S. states and the District of Columbia have various laws allowing medical marijuana use. The federal government, however, classifies marijuana as a Schedule I drug which has high potential for abuse, is not currently accepted for medical treatment in the United States and has a lack of safety even under medical supervision. Possession and use are illegal under federal law.
As a result, employees of federal agencies cannot prescribe or recommend its use, even in states where the use of medical marijuana is legal.
Current VHA policy notes that, “if a veteran presents an authorization for marijuana to a VA provider or pharmacist, VA will not provide marijuana. Nor will it pay for it to be provided by a non-VA entity.”
In addition, the policy adds, “Possession of marijuana, even for authorized medical reasons, by veterans while on VA property is in violation of VA regulation 1.218(a)(7) and places them at risk for prosecution under the Controlled Substances Act.”
Veterans who participate in state marijuana programs aren’t denied from also receiving treatment by VA, and the policy leaves to individual providers “decisions to modify treatment plans in those situations,” in partnership with patients.
The issue of medicinal marijuana remains controversial. While the Food and Drug Administration has approved no marijuana products as safe or effective for the treatment of any disease or condition, it said it has no problem with “researchers who conduct adequate and well-controlled clinical trials which may lead to the development of safe and effective marijuana products to treat medical conditions.”
Indeed, such research has been ongoing. In one paper published in May 2014 in Arthritis Care & Research, a journal of the American College of Rheumatology, the authors reviewed the current evidence for the use of herbal cannibis in rheumatic pain management. The authors concluded that they “cannot recommend herbal cannabis for arthritis pain management given the lack of efficacy data, potential harm from the drug, and availability of other therapies for managing pain.”1
“Physicians caring for patients who are self-medicating with marijuana need to understand the health implications of using this drug,” lead investigator Mary-Ann Fitzcharles, MD, a researcher and rheumatologist at the McGill University Health Centre (MUHC) and the Research Institute of the MUHC in Quebec, Canada, said in a statement.
Another 2014 study published in JAMA Internal Medicine by Marcus A. Bachhuber, MD, of the Philadelphia Veterans Affairs Medical Center and his colleagues, found that states implementing medical marijuana laws appear to have lower annual opioid analgesic overdoses death rates — both from prescription painkillers and illicit drugs such as heroin — than states without such laws, although the reason why was not clear to the authors.
They suggested that further research is required “to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.”
1 Fitzcharles MA, Clauw DJ, Ste-Marie PA, Shir Y. The dilemma of medical marijuana use by rheumatology patients. Arthritis Care Res (Hoboken). 2014 Jun;66(6):797-801. doi: 10.1002/acr.22267. Review. PubMed PMID: 24591442.
2 Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014 Oct;174(10):1668-73. doi: 10.1001/jamainternmed.2014.4005. PubMed PMID: 25154332.