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Bill Seeks to Give VA Providers Leeway in States Allowing Medical Marijuana

by U.S. Medicine

January 5, 2015

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?

Neon sign from a medical marijuana dispensary on Ventura Boulevard in Los Angeles, California. Source: Wikipedia

Neon sign from a medical marijuana dispensary on Ventura Boulevard in Los Angeles, California. Source: Wikipedia

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.


8 Comments

  • Emanuel H. Rosen, MD says:

    This is consistent with the avowed aim of our new Chief of the VA to make us more “customer” oriented. But the reality is, when we make our patients “customers”, we create a culture antithetical to good medical care, and one could argue particularly so in the field of psychiatry with its plethora of addiction and disability issues.
    Cannabis as an established treatment for PTSD and Depression? Why not throw in Bipolar Disorder? I have seen patients with psychotic conditions who have been recommended cannabis.
    There will be an inevitable backlash to this indiscriminate prescription of cannabis, which sadly, will likely enrich the trial attorneys and further delay the appropriate treatment of Veterans who would most likely benefit from any effective non-toxic ingredients.

  • Emanuel H. Rosen, MD says:

    This is consistent with the avowed aim of our new Chief of the VA to make us more “customer” oriented. But the reality is, when we make our patients “customers”, we create a culture antithetical to good medical care, and one could argue particularly so in the field of psychiatry with its plethora of addiction and disability issues.
    Cannabis as an established treatment for PTSD and Depression? Why not throw in Bipolar Disorder? I have seen patients with psychotic conditions who have been recommended cannabis.
    There will be an inevitable backlash to this indiscriminate prescription of cannabis, which sadly, will likely enrich the trial attorneys and further delay the appropriate treatment of Veterans who would most likely benefit from any effective non-toxic ingredients.

  • Nelson Monroy MD says:

    I believed that no persons should be prevented from getting the benefits of any new “MEDICATION” but providing the raw material is dangerous, unwise, and poorly controlled, it opens de door to misuse as we have seen it with lot of medications.

    I would love to see the Active chemical compounds of any plant to be processed and presented to the community in a normal pharmacological presentation, (tab, pills, injection, elixir…etc)

    As investing to process marijuana (into pills….) at this time does not seem to be attractive to some Industries, the Government should invest in researching that will allow the active and beneficial compounds of the plants to be process and provided to the Medical Community to prescribe them as the “Medication” to the people who need it. not the raw material.

    N. Monroy MD

  • Nelson Monroy MD says:

    I believed that no persons should be prevented from getting the benefits of any new “MEDICATION” but providing the raw material is dangerous, unwise, and poorly controlled, it opens de door to misuse as we have seen it with lot of medications.

    I would love to see the Active chemical compounds of any plant to be processed and presented to the community in a normal pharmacological presentation, (tab, pills, injection, elixir…etc)

    As investing to process marijuana (into pills….) at this time does not seem to be attractive to some Industries, the Government should invest in researching that will allow the active and beneficial compounds of the plants to be process and provided to the Medical Community to prescribe them as the “Medication” to the people who need it. not the raw material.

    N. Monroy MD

  • J Laizer, MD says:

    This is why politicians need to stay OUT of the practice of medicine.

    There are no large, double blinded, multi center controlled studies concerning different strains of marijuana and their effects.

    The federal government’s rules make it very difficult to conduct these studies!

    Please see Barry Bostwick MD’s excellent article on medical cannabis and politics.

    Physicians cannot make an ethical and thoughtful recommendation with regards to any medication, -without knowing exactly what formulation and dosage strength we are dealing with.
    Well intentioned, but thoughtless legislation like this, puts Physicians in a bad position with their patients.
    The federal government will not legalize marijuana or study it but they want to “allow” us to recommend it. There will be plenty of demands for these recommendations.
    Personally, I am all for medical cannabis if it helps patients with cancer pain and anxiety surrounding terminal diagnoses. If a certain strain would help with PTSD while not interfering with work performance and motivation, I would be thrilled. If a certain formulation would help with seizures in a way that we could objectively measure, This would be wonderful. I would like to see the non-psychoactive strains studied and quickly brought to market.

    What other “medication” is currently legal for “recreational” use?

  • Alice Buckley MD says:

    Medical marijuana per avid supporters is panacea for many medical problems. Currently, the field of medial marijuana it not adequately controlled, benefits vary and the potential for inappropriate use/misuse/diversion/poor follow-up is TOO high for the VA health system or any government system to adequately manage. The episodic care that is all too common at our VAMCs is not the arena for this substance. More long term, diverse studies where definitive a risk-benefit is better understood before we jump to allowing widespread use. Additionally, continuity of care is a major issue in VAMC system. How many providers out there want to take over a panel of patients treated (either liberally or at all) with marijuana? I wouldn’t.

  • J Laizer, MD says:

    This is why politicians need to stay OUT of the practice of medicine.

    There are no large, double blinded, multi center controlled studies concerning different strains of marijuana and their effects.

    The federal government’s rules make it very difficult to conduct these studies!

    Please see Barry Bostwick MD’s excellent article on medical cannabis and politics.

    Physicians cannot make an ethical and thoughtful recommendation with regards to any medication, -without knowing exactly what formulation and dosage strength we are dealing with.
    Well intentioned, but thoughtless legislation like this, puts Physicians in a bad position with their patients.
    The federal government will not legalize marijuana or study it but they want to “allow” us to recommend it. There will be plenty of demands for these recommendations.
    Personally, I am all for medical cannabis if it helps patients with cancer pain and anxiety surrounding terminal diagnoses. If a certain strain would help with PTSD while not interfering with work performance and motivation, I would be thrilled. If a certain formulation would help with seizures in a way that we could objectively measure, This would be wonderful. I would like to see the non-psychoactive strains studied and quickly brought to market.

    What other “medication” is currently legal for “recreational” use?

  • Alice Buckley MD says:

    Medical marijuana per avid supporters is panacea for many medical problems. Currently, the field of medial marijuana it not adequately controlled, benefits vary and the potential for inappropriate use/misuse/diversion/poor follow-up is TOO high for the VA health system or any government system to adequately manage. The episodic care that is all too common at our VAMCs is not the arena for this substance. More long term, diverse studies where definitive a risk-benefit is better understood before we jump to allowing widespread use. Additionally, continuity of care is a major issue in VAMC system. How many providers out there want to take over a panel of patients treated (either liberally or at all) with marijuana? I wouldn’t.


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