VA clears path for med­i­cal mar­i­juana use in some states

Austin American-Statesman - - FRONT PAGE - By Dan Frosch

DEN­VER — The Depart­ment of Vet­er­ans Af­fairs will for­mally al­low pa­tients treated at its hos­pi­tals and clin­ics to use med­i­cal mar­i­juana in states where it is le­gal, a pol­icy clar­i­fi­ca­tion that vet­er­ans have sought for sev­eral years.

A depart­ment di­rec­tive, ex­pected to take ef­fect next week, re­solves the con­flict in vet­er­ans fa­cil­i­ties be­tween fed­eral law, which out­laws mar­i­juana, and the 14 states that al­low medic­i­nal use of the drug — in ef­fect, de­fer­ring to the states.

The pol­icy will not per­mit depart­ment doc­tors to pre­scribe mar­i­juana. But it will ad­dress the con­cern of many pa­tients who use the drug that they could lose ac­cess to their pre­scrip­tion pain med­i­ca­tion if caught.

Un­der depart­ment rules, vet­er­ans can be de­nied pain med­i­ca­tions if they are found to be us­ing il­le­gal drugs. Un­til now, the depart­ment had no writ­ten ex­cep­tion for med­i­cal mar­i­juana.

This has led many pa­tients to dis­trust their doc­tors, vet­er­ans say. With doc­tors and pa­tients press­ing the vet­er­ans depart­ment for

for­mal guid­ance, agency of­fi­cials be­gan draft­ing a pol­icy last fall.

“When states start le­gal­iz­ing mar­i­juana we are put in a bit of a unique po­si­tion be­cause as a fed­eral agency, we are be­holden to fed­eral law,” said Dr. Robert Jesse, the prin­ci­pal deputy un­der sec­re­tary for health in the vet­er­ans depart­ment.

At the same time, Jesse said, “We didn’t want pa­tients who were legally us­ing mar­i­juana to be ad­min­is­tra­tively de­nied ac­cess to pain man­age­ment pro­grams.”

The new, writ­ten pol­icy ap­plies only to vet­er­ans us­ing med­i­cal mar­i­juana in states where it is le­gal. Doc­tors may still mod­ify a vet­eran’s treat­ment plan if the vet­eran is us­ing mar­i­juana, or de­cide not to pre­scribe pain medicine al­to­gether if there is a risk of a drug in­ter­ac­tion. That de­ci­sion will be made on a case-by-case ba­sis, not as blan­ket pol­icy, Jesse said.

Al­though vet­er­ans of the Viet­nam War were the first group to use mar­i­juana widely for med­i­cal pur­poses, the pop­u­la­tion of vet­er­ans us­ing it now spans gen­er­a­tions, said Michael Krawitz, ex­ec­u­tive di­rec­tor of Vet­er­ans for Med­i­cal Mar­i­juana Ac­cess, which worked with the depart­ment on for­mu­lat­ing a pol­icy.

Vet­er­ans, some of whom have been at the fore­front of the med­i­cal mar­i­juana move­ment, praised the depart­ment’s de­ci­sion. They say cannabis helps sooth phys­i­cal and psy­cho­log­i­cal pain and can al­le­vi­ate the side ef­fects of some treat­ments.

“By cre­at­ing a di­rec­tive on med­i­cal mar­i­juana, the VA en­sures that through­out its vast hos­pi­tal net­work, it will be well un­der­stood that le­gal med­i­cal mar­i­juana use will not be the ba­sis for the de­nial of ser­vices,” Krawitz said.

Al­though the Obama ad­min­is­tra­tion has not em­braced med­i­cal mar­i­juana, in a pol­icy shift in Oc­to­ber, the Jus­tice Depart­ment an­nounced that it would not pros­e­cute peo­ple who used or dis­trib­uted it in states where it was le­gal.

Ad­vo­cates of med­i­cal mar­i­juana use say that in the past, the patch­work of vet­er­ans hos­pi­tals and clin­ics around the coun­try were some­times un­clear how to deal with vet­er­ans who needed pain med­i­ca­tions and were legally us­ing med­i­cal mar­i­juana. The depart­ment’s em­pha­sis on keep­ing pa­tients off il­le­gal drugs and from abus­ing their med­i­ca­tion “gave many prac­ti­tion­ers the feel­ing that they are sup­posed to po­lice mar­i­juana out of the sys­tem,” Krawitz said.

“Many med­i­cal-mar­i­jua­naus­ing vet­er­ans have just aban­doned the VA hos­pi­tal sys­tem com­pletely for this rea­son,” he said.

This month, Dr. Robert A. Pet­zel, the un­der sec­re­tary for health for the vet­er­ans depart­ment, sent a let­ter to Krawitz lay­ing out the depart­ment’s pol­icy. If a vet­eran ob­tains and uses med­i­cal mar­i­juana in ac­cor­dance with state law, Pet­zel wrote, he should not be pre­cluded from re­ceiv­ing opi­oids for pain man­age­ment at a vet­er­ans fa­cil­ity.

Pet­zel also said that pain man­age­ment agree­ments be­tween clin­i­cians and pa­tients, which are used as guide­lines for cour­ses of treat­ment, “should draw a clear dis­tinc­tion be­tween the use of il­le­gal drugs, and le­gal med­i­cal mar­i­juana.”

Steve Fox, di­rec­tor of govern­ment re­la­tions for the Mar­i­juana Pol­icy Project, which fa­vors the le­gal reg­u­la­tion of the drug, called the de­ci­sion his­toric.

“We now have a branch of the fed­eral govern­ment ac­cept­ing mar­i­juana as a le­gal medicine,” he said.

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