V.A. Easing Rules for Users of Medical Marijuana

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  V.A. Easing Rules for Users of Medical Marijuana

Posted by CN Staff on July 23, 2010 at 17:46:13 PT
By Dan Frosch 
Source: New York Times 

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, effectively 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 it that they could lose access to their prescription pain medication if caught.Such fear 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, Dr. Jesse said, “We didn’t want patients who were legally using marijuana to be administratively denied access to pain management programs.”The new 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. But that decision will be made on a case-by-case basis, not as blanket policy, Dr. Jesse said.Though 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 Veterans Department on formulating a policy.Veterans, some of whom have been at the forefront of the medical marijuana movement, praised the new policy. 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 V.A. 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,” Mr. Krawitz said.Many clinicians already prescribe pain medication to veterans who use medical marijuana for pain management, as there was no rule explicitly prohibiting them from doing so, despite the federal marijuana laws.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,” Mr. Krawitz said.“Many medical marijuana using veterans have just abandoned the V.A. hospital system completely for this reason,” he said, “and others that stay in the system feel that they are not able to trust that their doctor will be working in their best interests.”In rare cases, veterans have been told that they need to stop using marijuana, even if it is legal, or risk losing their prescription medicine.David Fox, 58, an Army veteran from Pompey’s Pillar, Mont., uses medical marijuana legally to help quiet the pain he experiences from neuropathy, a nerve disorder. But he said he was told this year by the medical staff at a veterans clinic in Billings that if he did not stop using marijuana, he would no longer get the pain medication he was also prescribed.A letter written to Mr. Fox in April from Robin Korogi, the director of the veterans health care system in Montana, explained that the department did not want to prescribe pain medicine in combination with marijuana because there was no evidence that marijuana worked for noncancer patients and because the combination was unsafe.“In those states where medical marijuana is legal, the patient will need to make a choice as to which medication they choose to use for their chronic pain,” Ms. Korogi wrote. “However, it is not medically appropriate to expect that a V.A. physician will prescribe narcotics while the patient is taking marijuana.”Mr. Fox was shocked by the decision, he said.“I felt literally abandoned,” he said. “I still needed my pain meds. I thought they were supposed to treat you. It was devastating for me.”Mr. Fox, who said that at one point he was weaning himself off his pain medication for fear of running out, has held one-man protests in front of the clinic, carrying signs that read “Abandoned by V.A., Refused Treatment.”Veterans officials would not comment on specific cases, citing medical privacy laws.This month, Dr. Robert A. Petzel, the under secretary for health for the veterans department, sent a letter to Mr. Krawitz laying out the new policy. Now, Dr. Petzel wrote, if a veteran obtains and uses medical marijuana in accordance with state law, he should not be precluded from receiving opioids for pain management at a veterans facility.Dr. 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.” Dr. Jesse, the veterans department official, said that formalizing rules on medical marijuana would eliminate any future confusion and keep patients from being squeezed between state and federal law.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.But Mr. Fox said he wished the policy had been extended to veterans who lived in states where medical marijuana was not legal.Mr. Fox said it was critical that the veterans department make clear its guidelines on medical marijuana to patients and medical staff members, something officials said they planned on doing in coming weeks.James Dao contributed reporting from New York.Source: New York Times (NY)Author:  Dan FroschPublished: July 23, 2010Copyright: 2010 The New York Times CompanyContact: letters nytimes.comWebsite: Medical Marijuana Archives 

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Comment #16 posted by bullhead on July 25, 2010 at 17:51:23 PT:
Federal Recognition
BOOM! Did you hear that! Things they are a changing! I feel this will move things along rather quickly now!!!!! BOOM BOOM BOOM
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Comment #14 posted by charmed quark on July 24, 2010 at 16:37:56 PT

It is huge
An agency of the Federal government has now implicitly recognized the right of states to allow the use of medical marijuana.Plus, it is a major sea change that portents a lot more.And it will help a lot of vets.
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Comment #13 posted by Hope on July 24, 2010 at 11:25:01 PT

Being kind and gentle is not necessarily being docile. You, our dear FoM, are bout as docile as a bulldozer with a perpetual high octane fuel supply!(A kind and loving bulldozer though... not a mean scary one like a Stephen King construct. Well... the prohibitionists probably think you're scary... but you would not actually physically hurt them at all... and they would hurt people to maintain their prohibition... and think they were doing the right thing. Aaarggh!)
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Comment #12 posted by Hope on July 24, 2010 at 11:17:17 PT

I've always liked the way you've handled that situation. Roll on! You're so cool!
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Comment #11 posted by Hope on July 24, 2010 at 11:16:18 PT

This is wonderful!
This is so wonderful!This is big. Surely it is. Really big. World wide. Balm for the pain. Relief for the suffering. Surely it will be wonderfully helpful in stopping the overall cruelty and idiotic abuse of people by by other people over use of a plant. Amazing good news!Amen, Keydet46!Thank you, Steven, for all your fight. You're an amazing fighter for good and right.
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Comment #10 posted by FoM on July 24, 2010 at 11:15:56 PT

Thank you. I walk softly and carry a big stick! LOL!
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Comment #9 posted by Sam Adams on July 24, 2010 at 11:04:43 PT

fom no way!
You are the opposite of docile, I would not call running a national website apathetic!I've been working on some other local issues besides cannabis and I've been shocked at how most people get told "no" once and go home and sulk without ever doing anything, very frustrating

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Comment #8 posted by FoM on July 24, 2010 at 08:32:50 PT

I am very docile. What's to get upset about since change is happening right before our eyes? We have 2 more years under this administration to get much more accomplished.
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Comment #7 posted by Sam Adams on July 24, 2010 at 08:00:49 PT

great news
Bless this guy who went out front and protested! He is a real hero. Thousands of Americans, veteren and not, get told every year that they won't be getting any more medical care from pain treatment centers because they use medical cannabis and most do nothing.I'm starting to realize that the vast majority of people here are totally docile, and never even bother to call their elected officials no matter what. That is how the govt. gets away with everything from oil spills to drug laws to huge prisons.

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Comment #6 posted by afterburner on July 24, 2010 at 07:45:17 PT

If governments talk about drugs, journalists talk 
Why our drug policy is 'inconsistent' with all available evidence.
 By Dan Gardner, The Ottawa Citizen July 24, 2010 8:18 AM. Comments (14)
If governments talk about drugs, journalists talk about drugs; if they don't, we don't.

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Comment #5 posted by ezrydn on July 24, 2010 at 05:41:56 PT:

When Asked
When I'm at the VA hospital and I have "that" conversation with the doctor, it usually goes like this:Dr: Are you taking anything for your PTSD?
Me: Yes
Dr: What are you taking?
Me. I can't tell ya, Doc.
Dr: Why not?
Me: Because [state] is NOT a compassionate state.I say nothing more. Let them draw their own conclusions. However, nothing they come up with is either verified nor rejected. It's their call as to what I mean by the above. Some understand, some don't.
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Comment #4 posted by FoM on July 24, 2010 at 03:57:52 PT

Just My Thoughts
I think it is a big deal. My husband and I appreciate the VA. They saved his life when he had a heart attack on the treadmill at a big VA hospital. Our state doesn't have a medical marijuana law yet but it will be great when we do.
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Comment #3 posted by keydet46 on July 24, 2010 at 03:56:54 PT:

Thank god
Free at last, thank god free at last
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Comment #2 posted by Cheebs1 on July 24, 2010 at 02:07:25 PT:

Isn't This Huge???
I may not be awake yet but I think this sums it up perfectly.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.Won't this compel the reschedulization of cannabis? The lack of accepted medical use has been the back bone of the federal prohib stance. We already know about the patents held by the federal government on medications made from cannabis. With this new stance on usage for vets it would seem to me that it should be easier to get into a legal venue to force reschedulization. Legal testimony introduced into a court of law that will show medical efficacy is what is needed. 
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Comment #1 posted by herbdoc215 on July 24, 2010 at 00:43:07 PT

The VA here has been putting me through hell
in Loma Linda,CA over this very subject the last 6 months...we have been around and around with me having to finally go to the dept head to be treated and I still won't even try letting them do my pain meds but it even effects treatment for other things as well as the abusive attitude makes the experience horrible, even when you try and play their game...the older Vietnam Vets all get on me and tell me I don't complain enough but I just wasn't raised that way and it's a shame this is how our country treats those whom have served and are service-connected disabled! Peace, Steve Tuck 
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