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Should VA Doctors Be Allowed To Talk About And Prescribe Medical Marijuana?

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Twenty three  U.S. States and the District of Columbia have enacted laws to legalize the use of medical marijuana when prescribed by a physician. (Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington)

Four states (Alaska, Colorado, Oregon and Washington) and the District of Columbia have legalized marijuana for recreational use (with some restrictions), but they are quickly learning that the revenue brought in by the taxes they are able to charge is filling their coffers.  Other state lawmakers are likely watching these states closely and noticing the increase in tax revenue and it is only a matter of time before more U.S. States follow suit and legalize some form of recreational marijuana use.

According to a CNN News Report titled “10 diseases where medical marijuana could have impact“, Dr. Sue Sisley, psychiatrist who works with veterans struggling with post-traumatic stress disorder (PTSD), many of her patients do not like how they feel when they sometimes have to take 8 or more different medications to manage their anxiety, sleeplessness, depression and the flashbacks.  She likened the Veterans she treats to zombies when they take their cocktails of prescribed medications.  Dr. Sisley noticed that some of her patients were starting to feel better and as she dug for clues, she learned that they were self-medicating with marijuana.

Medical marijuana is legal in almost half of the U.S. and it is currently used to treat medical issues such as multiple sclerosis, arthritis, epilepsy, glaucoma, HIV, chronic pain, Alzheimer’s, cancer and others.  Unfortunately, clinical testing of the health effects of marijuana is limited because, while legal when prescribed by a doctor in almost half of the U.S., the U.S. Government and the Drug Enforcement Agency (DEA) ranks it up there as a class 1 drug with Ecstasy, GHB, Heroin and LSD.

According to the DEA, the characteristics of a Class 1 drug are:

  • The drug or other substance has a high potential for abuse.
  •  The drug or other substance has no currently accepted medical treatment use in the U.S.
  •  There is a lack of accepted safety for use of the drug or substance under medical supervision.

Tetrahydrocannabinol (THC, marijuana) is still considered a Schedule 1 drug by the DEA, even though some U.S. states have legalized marijuana for personal, recreational use or for medical use.

Veterans Affairs doctors are under a gag order when it comes to talking about medical marijuana with patients, even in states where medical marijuana and or recreational use of marijuana has been legalized because marijuana is considered a class 1 drug by the DEA but some in the medical community and some law makers are working to get that changed so Veterans have equal access to medications and treatments as their civilian counterparts.

Dr. E. Deborah Gilman is a recently retired Veterans Affairs physician who wrote a letter urging Congress to lift the gag order on V.A. doctors and pass the Veterans Equal Access Amendment.

Letter to Congress from Dr. Gilman:

U.S. Navy veteran T.J. Thompson recently joined three senators at a press conference to discuss his inability to access proper medical treatment via the Veterans Health Administration.

He wasn’t there to talk about a lack of benefits or long waiting lists.  He has coverage and he can get an appointment with a doctor. The problem is, his doctor is not allowed to help him.

T.J. explained his situation while standing alongside Sens. Kirstin Gillibrand, Cory Booker, and Rand Paul as they introduced the CARERS Act, the first comprehensive medical marijuana bill in U.S. Senate history.

T.J. suffers from post-traumatic stress disorder and would prefer to treat his condition with marijuana rather than prescription anti-depressants. But even if he lives in a state where medical marijuana is legal if a physician recommends it, and even if his doctor at the VA believes medical marijuana would be the most effective treatment, his doctor can’t tell him that.

The problem stems from a Veterans Health Administration directive prohibits VA providers “from completing forms seeking recommendations or opinions regarding a Veteran’s participation in State medical marijuana programs.”

That directive and the policy it espoused are now six years old. They came at a time when medical marijuana was more politically controversial and many were not yet familiar with its efficacy. But views on marijuana have shifted rapidly.

Today, national opinion polls routinely find support for medical marijuana above 80 percent—an unheard of figure in today’s polarized political climate—and respected physicians like CNN’s chief medical correspondent, Dr. Sanjay Gupta, are joining the call for laws that allow seriously ill people to access medical marijuana.

It’s true that we could use more studies on marijuana, and we would have them if government agencies weren’t actively obstructing them, but the fact of the matter is we have enough information to know that medical marijuana can be a safe and effective treatment for a variety of medical conditions. The clinical and anecdotal evidence for marijuana as a treatment for nausea, appetite loss, muscle spasticity, and severe and chronic pain is overwhelming.

It would be cruel to deny access to any medication for any patient when his or her doctor decides the benefits outweigh the risks and recommends it, but that’s particularly true for veterans and medical marijuana. Our men and women in uniform make incredible sacrifices for our country, and the least we could do make every possible treatment option available to them when they come home.

Veterans returning from Iraq and Afghanistan with debilitating injuries are often prescribed highly addictive opioid painkillers with severe side effects, particularly for long-term use. Marijuana possess significantly less risk of dependence, along with fewer and less severe side effects. What’s more, studies have shown marijuana can be an effective supplemental therapy by reducing patients’ reliance on opioids, or even acting as a “reverse gateway” by replacing narcotic painkillers altogether. Other research shows states where medical marijuana is legal have a 25 percent lower rate of fatal overdoses from opioids.

It is not just the wounds we can see that medical marijuana might help treat. No one knows better than our vets that PTSD is a notoriously difficult condition to treat, with the most common current regimen involving some combination of anti-depressants, anti-psychotics and counseling. The success rate with this cocktail is not particularly encouraging. Many vets instead opt to self-medicate with alcohol and other drugs. And the suicide rate for veterans is alarming—22 per day according to a recent VA analysis. Meanwhile, research has shown a 10 percent reduction in suicide rates in states with medical marijuana laws following passage of those laws.

Even those who don’t support the idea of medical marijuana have reason to support changing the VA’s medical marijuana policy.

In order to provide effective treatment, it’s vital that the doctor-patient relationship be one of open, honest communication. A policy that discourages veterans from asking their doctor about medical marijuana use, and prohibits doctors from even expressing their opinion on it, limits doctors’ ability to ensure veterans using or considering it are fully informed of potential dependence and drug interaction issues.

This week, the U.S. House of Representatives will debate a bill funding the Department of Veterans Affairs, and it will have an opportunity to rescind the VA’s gag order. Congress should seize it and end this outdated and discriminatory policy. It’s time to let veterans like T.J. get the treatment they deserve.

Dr. E. Deborah Gilman, MD
Phoenix, AZ
[email protected]
(612) 992-7438

About the Veterans Equal Access Amendment to the FY2016 Military Construction and Veterans Affairs Appropriations Bill

Current Policy – the reason why veterans are being denied equal access:

Veterans who are reliant on the VA for their healthcare are denied equal access to state medical marijuana programs. The current VA policy on medical marijuana, VHA Directive 2011-004, not only prohibits VA physicians from writing state medical marijuana recommendation forms, it forbids them from even offering opinions on whether a veteran patient could benefit or harm their health by participating in a state medical marijuana program. This is tantamount to a gag order on VA physicians! Moreover, this policy denies veterans equal access to state-authorized medical marijuana programs that other patients in these states are able to utilize.

Purpose of the Amendment – allow veterans to have the same access as civilians:

To allow VA physicians to recommend medical marijuana to veteran patients in accordance with state laws that authorize the medical use of marijuana. This would allow veterans who receive the medical care from the VA to be eligible to obtain medical marijuana to treat conditions such as chronic pain and post-traumatic stress disorder (PTSD) that may have been inflicted upon the veteran-patient during service to their country

What the Amendment does:

  • The amendment would provide that VA physicians would no longer be denied the ability to provide a written recommendation to veteran patients in their care who they believe would benefit from medical marijuana therapy
  • The amendment would provide that Veterans would no longer be forced outside of the VA system – at their own expense – to seek a simple recommendation for treatment for a debilitating condition that is granted to them by state law
  • American Chronic Pain Association has estimated that 25 million veterans are living with chronic pain in the USA
  • Approximately 22 veterans per day are committing suicide, many as a result of PTSD

What the Amendment does not do:

  • The amendment does not require V.A. physicians to violate federal law, as recommending the therapeutic use of marijuana is protected speech under ruling in Conant v. Walters, (9th Cir. 2002) 309 F.3d 629, cert denied Oct. 14, 2003)
  • The amendment does not authorize the possession or use of marijuana for any purposes on federal property

 

Should the VA allow its doctors to talk about and prescribe medical marijuana to Veterans in cases where medical marijuana has been found to work with other patients?  Some argue that medical marijuana does not have the side effects that other currently prescribed medications may have and it is less addictive than some other controlled drugs that are prescribed such as some of the pain killers, but a lack of medical testing to prove that the medical marijuana is effective to treat certain diseases and conditions along with a gag order on VA doctors is withholding any benefits that medical marijuana may offer as a treatment option for many Veterans.

If you have any thoughts on the use of medical marijuana by the VA, please post them in the comment section below.

1 Comment on "Should VA Doctors Be Allowed To Talk About And Prescribe Medical Marijuana?"

  1. ABSOLUTELY NOT!!!

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