Veterans Administration Allows Medical Marijuana Use (FEATURE)

Thanks largely to years of work by a disabled Virginia US Air Force vet who uses medical marijuana, the Veterans Administration (VA) has formally clarified its policy on medical marijuana and will allow patients in its system to use it in the 14 states and the District of Columbia where it is legal. Under VA rules, veterans can be denied pain medications if they are found to be using illegal drugs, and until this policy clarification, there was no exception for medical marijuana use.

The clarification came in a July 22 directive from Dr. Robert Petzel, Undersecretary of Health for the department. "Veterans Health Administration policy does not prohibit veterans who use medical marijuana from participating in VHA substance abuse programs, pain control programs, or other clinical programs where the use of marijuana may be considered inconsistent with treatment goals," he wrote. "Although patients participating in state medical marijuana programs must not be denied VHA services, modifications may need to be made in their treatment plans. Decisions to modify treatment plans in those situations are best made by individual providers in partnership with their patients. VHA endorses a step-care model for the treatment of patients with chronic pain: any prescription(s) for chronic pain should be managed under the auspices of such programs described in VHA policy regarding Pain Management."

"This is a victory for veterans and a victory for us all," said Michael Krawitz, the vet in question and the director of Veterans for Medical Marijuana. "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," he said.

"This means a lot for vets," Krawitz continued. "The vets I've been working with, especially older vets, were of the mindset that this was not possible; they felt like nobody in the system cares about them. This is a paradigm changer, but the VA is only doing the right thing."

But he was quick to add it was only a partial victory. VA doctors still cannot recommend medical marijuana because federal law doesn't recognize it, he noted.

"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," Dr. Robert Jesse, the principal deputy under secretary for health in the veterans department, told the New York Times. But 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 directive was the end result of more than a year's worth of wrangling between Krawitz and the VA over VA policy on medical marijuana.

Krawitz had noted inconsistencies -- some VA facilities accommodated medical marijuana use, while in other cases, patients were removed from pain management programs because of their use. Chugging his way through the VA bureaucracy, Krawitz earlier this month received a letter from the VA's Dr. Petzel.

"lf a Veteran obtains and uses medical marijuana in a manner consistent with state law, testing positive for marijuana would not preclude the Veteran from receiving opioids for pain management in a Department of Veterans Affairs (VA) facility," Petzel wrote. "Standard pain management agreements should draw a clear distinction between the use of illegal drugs, and legal medical marijuana. However, the discretion to prescribe, or not prescribe, opioids in conjunction with medical marijuana, should be determined on clinical grounds, and thus will remain the decision of the individual health care provider. The provider will take the use of medical marijuana into account in all prescribing decisions, just as the provider would for any other medication. This is a case-by-case decision, based upon the provider's judgment and the needs of the patient."

The July 22 directive formalized Petzel's stance. Dr. Jesse said that formalizing the rules on medical marijuana would eliminate confusion and keep patients from being caught in the contradiction between state and federal law.

"This is great for veterans in the states that have medical marijuana laws, but there are still vets in 36 states that don't have such laws who can't use it," said Mike Meno, communications director for the Marijuana Policy Project, which worked with Krawitz on obtaining the clarification. "This is also problematic for vets who rely exclusively on the VA for health care because VA docs can't recommend medical marijuana. This is an arm of the federal government basically affirming that medical marijuana, and that's very important, but there is still a lot of work to be done."

"The VA docs are not being treated fairly," said Krawitz. "Why would doctors in the VA not be afforded the same free speech rights as other doctors? It's because the VA general counsel is saying they cannot do that, and because it is forwarding a threat from the DEA."

Krawitz has some words of advice for other activists: Keep plugging away and never get weary. "It takes the patience of Job and a little bit of luck," he said.

In this case, patience and persistence have paid off big time for veterans fortunate enough to live in a medical marijuana state. Now, to do something for those who don't.