VA docs forbidden to recommend medical marijuana

(Source: New Mexico Independent)  The largest group of patients enrolled in New Mexico’s medical marijuana program are those who suffer from post traumatic stress disorder, or PTSD, according to the most recent New Mexico Department of Health data. But Albuquerque’s Veteran’s Administration hospital–which many veterans rely on as their only source of health care–doesn’t allow its physicians to recommend the use of marijuana to patients.

Of 1,249 patients enrolled in the state medical marijuana program as of mid February, 291 have a diagnosis of PTSD. The next two largest groups are cancer patients, at 198, and HIV/AIDS patients, at 130.

PTSD is an anxiety disorder, sometimes severe, that is experienced by people who’ve endured dangerous situations, such as military combat. A Rand Corporation study in 2008 concluded that 20 percent of returning veterans from Iraq and Afghanistan suffer from PTSD or major depression.

At the same time, fewer than 10 percent of veterans with PTSD complete treatment programs for the disorder. Suicide among veterans has skyrocketed, and more vets have committed suicide since 2001 than have died on the battlefield in Iraq or Afghanistan.

Drug Enforcement Agency advises VA on policy

The VA policy that prohibits its doctors from recommending medical marijuana derives from the advice of the federal Drug Enforcement Agency, according to a policy statement given to The Independent by Sonja Brown, Chief of the Voluntary Service & Public Affairs Operations of the New Mexico VA Health Care System. This advice reflects the continued federal classification of marijuana as an illegal drug, despite the fact that  14 states now allow its use for medicinal purposes.

The VA policy does allow it’s physicians to tell patients that they are free to seek a recommendation from doctors outside the VA system,  and also encourages physicians to inform patients about treatments other than marijuana.

Paul Culkin and his wife, Victoria, at the Roundhouse to speak about the benefits of medical marijuana to PTSD patients. Photo by Marjorie ChildressPaul Culkin and his wife, Victoria, at the Roundhouse to speak about the benefits of medical marijuana to PTSD patients. Photo by Marjorie Childress

That the largest group enrolled in the state program is composed of PTSD patients reflects the large number of veterans returning from the wars who need help, Army veteran Paul Culkin told The Independent. Culkin uses medical marijuana to help deal with the PTSD he returned home with after serving as a Staff Sergeant on the Army bomb squad in Iraq.

Both Culkin and another patient The Independent interviewed in January, Mr. Garcia, described  their VA treatment for PTSD as involving numerous different prescription drugs that induced a zombie-like state. Marijuana, they both told The Independent, has enabled them to reduce the amount of prescription drugs they take and lead more normal lives.

“The medications were turning me into a zombie, I couldn’t relate to my daughter,” Culkin told a group assembled at New Mexico’s state capitol last week. “Medical cannabis made me a father and a husband again.”

Research supports the anecdotal evidence that marijuana helps PTSD sufferers to find relief. A 2007 study of marijuana use by PTSD patients, reported in the Journal of Traumatic Stress, found that the severity of PTSD symptoms correlated with the use of marijuana as a coping method, with that being the only motive for using the drug.

Vets self-medicate with alcohol and often abuse prescription drugs

But, Culkin said, the VA hospital policy makes it difficult to use the drug, because it doesn’t acknowledge it’s benefits and penalizes veterans who use it outside of the state program while not helping veterans access the state program.

“A lot [of veterans] are self-medicating, especially with alcohol, or are given prescription drugs while still on active duty and they come out addicted,” he said. “When they get out, they go into the VA rehabilitation program but if they test hot for cannabis [they have a problem].”

Culkin heads up the New Mexico Medical Marijuana Patient’s Group, along with Garcia. A key objective they both mention is to expand access to medical marijuana, including through the VA system.

While the VA doesn’t help patients acquire a state license, it does accommodate them in its rehabilitation programs once they have an approved state-license, said Brown.

“As long as the vet has a legitimate license from [the] State they would not be viewed as having a relapse,” Brown wrote in an email to The Independent. “The legitimate license ensures the VA that they are enrolled in the state program so a positive test is very likely.”

The Independent asked if this is official policy, like the prohibition on VA doctors making medical marijuana recommendations, but has yet to receive a reply.

Here is the official VA policy regarding making medical marijuana recommendations, provided to The Independent by Brown:

How should VA physicians respond to patient requests to fill out state forms authorizing medical marijuana?

Source of information:   In March of 2008, the General Counsel provided the Under Secretary for Health with a legal opinion regarding “State Medical Marijuana Registration Forms” documented in VA memorandum VAOPCGADV9-2008. This memorandum addresses the legal issues involved in a VA physician responding to patient requests to complete forms that might allow a patient to participate in a state medical marijuana program.  The memorandum also discusses the possibility of criminal or other penalties resulting from VA physicians resulting competing such forms.

Answer: General Counsel has held that: “VA should not authorize completion of forms seeking recommendation or opinions regarding” participation in medical marijuana programs and that “applicable statutes and regulations do not require VA physicians to complete such forms.”

Further “A VA physicians’ completion of a form that would permit a patient to participate in a state medical marijuana program could result in DEA action to seek actual or threatened revocation of the physician’s registration to prescribe controlled substances as well as criminal charges.”

The language in the New Mexico form requires physician certification that “the potential health benefits of the medical use of marijuana would likely outweigh health risks for the patient.”  Informal advice received from the DEA suggests that the Department of Justice may seek civil or criminal penalties for Federal physicians and other practitioners who complete forms that either recommends the use of medical marijuana or forms that describe the patient’s physical condition in order to facilitate the patient’s entry into a state medical marijuana program.

When patient’s request that physician’s complete state forms for medical marijuana programs it is import to educate the patient that Federal law supersedes that of the state and that as Federal employees, VA physicians are not permitted to complete the forms.

What can VA physicians appropriately do to assist the patient requesting medical marijuana?

VA physicians can inform veterans that they may seek the assistance of a community physician to complete the forms and that patients have the right to sign a release to provide their medical information to providers outside the VA system. In addition, VA physicians are encouraged to discuss with their patients other possible treatment options for the medical disorders and clinical symptoms for which they are seeking medical marijuana.

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