Pubdate: Sat, 24 Jul 2010
Source: New York Times (NY)
Page: A1, Front Page
Copyright: 2010 The New York Times Company
Author: Dan Frosch
Cited: Veterans for Medical Marijuana Access
Referenced: The letter to Mr. Krawitz
Bookmark: (Cannabis - Medicinal - U.S.)


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 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, Dr. 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. 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 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 soothe 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.

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

Laura Sweeney, a spokeswoman for the Justice Department, would not 
comment spefically on the veterans department policy. "What we have 
said in the past, and what we have said for a while, is that we are 
going to focus our federal resources on large scale drug 
traffickers," she said. "We are not going to focus on individual 
cancer patients or something of the like."

Many clinicians already prescribe pain medication to veterans who use 
medical marijuana, 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, Mr. Krawitz said.

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 a 
doctor 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 
department's policy. If a veteran obtains and uses medical marijuana 
in accordance with state law, Dr. Petzel wrote, 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.

He said it was critical that the veterans department make its 
guidelines clear to patients and medical staff members, something 
officials said they planned on doing in coming weeks.

Said Dr. Jesse, "The whole goal of issuing a national policy is to 
make sure we have uniformity across the system."
- ---
MAP posted-by: Richard Lake