VA clears the air on talking to patients about marijuana use

January 12, 2018 by Michelle Andrews, Kaiser Health News

"Don't ask, don't tell" is how many veterans have approached health care conversations about marijuana use with the doctors they see from the Department of Veterans Affairs.

Worried that owning up to using the drug could jeopardize their VA benefits—even if they're participating in a program approved by their state—veterans have often kept mum. That may be changing under a new directive from the Veterans Health Administration urging vets and their physicians to open up on the subject.

The new guidance directs VA clinical staff and pharmacists to discuss with veterans how their use of medical could interact with other medications or aspects of their care, including treatment for pain management or .

The directive leaves in place a key prohibition: VA providers are still not permitted to refer veterans to state-approved medical marijuana programs, since the drug is illegal under , with no accepted medical use.

That disconnect makes veterans wary, said Michael Krawitz, a disabled Air Force in Ironto, Va., who takes oxycodone and marijuana to treat extensive injuries he suffered in a non-combat-related motorcycle accident while stationed in Guam in 1984.

"Vets are happy that there's a policy, but they're unnerved by that prohibition," he said.

Krawitz, 55, is the executive director of Veterans for Medical Cannabis Access, an advocacy group. He has always been open with his VA doctors about his medical marijuana use and hasn't suffered any negative consequences. But Krawitz said he has worked with veterans who have been kicked out of their VA pain management program after a positive drug test and told they couldn't continue until they stopped using cannabis.

Such actions are usually misunderstandings that can be corrected, he said, but he suggests that the Veterans Health Administration should provide clear guidance to its staff about the new directive so veterans aren't harmed if they admit to using marijuana.

Although the new guidance encourages communication about veterans' use of marijuana, the agency's position on the drug hasn't changed, said Curtis Cashour, a VA spokesman.

Cashour referred to a quote from Veterans Affairs Secretary David Shulkin at a White House briefing last May, who said he thought that among "some of the states that have put in appropriate controls (on the use of medical marijuana), there may be some evidence that this is beginning to be helpful. And we're interested in looking at that and learning from that." But until federal law changes, the VA is not "able to prescribe medical marijuana."

Cashour declined to provide further information about the new directive.

Under federal law, marijuana is classified as a Schedule 1 drug, meaning it has no accepted medical use and a high potential for abuse. Heroin and LSD are other Schedule 1 drugs. Doctors aren't permitted to prescribe marijuana. Instead, in states that have legalized the use of medical marijuana, doctors may refer patients to state-approved programs that allow marijuana use in certain circumstances. (Doctors can, however, prescribe three drugs approved by the Food and Drug Administration that are made of or similar to a synthetic form of THC, a chemical in marijuana.)

Twenty-nine states and the District of Columbia have laws that allow people to use marijuana legally for medical purposes. Patients who have a disease or condition that's approved for treatment with marijuana under the law are generally registered with the state and receive marijuana through state-regulated dispensaries or other facilities.

Moves by states to legalize marijuana for medical or recreational use have created a confusing landscape for patients to navigate. Attorney General Jeff Sessions announced recently he would rescind an Obama-era policy that discouraged federal prosecution for marijuana use in states where it is legal. That action has further clouded the issue.

Some consider caution a good thing. The accelerating trend of states approving marijuana for medical and recreational purposes may be getting ahead of the science to support it, they say.

A report released last January by the National Academies of Sciences, Engineering and Medicine examined more than 10,000 scientific abstracts about the health effects of marijuana and its chemical compounds on conditions ranging from epilepsy to glaucoma. The experts found conclusive evidence for a relatively limited number of conditions, including relief of chronic pain, nausea and vomiting associated with chemotherapy and muscle spasms associated with multiple sclerosis.

"I believe that there are chemicals in marijuana that have medicinal properties," said Dr. Otis Brawley, chief medical officer at the American Cancer Society. "I would love to know what those are, what their medicinal properties are and what the dose should be." But, he said, studies are extremely challenging to do because of restrictions in the United States on conducting research on Schedule 1 drugs.

No matter where the research stands, getting a complete medication or history should be standard procedure at any medical appointment, say medical providers.

In that respect, the guidance from the VA is a positive development.

"It's absolutely critical that you know what your patients are taking, if only to be better able to assess what is going on," said Dr. J. Michael Bostwick, a psychiatrist at Mayo Clinic in Rochester, Minn., who has written on medical marijuana use.

Explore further: Bill to make medical marijuana available in Malta proposed

Related Stories

Bill to make medical marijuana available in Malta proposed

November 20, 2017
Malta's government has proposed allowing all doctors in the country to prescribe medical marijuana.

Medical marijuana for children with cancer? What providers think

December 12, 2017
A study published in Pediatrics examined interdisciplinary provider perspectives on legal medical marijuana use in children with cancer. It found that 92 percent of providers were willing to help children with cancer access ...

1000 veterans line up for free marijuana

September 28, 2014
(AP)—A marijuana giveaway for veterans attracted about 1,000 people to a Colorado hotel.

Congress warming to idea of medical marijuana for veterans

May 20, 2016
Congress is showing an increased willingness to let VA doctors talk to veterans about medical marijuana in states where it's legal, although final approval is far from certain.

Government won't reclassify marijuana, allows more research

August 11, 2016
The Obama administration isn't going to reclassify marijuana and remove it from the list of the most dangerous drugs.

Recommended for you

Time to ban the sale of energy drinks to children, says senior doctor

September 19, 2018
It's time to bring in laws to ban the sale of caffeinated energy drinks to children and young people in England to tackle the twin epidemics of obesity and mental health problems, argues Professor Russell Viner, President ...

For-profit hospitals correlated with higher readmission rates

September 19, 2018
Patients who receive care in a for-profit hospital are more likely to be readmitted than those who receive care in nonprofit or public hospitals, according to a new study published by University of Illinois at Chicago researchers.

Sugar content of most supermarket yogurts well above recommended threshold

September 18, 2018
A comprehensive survey of ingredients in yogurts highlights high sugar levels in many—particularly organic yogurts and those marketed towards children.

Research confronts 'yucky' attitudes about genetically engineered foods

September 18, 2018
Is a non-browning apple less "natural" than non-fat milk? In one case, people have injected something into apple DNA to prevent it from turning brown after it's cut. In the other, people used technology to remove something ...

Your teen is underestimating the health risks of vaping

September 17, 2018
Teens today are more reluctant to smoke cigarettes than their counterparts nearly three decades ago, according to a study released this summer. But parents should hold their collective sigh of relief. The study, carried out ...

Thinking beyond yourself can make you more open to healthy lifestyle choices

September 17, 2018
Public health messages often tell people things they don't want to hear: Smokers should stop smoking. Sedentary people need to get moving. Trade your pizza and hot dogs for a salad with lean protein.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.