VA Clears The Air On Talking To Patients About Marijuana Use

KHN contributing columnist Michelle Andrews writes the sequence Insuring Your Health, which explores well being care protection and prices.

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“Don’t ask, don’t tell” is what number of veterans have approached well being care conversations about marijuana use with the docs they see from the Department of Veterans Affairs.

Worried that proudly owning as much as utilizing the drug might jeopardize their VA advantages — even when they’re taking part in a medical marijuana program permitted by their state — veterans have typically stored mum. That could also be altering underneath a brand new directive from the Veterans Health Administration urging vets and their physicians to open up on the topic.

The new guidance directs VA scientific workers and pharmacists to debate with veterans how their use of medical marijuana might work together with different medicines or elements of their care, together with remedy for ache administration or post-traumatic stress dysfunction.

The directive leaves in place a key prohibition: VA suppliers are nonetheless not permitted to refer veterans to state-approved medical marijuana packages, because the drug is illegitimate underneath federal legislation, with no accepted medical use.

That disconnect makes veterans cautious, stated Michael Krawitz, a disabled Air Force veteran in Ironto, Va., who takes oxycodone and marijuana to deal with intensive accidents he suffered in a non-combat-related motorbike accident whereas stationed in Guam in 1984.

“Vets are happy that there’s a policy, but they’re unnerved by that prohibition,” he stated.

Krawitz, 55, is the manager director of Veterans for Medical Cannabis Access, an advocacy group. He has all the time been open along with his VA docs about his medical marijuana use and hasn’t suffered any damaging penalties. But Krawitz stated he has labored with veterans who’ve been kicked out of their VA ache administration program after a constructive drug check and instructed they couldn’t proceed till they stopped utilizing hashish.

Such actions are often misunderstandings that may be corrected, he stated, however he means that the Veterans Health Administration ought to present clear steerage to its workers concerning the new directive so veterans aren’t harmed in the event that they admit to utilizing marijuana.

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Although the brand new steerage encourages communication about veterans’ use of marijuana, the company’s place on the drug hasn’t modified, stated Curtis Cashour, a VA spokesman.

Cashour referred to a quote from Veterans Affairs Secretary David Shulkin at a White House briefing final May, who said he thought that amongst “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 till federal legislation adjustments, the VA is just not “able to prescribe medical marijuana.”

Cashour declined to offer additional details about the brand new directive.

Under federal legislation, marijuana is classed as a Schedule 1 drug, which means it has no accepted medical use and a excessive potential for abuse. Heroin and LSD are different Schedule 1 drugs. Doctors aren’t permitted to prescribe marijuana. Instead, in states which have legalized using medical marijuana, docs could refer sufferers to state-approved packages that permit marijuana use in sure circumstances. (Doctors can, nonetheless, prescribe three drugs permitted by the Food and Drug Administration which might be product of or much like an artificial type of THC, a chemical in marijuana.) 

Twenty-nine states and the District of Columbia have laws that permit individuals to make use of marijuana legally for medical functions. Patients who’ve a illness or situation that’s permitted for remedy with marijuana underneath the legislation are usually registered with the state and obtain marijuana via state-regulated dispensaries or different amenities.

Moves by states to legalize marijuana for medical or leisure use have created a complicated panorama for sufferers to navigate. Attorney General Jeff Sessions announced last week he would rescind an Obama-era coverage that discouraged federal prosecution for marijuana use in states the place it’s authorized. That motion has additional clouded the issue.

Some take into account warning a very good factor. The accelerating pattern of states approving marijuana for medical and leisure functions could also be getting forward of the science to assist it, they are saying.

A report launched final January by the National Academies of Sciences, Engineering and Medicine examined greater than 10,000 scientific abstracts concerning the well being results of marijuana and its chemical compounds on circumstances starting from epilepsy to glaucoma. The specialists discovered conclusive proof for a relatively limited number of conditions, together with aid of persistent ache, nausea and vomiting related to chemotherapy and muscle spasms related to a number of sclerosis.

“I believe that there are chemicals in marijuana that have medicinal properties,” stated Dr. Otis Brawley, chief medical officer on 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 stated, research are extraordinarily difficult to do due to restrictions within the United States on conducting analysis on Schedule 1 medicine.

No matter the place the analysis stands, getting a whole treatment or drug historical past needs to be customary process at any medical appointment, say medical suppliers.

In that respect, the steerage from the VA is a constructive growth.

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

Michelle Andrews: @mandrews110

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