V.A. Easing Rules for Users of Medical Marijuana

NY Times

David Fox, an Army veteran, at home in Montana. He uses medical marijuana to help quiet the pain from neuropathy. 

 

 

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.”

DC Passes Medical Marijuana Bill

Associated Press

WASHINGTON — The D.C. Council has passed a measure to legalize medical marijuana, sending the bill to Washington Mayor Adrian Fenty.

Under the measure passed Tuesday, the nation's capital would join 14 states that allow medical marijuana.

Patients with chronic illnesses such as AIDS or cancer could obtain marijuana with a doctor's recommendation. It would be given out at five to eight distribution centers.

Patients would be limited to two ounces of marijuana per month.

If Fenty signs the bill as expected, Congress would have 30 days to review before it becomes law.

In 1998, residents voted to legalize medical marijuana, but Congress blocked the initiative from taking effect for years.

New Superstore for Growing Medical Cannabis Opens in Oakland

Mercury News

The place has the feel of the nursery at a Home Depot, but the house plants, barbecues and sheds are replaced with hydroponic equipment, fans and nutrients for growing medical cannabis plants.

It's called iGrow, and the owner of the 15,000-square-foot superstore, Dhar Mann, describes it as a one-stop shop for medical marijuana patients who want to grow their own cannabis plants.

"What we are doing is taking the black market out of the (medical cannabis growing industry)," said Mann, the 25-year-old son of the owners of Friendly Cab, an Oakland-based company for more than three decades.

The shop was made possible, in part, by a City Council resolution that allows medical marijuana patients to have a maximum of 72 plants indoors, a 36-square-foot growing area, 20 plants outdoors and up to three pounds of dried marijuana.

"If you come in here with valid California identification and you have a medical recommendation or patient identification card, we will be open to talking to you about growing cannabis," said General Manager Justin Jorgensen.

And even if you don't, iGrow will have a doctor on site to write recommendations for those who qualify.

"He is going to ask for supporting (medical documentation), and if you don't have it you may or may not get approved," said Jorgensen.

The iGrow superstore, located at 70 Hegenberger Loop near the airport, isn't the first hydroponics store in the city, but Mann says it's the largest in the Bay Area. Like other stores, the shelves are stocked with various types of grow lights, fans, plant nutrients and additives, and growing containers.

Many City Council members are supportive of the store.

"It's going to create new job opportunities for residents," said Councilmember Larry Reid (Elmhurst-East Oakland), who represents the district where iGrow opened Thursday.

Reid said he is confident the store has enough security to keep out criminals looking to steal valuable equipment and products. And he said he is excited that the store could appeal to gardeners looking to improve their vegetable or flower gardens.

"It can be useful for those that want to just grow tomatoes or any other vegetable in their backyard," Reid said.

But the main focus of iGrow will be selling supplies for and giving classes about growing medical marijuana.

A portion of the warehouse will be sectioned off for the 25 online classes offered by the University of Cannabis, also recently launched and run by Mann. Courses cover everything from the "Global History of Hemp" to "Sharpening Your Green Thumb" to "The Brain, the Body & the Bud." Classes, which run from $40 to $60, can be taken at
iGrow or on your own computer, Mann said.

And then there's the Grow Squad, experienced indoor cultivators who will give three hours of complimentary in-person or over-the-phone advice to people interested in growing cannabis, Mann said.

"We want to educate you," Mann said. "And hopefully that education will cut down on some of the fires (in grow houses recently)."

Mann has been working on the $250,000 project, which included a new storefront and a complete overhaul of the long-vacant warehouse, since the fall.

Several hundred people attended Thursday's grand opening, which included speeches by Reid and Oakland Councilmember Rebecca Kaplan (at-large).



"The grow business is an economic opportunity for our city," Kaplan said. "We want to celebrate, we want to support and we want to uplift that to help pay for the parks, libraries and services that people need," referring to the fact that the business will generate tax revenue.

Dave Weddingdress, co-founder of the Harborside Health Center cannabis club in San Jose, also attended the event.

"We are happy to see these places open under reasonable regulations," he said.

Mann also had short videos from other elected officials, including Rep. John Garamendi, touting the project as a boon for urban agriculture and the city's economy.

"We're excited that iGrow was born in the epicenter of the cannabis movement," said Mann. "And we're even more thrilled to see the strong support that the city of Oakland and the community has shown us for the grand opening of our new business."

A Doctor's Case For Legal Cannibis

The Wall Street Journal / Dr. David L. Nathan

Most Americans are paying too much for marijuana. I'm not referring to people who smoke it—using the drug generally costs about as much as using alcohol. Marijuana is unaffordable for the rest of America because billions are wasted on misdirected drug education and distracted law enforcement, and we also fail to tax the large underground economy that supplies cannabis.

On Monday, the New Jersey legislature passed a bill legalizing marijuana for a short list of medical uses. Outgoing Democratic Gov. Jon Corzine says he will sign it into law. This is a positive step, as cannabis has several unique medical applications. But the debate over medical marijuana has obscured the larger issue of pot prohibition.

As a psychiatrist, I treat individuals who often suffer from devastating substance abuse. Over many years of dealing with my patients' problems, I have come to realize that we are wasting precious resources on the fight against marijuana, which more closely resembles legal recreational drugs than illegal ones. My conscience compels me to support a comprehensive and nationwide decriminalization of marijuana.

Prohibition did decrease alcoholism and alcohol consumption in the 1920s. However, the resulting rise of violent organized crime and the loss of tax revenue were untenable and led to the repeal of Prohibition. By analogy, while the broad decriminalization of marijuana will likely reduce the societal and economic costs of pot prohibition, it could lead to more use and abuse.

The risks of marijuana use are mild compared to those of heroin, ecstasy and other illegal drugs, but the drug is not harmless. A small number of my patients cannot tolerate any use without serious impact on underlying disorders. Others become daily, heavy smokers, manifesting psychological if not physiological dependence. While most of my patients appear to suffer no ill effects from occasional use, the drug makes my work more difficult with certain individuals.

So why do I support decriminalization? First, marijuana prohibition doesn't prevent widespread use of the drug, although it does clog our legal system with a small percentage of users and dealers unlucky enough to be prosecuted. More to the point, legal cannabis would never become the societal problem that alcohol already is.

In most of my substance-abuse patients, I am far more concerned about their consumption of booze than pot. Alcohol frequently induces violent or dangerous behavior and often-irreversible physiological dependence; marijuana does neither. Chronic use of cannabis raises the risk of lung cancer, weight gain, and lingering cognitive changes—but chronic use of alcohol can cause pancreatitis, cirrhosis and permanent dementia. In healthy but reckless teens and young adults, it is frighteningly easy to consume a lethal dose of alcohol, but it is almost impossible to do so with marijuana. Further, compared with cannabis, alcohol can cause severe impairment of judgment, which results in greater concurrent use of hard drugs.

Many believe marijuana is a gateway drug—perhaps not so harmful in itself but one that leads to the use of more serious drugs. That is not borne out in practice, except that the illegal purchase of cannabis often exposes consumers to profit-minded dealers who push the hard stuff. In this way, the gateway argument is one in favor of decriminalization. If marijuana were purchased at liquor stores rather than on street corners where heroin and crack are also sold, there would likely be a decrease in the use of more serious drugs.

The nation badly needs the revenue of a "sin tax" on marijuana, akin to alcohol and tobacco taxes. Our government could also save money by ending its battle against marijuana in the drug war and redirecting funds to proactive drug education and substance-abuse treatment. Hyperbolic rants about the evils of marijuana could give way to realistic public education about the drug's true risks, such as driving under the influence.

Our nation can acknowledge the dangers of cigarettes, alcohol and marijuana while still permitting their use. The only logically and morally consistent argument for marijuana prohibition necessitates the criminalization of all harmful recreational drugs, including alcohol, nicotine and caffeine. We can agree that such an infringement on personal freedoms is as impractical as it is un-American. The time has come to accept that our nation's attitude toward marijuana has been misguided for generations and that the only rational approach to cannabis is to legalize, regulate and tax it.

New Federal Policy On Medical Marijuana: Lighten Up

NY Times

People who use marijuana for medical purposes and those who distribute it to them should not face federal prosecution, provided they act according to state law, the Justice Department said Monday in a directive with far-reaching political and legal implications.

In a memorandum to federal prosecutors in the 14 states that make some allowance for the use of marijuana for medical purposes, the department said that it was committed to the “efficient and rational use” of its resources and that prosecuting patients and distributors who are in “clear and unambiguous compliance” with state laws did not meet that standard.

The new stance was hardly an enthusiastic embrace of medical marijuana, or the laws that allow it in some states, but signaled clearly that the administration thought there were more important priorities for prosecutors.

“It will not be a priority to use federal resources to prosecute patients with serious illnesses or their caregivers who are complying with state laws on medical marijuana,” Attorney General Eric H. Holder Jr. said in a statement accompanying the memo, “but we will not tolerate drug traffickers who hide behind claims of compliance with state law to mask activities that are clearly illegal.”

Emphasizing that it would continue to pursue those who use the concept of medical marijuana as a ruse, the department said, “Marijuana distribution in the United States remains the single largest source of revenue for the Mexican cartels,” and pursuing the makers and sellers of illegal drugs, including marijuana, will remain a “core priority.”

The new policy was tbe laszThe politics swirling around marijuana cross ideological lines. For instance, in effectively deferring to the states on some issues involving marijuana, the Obama administration is taking what could be seen as a states’ rights stance, more commonly associated with conservatives. That was a theme that echoed on many conservative and libertarian Internet sites in the wake of Monday’s announcement.

But one prominent conservative, Representative Lamar Smith of Texas, criticized the Justice Department’s position, saying it would weaken federal enforcement of drug laws.

“By directing federal law enforcement officers to ignore federal drug laws, the administration is tacitly condoning the use of marijuana in the United States,” said Mr. Smith, the senior Republican on the House Judiciary Committee. “If we want to win the war on drugs, federal prosecutors have a responsibility to investigate and prosecute all medical marijuana dispensaries and not just those that are merely fronts for illegal marijuana distribution.”

Polls have shown for years that there is widespread public support for making marijuana available to relieve the suffering of people who are very ill. But repeated efforts in Congress to block federal prosecution of medical marijuana have fallen short, and the new policy was a sharp departure from that of the Bush administration, in which the Drug Enforcement Administration raided medical marijuana distributors even if the distributors appeared to be complying with state laws.

The new policy, which reflects positions that Mr. Obama took as a presidential candidate and that Mr. Holder laid out in March, came in a memo from David W. Ogden, the deputy attorney general, to the United States attorneys in the affected states, most notably California.

The White House sought to turn aside any impression that Mr. Obama would like other states to follow the example of the 14 that make some allowance for medical marijuana.

“I’m not going to get into what states should do,” said the president’s chief spokesman, Robert Gibbs.

Mr. Gibbs said the memo to federal prosecutors “simply adds guidelines to a decision that Attorney General Holder talked about in mid-March and has been administration policy since the beginning of this administration in January.”

The guidelines give specific examples of conduct that would causes prosecutors to look at a case involving marijuana even if a user or distributor said it was for medical use. The examples include unlawful possession or use of a firearm, sales to minors and evidence of money laundering activity.

Graham Boyd, director of the Drug Law Reform Project at the American Civil Liberties Union, called the Justice Department’s move “an enormous step in the right direction and, no doubt, a great relief to the thousands of Americans who benefit from the medical use of marijuana.”

Mr. Boyd predicted that states and cities “will have a strong incentive to create regulated, safe and sensible means of getting marijuana to patients who need it.”

The new policy follows a series of changes, including the appointment of Richard Gil Kerlikowske, a former police chief of Seattle, to be Mr. Obama’s top drug policy adviser.

Medical marijuana thrived in Seattle on Mr. Kerlikowske’s watch, and advocates of more liberal marijuana laws hoped that his appointment to the office, which he assumed in May, signaled the administration’s willingness to decriminalize medical marijuana.

Some federal law enforcement officials are opposed to the administration’s position.

Privately, some federal law enforcement officials complained that medical marijuana and marijuana being smuggled in from Mexico are one and the same, and that the Obama administration has backed away from necessary enforcement of drug laws. Agents from the D.E.A. often work alongside local police officers.

As Mr. Ogden’s memo was being made public, the Web site of the Drug Enforcement Administration outlined its position on medical marijuana: “Smoked marijuana has not withstood the rigors of science — it is not medicine and it is not safe. D.E.A. targets criminals engaged in cultivation and trafficking, not the sick and dying.”

Advocates of medical marijuana say it can reduce chronic pain, nausea and additional symptoms associated with cancer and other serious illnesses. In 1996, California became the first state to make it legal to sell marijuana to people with doctors’ prescriptions. The other states that allow some use of marijuana for medical purposes are Alaska, Colorado, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington.