Southern California Regional VA Policy Revised to Allow for Medical Marijuana Use with Opioids


December 8, 2017 – The VA has issued VHA Policy Directive 2017-1315 stating, “Veterans must not be denied VHA services solely because they are participating in State-approved marijuana programs.” The directive, signed by Executive in Charge Carolyn M. Clancy, M.D., replaces VHA Directive 2011-004 which had the same language. The new directive is scheduled for recertification on or before the last working day of December 2022.

Like the old directive, the current one does not allow VA doctors to recommend medical cannabis, or for VA pharmacies to supply it. Unlike the old one, it specifically allows doctors to discuss a patient’s cannabis use, and requires that discussion to be documented. The purpose of the new policy is “to support the Veteran-provider relationship when discussing the use of marijuana and its impact on health including Veteran-specific treatment plans.”

The current directive specifically states that the VISN Director is responsible for assuring that this policy is disseminated and implemented at all facilities in the VISN, and that the VA Medical Facility Director is responsible for educating VA facility staff about the policy.

It also states, “Possession of marijuana, even for authorized medical reasons, by Veterans
while on VA property is in violation of 38 CFR 1.218(a)(7) and places them at risk for
prosecution under the Controlled Substances Act, 21 U.S.C 801 et. al.”

A survey conducted by the American Legion in October 2017 revealed that 92% of veterans support research into medical cannabis and 83% of veteran households support legalizing medical cannabis. The survey also indicated that 22% of veterans are currently using cannabis to treat a medical condition with the the most prevalent conditions being chronic pain and PTSD. Veterans are twice as likely to succumb to accidental opioid overdose than non-veterans.

4/22/16: DEA Approves Cannabis Study Aimed at Treating Veterans with PTSD

5/21/15: Senators, Including Feinstein, Approve Amendment Allowing Vets to Use Medical Marijuana

5/15/15: Combination Of Medical Marijuana, Opioids Does Not Increase Substance Abuse Risk, Study Finds

March 10, 2015 – In response to months of effort from California NORML, Veterans for Medical Cannabis Access, affiliated groups and Congressional offices, Cal NORML has been informed that VISN-22 policy has been revised to allow the use of medical marijuana with opioid prescriptions at all VA facilities in the Southern California region.

The new policy states:

If the UDS detects marijuana, and the patient participates in a State medical marijuana program, the provider and patient will discuss the various options and information available, including the safety risk associated with concurrent use. The patient and provider will then make a shared decision as to what direction the non-malignant pain will be managed.

Providers concurring in providing opioids in patients participating in a State medical marijuana program, must follow procedures that include a signed “Medical Marijuana Patient Use Agreement” and a “Concomitant Use of Opioids/Medical Marijuana Note”, documenting that any contraindications have been addressed and validating patient is enrolled in a State medical marijuana program.

Patients may appeal a provider decision not to provide opioid in a patient participating in a State medical marijuana program, by following the procedure outlined in “Network-Wide Policy for Clinical Appeals”; 2002-7.

The chief of staff at each VHA is responsible for implementation and monitoring of compliance with the policy.

Cal NORML began receiving phone calls last fall from veterans impacted by a policy directive issued by former VISN-22 acting chief Jeffrey Gering stating that any patient using medical marijuana would be tapered off their pain medications. Callers included a paratrooper injured in a training exercise who was denied his pain meds at Loma Linda hospital on Christmas eve, and a 70-year-old former pilot injured in a forced landing while in service.

Since the policy was in direct conflict with national VA policy allowing doctors to determine the best course of treatment in medical marijuana states, Michael Krawitz of VCMA put the national ethics committee of the VA in touch with Gering’s office, reportedly gaining assurance that the policy would be changed just before Thanksgiving. However no change took place and Cal NORML deputy director Ellen Komp spent much of the month of January in the Southern California area visiting VA hospitals with veterans and reaching out to activist groups and Congressional offices. San Diego activists (pictured) helped bring about opposition from the Veterans Democratic Club of San Diego County.

“I hope and expect that this policy change will mean better care for veterans in the Southern California region who choose to use medical marijuana to augment their pain management regimen,” said Komp. She thanked all who worked towards making this policy change, in particular David Zink of Long Beach VA Patient Experience Council, and Michael Krawitz of VCMA. In addition Marcus Boyd of San Diego ASA, himself a veteran, mounted a petition that gathered over 20,000 signatures in support of a policy change.

Already NORML has received word that one veteran’s doctors have told him he will be denied despite the change in policy. The new policy contains a means by which veterans can appeal any denial of medication. Other services, such as PTSD psychotherapy programs and anxiety medications, have also been denied due to medical marijuana use. This is highly ironic since to many, cannabis is helpful with PTSD and anxiety.

Cal NORML urges all to write their Congressional representatives in support of the Veterans Equal Access Act, which would allow VA doctors to recommend medical marijuana to their patients.

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