Guam – Senator Rory Respicio has received confirmation from the Veterans Administration that Guam veterans will be treated the same as stateside veterans concerning legally authorized medicinal cannabis (marijuana) programs.
Sen. Respicio’s Bill No. 423, “The Compassionate Health Care Act of 2010,” would authorize licensed physicians to recommend the use of marijuana for debilitating medical conditions.
The Bill provides a framework of rules and regulations for the dispensaries that would be legally authorized and approved to dispense medicinal marijuana.
On July 22, 2010, the Veterans Health Administration issued a new policy directive stating that veterans will not be denied VA services on the basis of their participation in state medical marijuana programs.
In response, Senator Respicio wrote to the local VA clinic on August 3erd expressing his position that Guam, a territory, should receive the same benefit extended to the states through the VHA Directive, in the event his Bill 423 becomes law.
In response to the letter from Respicio, Guam VA clinic director Dr. James Hastings wrote: “Should Guam pass medical marijuana legislation, the VA Community Based Outpatient Clinic (CBOC) will comply with the provisions of VHA Directive 2010-035, and not refuse services to Guam’s veterans.” However he emphasized that “VA doctors cannot prescribe marijuana, nor will the VA pay for the prescription to be filled by a non-VA entity.”
In a release quotes Respicio is quoted as saying: “This is great news for our veterans. I’ve heard and read the horror stories from these brave men and women who suffer from the side effects of the medications they’ve been prescribed, some as extreme as death, as recently reported. Our veterans have served our country and made the same sacrifices as their mainland counterparts. It’s only right they receive the same benefits. It’s imperative that Guam continue to fight for equal treatment as American citizens and this is one great step in that direction.”
MEDICAL MARIJUANA DIRECTIVE ISSUED JULY 22
Department of Veterans Affairs
Veterans Health Administration
Washington, DC 20420
VHA DIRECTIVE 2010-035
1. PURPOSE: The purpose ofthis Veterans Health Administration (VHA) Directive is to provide guidance on access to and the use of medical marijuana by Veteran patients.
a. Fourteen states have enacted laws authorizing the use ofmedical marijuana. These authorizations generally require a physician to complete forms stipulating that a patient suffers from one or more ofa variety ofconditions and would benefit from the use of marijuana for medical purposes. Medical conditions associated with the use of medical marijuana include, but are not limited to: glaucoma, chemotherapy induced nausea, multiple sclerosis, epilepsy and chronic pain. Veterans who receive their care from the Department of Veterans Affairs (VA) and who have a desire to participate in state medical marijuana programs might ask their VA physicians to complete these authorization forms.
b. State laws authorizing the use of medical marijuana are contrary to Federal law. The Controlled Substances Act (Title 21 United States Code (U.S.C.) 801 et al.) designates marijuana as a Schedule I drug meaning that it has no currently accepted medical use and there are criminal penalties associated with its production, distribution, and possession. A VA physician’s completion ofa form that would permit a patient to participate in a state medical marijuana program could result in the Drug Enforcement Administration’s actual or threatened revocation ofthe physician’s registration to prescribe controlled substances, as well as criminal charges.
c. VHA policy does not prohibit Veterans who use medical marijuana from participating in VHA substance abuse programs, pain control programs, or other clinical programs where the use of marijuana may be considered inconsistent with treatment goals. Although patients participating in state medical marijuana programs must not be denied VHA services, modifications may need to be made in their treatment plans. Decisions to modify treatment plans in those situations are best made by individual providers in partnership with their patients. VHA endorses a step-care model for the treatment of patients with chronic pain: any prescription(s) for chronic pain should be managed under the auspices of such programs described in VHA policy regarding Pain Management.
3. POLICY: VA providers must comply with all Federal laws, including the Controlled Substances Act. Due to marijuana’s classification as a Schedule I drug under the Controlled Substances Act, it is VHA policy to prohibit VA providers from completing forms seeking recommendations or opinions regarding a Veteran’s participation in a state medical marijuana program. If a Veteran presents a prescription or authorization for medical marijuana to a VA provider or pharmacist, VA will not provide marijuana nor will it pay for the prescription to be filled by a non-VA entity. NOTE: Possession of medical marijuana by Veterans while on VA property is in violation of VA regulation 1.218(a)(7) and places them at risk for prosecution under the Controlled Substances Act.
a. Deputy Under Secretary for Health for Operations and Management (10N). The Deputy Under Secretary for Health for Operations and Management is responsible for ensuring that medical facility Directors are aware of the prohibition of completing forms for participation in state medical marijuana programs.
b. Chief Officer Patient Care Services. The Chief Officer Patient Care Services is responsible for providing clinical guidance to VA providers regarding factors to be considered when determining how substance abuse, pain control, or other treatment plans could be impacted by Veterans’ participation in state medical marijuana programs.
c. Medical Facility Directors. Medical facility Directors are responsible for ensuring VA clinical staff are aware:
(1) Of the prohibition of completing forms for participation in medical marijuana programs.
(2) That if a patient reports participation in a state medical marijuana program to the clinical staff, that information is entered into the “non-VA medication section” of the patient’s electronic medical record following established medical facility procedures for recording non-VA medication use.
a. Office of General Counsel (OCG) Opinion on State Medical Marijuana Registration Forms – VAOPGCADV 9-2008.
b. Title 21 U.S.C. 801 et al, the Controlled Substances Act.
c. VHA policy regarding Pain Management.
6. FOLLOW-UP RESPONSIBILITY: Pharmacy Benefits Management Services (119) is responsible for the content of this Directive. Questions may be addressed to (202) 461-7326.
7. RESCISSIONS: None. This VHA Directive expires July 31, 2015.
Robert E. Petzel, M.D.
Under Secretary for Health
e-mailed to the VHA Publications Distribution List 07/22/2010
Respicio’s Letter to VA:
August 3, 2010
Dr. James Hastings
VA Pacific Islands Health Care System
459 Patterson Road ‐ wE‐Wing
Honolulu, HI 96819‐1522
Hafa Adai Dr. Hastings:
I write in regards to VHA DIRECTIVE 2010‐035, which provides long‐sought clarification on the issue of participation in state medical marijuana programs by veterans who are also VA beneficiaries. As you may know, I have introduced Bill No. 423 (COR) – An act to authorize and regulate the recommending and certifying of the use of medicinal cannabis by licensed physicians to patients with debilitating medical conditions, and to create cannabis dispensaries, to be known as “Compassionate Care Centers,” to make medicinal cannabis available for such patients. This act shall be known as “The Compassionate Health Care Act of 2010.”
The Directive clarifies that Veterans will not be denied VA services based on their participation in state medical marijuana programs. Bill 423, if enacted into law, would establish a medical marijuana program in Guam. In many cases, territories are intended to be included in references made to ‘states.’ Veterans have been critical vocal supporters of this proposed legislation, and rightfully so, since they are one of the larger populations across the nation to benefit from such a move. Guam is no exception and we hope to be able to afford them this same service as has been done in 14 (and arguably 26) other states.
Please advise as to whether the Guam VA clinic will support the provisions set forth in the Directive as they apply to ‘state’ programs, should Guam, a ‘territory’, implement the same type of program.
Very Truly Yours,
Rory J. Respicio
Ms. Bernadette Santos, Clinic Manager, Guam
Ms. Tricia Lizama, Team Leader, Guam