VA Assures Respicio Medicinal Marijuana Programs OK for Vets

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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
July
22, 2010

MEDICAL MARIJUANA
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.

2. BACKGROUND
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.

4. ACTION

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.

5. REFERENCES
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

DISTRIBUTION:

e-mailed to the VHA Publications Distribution List 07/22/2010

Respicio’s Letter to VA:

August 3, 2010
 
VIA FACSIMILE
(808) 433‐0385
 
Dr. James Hastings
Director
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
cc:
Ms. Bernadette Santos, Clinic Manager, Guam
Ms. Tricia Lizama, Team Leader, Guam

September 2, 2010
NEWS RELEASE

VA CLINIC RESPONDS TO RESPICIO’S CONCERNS FOR GUAM VETERANS

(Hagatna, Guam) Senator Rory J. Respicio (D-Agaña Heights) has received confirmation that
Guam veterans will be treated the same as stateside veterans concerning legally authorized
medicinal cannabis (marijuana) programs. Respicio’s Bill No. 423 proposes to establish such a
program in Guam.
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 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.
Respicio said: “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.”

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.” He
reiterated that “VA doctors cannot prescribe marijuana, nor will the VA pay for the
prescription to be filled by a non-VA entity.” Thanking Sen. Respicio for his concern for the
health of Guam’s veterans, Dr. Hastings assured the Senator “that the VA will do everything
possible to ensure your veterans receive the best health care possible.”
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.
###

Enclosures (3): 07/22/2010 VHA Directive 2010-035;
08/03/2010 letter from Sen. Respicio to Dr. Hastings;
08/23/2010 response from Dr. Hastings

Department of Veterans Affairs
Veterans Health Administration
Washington, DC 20420
VHA DIRECTIVE 2010-035

July

22, 2010
MEDICAL MARIJUANA
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.
2. BACKGROUND
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
ofmarijuana 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 ofpatients 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
THIS VHA DIRECTIVE EXPIRES JULY 31, 2015

VHA DIRECTIVE 2010-035
July 22, 2010
2
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.
4. ACTION
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.
5. REFERENCES
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.

VHA DIRECTIVE 2010-035
July 22, 2010
3
7. RESCISSIONS: None. This VHA Directive expires July 31, 2015.
Robert E. Petzel, M.D.
Under Secretary for Health
DISTRIBUTION:
E-mailed to the VHA Publications Distribution List 07/22/2010

 

August 3, 2010 
 
VIA FACSIMILE 
(808) 433‐0385 
 
Dr. James Hastings 
Director 
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 

 
cc: 
Ms. Bernadette Santos, Clinic Manager, Guam 
Ms. Tricia Lizama, Team Leader, Guam