A new policy encouraging doctors with the U.S. Department of Veterans Affairs to talk more about marijuana with veterans is being rolled out this month. Doctors are still not able to directly recommend cannabis, but, as the directive states, they can "discuss with the Veteran marijuana use, due to its clinical relevance to patient care, and discuss marijuana use with any Veterans requesting information about marijuana."
The policy still echoes the department’s position of compliance with the Federal laws, such as the Controlled Substances Act. Therefore, “providers are prohibited from completing forms or registering Veterans for participation in a State-approved marijuana program."
Misstating the Federal Law
There is a discrepancy between what the policy says and what actually is true. There is no provision of federal law that prohibits the department from allowing doctors to recommend cannabis to patients in states where it is legal, even in the Controlled Substances Act.
The U.S. Supreme Court ratified a federal ruling in 2003, that clearly states doctors have a First Amendment right to recommend medical cannabis to patients, as long as they don’t actually provide it themselves. The only factor that stands in the way of government doctors and medical cannabis recommendations is the internal policy of the Department of Veteran Affairs, which was extended under the new memorandum, by the department's Veterans Health Administration.
VA secretary, David Shulkin has been repeatedly asked about this issue but has shifted responsibility to Congress. Earlier this year, he stated in a White House briefing that medical cannabis legislation “may be providing some evidence that this is beginning to be helpful, and we’re interested in looking at that and learning from that.” However, he was quick to add that “until the federal law changes, we are not able to be able to prescribe medical marijuana for conditions that may be helpful.”
Shulkin has also expressed the opinion that the agency can’t participate in medical cannabis research. “From the federal government point of view, right now we are prohibited by law from doing research on it or prescribing it," he stated in one interview with POLITICO. "We are not going to be out there doing that research or prescribing these different medicinal preparations unless the law is changed.”
Shulkin has also said in another interview that “it is not within our legal scope to study that in formal research programs or to prescribe medical marijuana, even in states where it’s legal (...) if a law change at the federal level is appropriate, that could happen.”
“[The] VA is uniquely situated to pursue research on the impact of medical marijuana on veterans suffering from chronic pain and PTSD given its access to world-class researchers, the population it serves, and its history of overseeing and producing research resulting in cutting-edge medical treatments. … VA’s pursuit of research into the impact of medical marijuana on the treatment of veterans diagnosed with PTSD who are also experiencing chronic pain is integral to the advancement of health care for veterans and the nation. We ask VA to respond with a commitment to the development of VHA-led research into this issue.”
A month before, a team representing The American Legion sent a separate letter to Shulking, encouraging the VA to assist in FDA-approved clinical trials regarding the effect of various marijuana strains in veterans with PTSD. VA has yet to respond to either of the letters.
Currently, no physician in the US can legally prescribe marijuana due to its federally illegal status. As of now, cannabis falls under the Controlled Substances Act’s restrictive Schedule I, a category that includes drugs with no medical value and high potential for abuse.
The new directive also encourages government doctors to track and record information about how veterans use medical cannabis:
"Clinical staff may discuss with Veterans relevant clinical information regarding marijuana and when this is discussed it must be documented in the Veteran’s medical record (...) Providers need to make decisions to modify treatment plans based on marijuana use on a case-by-case basis, such decisions need to be made in partnership with the Veteran and must be based on concerns regarding Veteran health and safety."
The VA’s medical cannabis policy was first enacted in 2011 and has been now replaced by the new directive, effective this month. The new version of the policy will expire at the end of 2022.