Officials with the U.S. Department of Veterans Affairs (V.A.) mistakenly believe that federal law is blocking them from allowing government doctors to recommend medical marijuana or even to conduct research on cannabis, but that’s actually not the case.
“The V.A. is in the position of being required to follow the statutory law, and so as federal employees we are prohibited from recommending marijuana,” Dr. Laurence Meyer, the chief officer for specialty care at the V.A.’s Veterans Health Administration, said on Wednesday. “If Congress would change regulations, we would have more freedom both to investigate and to give therapy.”
He was responding to a question from Sen. Brian Schatz (D-HI) during an Appropriations subcommittee hearing on “V.A. Efforts to Prevent and Combat Opioid Overmedication.”
Schatz cited a 2014 study in the Journal of the American Medical Association which found that opioid overdose death rates are roughly 25 percent lower in states with legal medical cannabis access than in states where marijuana is strictly prohibited. A number of other studies have reported similar results.
Despite Meyer’s contention that V.A. can’t do anything on marijuana until Congress acts, that’s not true, inasmuch as there is no overarching federal law that blocks the department from allowing its doctors to recommend medical cannabis in states where it is legal, even though the drug is still considered illegal under federal law.
The only thing standing in the way is V.A.’s own internal policy, something that Veterans Affairs Secretary David Shulkin can change at any time.
But Shulkin himself has repeatedly tried to pass the buck to Congress when asked about the issue.
During a White House briefing earlier this year, he said that state medical cannabis laws may be providing “some evidence that this is beginning to be helpful, and we’re interested in looking at that and learning from that.” But he added that “until time the federal law changes, we are not able to be able to prescribe medical marijuana for conditions that may be helpful.”
In a separate interview, he said, “From the federal government point of view, right now we are prohibited by law from doing research on it or prescribing it… We are not going to be out there doing that research or prescribing these different medicinal preparations unless the law is changed.”
In another interview, he said 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.” He added, “if a law change at the federal level is appropriate, that could happen.”
The distinction between recommendation and prescription is an important one.
No physician in the U.S. — government or private — can prescribe marijuana, because prescription is a federally-regulated process and cannabis currently falls under the Controlled Substances Act’s restrictive Schedule I, a category that is supposed to be reserved for drugs with a high potential for abuse and no medical value.
That’s why the 29 states with medical cannabis access allow doctors to simply recommend the drug, circumventing the prescription process.
Under a current internal V.A. administrative directive, the department’s policy is “to prohibit VA providers from completing forms seeking recommendations or opinions regarding a Veteran’s participation in a State marijuana program.” The directive technically expired on January 31, 2016, but remains in force in practice until a new one is instituted to replace it.
Shulkin has the unilateral authority to rescind the ban and clear the way for V.A. doctors to recommend medical cannabis to veterans in states where it is legal.
Congressman Earl Blumenauer (D-OR) told Marijuana Moment last month that V.A.’s position is “disturbing.”
“For years, the V.A. has been throwing up serious barriers to veterans’ safe access to cannabis,” he said. “Yet, it’s had no problem prescribing them highly addictive opioids that have killed thousands. It makes no sense. Our veterans deserve better. They deserve equal treatment from the V.A. doctors who know them best.”
In addition to refusing to let doctors issue recommendations, V.A. has blocked federally-approved researchers from recruiting veterans for research on medical cannabis.
One such study on marijuana’s effects on PTSD has been prevented from reaching veterans at the Phoenix, Arizona V.A. hospital.
“This study needs 50 more participants and the Phoenix V.A. is in the best possible position to assist by simply allowing principle investigators to brief [V.A.] medical staff on the progress of the study, and by allowing clinicians to reveal the existence of the study to potential participants,” the American Legion, which represents more than 2.4 million military veterans, wrote to Shulkin in September. “Your immediate attention in this important matter is greatly appreciated. We ask for your direct involvement to ensure this critical research is fully enabled.”
Shulkin hasn’t yet responded, but the group has been increasing pressure on the recommendation and research issues. This month the organization released a poll finding that 81 percent percent of veterans want marijuana to be a “federally-legal treatment.”
Congresswoman Dina Titus (D-NV) said in an interview with Marijuana Moment this month that she’s “disappointed” in Shulkin for not taking initiative to remove V.A.’s internal ban on medical cannabis recommendations. And last month, a group of ten lawmakers wrote to the secretary asking him to direct the department to increase research on the drug’s potential benefits.
Despite the misunderstanding of federal law, Meyer and another V.A. official testifying at the Wednesday Senate hearing seemed to understand that the potential for cannabis has shown to help veterans warrants further investigation and application.
“I don’t think we can wait to have the perfect evidence for everything,” Meyer said. “If you have evidence that something is working, you don’t need to wait to figure our what it’s working — I’m talking in very general terms here — in order to employ it.”
Dr. Friedhelm Sandbrink, the V.A.’s acting national program director for pain management, testified that it is important to determine what’s behind the correlation between increased legal marijuana access and reduced opioid deaths in the study Schatz cited.
“For those states that have implemented cannabis laws and implemented the availability of cannabis for medical purposes…there has been about a 25 percent reduction of overdose deaths,” he said. “Obviously, that’s a very important finding. We need to understand what is truly providing this what seems to be a protectional reduction of overdose deaths.”
Schatz, who called the existing study “compelling,” pushed the V.A. officials to step up research.
“You need to do the academic and scientific inquiry to try to figure out really what’s going on here,” he said.
But that likely won’t happen until V.A. officials realize that federal law isn’t actually preventing it from participating in such research or increasing veterans’ access to cannabis.
Photo courtesy of U.S. Air Forces Special Operations Command.
Feds Award $3 Million In Grants To Study Marijuana Ingredients As Alternatives To Opioids
The federal government has awarded $3 million in grants for research into the therapeutic benefits of ingredients in marijuana other than THC, emphasizing their potential as alternatives to prescription opioids.
In a notice published on Thursday, the National Institutes of Health (NIH) explained why the studies were necessary and listed grant recipients and the subjects they will investigate. That includes research into the use of CBD for arthritis pain, which will be led by New York University School of Medicine.
“The treatment of chronic pain has relied heavily on opioids, despite their potential for addiction and overdose and the fact that they often don’t work well when used on a long-term basis,” Helene Langevin, director of the National Center for Complementary and Integrative Health (NCCIH), said in a press release. “There’s an urgent need for more effective and safer options.”
A total of nine grants were issued, with NIH stating that the funds will help identify alternative treatment options for pain and provide information about the impact of consuming cannabis compounds such as CBD and other lesser-known cannabinoids as well as terpenes found in the plant.
“The cannabis plant contains more than 110 cannabinoids and 120 terpenes, but the only compound that’s been studied extensively is THC,” the press release said.
But while THC is known to treat certain forms of pain, NIH is concerned that its intoxicating effects limit its medical applicability.
“THC may help relieve pain, but its value as an analgesic is limited by its psychoactive effects and abuse potential,” David Shurtleff, deputy director of NCCIH, said. “These new projects will investigate substances from cannabis that don’t have THC’s disadvantages, looking at their basic biological activity and their potential mechanisms of action as pain relievers.”
Just released: Nine new research awards, funded by our Center, will investigate the potential pain-relieving properties and mechanisms of actions of the diverse phytochemicals in cannabis, including both minor cannabinoids and terpenes. https://t.co/03MxrycfFa
— NIH NCCIH (@NIH_NCCIH) September 19, 2019
NIH first announced that it would be issuing grants for studies into minor cannabinoids and terpenes last year.
Federal health agencies aren’t the only institutions interested in learning about marijuana compounds other than THC. On Wednesday, a Senate committee issued a spending report that called for research into CBD and CBG while also criticizing the federal drug scheduling system for inhibiting such research.
Read descriptions of the federal cannabinoid and terpene research grant awards below:
Mechanism and Optimization of CBD-Mediated Analgesic Effects; Boston Children’s Hospital, Boston,; Zhigang He, Ph.D., B.M., and Juan Hong Wang, Ph.D. This project will investigate how the pain-relieving effects of cannabidiol (CBD) and other minor cannabinoids may be modulated by the activity of potassium-chloride cotransporter 2 (KCC2), a chloride extruder expressed in most neurons. (Grant 1R01AT010779)
Neuroimmune Mechanisms of Minor Cannabinoids in Inflammatory and Neuropathic Pain; University of California, San Francisco; Judith Hellman, M.D., and Mark A. Schumacher, M.D., Ph.D. This project will explore the effects of minor cannabinoids on inflammatory and neuropathic pain in vitro and in vivo, focusing on the interactions of the cannabinoids with the peripheral receptor called TRPV1 and a cannabinoid receptor, CB1R. (Grant 1R01AT010757)
Minor Cannabinoids and Terpenes: Preclinical Evaluation as Analgesics; Research Triangle Institute, Research Triangle Park, North Carolina; Jenny L. Wiley, Ph.D. This project will evaluate purified biosynthesized minor cannabinoids and selected terpenes alone and in planned combinations to determine their potential efficacy as pain relievers against acute thermal, inflammatory, neuropathic, and visceral pain. (Grant 1R01AT010773)
Identifying the Mechanisms of Action for CBD on Chronic Arthritis Pain; New York University School of Medicine, New York City; Yu-Shin Ding, Ph.D. This project will use neuroimaging studies and behavioral assessments to investigate the mechanisms of action of CBD in the modulation of chronic pain associated with osteoarthritis in a mouse model. (Grant 1R21AT010771)
Synthetic Biology for the Chemogenetic Manipulation of Pain Pathways; University of Texas, Austin; Andrew Ellington, Ph.D. This project will use a novel method to evolve individual variants of cannabinoid receptor type 2 (CB2) that interact with high affinity with minor cannabinoids and evaluate the new variants in a mouse model of pain. (Grant 1R21AT010777)
Exploring the Mechanisms Underlying the Analgesic Effect of Cannabidiol Using Proton Magnetic Resonance Spectroscopy; University of Utah, Salt Lake City; Deborah A. Yurgelun-Todd, Ph.D. This project will use proton magnetic resonance spectroscopy (1H-MRS) to evaluate changes in brain chemistry in critical pain-processing regions after short-term administration of a cannabis extract enriched in CBD. (Grant 1R21AT010736)
Mechanistic Studies of Analgesic Effects of Terpene Enriched Extracts from Hops; Emory University, Atlanta; Cassandra L. Quave, Ph.D. This project will take a multidisciplinary approach to investigate the analgesic effects of terpenes from Humulus lupulus (hops), a plant that is closely related to cannabis and has a very similar terpene profile. (Grant 1R21AT010774)
Systematic Investigation of Rare Cannabinoids With Pain Receptors; University of Illinois at Urbana-Champaign; David Sarlah, Ph.D. This project involves synthesizing several classes of rare phytocannabinoids, systematically evaluating their anti-inflammatory potential, and examining the effects of the compounds with the strongest anti-inflammatory potential on the major receptors involved in pain sensation. (Grant 1R21AT010761)
Analgesic efficacy of single and combined minor cannabinoids and terpenes; Temple University, Philadelphia; Sara J. Ward, Ph.D. This project will use rodent models of pain to evaluate the effects of four biologically active components of cannabis that may act synergistically to protect against pain development and to assess the interactions of these four substances with morphine. (Grant 1R01AT010778)
Beto O’Rourke Proposes Drug War Reparations Funded By Marijuana Taxes
Marijuana would not only be legalized under a plan proposed on Thursday by Democratic presidential candidate Beto O’Rourke, but cannabis tax revenue would be used to directly repay formerly incarcerated people through a new “Drug War Justice Grant” program.
Unlike other contenders who have come around to supporting marijuana legalization in just the past couple of years, the former Texas congressman has long called for ending prohibition—and his new plan in many respects goes further than those rolled out by other campaigns.
(Marijuana Moment’s editor provides some content to Forbes via a temporary exclusive publishing license arrangement.)
Support Grows For Marijuana Legalization Bill In Colombia
Colombia’s legislature will soon take up a bill to legalize and regulate the production and consumption of marijuana for adults.
The legislation, which is being filed by Sen. Gustavo Bolivar of the opposition Colombia Humana party, seeks to end prohibition as a means of curtailing crime and supporting a public health-focused approach to drug policy.
Bolivar, an author who has written several books centered on drug trafficking, has characterized the bill as being about “regularization, not legalization,” but it would provide for legal sales to adults with restrictions similar to those imposed for tobacco and alcohol. There would be penalties for selling to underage individuals and smoking wouldn’t be permitted in public spaces.
The senator pointed to Uruguay, Canada and states in the U.S. as regulatory models for legalization.
“It has been proven that crime levels are lowered and public health is improved,” he said, according to Colombia Reports.
Sen. Alberto Castilla Salazar of the leftist Polo Democrático party said that his coalition supports the reform measure.
Colombia debe superar el prohibicionismo y romper los vínculos de los grupos ilegales con el control del Cannabis, para que sea el Estado quien regule, defina las formas y entienda el consumo como problema de salud pública. Como @PoloDemocratico respaldamos está iniciativa. pic.twitter.com/YBDHqojENJ
— Alberto Castilla Salazar (@CastillaSenador) September 17, 2019
“Colombia must overcome prohibitionism and break the ties of illegal groups with the control of cannabis, so that it is the State that regulates, defines the forms and understands consumption as a public health problem,” he said on Tuesday.
Sen. Julián Gallo Cubillos of the FARC party said his coalition supports the legislation and that it represents “a new way to fight the scourge of drug trafficking.”
— Senado Colombia (@SenadoGovCo) September 18, 2019
The proposal has also garnered the support of former President Juan Manuel Santos, who has been an outspoken advocate for ending the war on drugs. His Liberal party could make or break the legislation depending on where members fall.
While left and center-left lawmakers seem largely united around legalizing marijuana, the issue will likely face resistance from President Ivan Duque, who last year signed a decree banning low-level possession of cannabis and cocaine despite court rulings that such activity is permissible.
As Colombia Reports noted, however, Duque’s far-right Democratic Center party is in the minority.
“We’ll have to see how many senators are left to former president Juan Manuel Santos and see how public opinion receives the idea that marijuana can be consumed in public spaces,” Sen. Paloma Valencia, a member of the president’s party, said.
If the country does opt to pursue a regulated cannabis program, it will join Mexico, where lawmakers are readying legislation to legalize marijuana for adult use following a Supreme Court ruling establishing that a ban on possession and cultivation for personal use is unconstitutional.
Photo courtesy of Brian Shamblen.