Seven members of the Massachusetts congressional delegation are urging the head of the U.S. Department of Veterans Affairs (VA) to allow VA physicians to verbally recommend medical marijuana to military veterans amid the coronavirus pandemic.
The letter, led by Sen. Elizabeth Warren (D-MA) and shared exclusively with Marijuana Moment, stresses that Massachusetts has shuttered recreational marijuana shops during the COVID-19 crisis, which has driven some to transition to the medical cannabis dispensaries that remain open as essential services under the governor’s order. But because veterans may avoid registering as cannabis patients out of concern that they could lose federal benefits and are now left without access to medicine, the lawmakers want VA to amend its policies, at least on a temporary basis.
“As this global pandemic continues to adversely affect veterans’ behavioral and physical health conditions, we believe that veterans who legally use cannabis in the Commonwealth to treat their ailments deserve to receive more robust assistance from qualified medical personnel at their local VA,” the lawmakers, including House Rules Committee Chairman James McGovern (D-MA), wrote, adding that they feel VA should “consider making this directive the official policy” of VA on a permanent basis once the current health emergency is over.
It’s unclear what the practical impact of allowing VA doctors to make “verbal” recommendations would be, given that state medical marijuana certifications generally require a written component from doctors.
An aide to Warren told Marijuana Moment that the senator would ultimately like to see VA doctors be able to offer written recommendations and that the hope is the incremental reform could provide short-term relief to veterans and set the stage for broader policy changes down the line.
The staffer also noted that Warren is pushing for comprehensive federal marijuana legalization and wants medical cannabis products covered under VA insurance for veterans just like any other legal medication.
VA currently allows and encourages veterans to discuss their use of marijuana as a treatment for various ailments with their government doctors, but it specifically prohibits its physicians from issuing recommendations needed to register as a qualified patient under a state-legal program or from assisting in obtaining medical cannabis in any way.
“Veterans in Massachusetts use medical marijuana to treat a variety of ailments, including post-traumatic stress disorder (PTSD), anxiety, chronic pain, and others,” the Wednesday letter, which was also signed by Sen. Ed Markey and Reps. Katherine Clark, Seth Moulton, Ayanna Pressley and Joseph Kennedy III, all Democrats, states.
“For many veterans in Massachusetts, medical marijuana works in treating their health conditions, which can be exacerbated by the coronavirus pandemic,” they wrote to VA Secretary Robert Wilkie. “Therefore, during this unprecedented public health emergency, VA should issue a directive explicitly authorizing its health care providers to make sensible, clinically sound verbal recommendations to veterans related to participation in state-approved medical marijuana programs and services and to provide advice to veterans as they complete forms and other paperwork reflecting those recommendations.”
States that have medical cannabis programs generally require a licensed doctor’s signature in order for a patient to be certified, so the language around “verbal” recommendations by itself wouldn’t help veterans obtain legally protected patient status. But the letter has a suggestion for how VA personnel could help nonetheless.
“When veterans request advice on paperwork related to participating in a state-approved marijuana program, VA clinicians should be advised that they can make verbal referrals to knowledgeable non-VA providers who are registered with a state-approved program and can offer feasible options that minimize, or completely waive, the cost to the veteran,” the lawmakers wrote.
But veterans are already able to seek out written recommendations from non-VA physicians, and it’s not clear how VA would be able to facilitate a process where those private providers would waive or minimize costs, as the letter encourages.
That said, Debbie Churgai, interim director of Americans for Safe Access, told Marijuana Moment that she does not view the verbal recommendation caveat as “an extra hoop to jump through,” but rather as “an opportunity for many veterans to openly talk with and get acceptance and assistance from their VA physicians.”
If veterans are able to get verbal advice from VA doctors on how to fill out state applications to become registered patients and can be directed on the process of submitting them to relevant agencies, that would represent a positive development compared to the current system, where patients are completely on their own in navigating the process.
“I think having the ability to talk with their primary physician about cannabis and get verbal approval (i.e recommendation) from them is really huge and amazing news for veterans. Or at least it’s a tiny step in the right direction,” Churgai said. “Having a VA physician suggest cannabis as medicine with a verbal recommendation could help many patients open up their minds about cannabis as an option for treatment.”
She added that “this could help in court as well to protect physicians when talking about cannabis” because the current policy of allowing them to discuss it but not endorse it “could be seen as confusing, so for many this may help physicians feel more comfortable talking about cannabis with their patients.”
In their letter, the Massachusetts lawmakers went on to say that “VA clinicians who provide this temporary, limited assistance to veterans should be clearly advised by the VA that they will not be subject to disciplinary action,” and they urged “VA to work with the Justice Department to formally advise VA providers who conduct these clinical activities that they will not face criminal prosecution under federal marijuana laws.”
“By authorizing these tailored, temporary actions, the VA could help Massachusetts veterans who use, or are interested in using, medical marijuana receive more comprehensive clinical advice from their VA providers, reduce opioid addiction and substance use disorders, and achieve better health outcomes,” they concluded. “Finally, when this public health emergency ends, we urge VA to consider making this directive the official policy of the Department going forward.”
Advocates also say that such a policy change would be important because veterans should be empowered to discuss cannabis treatment, get a recommendation and continue that dialogue with a VA clinician they know and have an existing relationship with. It could help that VA doctors would be making referrals to credible non-VA physicians to complete the registration process, as well, instead of having veterans use less trustworthy cannabis-focused physician services that they have to find on their own.
Michael Liszewski, principal of the Enact Group, acknowledged that the move “would not necessarily facilitate a veteran being able to register with a state medical cannabis program” but said that “it does have some practical merit.”
“By encouraging vets to speak with their VA doctors from which they are receiving ongoing care, veterans would receive more fully-informed care,” he said. “While allowing referrals to trusted physicians outside the VA system to complete paperwork means veterans will still be paying out of pocket for the exam, the directive would ease the barrier.”
Clark, one of the representatives signing the new letter, has previously cited veterans’ access to cannabis in urging the Massachusetts government to reverse its decision to close recreational marijuana shops—which the governor said was necessary to prevent out-of-state consumers from visiting and potentially spreading the coronavirus.
Under federal policy, @DeptVetAffairs health care providers may not recommend marijuana or assist veterans in obtaining it. VA must change its policy so that no veteran is left when it comes to accessing health care during a national emergency — or ever. https://t.co/iUgrsaNCBB
— Katherine Clark (@RepKClark) April 16, 2020
A bill to allow VA doctors to issue medical cannabis recommendations (without the “verbal” stipulation) was approved by the House Veterans’ Affairs Committee last month. Rep. Earl Blumenauer (D-OR) is the sponsor of that legislation, which was opposed by a VA official in an earlier hearing. The official said the the Drug Enforcement Administration advised against allowing the policy change.
“I’m appreciative of any attempt to broaden veterans’ access to cannabis. It’s an important step towards removing barriers that many veterans face when seeking care,” Blumenauer told Marijuana Moment in response to the new push from the Massachusetts delegation. “During this time when we are recommending that those at risk distance themselves from others, that includes going to the doctor unnecessarily. Veterans deserve access to medical cannabis treatment at the recommendation of their physician, period. It’s past time we give them that unfettered access.”
The Congressional Budget Office released an analysis last month projecting that Blumenauer’s bill would have zero fiscal impact.
Outside of the veterans-specific issues related to federal marijuana policies during the coronavirus pandemic, there’s also a congressional push in the works to expand disaster relief benefits to marijuana businesses. And eleven senators sent a letter to Appropriations Committee leadership earlier this month, asking for a provision to future spending legislation that would allow cannabis companies to access Small Business Administration (SBA) programs.
Also, in a recent call with the Democratic Caucus, Rep. Ed Perlmutter (D-CO) raised the issue marijuana banking access and, according to the congressman, House Speaker Nancy Pelosi (D-CA) said she wanted to include language ensuring that cannabis businesses can access those financial services in an upcoming coronavirus stimulus package.
Read the lawmakers’ medical marijuana letter to VA below:
Photo courtesy of WeedPornDaily.
Mississippi Supreme Court Overturns Medical Marijuana Legalization Ballot That Voters Approved
A voter-approved initiative to legalize medical marijuana in Mississippi has been overturned by the state Supreme Court.
On Friday, the court ruled in favor of a Mississippi mayor who filed a legal challenge against the 2020 measure, nullifying its certification by the Secretary of State. The lawsuit was unrelated to the reform proposal itself, but plaintiffs argued that the constitutional amendment violated procedural rules in place.
While the court acknowledged that a “strong, if not overwhelming, majority of voters of Mississippi approved Initiative 65” to legalize medical cannabis in the state, Madison Mayor Mary Hawkins Butler’s (R) petition was valid for statutory reasons.
Madison’s challenge cites a state law stipulating that “signatures of the qualified electors from any congressional district shall not exceed one-fifth (1/5) of the total number of signatures required to qualify an initiative petition for placement upon the ballot.” But that policy went into effect when Mississippi had five congressional districts, and that’s since been reduced to four, making it mathematically impossible to adhere to.
The state pushed back against the lawsuit and argued that a plain reading of the state Constitution makes it clear that the intention of the district-based requirement was to ensure that signatures were collected in a geographically dispersed manner—and the result of the campaign met that standard.
But in the court’s ruling released on Friday, the justices said that their hands were tied. The legislature or administration might be able to fix the procedural ballot issue, but it had to follow the letter of the law.
“We find ourselves presented with the question squarely before us and nowhere to turn but to its answer,” the decision states. “Remaining mindful of both the November 3, 2020 election results and the clear language in section 273 seeking to preserve the right of the people to enact changes to their Constitution, we nonetheless must hold that the text of section 273 fails to account for the possibility that has become reality in Mississippi.”
In sum, a Census-driven change in the number of congressional districts in Mississippi “did, indeed, break section 273 so that, absent amendment, it no longer functions,” meaning there’s no legal way to pass a constitutional ballot initiative in the state.
“Whether with intent, by oversight, or for some other reason, the drafters of section 273(3) wrote a ballot-initiative process that cannot work in a world where Mississippi has fewer than five representatives in Congress. To work in today’s reality, it will need amending—something that lies beyond the power of the Supreme Court.”
“We grant the petition, reverse the Secretary of State’s certification of Initiative 65, and hold that any subsequent proceedings on it are void,” the court ruled.
One justice who dissented said that the district-based requirement is arbitrary as it concerns Mississippi elections. While the federal government defines the state as having five congressional districts, the state Constitution “lays out the five districts,” and “there have been zero changes to the five districts” as far as the state’s laws are concerned.
In any case, this marks a major defeat for cannabis reform activists in the state who collected more than 214,000 signatures for their measure and saw 68 percent of voters approve it last year.
Under the voter-approved initiative, patients with debilitating medical issues would have been allowed to legally obtain marijuana after getting a doctor’s recommendation. The proposal included 22 qualifying conditions such as cancer, chronic pain and post-traumatic stress disorder, and patients would have been able to possess up to 2.5 ounces of marijuana per 14-day period.
There was an attempt in the legislature to pass a bill to legalize medical marijuana in the event that the court overruled the voter-approved initiative, but it failed to be enacted by the session’s end.
This is the latest state Supreme Court setback to affect cannabis reform efforts.
Last month, the Florida Supreme Court dealt a critical blow to marijuana activists working to legalize marijuana in the state—killing an initiative that hundreds of thousands of voters have already signed and forcing them to start all over again if they want to make the 2022 ballot.
While a Nebraska campaign collected enough signatures to qualify a reform initiative in 2020, the state Supreme Court shut it down following a legal challenge. It determined that the measure violated the state’s single-subject rule, much to the disappointment of advocates.
Read the Mississippi Supreme Court ruling on the medical cannabis initiative below:
Congressional Bill Filed To Protect Marijuana Consumers From Losing Public Housing
A congresswoman on Thursday reintroduced a bill that would allow people living in federally assisted housing to use marijuana in compliance with state law without fear of losing their homes.
As it stands, people living in public housing are prohibited from using controlled substances in those facilities regardless of state law, and landlords are able to evict such individuals. But the bill from Rep. Eleanor Holmes Norton (D-DC) would change that.
It would provide protections for people living in public housing or Section 8 housing from being displaced simply for using cannabis in states that have legalized it for medical or recreational purposes.
“Individuals living in federally assisted housing should not be denied admission, or fear eviction, for using a legal product,” Norton said on Thursday. “Adult use and/or medical marijuana is currently legal in 36 states and the District of Columbia, and over 90 percent of Americans support legalized medical marijuana.”
The legislation would also require the head of the Department of Housing and Urban Development (HUD) to enact regulations that restrict smoking marijuana at these properties in the same way that tobacco is handled.
“HUD, like DOJ, should not be allowed to enforce federal marijuana laws where states have taken action to legalize marijuana,” the congresswoman said, referring to a congressionally approved rider that prevents the Department of Justice from interfering with state medical cannabis laws.
Norton filed earlier versions of the Marijuana in Federally Assisted Housing Parity Act in 2018 and 2019, but they did not receive hearings or votes.
In 2018, a Trump administration official said that she was working to resolve conflicting federal and state marijuana laws as it applies to residency in federally-subsidized housing, but it’s not clear what came of that effort.
Rep. Alexandria Ocasio-Cortez (D-NY) also raised the issue during a committee hearing in 2019, pressing former HUD Secretary Ben Carson on policies that cause public housing residents and their families to be evicted for committing low-level offenses such as marijuana possession.
She pointed to two specific HUD policies: the “one strike” rule, which allows property managers to evict people living in federally assisted housing if they engage in illicit drug use or other crimes, and the “no fault” rule, which stipulates that public housing residents can be evicted due to illicit drug use by other members of their household or guests—even if the resident was unaware of the activity.
Ocasio-Cortez and then-Sen. Kamala Harris (D-CA) also filed legislation that year that would protect people with low-level drug convictions from being denied access to or being evicted from public housing.
Sen. Jeff Merkley (D-OR) also introduced an affordable housing bill last year that included a provision to prevent landlords from evicting people over manufacturing marijuana extracts if they have a license to do so.
Read the text of the marijuana housing legislation below:
Photo courtesy of Martin Alonso.
FDA Clears Researchers To Study MDMA Use By Therapists Being Trained In Psychedelic Medicine
The Food and Drug Administration (FDA) has already authorized clinical trials into the therapeutic potential of MDMA for patients with post-traumatic stress disorders—but now it’s given the green light to a psychedelics research institute to expand its studies by administering the substance to certain therapists.
Volunteer therapists who are being trained to treat people with PTSD will be able to participate in the Phase 1 trials to gain personal experience with the treatment option. This is a complementary research project that comes as the Multidisciplinary Association for Psychedelic Studies (MAPS) is in the process of conducting Phase 3 trials involving people with the disorder.
The development comes months after Canadian regulators announced that certain therapists would be allowed to take psilocybin in order to gain a better understanding of the psychedelic when treating patients.
MAPS sought permission to proceed with the therapist-specific trials in 2019, but FDA placed them on a 20-month hold because of concerns about the merits, risks and credentials of investigators. MAPS appealed that hold, providing evidence about the study’s scientific value and ability of its staff, and FDA cleared them on Tuesday.
— MAPS (@MAPS) May 13, 2021
The organization “chose to dispute” FDA’s hold not just because of the impact it had on the planned studies, “but in an attempt to resolve an ongoing issue with the FDA regarding investigator qualifications across studies,” it said in a press release on Wednesday.
“While the term ‘dispute’ may seem adversarial, this process can actually strengthen the relationship and trust between us and our review Division and ensures the Division has support on this project from the [FDA] Office of Neuroscience,” MAPS Public Benefit Corporation (PBC) CEO Amy Emerson said. “This decision demonstrates how our strategic, data-driven strategy in challenging the FDA rulings can be successful.”
Now MAPS is able to launch the Phase 1 clinical trials into MDMA-assisted therapy for therapists.
It will be designed to “measure development of self-compassion, professional quality of life, and professional burnout among clinicians delivering the treatment to patients,” the association said.
Getting personal experience with the substance “is widely considered to be an important element in preparation and training to deliver psychedelic-assisted therapies.”
This will “support the goals of the MDMA Therapy Training Program to provide comprehensive training to future providers,” and it “builds capacity to deliver quality, accessible care to patients, pending approval of MDMA-assisted therapy as a legal prescription treatment,” MAPS PBC Director and Head of Training and Supervision Shannon Carlin said.
FDA first granted MAPS’s request for an emergency use authorization for MDMA in PTSD in 2017. The organization expects to complete its Phase 3 trails in 2022.
The scientific expansion move also comes as the psychedelics decriminalization movement continues to build in the U.S.