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news-sep21_Layout 1 01/09/10 10:31 AM Page 1405 CMAJ News United States war veterans gain access to medicinal marijuana Previously published at www.cmaj.ca he military culture and the coun- terculture once stood apart across T a great divide in the United States, one side waving red, white and blue, the other side letting its freak flag fly — often through a cloud of cannabis. Times change. The US Veterans Affairs Depart- ment is quietly embracing old soldiers who use marijuana for pain and infir- mity. Under a new directive, health care provided to veterans by the federal government will no longer be at risk if they use medicinal marijuana in states where it is legal. Medicinal marijuana falls into an odd limbo in the US, forbidden coast to Nicholson Reuters/Lucy coast under federal statute, yet sanc- A medical marijuana doctor shakes hands with a man outside a medical marijuana dis- tioned by 14 states and counting. pensary on Venice Beach in Los Angeles, California. To deal with this contradiction, President Barack Obama’s administra- tion has effectively shelved the federal More than 150 years after the Cali- rosis (www.cmcr.ucsd.edu/CMCR law, only prosecuting cases that run fornia Gold Rush, California leads the _REPORT _FEB17.pdf). Relief was afoul of state laws. Now with the Vet- “Green Rush” as the first state to found to be comparable to that from erans Affairs directive, Washington has legalize medicinal marijuana, is a antidepressants and medications com- essentially agreed to turn a blind eye to powerhouse producer of illicit and monly prescribed for neuropathic pain. medicinal marijuana use by patients legal cannabis, and is home to prolif- Krawitz was stationed in Guam with under the department’s own care. erating storefront pot dispensaries and the Air Force in the mid-1980s when he “He took the heat off this issue,” co-operatives. In November, Califor- had a motorcycle crash in the line of Michael Krawitz, executive director of nians will vote on a groundbreaking duty, requiring more than a dozen surg- Veterans for Medical Marijuana Access, initiative to make marijuana legal for eries and untold pain medications. “A says of the president. “It’s got to be recreational use while voters in several fellow patient handed me the butt end uncomfortable at the bureaucratic level other states decide whether to expand of a marijuana cigarette,” he recalls. “I to make a statement like this. But this is medicinal marijuana. thought, maybe I’ll get a little high and something that needed to be done.” Mainstream opinion polls find that feel good for a minute, like you’ve had The VA directive still leaves med- Americans — even conservative a cognac or something.” ical pot in a less permissive environ- Republicans — now believe marijuana “What I experienced was different. I ment than in Canada, where court rul- offers genuine medical benefits for experienced relief. I was a mess and for ings forced the federal government to some patients and should be legal for the first time in months I felt relief. At develop medicinal marijuana regula- that purpose. Public support is not there, that moment, it was a new relationship tions that allowed the weed to be used however, for outright legalization. with that plant.” by patients if they obtained physician In February, a research centre estab- That was early in the US “war on approval. Military veterans now can lished by the California legislature in drugs,” when penalties stiffened for have their supplies paid by Ottawa. 2000 reported on the first clinical trials illicit drug use across the board and But for the US, it’s part of a slow, in more than 20 years on the medical authorities even dared hope they could broad shift away from the old cultural benefits of marijuana. The centre con- eradicate marijuana worldwide. Gov- ramparts erected in the 1960s and cluded pot is effective in reducing pain ernment, says Krawitz, was running 1970s by the conservative “silent caused by various neurological injuries “scared of Ma and Pa America.” majority” and the tie-dyed, antiwar and illnesses and in controlling muscle Acceptance of pot as a salve for pain masses on the left. spasms associated with multiple scle- came gradually, starting with Califor- CMAJ•SEPTEMBER 21, 2010 • 182(13) 1405 © 2010 Canadian Medical Association or its licensors news-sep21_Layout 1 01/09/10 10:31 AM Page 1406 News nia’s decision to legalize it for that pur- think that’s entirely appropriate,” he VA’s undersecretary for health, “if a pose in 1996. said then. veteran obtains and uses medical mari- In 1999, the Institute of Medicine He further vowed: “I would not have juana in a manner consistent with state reported “a potential therapeutic value the Justice Department prosecuting and law, testing positive for marijuana for cannabinoid drugs,” particularly raiding medical marijuana users.” would not preclude the veteran from for pain relief, control of nausea and Obama, 49, is a child of the 1960s receiving opioids for pain manage- appetite stimulation (http://books.nap but not of the counterculture: He was ment” in a VA facility. .edu /openbook.php?record_id =6376 & only six when Woodstock happened. Washington’s decision to let state page =R1). That study said the benefits Yet his generation had plenty of expo- laws take precedence eases matters are modest, often surpassed by other sure to drugs, and he has acknowledged for patients but leaves patchwork medications and associated with “a using marijuana and cocaine in his rules in place. powerful drug with a variety of effects.” youth to “push questions of who I was Only New Mexico, for example, Still, it found the adverse effects to be out of my mind.” His predecessor in explicitly allows people with post- within the range tolerated for other office, George W. Bush, routinely traumatic stress syndrome — a com- medications for certain patients. cracked down on medical marijuana mon condition of veterans returning Now, the federal government’s purveyors, regardless of state law, and from the Iraq and Afghanistan wars nuanced shift on medicinal marijuana maintained restrictions on veterans that — to use medical marijuana. Califor- enforcement comes as little surprise, Obama is only now relaxing. nia doctors can recommend medical given Obama’s stance in the 2008 pres- Veterans Affairs policy had stated marijuana for any illness for which idential campaign. that patients treated at VA hospitals and pot provides relief. Other states are “I think the basic concept of using clinics could be denied pain medication more restrictive. — Cal Woodward, medical marijuana for the same pur- if they were found in drug testing to Washington, DC poses and with the same controls as have used an illicit substance. other drugs prescribed by doctors — I Now, says Dr. Robert A. Petzel, the DOI:10.1503/cmaj.109-3334 Patient charters all buzz and no bite, advocates say Previously published at www.cmaj.ca we could forego the charter altogether The inherent difficulty of imple- and just implement the content, then menting a charter from the top down is atient groups are skeptical that a that would be great.’ It just wasn’t on among the reasons previous attempts to national charter of patient rights the radar.” legislate patient rights at the provincial P would reap real-world changes in The summit brought together some Canada’s health care system. 200 people representing more than 30 The Canadian Medical Associa- patient organizations across the coun- tion’s recent proposal that a national try. According to Philp, many partici- patient charter be established in Canada pants said a charter should come after, follows on the heels of two decades of not before Canada tackles more nuts- efforts to legislate patient rights at the and-bolts changes to system. Drafting a provincial level, a hit-and-miss experi- charter any sooner would only “bog ence that’s left patient groups question- down” necessary reform with “a lot of ing the necessity of such a document. lip service.” It’s commonly held that patient Summit participants identified a num- charters provide people with a bit of ber of more pressing health care reforms, ammunition in dealing with indifferent says Philp, such as reducing wait times, or stubborn health care bureaucracies, implementing a national catastrophic helping them to obtain information drug plan and improving access to health about their conditions from health care care providers and services. providers or about medical mishaps. If systemic change doesn’t precede But the creation of a national char- the creation of a national charter, ter listed low among health consumer implementation will likely be an uphill priorities at the Canadian Patient Sum- battle, says Chris Summerville, CEO Society Schizophrenia Manitoba mit in March, says Karen Philp, chair of the Schizophrenia Society of “Until you deal with the issues of sup- of the summit and CEO of the Cana- Canada. “Until you deal with the ply and demand, it’s going to be very dian Wound Care Association. “Their issues of supply and demand, it’s difficult to honour the spirit of a char- ter,” says Chris Summerville, CEO of the attitude was, ‘Well that’s nice, but let’s going to be very difficult to honour the Schizophrenia Society of Canada. not spend too much energy on it, and if spirit of a charter.” 1406 CMAJ•SEPTEMBER 21, 2010 • 182(13) © 2010 Canadian Medical Association or its licensors.

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