Vets Using Medical Marijuana Could Lose VA Prescriptions

By Alexandra Olgin
Published: Wednesday, September 17, 2014 - 6:05am
Updated: Wednesday, September 17, 2014 - 8:22am
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Ted S. Warren/AP/NPR
Marijuana leaves.

Medical marijuana has been legal in Arizona since 2010. But veterans who get opiate medicine for pain relief, can’t use medical marijuana along with their other pain medicines if they're being treated at the Veterans Health Administration.

According to federal law, marijuana is illegal, and the VA is a federal agency. This ban may have serious consequences for some veterans.

John was injured by a roadside bomb while serving in Afghanistan. He lost muscles in his legs, back and neck from the blast. He also has been diagnosed with Post Traumatic Stress Disorder.

John didn’t want us to use his name because he is concerned that telling us about his medical situation will jeopardize his ability to continue treatments at the Veterans Health Administration. After years of trying different painkillers he found a combination allowed him to control his pain and stress in 2012. It was a mix of medical marijuana with opiate painkillers.   

“I was sleeping without having to take pharmaceutical sleep aids, I was able to stay at the same dose of opioid painkillers for years.” John said. That changed this summer. "I was mailed this letter: Due to your urine drug screen has a positive result for cannabinoids as a result my doctor would not be renewing your pain medication.”

In May the VA standardized the opioid agreement, a contract patients who receive long-term painkillers have to sign detailing the rules of taking the pills. The agreement also specifies no illegal drugs. To the federal government, marijuana is an illegal drug — medical or not.

This creates a conflict in Arizona, where medical marijuana is legal. John was already out of morphine when he got that letter saying his meds would not be renewed.  

“Being in withdrawal is an assault on all five of your senses," John said, "I couldn’t work or sleep. Sweating, agitated, having muscle spasms, in a great amount of pain and unable to think clearly you are in as sense similar to a vegetable. You don't have control over your bodily functions.”

This lasted two weeks before the VA eventually put him back on the opiates, under the condition he stop using marijuana.

Federal law still lists marijuana as a Schedule I drug, like heroin, LSD and ecstasy. This puts VA doctors in the middle of a federal-state tussle over the use of the drug. VA doctors cannot prescribe it, but some tolerate its use.

Dr. Christopher Burke is the head of primary care at the Phoenix VA. Burke wasn't John’s doctor, but said the policy leaves a gray area.

“Luck of the draw sometimes a way to put it," Burke said. "It does kind of depend on who you get and what beliefs and again their own clinical judgment.”

John’s previous doctor, who left the VA earlier this year, was OK with him using marijuana. His new doctor made him choose between marijuana or opiate painkillers. Some physicians are concerned about the effect of the taking the drugs together.

"Each drug is going to have its own effect whether it’s being used simultaneously or by itself. Whether it’s escalated when it’s used together that’s probably the better question, and I don’t have a great answer for that,” Burke said.

A study published in August in the Journal of the American Medical Association found states with medical marijuana laws had 25 percent fewer opioid overdose deaths.

Author Marcus Bachhuber said the use of medical marijuana in 2010 led to 1,700 fewer overdose deaths across the country.

“Often they use medical marijuana as a substitute for opioids or they supplement with medical marijuana and reduce their opioid dose, their painkiller dose. So that would be expected to lower their risk of overdose," Bachhuber said.

Medical marijuana treatment for PTSD will be allowed in Arizona starting in January. With more than 300,000 Iraq and Afghanistan vets across the country estimated to suffer from PTSD, the VA will likely to face mounting pressure to re-visit its policy on opiates and medical marijuana.

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