11/30/14 Doug McVay

Century of Lies

Legislation is being introduced to allow VA doctors to recommend medical cannabis to their patients, so to find out more we talk with Michael Krawitz of Veterans for Medical Cannabis Access.

Audio file



NOVEMBER 30, 2014

DOUG MCVAY: Hello and welcome to Century of Lies. I'm your host, Doug McVay, editor of Drug War Facts dot org. Century of Lies is a production of the Drug Truth Network, which comes to you through the Pacifica Foundation Radio Network and is supported by the generosity of the James A. Baker III Institute for Public Policy and of listeners like you.

Find us on the web at drug truth dot net, where you can find past programs and you can subscribe to our podcasts. You can follow me on twitter, where I'm at drug policy facts, and also at dougmcvay. The Drug Truth Network is on Facebook, be sure to give its page a Like. Find Drug War Facts on facebook as well, please give it a like and share it with friends. Remember, knowledge is power.

Now, on with the show. This is the beginning of a major holiday season in the United States, I'm recording this just shortly after Thanksgiving – and my birthday.

Meanwhile, we've just finished a bitterly-fought general election. Congress is finishing up its lame duck session before the new Congress is seated. Control over the Senate is about to change hands. The eyes of the world are focused on Ferguson, Missouri. Everyone's attention is on race, on the injustice of our criminal justice system, on the problems of racially biased law enforcement, and on our increasingly militarized police forces. In the words of Lou Reed, it takes a busload of faith to get by.

One person I know has a busload of faith, several busloads in fact, that's Michael Krawitz. Mike is the director of Veterans for Medical Cannabis Access, he's also an activist with Virginians Against Drug Violence, and he also works on international drug policy reform through the Vienna and New York Nongovernmental Organization Committees. He was kind enough to spend some time on Skype with me recently to discuss some of the progress that we're making, so let's listen to part of that interview:

MICHAEL KRAWITZ: I mean, I can't even express how humble I am to stand by Congressman Rohrabacher and Congressman Blumenauer, you know. I really didn't, never knew so much about Congressman Blumenauer's history, until I saw him give a speech just recently in Oregon on the successful legalization measure out there, congratulations by the way. Congressman Blumenauer said that he'd actually been working on these issues since the 1970s, and I didn't realize that, he's got me beat by quite a ways.

But, the bill that they're putting forward, actually, the problem that it's fixing, is that the VA came out with a medical marijuana policy, and the policy was great because it allowed the veterans the little bit of space that they needed to use the medical marijuana at state level and then not get punished when they come into the VA hospital. The tendency these days, although it's unethical, is to punish patients that “violate the rules”, in air quotes, and medical marijuana, being illegal at the federal level, is listed on this small list of drugs that are illegal that they test people for routinely, and hassle them for. And again, it's unethical, but it's very very very widespread.

And that's the good part of the rule, is that it allows veterans to use the medical marijuana without running afoul of any VA policy so that they can integrate it into their care. The problem is though that at the very same time the VA looked into this and came to the conclusion, based on what the DEA was threatening them, that they could not recommend cannabis, that the VA couldn't be in the process of filling out forms for the veteran, even though that's called for by federal law. Federal law requires that the VA help veterans fill out forms to satisfy the, uh, medical requirements for state programs.

But in this case they're not allowed to fill out those forms, they're not allowed to write a recommendation, and Congressman Sam Farr a couple of years ago started this effort in Congress to change the rules, to change the law, so that the VA would indeed be able to allow Veterans Affairs doctors to write recommendations. Congressman Farr's first effort wasn't well understood. The next year Congresman Blumenauer picked it up and rewrote it, and we kind of test marketed that and it was very well understood. We got a very good vote, it was actually one of the highest vote counts in Congress right up before we got a successful vote count out of Congress on the DEA funding issue.

But this is, I think, right on the heels of that, and now Congressman Blumenauer has resubmitted it, and right out of the gate we have really, really good, across the board support, very excited people out there working on this already. HR 5762 of the 113th Congress, 2013-2014. I'm not sure if it will get a new number as we come into 2015, not sure how that works, but Congressman Blumenauer is the go-to on this, and we're, again, we're just so proud, I'm just so thrilled to be able to stand by Congressman Blumenauer and fight for the rights of Veterans Affairs doctors, in this case, so that they have freedom of speech, because that's what, you know, this is all about, in the end. The writing of recommendations is part of the free speech, part of the doctor-patient relationship.

Well, the, some of the issues that we're running into, like for example in Colorado, one of the issues that played into legalization there was the effort year after year of veterans and their doctors, and other interested patients and their doctors, and caregivers and, you know, great advocates like SAFER Colorado and etc., Drug Policy Alliance, others, coming in to help us to add post-traumatic stress as a qualifying condition under the state law. And just like in Oregon, the panel let us down, the commission that's tasked with doing that job, that's supposed to add conditions under those circumstances, failed to do their job.

There's no compelling argument from the other side, there was no string of cases, in fact there was no case that I know of, of any adverse events, or someone using marijuana for post-traumatic stress and it not working well even. So the only opposition was just kind of a knee-jerk opposition coming from the psychiatric quarter, psychiatric association, that was really making arguments against medical marijuana that sounded a lot like 1995, you know, they're just arguing against medical marijuana in general, it's illegal under federal law, those kind of arguments.

So what happened was, we wound up in a situation where we had a veteran down there, Sean Azzariti, who got in front of the cameras and said Hey, you know, if you all legalize, speaking of the state of Colorado, if you all legalize marijuana for adult use, I'm an adult, I'll be able to go get it for my post-traumatic stress right through the store setting and I won't have to go through this onerous commission to get access to medicine. And he did, you know, he was the first person to buy legal marijuana in Colorado, and as a veteran he made a big point about the fact that now he can get the marijuana they were withholding from him for his post-traumatic stress.

The problem with that is the VA's policy hinges upon a doctor's authorization, it's a medical program, it's a medical policy, so you're really not protected at the VA in that same way when you're using it legally as you would be using it medically. Now, we've never run into any real issues with that, we've never had any real string of you know, of vets coming to us and saying Oh, I've failed a drug test because I came back from Amsterdam, and, you know, and I had marijuana all week last week and now they're drug testing me this week. That really just doesn't happen that often, I don't know why, but we're kind of bracing for impact here, and hoping that in Oregon and elsewhere with legalization we don't have a string of cases where that very thing happens. But other than that, legalization, what, you know, really happens for us is the same thing as any other patient group, we're concerned that products like high-CBD rich cannabis wouldn't be very popular in a social use market, that, you know, the social use market's objectives are, are wrong for us. The objectives of a social use market are to minimize the cost to society of access, it's a regulated access so that you minimize the access to young people, minimize the harms from abuse, and minimize overall use, toward that end. That's exactly opposite of medical, medical you want to have as much access as possible for those who need it, so that they can have what they need for their medical use, with no regard for limitations, with no regard for discouragement of use, only discouragement of abuse. And abuse, with a medical patient, is a very different animal than abuse, you know, in terms of society with regard to keeping it out of the hands of children. So those are I guess the main issues that jump to mind.

DOUG MCVAY: Actually let's step back for a moment and look at how all of this has evolved. Years ago you were working to get the Veterans Administration to change its policy, it had a very much zero tolerance attitude toward medical cannabis as far as pain management was concerned, the opioid painkillers and pain management contracts that are becoming, you know, the pain management contracts that are becoming so widespread. The VA doctors as I understand were, were basically giving patients a choice, either accept care, you know, their version of care, or go with medical cannabis but they couldn't do both. Now, you were instrumental in making the change to that.

MICHAEL KRAWITZ: Absolutely, that's kind of the main focus of my work in the VA. I always give credit where credit is due, and I always speak very fondly of my memory of Dr. Tod Mikuriya. And Dr. Mikuriya really taught us all something very very valuable with his patient, you know, database. He had, I don't know, 10,000 patients or so that he had seen by the time he wrapped up his tenure there, Prop 215 California's medical marijuana program. And he chronicled each and every one of those patients, uh, diagnoses. He looked up the diagnoses … and pulled up the number for each and every one of those diagnoses and talked about how cannabis had helped, and listed them. There's a hundred or so, Dr. Mikuriya's list, it's still out there on the web, very very useful for understanding the wide variety of kind of neurologically-based things that cannabis seems to help for.

But most of the things, most of the patients were pain patients, most of the symptoms were under that general umbrella of pain, and most of those pain patients according to Dr. Mikuriya were using cannabis as an adjunct. And that's where I became, you know, aware that my own personal situation, as a veteran in pain and using cannabis as an adjunct, that I found through, you know, process of trial and error, actually matched up with the literature, and actually matched up with the history and it matched up with the experience out there in the states where medical marijuana was allowed.

And this really kind of sat in the back of my mind, and I realized that there was crossroads that we were going to hit eventually, where if they're using cannabis as an adjunct, and they're mixing it together with other medications successfully, what's going to happen when the drug war meets the, you know, the patient in the doctor's office, in their medicine cabinet. And what's going to happen when the drug war makes the final ultimatum and says, My way or the highway, just like you said. And ironically, believe it or not, Doug, there were actually more problems outside the VA when I started than inside the VA. The VA was slow to pick up on this pain contract thing but when it did, you know, it's a very tight system and it spread very very quickly throughout the system.

And I started fighting the pain contract, gosh, it must have been in the mid-1990s. We got the VA policy in 2010, so that's how long it took to work through the system, starting complaining essentially to my doctor, to work my way up to the top of the VA, working with the pain management directorate, the undersecretary of health and the ethics committee and the office of the general counsel. Now all of this is kind of enshrined in history, you can go to the web and type in Dr. Cynthia Geppert, the evolution of the VA medical marijuana policy, and you can read the entire history of how we brought it together.

The only thing that it doesn't mention is the importance of our good friend out there Marty Chilcutt in Michigan, who was so adamant about working on medical marijuana as a veterans issue, that when Michigan passed its medical marijuana law, the media went right to the VA and asked them for comment. And those comments from that VA out in Detroit and elsewhere were formative in my conversation with the undersecretary of health and actually helped us create that VA medical marijuana policy.

But the situation of pain contracts is now resolved in the VA, and I think the VA is a good model for the rest of the world to follow, believe it or not, at this point on this issue. We've got a system in the VA that's not called a pain contract any more, that language has been completely removed, and it's now an informed consent system, and the drug testing associated with it, which the FDA does recommend, and the FDA requires the document to be signed, this pain agreement under informed consent, but this is why: the FDA says that use of controlled substances, opiates for long-term pain, not short-term pain or cancer pain, but long-term, non-cancer pain, the FDA says that carries a special risk and that patients need to be informed of that risk, and that you sign that document to show that the doctor's done their due diligence in educating you, the patient, about that risk, you sign off – just like you would informed consent for surgery, that's how you should be looking at that document.

And the drug testing is for the, to help the communication between you and your doctor. The resolution of this is that you need to look at the drug testing and the document that the doctor asks you to sign in the context of your treatment, that it has to have some value for your treatment. There's no punitive aspect of these documents or the drug testing. Even though it's very widespread, that it's being used that way outside the VA and inside the VA, I can tell you at this point that that is aberrant, that's the wrong thing to do. The ethics have been very clearly spelled out to us at this point, we've gotten quite a few lessons from the ethics committee of the VA, and the ethical considerations are this: the only time you take away someone's pain treatment, or any medical treatment, is if they're no longer in pain, or if the treatment is no longer working. Other than that, there's no legitimate reason to take away someone's treatment.

And as for as documentation and drug testing, that's all supposed to help in the communication between the patient and the doctor, it's never ever supposed to be used in a punitive way. If you have some drug issue that's unexplained perhaps, maybe the drug test could help inform you and the doctor as to what's going on. Maybe someone was slipping you an illegal drug without you knowing it, who knows? But as far as, you know, drug testing to weed out the bad eggs, that's the wrong thing, and that's the wrong perspective, and that's something that we need to get rid of out of our medical system entirely, top to bottom, left to right, inside and outside the VA, and I think the VA's policy can help us to a certain extent.

The ethics committee has said that, when you're looking at medical marijuana as a doctor, you need to consider clinical safety. And what clinical safety is, according to the ethics committee, is, you look at the pros and the cons of all the various treatment options, you communicate well with the patient those risks versus benefits, and together with the patient you come up with a viable treatment plan, and you effect that treatment plan based on medical evidence. And if you do that, then you don't have to worry about which side of the DEA fence you're on, you don't have to worry about good eggs and bad eggs, and you're doing your job, and you're treating the patient.

And you're going to find out through that process what you need to know to treat that patient effectively, and you won't be making the mistake of treating all of your patients at once with some ad hoc or, you know, prohibitionist policy that derails that individualized care. Individualized care requires that the patient and the doctor come to a conclusion in that particular case. Every single patient is different.

DOUG MCVAY: Right on. So know, so then, reeling it back in toward this new development. For the last four years then, physicians at the VA have been officially okeh with the idea that their patients are using medical marijuana for pain relief, as an adjunctive medication for pain relief or for treating the PTSD, however they have not been able to actually give recommendations to their patients. Instead, patients are forced to shell out an extra $150 to $200 each year to a private medical cannabis clinic where they see someone who goes over the records and says Yep, that doctor diagnosed you correctly.

So now, if this legislation, which hopefully gets reintroduced in the 114th Congress, both Rohrabacher and Blumenauer are coming back, are certainly coming back next year. So if they reintroduce, the point of the legislation would be that a VA, tell me if I've got this right, that a VA doctor would now be able to actually sign their name to a piece of paper and give that vet a recommendation. Is that right?

MICHAEL KRAWITZ: Absolutely. You have to really kind of follow this down the rabbit hole to realize how big a problem this is. It doesn't seem to be as big a problem on its face until you really look at it for a minute. The doctor at the VA, not being able to recommend cannabis, what that has essentially created, and I love the way the marijuana.com article that came out just recently for Veterans Day, helped me articulate it very well I think, the concept of the new Don't Ask Don't Tell policy that veterans have to follow. Because think about it, if you're going into the VA clinic, you don't want to start talking about marijuana, trying to teach them marijuana stuff. If you start talking about marijuana without them asking you about it, you can actually run into trouble sometimes. They look at you funny, want to know why you're talking about illegal drugs, right?

But if you need to tell them, if you have a medical recommendation and it becomes an issue in your care, then you have to tell them, and then they have to act. But on the flipside, on the doctor's side, is where the real problem lies. If you look at it objectively, the doctor has to sit there and basically know nothing about cannabis. If you're suffering from post-traumatic stress and you've gone through all these other medical options and you're getting no results, or let's say you're, a very well-known use of cannabis, there's a lot of cancer cases in the VA, a lot of Navy vets, you know, that were exposed to asbestos, on and on, the causes of cancer that you see in the veterans population.

So you've got a veteran in front of you that's dying of cancer, and can't stand the chemotherapy anymore, all the anti-emetics have failed, and you can't mention marijuana. In any of those cases you can't mention marijuana. It's a new Don't Ask Don't Tell policy, and the Veterans Affairs doctor's put in this increasingly difficult ethical dilemma. Think about the new research that we've got that shows the suicide rates drop around medical cannabis, or that the overdose rates, the Journal of the American Medical Association report showed that up to a 25% reduction in overdose rates. Here's a population that's got a higher than national average overdose rate from opiates, and yet the doctor's not able to recommend the cannabis.

The ethical dilemma is extreme, and from the doctor's perspective, they have to sit there and know nothing about cannabis. If they know anything about cannabis it can actually run them into issues. But if you as a veteran come in and hand them a recommendation, then they have to be immediately an expert, then they have to coordinate that, integrate that into your care, know all the pros and cons about medical marijuana.

We get this bill passed, and then we have the ability for the VA doctor to recommend cannabis, they don't have to keep their mouth shut when a cancer patient is in front of them that may need it, or a post-traumatic stress sufferer, or someone suffering from pain that can really benefit from it, on and on, all the different things on Dr. Mikuriya's list, the Veterans Affairs doctor will be able to talk about it and openly recommend the cannabis, and then at that point, finally, that ethical dilemma can be removed and the VA doctor-patient relationship can join the free world.

DOUG MCVAY: This is tremendous news, I mean, the scope of the problem is something that a lot of people will have trouble wrapping their heads around, but just going to the – I mean, look back at the Vietnam era, the Agent Orange, at first we thought that it's a few hundred thousand people maybe, tops, then well actually it's several hundred thousands, oh well, maybe a million, actually everyone who set foot within that region, within that war zone, was probably affected, and it goes to the second and the third generation, and among the systems are cancers but also neuropathic pain, so you're talking about millions of people who were exposed and who are suffering and it's our own fault, because of our policies, that it all happened, and so – it's ...

MICHAEL KRAWITZ: There's kind of two issues there that jump out. One is the recognition of the problem. You know, oftentimes, the Department of Defense may have, you know, national security reasons, or just embarrassment, as a reason to not want to disclose the cause of some of these illnesses, like Gulf War Syndrome, or Agent Orange exposure, you know, high incidences of post-traumatic stress. And I think that translates into, you know, a very bad situation for veterans where they internalize that, they're not being, you know, treated with respect, their medical condition isn't valid, you know, that somehow they're the ones that are wrong, and that's just horrible, and then on top of that to then have a treatment issue where you've got a medicine out there that's widely available to the public in many states, yet the Veterans Affairs doctors aren't able to use it.

And this isn't the only instance that that happens because of the drug war but it's certainly a really irritating one for a lot of people, for the very many reasons that you suggest.

DOUG MCVAY: That's from an interview with Mike Krawitz, director of Veterans for Medical Cannabis Access, which was recorded last week.

Get ready to mark your calendars. December 17th is the 100th anniversary of the Harrison Narcotics Act, the day the US began its 100 year long drug war – its century of lies. On that day, people in towns and cities around the nation will hold rallies at local courthouses and other events to call for an end to prohibition. You can get involved by emailing the Drug Truth Network's executive producer Dean Becker, he's dean @ drug truth dot net. Several organizations are already on board including Law Enforcement Against Prohibition, Students for Sensible Drug Policy, and the November Coalition. Get involved today. Find out more at endprohibition dot org. Also check out the facebook page, it's facebook dot com slash 100 Years Is Enough, that's facebook dot com slash 1 0 0 years is enough.

And finally: Back in 1985, New York State's Chief Judge, Sol Wachtler, was interviewed by a reporter for the New York Daily News. He was concerned that prosecutors had too much power and were abusing their discretion. In fact, he said that district attorneys have so much influence on grand juries that they could get them to quote "indict a ham sandwich." End quote. Think about that when you think about the Ferguson grand jury. As the French journalist Jean-Baptiste Alphonse Karr, editor of Le Figaro, once said “plus ca change, plus ca la meme chose.” The more it changes, the more it's the same thing.

And that's it for this week. I'm Doug McVay and this was Century of Lies. Thank you for listening.

Century Of Lies is a production of the Drug Truth Network. We are heard on 420 Radio dot org on Mondays at 11 am and 11 pm, and Saturdays at 4 am, all times are pacific. We are heard on time4hemp dot com on Wednesdays between 1 and 2pm pacific along with our sister program Cultural Baggage. And we're on The Detour Talk Network at thedetour.us on Tuesdays at 8:30pm. A few of the stations out there that carry Century Of Lies include WERU 89.9 FM in Blue Hill, Maine; WPRR 1680 am 95.3 fm in Grand Rapids, Michigan; WIEC 102.7 FM in Eau Claire, WI; WGOT-LP 94.7 FM in Gainesville, FL; KRFP 90.3 FM in Moscow, Idaho; and Free Radio Santa Cruz 101.3 fm in Santa Cruz California.

You can find a recording of this show and past shows at the website drug truth dot net, where you can check out our other programs and subscribe to our podcasts. Follow me on Twitter, where I'm @ Drug Policy Facts and @ Doug McVay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on facebook as well, please give it a like and share it with friends. Spread the word. Remember: Knowledge is power.

We'll be back next week with more news and commentary on the drug war and this Century Of Lies. For now, for the drug truth network, this is Doug McVay saying so long. So long!