VA policy on marijuana and painkillers lacks consistency, veterans say. What do you say?

AUSTIN, Texas (Tribune News Service) — Since early 2013, Vietnam veteran Bill Williams had received daily doses of hydrocodone to help him deal with chronic leg and back pain. For more than 30 years, he has taken anti-anxiety drugs like Valium to help with the post-traumatic stress disorder he developed after a lengthy tour on a Navy submarine.

Occasionally, the 62-year-old Brackettville resident would smoke marijuana, which he said provided relief for his pain and PTSD in ways the pharmaceuticals could not. His experience with that drug, which he said also helped him sleep, mirrors that of a growing number of veterans who have turned to medical marijuana as an alternative to traditional treatments.

At first, he said, his Department of Veterans Affairs doctors tolerated his marijuana use, telling him that if it helped his symptoms he should continue. But that changed with the introduction of stricter VA policies on narcotic painkillers, the result of new Drug Enforcement Administration rules on hydrocodone and a VA push to reduce the number of patients receiving the medications.

In April, after he tested positive for marijuana, the VA canceled his hydrocodone prescription.

The incident is emblematic of a brewing battle over marijuana use among veterans suffering with chronic pain and anxiety disorders and the VA's evolving, sometimes confusing, position as more states legalize the drug.

"There is no consistency, even in the states where it's legal," said Roger Martin, executive director of Grow4Vets, which advocates for marijuana treatment of pain and PTSD.

As a federal agency, the VA is in an unusual position. It recognizes marijuana possession as a federal offense, but its policy doesn't prohibit veterans who get state-sanctioned medical marijuana from participating in VA pain control programs.

And officials say a positive marijuana test doesn't automatically result in an opioid prescription cancellation, but should cause doctors to assess patients for "misuse, adverse effects and withdrawal." The decision to halt opioid drugs when a patient uses marijuana "need(s) to be made by individual providers in partnership with their patients," the agency's policy states.

But in states such as Texas, where marijuana isn't legal, the VA's policy is less clear. Asked specifically about marijuana use by Texas patients, VA officials couldn't provide clarification.

Williams' doctor at the San Antonio VA, for example, told him that the agency's policies provided no wiggle room. "Due to the presence of the marijuana, based on current VA practice guidelines, I am unable to prescribe further controlled substances (hydrocodone) at this time," he wrote in a letter to Williams.

Martin said his group has heard from a number of veterans like Williams who say their painkiller prescriptions have been abruptly canceled in recent months because of marijuana use.

"It's a flat-out violation of the Hippocratic oath," he said. "It puts veterans and the people around them in danger."

Pain specialist Dr. C.M. Schade, director emeritus of the Texas Pain Society, said that civilian doctors in Texas must halt narcotic prescriptions for patients who test positive for controlled substances; they can be resumed once the patient stops taking the illegal drug or enters treatment.

Williams said he stopped smoking marijuana months before his positive test, which he blamed on secondhand smoke from toking friends, but he acknowledged previous positive tests. But he said that shouldn't disqualify him from receiving the pain medication he needs to function on a daily basis, especially if it is allowed in states like Colorado and Washington.

He recently underwent a procedure to burn the nerve endings in his back, which should give him relief for several months, but he fears for the future.

"What's scaring me is that in (the coming) months, when I'm going to need pain medication, are they going to give it to me?" he said. "I'm not a person that's going to go beg the VA for pain meds. I have a high tolerance for pain. But once those nerves grow back I won't be able to live with it."

http://www.stripes.com/news/veterans/va-policy-on-marijuana-and-painkillers-lacks-consistency-veterans-say-1.352200