Many reasonable people have differing opinions on medical marijuana. Most advocates argue that it offers a level of relief to patients that is unavailable from conventional pharmaceuticals, while opponents worry that it can lead to drug abuse. In recent years, an increasing number of states have made the move to legalize marijuana for medical and even recreational purposes, bringing these states into conflict with federal laws outlawing use of the drug. The legal tension between states and the federal government has placed the Department of Veterans Affairs in a difficult situation.
The case of veteran Robert Lee highlights the legal gap into which many veterans have fallen. Lee, a Vietnam veteran with arthritis and PTSD, uses medical marijuana to deal with the symptoms of his ailments. His VA doctor also prescribes him a small dose of opiate painkillers. He lives in Oregon, where medical marijuana has been legal since 1998, and where voters recently approved a measure to legalize the drug for recreational purposes. Yet, after a recent change of doctors at the VA facility where he receives treatment, Lee found himself in a tough spot.
Lee’s new doctor gave him an ultimatum: choose opiate painkillers or marijuana. According to Lee, his former VA doctor had gone as far as writing a letter saying that a small dose of opiate painkillers combined with marijuana was good for Lee’s health. Despite this, the new doctor told him that his dosage of opiate painkillers would be increased and that he must cease all use of medical marijuana. Lee says he is wary of increasing his dosage of opiates due to the risk of addiction and the fact that it has wreaked havoc on his liver. The doctor says he will not allow the combination of painkillers and marijuana to continue.
Studies have suggested that marijuana and opioids do not have dangerous interactions, and that when used in combination, the marijuana might actually enhance the effects low-dose opiate painkillers. Further, statistical analysis has suggested that the use of opioids with marijuana does not increase the risk of substance abuse. Thus, from this standpoint, it is unclear why Lee’s doctor would be reticent to allow the combination. However, with the existing legal conflicts between state and federal governments, it is understandable why a doctor employed by an arm of the federal government might be hesitant to allow a patient to use both opiates painkillers and marijuana at that same time.
Nonetheless, recent headlines have suggested that VA doctors are over-prescribing opiate painkillers to the detriment of veterans. In fact, one VA doctor in Wisconsin became known as the “Candy Man” for his liberal prescription of opioids. Congress taken notice of the problem and just this week legislation was introduced to curb the abuse of opiate painkillers among veterans. Still, the path forward for the VA remains unclear.
With the recent scrutiny of VA’s use of opiate painkillers in treating veterans, it is worth noting that a study has found that states that legalize marijuana have seen a decrease in opioid overdoses and a reduction in addiction treatment admissions. In other words, the use of marijuana appears to have curbed the abuse of opiate painkillers in states that have legalized medical marijuana.
And this brings us back to Mr. Lee, the veteran from Oregon. His VA doctor wants him to replace his marijuana use with a higher dose of opiate painkillers, a type of drug which is responsible for more deaths each year in this country than suicide, guns, or car crashes according to the CDC. At the end of the day, while his doctor may feel that marijuana is not the answer for Mr. Lee’s pain, it is clear that a better answer will not come from painkillers. As we work to solve the opiate epidemic among veterans, our lawmakers would be wise to look at Mr. Lee’s case, and to consider for a moment whether medical marijuana might be part of a solution, rather than part of a problem.