V.A. EASING RULES FOR USERS OF MEDICAL MARIJUANA

DENVER -- The Department of Veterans Affairs will formally allow
patients treated at its hospitals and clinics to use medical
marijuana in states where it is legal, a policy clarification that
veterans have sought for several years.

A department directive, expected to take effect next week, resolves
the conflict in veterans facilities between federal law, which
outlaws marijuana, and the 14 states that allow medicinal use of the
drug, effectively deferring to the states.

The policy will not permit department doctors to prescribe marijuana.
But it will address the concern of many patients who use the drug
that they could lose access to their prescription pain medication if caught.

Under department rules, veterans can be denied pain medications if
they are found to be using illegal drugs. Until now, the department
had no written exception for medical marijuana.

This has led many patients to distrust their doctors, veterans say.
With doctors and patients pressing the veterans department for formal
guidance, agency officials began drafting a policy last fall.

"When states start legalizing marijuana we are put in a bit of a
unique position because as a federal agency, we are beholden to
federal law," said Dr. Robert Jesse, the principal deputy under
secretary for health in the veterans department.

At the same time, Dr. Jesse said, "We didn't want patients who were
legally using marijuana to be administratively denied access to pain
management programs."

The new, written policy applies only to veterans using medical
marijuana in states where it is legal. Doctors may still modify a
veteran's treatment plan if the veteran is using marijuana, or decide
not to prescribe pain medicine altogether if there is a risk of a
drug interaction. But that decision will be made on a case-by-case
basis, not as blanket policy, Dr. Jesse said.

Though veterans of the Vietnam War were the first group to use
marijuana widely for medical purposes, the population of veterans
using it now spans generations, said Michael Krawitz, executive
director of Veterans for Medical Marijuana Access, which worked with
the department on formulating a policy.

Veterans, some of whom have been at the forefront of the medical
marijuana movement, praised the department's decision. They say
cannabis helps soothe physical and psychological pain and can
alleviate the side effects of some treatments.

"By creating a directive on medical marijuana, the V.A. ensures that
throughout its vast hospital network, it will be well understood that
legal medical marijuana use will not be the basis for the denial of
services," Mr. Krawitz said.

Although the Obama administration has not embraced medical marijuana,
last October, in a policy shift, the Justice Department announced
that it would not prosecute people who used or distributed it in
states where it was legal.

Laura Sweeney, a spokeswoman for the Justice Department, would not
comment spefically on the veterans department policy. "What we have
said in the past, and what we have said for a while, is that we are
going to focus our federal resources on large scale drug
traffickers," she said. "We are not going to focus on individual
cancer patients or something of the like."

Many clinicians already prescribe pain medication to veterans who use
medical marijuana, as there was no rule explicitly prohibiting them
from doing so, despite the federal marijuana laws.

Advocates of medical marijuana use say that in the past, the
patchwork of veterans hospitals and clinics around the country were
sometimes unclear how to deal with veterans who needed pain
medications and were legally using medical marijuana. The
department's emphasis on keeping patients off illegal drugs and from
abusing their medication "gave many practitioners the feeling that
they are supposed to police marijuana out of the system," Mr. Krawitz said.

"Many medical-marijuana-using veterans have just abandoned the V.A.
hospital system completely for this reason," he said, "and others
that stay in the system feel that they are not able to trust that
their doctor will be working in their best interests."

In rare cases, veterans have been told that they need to stop using
marijuana, even if it is legal, or risk losing their prescription
medicine, Mr. Krawitz said.

David Fox, 58, an Army veteran from Pompey's Pillar, Mont., uses
medical marijuana legally to help quiet the pain he experiences from
neuropathy, a nerve disorder. But he said he was told this year by a
doctor at a veterans' clinic in Billings that if he did not stop
using marijuana, he would no longer get the pain medication he was
also prescribed.

A letter written to Mr. Fox in April from Robin Korogi, the director
of the veterans health care system in Montana, explained that the
department did not want to prescribe pain medicine in combination
with marijuana because there was no evidence that marijuana worked
for noncancer patients and because the combination was unsafe.

"In those states where medical marijuana is legal, the patient will
need to make a choice as to which medication they choose to use for
their chronic pain," Ms. Korogi wrote. "However, it is not medically
appropriate to expect that a V.A. physician will prescribe narcotics
while the patient is taking marijuana."

Mr. Fox was shocked by the decision, he said.

"I felt literally abandoned," he said. "I still needed my pain meds.
I thought they were supposed to treat you. It was devastating for me."

Mr. Fox, who said that at one point he was weaning himself off his
pain medication for fear of running out, has held one-man protests in
front of the clinic, carrying signs that read "Abandoned by V.A.,
Refused Treatment."

Veterans officials would not comment on specific cases, citing
medical privacy laws.

This month, Dr. Robert A. Petzel, the under secretary for health for
the veterans department, sent a letter to Mr. Krawitz laying out the
department's policy. If a veteran obtains and uses medical marijuana
in accordance with state law, Dr. Petzel wrote, he should not be
precluded from receiving opioids for pain management at a veterans facility.

Dr. Petzel also said that pain management agreements between
clinicians and patients, which are used as guidelines for courses of
treatment, "should draw a clear distinction between the use of
illegal drugs, and legal medical marijuana."

Dr. Jesse, the veterans department official, said that formalizing
rules on medical marijuana would eliminate any future confusion and
keep patients from being squeezed between state and federal law.

Steve Fox, director of government relations for the Marijuana Policy
Project, which favors the legal regulation of the drug, called the
decision historic. "We now have a branch of the federal government
accepting marijuana as a legal medicine," he said.

But Mr. Fox said he wished the policy had been extended to veterans
who lived in states where medical marijuana was not legal.

He said it was critical that the veterans department make its
guidelines clear to patients and medical staff members, something
officials said they planned on doing in coming weeks.

Said Dr. Jesse, "The whole goal of issuing a national policy is to
make sure we have uniformity across the system."