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Seven members of the Massachusetts congressional delegation are urging the head of the U.S. Department of Veterans Affairs (VA) to allow VA physicians to verbally recommend medical marijuana to military veterans amid the coronavirus pandemic.

The letter, led by Sen. Elizabeth Warren (D-MA) and shared exclusively with Marijuana Moment, stresses that Massachusetts has shuttered recreational marijuana shops during the COVID-19 crisis, which has driven some to transition to the medical cannabis dispensaries that remain open as essential services under the governor’s order. But because veterans may avoid registering as cannabis patients out of concern that they could lose federal benefits and are now left without access to medicine, the lawmakers want VA to amend its policies, at least on a temporary basis.

“As this global pandemic continues to adversely affect veterans’ behavioral and physical health conditions, we believe that veterans who legally use cannabis in the Commonwealth to treat their ailments deserve to receive more robust assistance from qualified medical personnel at their local VA,” the lawmakers, including House Rules Committee Chairman James McGovern (D-MA), wrote, adding that they feel VA should “consider making this directive the official policy” of VA on a permanent basis once the current health emergency is over.

It’s unclear what the practical impact of allowing VA doctors to make “verbal” recommendations would be, given that state medical marijuana certifications generally require a written component from doctors.

An aide to Warren told Marijuana Moment that the senator would ultimately like to see VA doctors be able to offer written recommendations and that the hope is the incremental reform could provide short-term relief to veterans and set the stage for broader policy changes down the line.

The staffer also noted that Warren is pushing for comprehensive federal marijuana legalization and wants medical cannabis products covered under VA insurance for veterans just like any other legal medication.

VA currently allows and encourages veterans to discuss their use of marijuana as a treatment for various ailments with their government doctors, but it specifically prohibits its physicians from issuing recommendations needed to register as a qualified patient under a state-legal program or from assisting in obtaining medical cannabis in any way.

“Veterans in Massachusetts use medical marijuana to treat a variety of ailments, including post-traumatic stress disorder (PTSD), anxiety, chronic pain, and others,” the Wednesday letter, which was also signed by Sen. Ed Markey and Reps. Katherine Clark, Seth Moulton, Ayanna Pressley and Joseph Kennedy III, all Democrats, states.

“For many veterans in Massachusetts, medical marijuana works in treating their health conditions, which can be exacerbated by the coronavirus pandemic,” they wrote to VA Secretary Robert Wilkie. “Therefore, during this unprecedented public health emergency, VA should issue a directive explicitly authorizing its health care providers to make sensible, clinically sound verbal recommendations to veterans related to participation in state-approved medical marijuana programs and services and to provide advice to veterans as they complete forms and other paperwork reflecting those recommendations.”

States that have medical cannabis programs generally require a licensed doctor’s signature in order for a patient to be certified, so the language around “verbal” recommendations by itself wouldn’t help veterans obtain legally protected patient status. But the letter has a suggestion for how VA personnel could help nonetheless.

“When veterans request advice on paperwork related to participating in a state-approved marijuana program, VA clinicians should be advised that they can make verbal referrals to knowledgeable non-VA providers who are registered with a state-approved program and can offer feasible options that minimize, or completely waive, the cost to the veteran,” the lawmakers wrote.

But veterans are already able to seek out written recommendations from non-VA physicians, and it’s not clear how VA would be able to facilitate a process where those private providers would waive or minimize costs, as the letter encourages.

That said, Debbie Churgai, interim director of Americans for Safe Access, told Marijuana Moment that she does not view the verbal recommendation caveat as “an extra hoop to jump through,” but rather as “an opportunity for many veterans to openly talk with and get acceptance and assistance from their VA physicians.”

If veterans are able to get verbal advice from VA doctors on how to fill out state applications to become registered patients and can be directed on the process of submitting them to relevant agencies, that would represent a positive development compared to the current system, where patients are completely on their own in navigating the process.

“I think having the ability to talk with their primary physician about cannabis and get verbal approval (i.e recommendation) from them is really huge and amazing news for veterans. Or at least it’s a tiny step in the right direction,” Churgai said. “Having a VA physician suggest cannabis as medicine with a verbal recommendation could help many patients open up their minds about cannabis as an option for treatment.”

She added that “this could help in court as well to protect physicians when talking about cannabis” because the current policy of allowing them to discuss it but not endorse it “could be seen as confusing, so for many this may help physicians feel more comfortable talking about cannabis with their patients.”

In their letter, the Massachusetts lawmakers went on to say that “VA clinicians who provide this temporary, limited assistance to veterans should be clearly advised by the VA that they will not be subject to disciplinary action,” and they urged “VA to work with the Justice Department to formally advise VA providers who conduct these clinical activities that they will not face criminal prosecution under federal marijuana laws.”

“By authorizing these tailored, temporary actions, the VA could help Massachusetts veterans who use, or are interested in using, medical marijuana receive more comprehensive clinical advice from their VA providers, reduce opioid addiction and substance use disorders, and achieve better health outcomes,” they concluded. “Finally, when this public health emergency ends, we urge VA to consider making this directive the official policy of the Department going forward.”

Advocates also say that such a policy change would be important because veterans should be empowered to discuss cannabis treatment, get a recommendation and continue that dialogue with a VA clinician they know and have an existing relationship with. It could help that VA doctors would be making referrals to credible non-VA physicians to complete the registration process, as well, instead of having veterans use less trustworthy cannabis-focused physician services that they have to find on their own.

Michael Liszewski, principal of the Enact Group, acknowledged that the move “would not necessarily facilitate a veteran being able to register with a state medical cannabis program” but said that “it does have some practical merit.”

“By encouraging vets to speak with their VA doctors from which they are receiving ongoing care, veterans would receive more fully-informed care,” he said. “While allowing referrals to trusted physicians outside the VA system to complete paperwork means veterans will still be paying out of pocket for the exam, the directive would ease the barrier.”

Clark, one of the representatives signing the new letter, has previously cited veterans’ access to cannabis in urging the Massachusetts government to reverse its decision to close recreational marijuana shops—which the governor said was necessary to prevent out-of-state consumers from visiting and potentially spreading the coronavirus.

Under federal policy, @DeptVetAffairs health care providers may not recommend marijuana or assist veterans in obtaining it. VA must change its policy so that no veteran is left when it comes to accessing health care during a national emergency — or ever. https://t.co/iUgrsaNCBB

— Katherine Clark (@RepKClark) April 16, 2020

A bill to allow VA doctors to issue medical cannabis recommendations (without the “verbal” stipulation) was approved by the House Veterans’ Affairs Committee last month. Rep. Earl Blumenauer (D-OR) is the sponsor of that legislation, which was opposed by a VA official in an earlier hearing. The official said the the Drug Enforcement Administration advised against allowing the policy change.

“I’m appreciative of any attempt to broaden veterans’ access to cannabis. It’s an important step towards removing barriers that many veterans face when seeking care,” Blumenauer told Marijuana Moment in response to the new push from the Massachusetts delegation. “During this time when we are recommending that those at risk distance themselves from others, that includes going to the doctor unnecessarily. Veterans deserve access to medical cannabis treatment at the recommendation of their physician, period. It’s past time we give them that unfettered access.”

The Congressional Budget Office released an analysis last month projecting that Blumenauer’s bill would have zero fiscal impact.

Outside of the veterans-specific issues related to federal marijuana policies during the coronavirus pandemic, there’s also a congressional push in the works to expand disaster relief benefits to marijuana businesses. And eleven senators sent a letter to Appropriations Committee leadership earlier this month, asking for a provision to future spending legislation that would allow cannabis companies to access Small Business Administration (SBA) programs.

SBA has stated that marijuana businesses—as well as those that work “indirectly” with the industry—do not qualify for COVID-related relief while cannabis remains federally prohibited.

Also, in a recent call with the Democratic Caucus, Rep. Ed Perlmutter (D-CO) raised the issue marijuana banking access and, according to the congressman, House Speaker Nancy Pelosi (D-CA) said she wanted to include language ensuring that cannabis businesses can access those financial services in an upcoming coronavirus stimulus package.

Read the lawmakers’ medical marijuana letter to VA below: 

Lawmakers Push VA On Medica… by Marijuana Moment on Scribd

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