In December of 2018, Missouri became the 33rd state to legalize medical marijuana. While many stood to benefit from the successful ballot initiative, not every citizen would be granted access to medical cannabis treatment options.
In January, the Missouri Veterans Commission announced that the residents of its seven nursing homes across the state would not be able to take advantage of the Missouri’s new medical cannabis laws. It added that it’s employees would also be barred from using cannabis.
What reason would the organization have for denying over 1,350 veterans a viable treatment option
Money. Why else?
Despite changes in state laws, America’s federal government still categorizes cannabis as a Schedule I drug, meaning it is classified alongside heroin and bath salts as a substance having no medicinal value whatsoever. Consequently, the distribution or possession of marijuana remains a criminal offence at the federal level.
Why does this matter to groups like the Missouri Veterans Commission? In order to receive funding from federal bodies such as Medicare and Medicaid, or to receive the per diem grants from Veterans Affairs that help these facilities make ends meet, they have to remain compliant with federal regulations.
Basically, if they want federal money, they need to follow federal laws, no matter how unjust or discordant they might be with those of the state.
“Unless there is a change in Federal law, our Veterans homes may not permit the use of medical marijuana as it would be considered a drug offense and would prevent us from receiving the VA per diem grants,” Jamie Melchert, Communications Director for the Commission told Civilized in an emailed statement.
It isn’t just Missouri either. Medical care facilities across the country are beholden to federal legislation, regardless of the substance’s legal status in any given state. That roadblock restricts access to cannabis treatments for potentially millions of veterans and seniors that sorely need it.
The Value of Medical Cannabis
It goes without saying that these vets and nursing home residents are not just looking for an excuse to get high.
“We’re talking about seniors here. This isn’t a bunch of 18-year-olds in a frat house fighting for cannabis,” Jose Belen, co-founder of veteran’s support organization Mission Zero, told Civilized. “These are geriatric patients, some of them with terminal conditions, just looking for comfort.”
Belen, a veteran who served in the US Army during the Iraq War, knows first-hand how much cannabis can benefit someone struggling from PTSD, chronic pain and other ailments borne from combat.
Belen (second from right) served as part of Operation Iraqi Freedom from 2003-2004
In 2017, Belen and his wife started Mission Zero, an organization designed to raise awareness to the issues facing veterans. Belen said that while cannabis does not solve all of one’s problems, it is “certainly an important tool in their toolbelt,” and was appalled, though not surprised, to hear about the announcement made by the Missouri Veterans Commission.
He told Civilized that for someone who needs medical cannabis, taking that option away from them would be a potential “train wreck” for their mental health.
“To take away a treatment from a veteran who has found a cannabis regimen that is allowing them to function again…that’s just not okay,” said Belen. “You’re slamming a door in the face of someone who is looking to be whole again.”
Last year, Belen, along with four other plaintiffs, sued former attorney general Jeff Sessions and the DEA to declare the classification of cannabis under the Controlled Substances Act unconstitutional, claiming it violated their rights. The case went to court but was swiftly dismissed. Still, Belen remains hopeful that change will come.
“The biggest thing that a veteran has is a voice. Their stories matter,” he said. “I would encourage them to write to their local politicians, be present, be visible. Do it with facts and professionalism. That’s how these initiatives start.”
Change can also begin on the administrative side, as the New York nursing home Hebrew Home at Riverdale has proven by approving a number of measures that indirectly enable their residents to engage in medical cannabis treatments.
Bound by the same regulations facing all nursing homes that make use of Medicare or other federal funding, the 735-bed facility is just as limited in what they are able to do to support their residents. Still, the home’s CEO Dan Reingold, along with its medical director Dr. Zachary Palace, took an interest in cannabis as a potential treatment for its aging and ailing clientele.
For Reingold, it was personal. He saw how beneficial cannabis was during his father’s end-of-life treatment. Dr. Palace, however, told Civilized that his interest was more academic at first.
“As a geriatrician working in longterm care in a skilled nursing facility, we see so much chronic pain. Arthritis, inflammation, Parkinson’s, multiple sclerosis—and many more that are indicated among the twelve medical conditions listed when medical cannabis became legal in New York State.”
In 2016, shortly after medical cannabis became legal New York, Dr. Palace took a course to become a certified cannabis physician learning a great deal in the process. However, as he endeavored to expand his education and learn how cannabis could be specifically used to treat geriatric patients, he came up depressingly short.
“The more I researched it, the less I found,” he said. “Especially in skilled nursing facilities.”
After gaining approval from their board, the pair began to look into ways that they could help residents who might benefit from medical cannabis. Since Hebrew Home could lose its funding by taking a misstep, the facility studied the laws and consulted with their council to determine exactly what they were and were not able to do, legally speaking.
“We weren’t at all trying to break the law,” maintains Dr. Palace. “The two main issues were possession and administration, so it was a matter of coming up with a safe and legal way the residents could keep it.”
The most important thing, Palace says, is that the home can take no active role in storing or administering the treatment. Basically, they can’t touch the stuff.
“They have to be able to access it themselves, or designate a caregiver, be it a family member or a friend, who would be committed to come and administer it to them. At no point, may that person be a Hebrew Home staff member.”
They are, however, able to provide residents with storage containers under lock and key, and host educational programs to help their residents better understand how medical cannabis works and how it can be properly administered to treat certain ailments.
“I’ve had patients say they want no part in it, that they’ve never used marijuana in their entire life, and are certainly not going to start now,” Dr. Palace explained. “But, as we’ve educated, we’ve changed a lot of minds, and have been able to demystify the stigma surrounding medical cannabis.”
Hebrew Home at Riverdale
By providing the residents with the facts, Hebrew Home enables residents to pursue their own medical cannabis treatments. For those who cannot travel to acquire their cannabis, there are other options available. New York’s certified Vireo dispensary offers Skype consultations and free delivery to the patients directly.
Of course, this is not a perfect system. There are several reasons why a nursing home would want to have more control over a resident’s treatment and medication.
“As a geriatrician, we’re very concerned with community-based patients, as they can go doctor shopping and end up getting different prescriptions from different physicians and end up on too many meds, which could have toxic effects,” Dr. Palace said. “Within the nursing home, we know exactly what our patients are getting, as we’re supposed to be the gatekeepers, so we have a little more control over that.”
With time, Palace is optimistic that the laws will change and enable homes to take a more hands-on approach with their resident’s medical cannabis treatments. In the meantime, Palace said that he isn’t worried about federal repercussions Hebrew Home’s program.
“This is a small program. We’re very mindful that everything we’re doing is compliant,” he said. “We’re simply giving our patients another option for symptom management.”
Could This Change?
There were over two million medical marijuana patients registered in 27 states across the US in 2018, and that number is only growing as more states create legal cannabis frameworks to provide access for their citizens. The momentum behind this is undeniable, with five more legalizing it in the past year.
Despite the federal government’s claim that cannabis has no medicinal value, numerous studies have shown how effective cannabis can be in treating chronic pain, insomnia and symptoms related to Alzheimer's. Even the FDA has admitted that cannabis has some benefits for those suffering from epilepsy and anorexia and weight loss associated with HIV/AIDS and chemotherapy treatments.
If the trend remains on its current trajectory, it's conceivable that we might see a day in which all 50 states legalize cannabis for medical use, despite its federal ban. In this case, our veterans and aging population would be among the only people in the country denied potentially life-changing medical cannabis treatments.
"The problem is," as Jose Belen told Civilized. "The politics have come before the people."