Dear Members of the Joint Committee:
As one of the senior cannabis physicians in the Commonwealth of Massachusetts, President of the Association of Cannabis Specialists, Board Member of the Massachusetts Patient Advocacy Alliance, and former VA physician I wish to convey some very specific concerns regarding House Bill 4274. Despite vocal advocacy by a few veterans, this bill is not in the interests of veterans or other patients.
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Qualifying Conditions
Section One seeks to add additional “qualifying conditions” to a list established in the current law that is superseded by the existing language “and other conditions as determined in writing by a registered qualifying patient's registered healthcare professional”. As additional conditions are already covered by the language of the original law and the reasonable practice of medicine, seeking to add conditions undermines the crucial clinical judgement that is expected of health professionals when treating those “other conditions”.
The law already provides for treatment of the conditions to be added under this bill, and thus adding them specifically risks undermining the ability of healthcare professionals to exercise their medical judgement as intended by the original language. We certain do not want to have every condition listed, and doing so undermines the application of professionalism and clinical judgment.
Disability
Section Two is a larger problem. This seeks to conflate a financial determination of “disability” by the Veteran’s Administration with a medical diagnosis, and assumes therefore that a simple diagnosis is a stand-in for ongoing evaluation and treatment by a health care practitioner. A VA determination of disability is a financial decision made by an administrator, not a clinician, that solely has value for determining VA benefits.
Disability is neither a diagnosis nor does it reflect a patient’s care or ongoing treatment. Furthermore, any current illness is an ongoing process subject to evolution and development worthy of care and guidance from medical professionals.
It is inappropriate to allow or disallow medical care (with cannabis) on the basis of an administrative determination without reference to current and ongoing condition. “…such a veteran shall not be required to receive a diagnosis from a registered healthcare professional,” very succinctly demonstrates the intent of this bill to side-step proper medical care. This is very much in the interest of the cannabis industry. It is very much not in the best interests of medical patients and puts them at risk of harm to their health from the very system intended to help them.
Use of Cannabis
While there is good evidence to support the use of cannabis for veterans, including those with PTSD, there is also good evidence that doing so without medical guidance leads rapidly to overuse and downstream consequences in the veteran population*. Veterans who use cannabis with careful, medically guided attention to dose, frequency, and method of delivery, along with adjunctive care like psychotherapy and conventional medications do better. Bypassing this care is harmful to veterans.
Veterans, like all patients, deserve the best healthcare options. This bill undermines their care and they deserve better. Please do not approve this bill.
Sincerely,
Jordan Tisher, M.D.
Harvard Medical School
Association of Cannabis Specialists
InhaleMD
*Loflin, M. J. E., Babson, K., Sottile, J., Norman, S. B., Gruber, S., & Bonn-Miller, M. O. (2019). A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis. American Journal of Drug and Alcohol Abuse, 45(5), 506–513. https://doi.org/10.1080/00952990.2019.1604722