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Delegates want the federal government to soften its stance on marijuana in hopes of facilitating research. "Colorado State is the only veterinary school that's currently soliciting for research on cannabinoid therapies," said Dr. Michael Ames, representing Arizona. "We may be a little bit behind the curve, but without the hard science, without the research, it's going to be difficult to move forward." CSU research shows that cannabidiol, a non-psychoactive cannabis compound, is measurable in blood and safe to study in canines. Clinical trials also are under way involving the use of hemp oil to treat epilepsy and osteoarthritis symptoms in canines.
Marijuana and its use in animals will be discussed by the American Veterinary Medical Association Board of Directors.
On their agenda is a directive from the AVMA House of Delegates, which asked the Board on Friday to consider pushing the federal government to reclassify cannabis as a way to facilitate research to understand its medical and therapeutic uses.
As a Schedule 1 drug, cannabis is among LSD and heroin in the most restrictive of five categories established by the Controlled Substances Act of 1970. Substances in this category, regulators say, have a high potential for abuse and no accepted medical use — a designation that scientists say is stifling clinical research into the plant's use as potential source of new therapies or pharmaceuticals.
Addressing the House last week during the group's annual meeting in Indianapolis, California delegate Dr. Richard Sullivan suggested the AVMA join advocates for human medicine by asking that marijuana be reclassified as a Schedule II drug, a class that includes most opioid painkillers.
"As the national association, we at least need to write a letter and ask the [U.S. Food and Drug Administration] to approve the research," he said. "Clients are asking us, and it’s our obligation morally and ethically to address these cases. We need the research, and we need our national association to represent us at FDA and get things moving … and get some action done, soon."
Given that the AVMA does not have a policy on marijuana research and use, Sullivan added, "… We do need to be in the conversation."
Federal law prohibits using cannabis for medicinal or recreation purposes, but at least 29 states and the District of Columbia have legalized it in some respect. With state and federal laws in conflict, anyone producing, selling or consuming marijuana is subject to arrest, asset forfeiture and conviction. The Justice Department, however, has pledged not to enforce federal criminal laws against those complying with state marijuana regulations.
Despite its enforcement discretion, the federal government's stance on marijuana presents obstacles for researchers. Scientists report that the approval process for researching marijuana is arduous, with policies of the FDA, Drug Enforcement Agency and National Institute on Drug Abuse making it difficult for researchers to access federal funds and federally provided strains of cannabis.
Reclassifying cannabis is up to the DEA, charged by Congress to uphold the Controlled Substances Act. While the American Medical Association and lawmakers in at least two states have petitioned the DEA to soften its stance on marijuana, the agency rejects the idea. In a response published in August 2016, DEA officials relayed that the Department of Health and Human Services advised against downgrading the drug's status because it "lacks an acceptable level of safety for use even under medical supervision."
The contradiction between societal and government views hampers research at a time when owners are dosing pets with edibles to ease their anxiety, pain and other maladies. Animals also are known to eat marijuana by accident. Dogs have a stronger reaction to tetrahydrocannabinol, the primary psychoactive compound in marijuana, than humans. Experts say it can be fatal in large doses.
"Even in states that have legalized it, none have stipulated its use in veterinary medicine," said Dr. Michael Ames, delegate representing Arizona. "Does that mean clients aren’t using it on their pets? Of course they are. Is there much in the way of hard research to provide a scientific base for that? No."
The result, veterinarians say, is an uptick in queries from clients and poisonings. Dr. Diana Thomé, alternate delegate representing Washington, said she sees a case of cannabis toxicity weekly. "Our clients come in almost daily asking us about the use of marijuana," she told the House. "Legally, I can't tell them anything … other than to say I can’t advise them to use it."
To provide the profession with guidance, delegates asked the AVMA to develop and disseminate information on marijuana as it pertains to four areas:
- current legal status of cannabis as applied to veterinarians
- unified definitions of cannabis and its derivatives
- current research on the use of cannabis in animals
- signs, symptoms and treatment of cannabis toxicity in animals.
Michigan delegate Dr. Kathleen Smiler suggested that a lack of input from veterinarians on using medical marijuana in pets has allowed human doctors to step in. While working on a neurological condition in dogs, she said she was contacted by a physician who's developing a topical medication containing cannabis compounds, used to treat ataxia.
"This is really happening," she said. "Human neurologists are trying to peddle marijuana for problems in veterinary medicine."
Reining in remote care
House discussions were robust concerning a new policy on telemedicine.
The AVMA's telemedicine policy advocates for advances in technology to remotely connect doctors and patients but preserves physical, face-to-face visits as a requisite for establishing a veterinary-client-patient relationship, or VCPR. Without a VCPR, the AVMA says that medical advice should be offered "generally, with no specific reference to a patient, diagnosis or treatment."
The telemedicine policy is intended to guide state regulatory boards as they oversee remote veterinary care. While some states prohibit licensees from establishing a VCPR through electronic means, others are less prescriptive. Veterinarians consulting with colleagues and clients across state lines struggle with the inconsistencies, according to an AVMA Practice Advisory Panel report on telemedicine, published in December.
"Given the current state of technological capabilities, available research, and the current state and federal regulatory landscape, the AVMA believes that veterinary telemedicine should only be conducted within an existing [VCPR], with the exception for advice given in an emergency until that patient can be seen by a veterinarian," the policy states.
Delegates passed the policy by a 97 percent margin, but not before striking from the draft version two sentences: "Remote consulting directly with the patient's owner is acceptable when authorized by the veterinarian who has established the VCPR. This authorization should be documented in the patient's medical record."
Sullivan of California suggested the omission. "We would really need a very tight definition of consulting, and I think this ... provides a loophole," he reasoned. "For example, if the consultant is discussing the case with a client, who has the VCPR? The consultant or the referring veterinarian? I'm concerned that this muddies the water of consulting."
The definition of consulting in the AVMA Model Veterinary Practice Act, he pointed out, involves "communicating to the referring veterinarian only, and that veterinarian holds the liability for the case."
To reflect the AVMA's newly adopted stance, delegates revised the model veterinary practice act. Used as a guide for state policymakers as they draft regulatory codes and laws, the model practice act states that without a VCPR, "any advice provided through electronic means shall be general and not specific to a patient, diagnosis or treatment. Veterinary telemedicine shall only be conducted within an existing VCPR, with the exception for advice given in an emergency until that patient can be seen by a veterinarian."
According to the AVMA, a growing number of owners are falsely outfitting their pets in service gear so they can access places that normally prohibit animals. To address this trend, the House passed a policy titled "The Veterinarian's Role in Supporting Appropriate Selection and Use of Service, Assistance and Therapy Animals."
The policy is intended to "serve as a foundation for further educational and lobbying efforts to promote the appropriate use of service, emotional support and therapy animals, and discourage misunderstandings and fraudulent activities in relation to these categories," the AVMA said. It calls on veterinarians to "discourage inaccurate or misleading descriptions" of service, therapy and emotional support animals and become versed in the service designations.
Misrepresenting a pet as a service animal is dangerous, delegates said. They recounted stories of bogus emotional support animals injuring people on airplanes and clients pressuring veterinarians to sign service certificates. Dr. Wendy Hauser, delegate representing the American Animal Hospital Association, said "it's critical that we as veterinarians do not relinquish our voice on the issue."
"When you see emotional support animals, I worry about the safety of the humans on the other end of the leash and the people in between them," she said. "I think it's important that we don't relegate our role in this."
Dr. Cia Johnson, director of the AVMA Animal Welfare Division, agreed: "There are many national professional associations that we need to work with. But we are in the process of trying to identify which bodies we need to work with to try to bridge the gap so we continue to have a voice in the conversation."
The House of Delegates approved a new policy on the therapeutic use of stem cells and regenerative medicine and made statements concerning the importance of federal veterinarians in food safety and emergency response.
Delegates also approved a policy on handling companion animal remains, but not before striking the sentence, "When appropriate and available, preference should be given to providers in good standing with relevant professional associations."
Revisions to the AVMA's stance on hospice care were enacted. The policy was renamed "end-of-life care" because delegates deemed the term "hospice" to be anthropomorphic. "It seems to me the more we do to humanize our patients, the further we move away from other areas of this profession. What is hospice care on a feed lot?" Texas delegate Dr. Mark Cox reasoned.
Delegates amended the AVMA bylaws to relax rules for constituent allied organizations seated in the House. For an allied group to be accepted into the House, its voting membership must represent 1 percent of the AVMA's voting members. The change allows an allied organization to remain in the House temporarily if its membership numbers fail to keep pace with the AVMA's. Any group unable to meet the 1 percent stipulation would have a year to do so.
The National Association of Federal Veterinarians and the American Association of Industry Veterinarians are among the groups in danger of losing their House seats.
A second bylaws change passed by the House incorporated Student Chapters of the American Veterinary Medical Association (SCAVMA) into the national Student American Veterinary Medical Association (SAVMA). The move is intended to unite the AVMA's student groups under a single entity by dissolving SCAVMA chapters and reinstating them as SAVMA chapters.