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California is poised to become the first state to explicitly bring veterinarians into the arena of medical marijuana, following the passage of a bill that protects licensees from disciplinary action solely for discussing the therapeutic use of marijuana in animals.
The state Senate on Wednesday approved AB 2215 on a vote of 37 to 1. The Assembly passed an earlier version of the bill, 60-10, in May.
The bill was back in the Assembly Thursday for concurrence on amendments. Gov. Jerry Brown has not indicated whether he will sign the legislation.
Speaking before the vote, Valerie Fenstermaker, executive director of the California Veterinary Medical Association, said, "We really want it to pass and for the governor to sign it. It’s what’s best for animals, it’s what’s best for clients and certainly, it’s what’s best for the veterinarians, because they’re the professionals.
"We have dispensaries selling these products," she explained, "and nobody ... outside of a veterinary professional should be giving advice about using these products in animals."
The legislation prevents state regulators from penalizing a veterinarian for merely talking with clients about using marijuana, also known as cannabis, in animal patients. However, veterinarians may not dispense or administer cannabis or cannabis products to patients.
Because the federal government outlaws marijuana — classifying it as a Schedule I controlled substance, which means that it considers the drug addictive, prone to abuse and without medical benefit — veterinarians in the United States widely believe that they mustn't talk about the drug with their patients' owners.
The wariness prevails even in states that permit recreational use of marijuana because no state laws directly address the use of cannabis in veterinary patients, either to permit or prohibit it.
A California Veterinary Medical Board legal memo dated Oct. 5, 2017, states that "Although a veterinarian may lawfully discuss and administer treatment for cannabis toxicity, it is unclear whether a veterinarian is prohibited from DEA [U.S. Drug Enforcement Administration] discipline or prosecution during discussions with a client regarding the use of cannabis treatment on an animal patient."
In the memo, Tara Welch in the state Department of Consumer Affairs Legal Affairs Division notes that "case law [has] determined that physicians would not place their DEA registrations in jeopardy for discussing cannabis treatment options with their patients.” Welch cites an appeals court decision that “physician speech with a patient regarding cannabis treatment is entitled to First Amendment protection because of the significance of the doctor-patient relationship." The case is Conant v. Walters.
"As with the physician-patient relationship," the memo continues, "the veterinarian-client-patient relationship depends upon open and frank communication for the proper treatment of the animal patient. However, legal protection of veterinarians and their discussions with clients of cannabis treatment for animal patients has yet to be codified in statute or challenged in court."
The memo concludes: "Due to the increasing exposure of animals to cannabis products and the need for veterinarians to properly treat animals suffering from cannabis toxicity or medical maladies for which animal owners are treating with cannabis products, the Board may wish to recommend legislative proposals to address these issues."
The bill passed by the Legislature requires the veterinary board to develop guidelines by Jan. 1, 2020, for practitioners to follow when discussing cannabis with clients.
While the legislation protects veterinarians from disciplinary action just for talking about cannabis with pet owners, it also provides for penalties if they:
- accept, solicit or offer any form of remuneration from or to a cannabis licensee if they or their immediate family have a financial interest with the cannabis licensee
- discuss medicinal cannabis with a client while employed by or have an agreement with a cannabis licensee
- distribute any form of advertising for cannabis in California
Fenstermaker said those prohibitions are consistent with restrictions placed on physicians in the state.
While California would be the first, and so far only, jurisdiction to expressly authorize veterinarians to discuss the use of medical marijuana with their patients' owners, that doesn’t mean veterinarians elsewhere can’t talk about it, maintains Dr. Narda Robinson, a veterinarian and physician in Colorado.
Robinson runs CuraCore Integrative Medicine & Education Center, a business in Fort Collins that offers courses in integrative medicine to health-care providers, focusing on the science behind complementary treatment approaches such as acupuncture, botanical medicine, massage and photomedicine.
Robinson said she’s heard time and again from veterinarians that they can’t talk about cannabis with clients, but when she searches for direct prohibitions, she comes up empty.
For example, Robinson said, she had heard from veterinarians in the Canadian province of Ontario that if they talked about cannabis with clients, they could lose their licenses. She asked representatives from the College of Veterinarians of Ontario, which regulates licensees in the province, whether that was true.
"They said that it’s not that you can’t discuss it at all," Robinson reported. The issue is that veterinarians don’t have the authority to administer, dispense or prescribe the product. That is not the same, Robinson said, as being unable to talk about it. "I don’t see where we can’t educate our clients," she said.
The Colorado Veterinary Medical Association has a similar, and stronger, view. Its position statement says: "Veterinarians have an obligation to provide companion animal owners with complete education in regard to the potential risks and benefits of marijuana products in animals."
The subject of cannabis comes up frequently at veterinary clinics, judging from the results of a survey by the Veterinary Information Network, an online community for the profession. About 36,000 members were invited by email to complete the survey, which was conducted between April 27 and May 16.
Of 2,131 respondents, 63 percent said they are asked by clients at least monthly — and some weekly or daily — about cannabis products for their pets. Most veterinarians answering the survey said they have never been the ones to initiate the discussion.
Fifty-six percent of the respondents said they have clinical experience with cannabis products, either by direct observation of effects or from client reports of effects on their pets.
Of those with experience, nearly 79 percent indicated that the products were somewhat or very helpful as analgesics for chronic pain; and more than 62 percent found them somewhat or very helpful for managing anxiety. A smaller proportion found them helpful as analgesics for acute pain (about 50 percent) and for reducing the frequency or severity of seizures (about 41 percent).
A great majority — more than 80 percent — had not observed or received client reports of any adverse effects except for sedation.
One aspect the California bill does not address is quality standards for medical cannabis products sold for use in animals. Originally, the bill would have amended the state Medicinal and Adult-Use Cannabis Regulation and Safety Act to include veterinary use. Owing to concerns that the proposal would increase the workload of the already burdened state Bureau of Cannabis Control, Fenstermaker said, the bill subsequently was changed to amend only the state Business and Professions Code.
Fenstermaker said addressing quality control of cannabis products sold for pets is a goal for a future legislative session. She also anticipates that veterinarians might one day be authorized to recommend cannabis for their patients.
“A lot depends on research,” she said. “There’s research going on right now even with the Schedule I classification. ... We think that eventually, if it proves out that this helps animals and the treatment of animals, that yes, that [authority] should come along in the future. We just don’t know when.”
Two scientific papers were published in July on research into the use of cannabidiol, also known as CBD, in dogs. The first, published in the Canadian Journal of Veterinary Research, examines the pharmacokinetics of a CBD product being used in a clinical trial at Colorado State University.
The second paper, published in Frontiers in Veterinary Science, describes the results of a clinical trial at Cornell University involving the use of CBD in dogs with osteoarthritis. Researchers found that the drug “can help increase comfort and activity in dogs with OA.”
Update: The Assembly approved the amended bill on Aug. 30, completing passage by the Legislature. The governor signed the bill on Sept. 27.
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