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Last year, California became the first state in the U.S. to recognize cannabis in veterinary medicine, providing legal protection to veterinarians who talk with pet owners about its use.
A bill before the state Legislature this year would go a step further, allowing qualified veterinarians to recommend cannabis for pets.
The expanded latitude is important because discussions with clients about cannabis often lead to pointed questions from clients about what products to use and at what dosages, said Dr. Gary Richter, a veterinarian with a holistic medicine practice in Oakland, and an advocate of the change.
"Where does 'discuss' end and 'recommend' begin?" Richter asked.
The bill, SB 627, authored by Sen. Cathleen Galgiani, a Democrat, is scheduled for a hearing on Monday before the Senate Business, Professions and Economic Development Committee. But before that comes a potentially make-or-break review on Wednesday by the California Veterinary Medical Board (CVMB).
Richter said opposition from the regulatory board likely would scuttle the bill, while support or a neutral stance would enable it to move forward.
The CVMB is in the midst of developing guidelines for veterinarians to discuss cannabis. The board must complete and post the guidelines by Jan. 1, as directed by the law passed last year.
California has a history of breaking ground on the legal status of marijuana, a drug derived from the cannabis plant. In 1996, California became the first state to permit the use of marijuana as medicine for people. Today, 34 states and the District of Columbia, Guam, Puerto Rico and the Virgin Islands allow marijuana for medical purposes, according to a tally by the National Conference of State Legislatures.
In the past seven years, 10 states — California among them — have legalized recreational use of marijuana by adults. However, the drug remains prohibited by federal law.
Hemp, which also comes from the cannabis plant, was illegal until the passage of the 2018 Farm Bill. Now industrial hemp is legal nationwide but the legality of products made from hemp is complicated, subject to a tangle of provisions.
Further, the U.S. Food and Drug Administration maintains authority to regulate food and drug products containing cannabis and cannabis-derived compounds, including cannabinoids. To date, the FDA has approved only one drug derived from the cannabis plant — Epidiolex, for treatment of certain epileptic conditions — and several products containing synthetic cannabinoids. The many cannabis products being sold online, in brick-and-mortar stores and in farmers markets occupy a regulatory gray zone.
Epidiolex, approved in 2018, contains cannabidiol, usually referred to as CBD. One of many biologically active compounds in cannabis, CBD is distinct from tetrahydrocannabidiol, or THC, which causes the "high" associated with marijuana. CBD does not cause intoxication or euphoria. Of all the cannabinoids, CBD has generated the most interest recently in its possible therapeutic properties.
A draft version of the CVMB guidelines for California veterinarians tends to emphasize the potential drawbacks of cannabis use, including that "no federal or state agency oversees standardization of cannabis product concentrations for use on animals" and "research to-date is lacking conclusions regarding dose, toxicity & efficacy." The draft acknowledges the changing landscape of cannabis use, noting that "discussions should be evaluated in accordance with accepted standards of practice as they evolve over time."
A fact sheet from advocates of the new bill says language in the draft guidelines is useful for veterinarians "who do not want to include medical cannabis in their practice." The proposed legislation would excuse veterinarians from adhering to the guidelines, saying that they "may, but [are] not required to, follow the guidelines adopted by the board."
The bill's provisions would apply only to "qualified veterinarians," defined as veterinarians licensed in California who have completed a medicinal cannabis program approved by the American Association of Veterinary State Boards' Registry of Approved Continuing Education (RACE).
Richter said several RACE-approved programs in veterinary cannabis exist, and there likely will be more in the future. "Obviously, it would be the purview of the Veterinary Medical Board to make a list of acceptable courses," he said.
He disclosed that he is co-teaching with Dr. Trina Hazzah, a board-certified oncologist, a "Cannabis in Veterinary Medicine" online continuing-education course this month. The course is hosted by the Veterinary Information Network, an online community for the profession and parent of the VIN News Service. Based in California, with members around the world, VIN has not taken a position on the proposed legislation.
The California Veterinary Medical Association is recommending that the bill be disapproved unless it is amended, CVMA executive director Valerie Fenstermaker told the VIN News Service today by email. Fenstermaker did not specify what part of the bill the CVMA wants amended.
The CVMA was a strong supporter of last year's legislation that protects veterinarians from disciplinary action for merely talking about cannabis with clients. Speaking about that legislation in August, Fenstermaker said, "When we hear from our members that every day they get questions and concerns from their clients, and we know that this [product] is being advised by non-professional individuals, that's a problem."
Richter said inquiries from clients led him to study the potential of cannabis as medicine for veterinary patients. Among pet owners, there is increasing interest in using cannabis to treat a variety of conditions, including anxiety, pain, seizures and cancer.
"Here's what classically happens," he said: "Their pet gets diagnosed with something, they panic and they run around and buy all this stuff. They go online or they go to a dispensary and say, 'What do I do?' "
Then, he said, they come to his clinic with products in hand and ask which they should use.
"Or even more commonly," he said, "someone comes into the office and says, 'My dog has cancer, I'd like to talk about whether or not cannabis can help. Can we talk about that?' So we'll 'discuss' it. And then at some point in the course of the discussion, the conversation will clearly come to, 'OK, great, what product do I use and what dosage do I use?'
"Now where am I?" Richter said.
Leaving clients to sort out dosing themselves based on information they've been given by non-veterinarians or information they find online is risky, he said. Considering that dosing often is expressed in milligrams per kilogram of weight (mg/kg), Richter said it's "incredibly easy" for an untrained person to miscalculate.
"If you shift the decimal point one way in the wrong direction, that's the difference between efficacy and your dog in the emergency room," he said.
"Whether or not you like cannabis as medicine ... the reality is that it's here, and it's not going away," Richter said. "Our options are either to get involved and help pet owners and keep animals safe, or we can sit on the sidelines and not get involved and put animals at risk."
Other states beyond California have pending bills related to veterinary cannabis. They include:
- New York: A970/S2835 would allow veterinary patients the same access as human patients to medical marijuana for specified conditions.
- Connecticut: HB 6518 would protect veterinarians from arrest, prosecution or disciplinary action for discussing marijuana.
- Tennessee: HB0793/SB0541 would prohibit licensing boards from disciplining health care professionals, including veterinarians, based solely on their recommending or marketing products derived from industrial hemp.
Updates: The CVMB did not support the bill. Board members expressed a variety of concerns, key among them that the medical potential of cannabis is not well-researched in veterinary species. Richter said bill advocates will amend the language to address as many of the regulators' concerns as possible, in hopes that the board will revisit the issue at its next meeting, in July. Despite the CVMB's reservations, the Senate Business, Professions and Economic Development Committee voted 9-0 in favor of the bill and sent it to the Appropriations Committee.