A key position at the U.S. Department of Veterans Affairs (VA) has been filled, with the Senate voting to confirm a nominee who previously helped oversee and expand New Jersey’s medical marijuana program and who has advocated for federal legalization.
Shereef Elnahal, President Joe Biden’s nominee for VA undersecretary of health, will be responsible for leading a key division of the department that until now has administratively prevented VA doctors from issuing medical cannabis recommendations to military veterans.
Not only did Elnahal enthusiastically work to regulate and improve New Jersey’s medical cannabis program as the state health commissioner from 2018-2019, but he’s also made clear that he personally believes federal prohibition must come to an end. And now, he has been confirmed for a top VA slot by a Senate vote of 66-23 on Thursday. He’s expected to be sworn in this week.
During a confirmation hearing before the Senate Veterans’ Affairs Committee in April, Sen. Dan Sullivan (R-AK) brought up Elnahal’s cannabis regulatory background and expressed frustration over VA’s consistent opposition to legislation, including his own, that would promote clinical research into the therapeutic potential of marijuana for conditions that commonly afflict the veteran population.
The now-confirmed official spoke about how, when he was serving as New Jersey’s health commissioner, he ran the medical marijuana program and “expanded access to the program across the state, and made it easier for veterans to enroll, as well.”
“As you know, senator, this issue is very complex from the national standpoint and the federal government standpoint because it remains a Schedule I drug,” he said, adding that he would commit to “have these discussions with leadership across the administration, but also with this committee, and try to set up next steps.”
Watch the conversation about medical cannabis and veterans, starting around 02:03:15 into the video below:
While it remains to be seen how vocal he will be about the issue as a federal official, Elnahal has made clear in the past that he feels marijuana’s restrictive status should change.
He tweeted in 2018 that cannabis “needs to be descheduled at the federal level.”
Marijuana needs to be descheduled at the federal level. Enough is enough.
Patients on #MedicalMarijuana deserve better.
Until then, we are stuck with:
-Scant research funding
-Limited to no access in hospitals/nursing homes
-High costs for patientshttps://t.co/iJDmCHVjYF
— Shereef Elnahal, MD (@ShereefElnahal) July 13, 2018
“Enough is enough. Patients on #MedicalMarijuana deserve better,” he wrote, listing complications of the federal-state policy conflict such as high cannabis costs and a lack of authorized access at health care facilities.
At the confirmation hearing, Sullivan followed up by asking if the nominee had seen any “benefits or takeaways” from his marijuana regulatory work, specifically as it concerns veterans who received cannabis treatment.
“I did. I did serve as an advocate for the program across the board for all patients who are eligible for specific conditions. It’s a condition-based system,” he said. “But the intersection with federal law was not something I had to contend with at the time, and so that would be a layer of issues that I would have to address if confirmed.”
Sen. Jon Tester (D-MT), chair of the committee who also sponsored the VA cannabis research bill alongside Sullivan, said that he’s aware of the numerous health conditions that people use marijuana to treat, and he’d be “all-in” if there was evidence supporting that cannabis can supplant the use of dangerous pharmaceuticals. But if the science doesn’t support those medical uses, he said he thinks “we’ll make a huge mistake.”
“We should be doing this research. And if it takes an act of Congress, we’ll do it,” Tester said. “But I hope you are aggressive in pushing the VA to do the research within the law.”
Meanwhile, other bipartisan lawmakers have devoted significant attention to marijuana- and veterans-related issues, including this month as the House has taken up appropriations and defense legislation for the 2023 Fiscal Year.
While VA under several administrations has repeatedly testified against modest cannabis measures, that hasn’t stopped members on both sides from filing and advancing bills and amendments to force policy changes and revise VA directives.
For example, a bipartisan coalition of House lawmakers recently attempted to attach language to a package of spending measures that would have prevented VA from using its funds to enforce provisions of a 2017 Veterans Health Administration (VHA) directive that ban department doctors from issuing medical cannabis recommendations to veterans and blocks VA from covering medical marijuana costs. (As VA undersecretary, Elnahal will lead VHA.)
The amendment as introduced was meant to merge prior standalone bills led by Congressional Cannabis Caucus co-chairs Reps. Dave Joyce (R-OH), Barbara Lee (D-CA), Earl Blumenauer (D-OR) and Brian Mast (R-FL). But it was not made in order in the Rules Committee, with committee leadership keeping it from floor consideration on procedural grounds.
Separately, an amendment did recently pass the House as part of a defense bill would tackle the issue of allowing VA doctors to issue medical cannabis recommendations to veterans, but it’s unclear if the Senate will follow suit.
In any case, VA itself has also created bureaucratic headaches for lawmakers who feel a duty to enact reform that enjoys widespread public support, including from much of the veterans community. To that end, Joyce said in a statement to Marijuana Moment on Friday that he’s “pleased to see the bipartisan confirmation of Dr. Shereef Elnahal.”
“The undersecretary of health is a critically important position at the VA, and it has been vacant for far too long,” Joyce, whose father was a World War II veteran, said. “I look forward to working with Dr. Elnahal to ensure that veterans get the health care they deserve and have earned, including increased medical cannabis access in states that have chosen to make it legal.”
It’s not clear just how much authority Elnahal will have to unilaterally reform administrative marijuana policies or spur additional VA-led research into cannabis, but his confirmation will likely be well-received by advocates and veterans organizations that have pushed for departmental policy changes on the issue for years.
In 2018, then-New Jersey Health Commissioner Elnahal talked about the recalcitrance of the medical community to embrace cannabis as a legitimate therapeutic, arguing that prevailing “stigma that’s built up over time” because of its recreational use has produced false narratives.
“Of course it’s been used illegally for those [recreational] reasons, but it has a lot of therapeutic benefits,” he said.
“The side effect profile, in particular the risk for dependence, addiction, overdose, death—all of those are much lower and nonexistent for marijuana versus opioids,” he said. “The other thing is we’re not necessarily recommending it as a first-line therapy, we’re just allowing you now to recommend it as a first-line therapy. It’s still a clinical judgement.”
While advocates were encouraged by the work of New Jersey regulators like Elnahal to expand the states medical cannabis program, with the number of registered patients increasing significantly under his tenure, he also recognized the need to do more to make it easier for patients to easily access affordable products, especially in a state that didn’t allow home cultivation.
We are finally giving the NJ #MedicalMarijuana program the attention it deserves- thousands more patients will have access, doctors will find it easier to recommend marijuana as a first-line tx, and dispensaries will find it easier to service many more @GovMurphy @NJDeptofHealth https://t.co/Lq8iKbeKBX
— Shereef Elnahal, MD (@ShereefElnahal) March 27, 2018
“It’s justified impatience,” he told Insider NJ in 2018, adding that the public pressure his office faced over access barriers “holds us accountable, makes sure we’re not losing perspective on how patients are feeling.” While he said he might not prefer receiving critical Twitter posts from people demanding faster reform, even that kind of informal feedback sometimes “leads to action.”
The then-commissioner oversaw numerous medical cannabis policy changes that were enacted in New Jersey, including adding new qualifying conditions, lowering registration fees, allowing patients to have more primary caregivers, repealing a strain limit and approving additional forms of medicine.
News on the growing number of patients who were enrolling in New Jersey’s medical cannabis system was met with applause from Elnahal, who said in 2018 that “we are building a compassionate, consumer-friendly program,” even though “our work is far from done.”
“More physicians should look to medicinal marijuana as a safe, effective treatment—and one that can help not only improve patients’ wellbeing but also combat the opioid crisis,” he said.
Elnahal also participated in a lecture tour where he visited hospitals and healthcare facilities around New Jersey to encourage doctors to participate in the medical cannabis program.
In another notable development to come out of the Biden administration recently, the president’s judicial nominee for a key federal appeals court has helped to craft Arizona’s marijuana legalization ballot initiative and also served in a leadership role for a national cannabis advocacy organization.
Also, last year, Biden nominated a White House drug czar who previously played a key role in overseeing the implementation and expansion of West Virginia’s medical marijuana program. The Senate-confirmed official has also publicly recognized both the therapeutic and economic potential of cannabis reform.
Part of the reason that these nominations are significant, as far as advocates are concerned, is because while Biden campaigned on modest marijuana reform proposals like rescheduling the plant, expunging prior federal cannabis records and letting states set their own policies, he remains out of step with the public—and particularly his party—as a consistent opponent of adult-use legalization.
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