Pubdate: Sat, 19 May 2012
Source: Hartford Courant (CT)
Copyright: 2012 The Hartford Courant
Author: William Weir


Years of debate and fine-tuning in the state legislature over 
allowing medical marijuana still have not settled all the questions 
Connecticut doctors have about medical marijuana. Is it, as some 
contend, a humane solution for patients who can't get relief from 
other medicines, or a reckless move toward something that hasn't been 
fully tested scientifically?

The Connecticut State Medical Society, which has a membership of 
about 7,000 practicing and training physicians, opposed the bill.

"On one hand, we're asked to be scientific and use evidence-based 
medicine," said Dr. Michael Krinsky, the medical society's president. 
"On the other hand, we're being legislated to by people who don't 
practice medicine, telling us this is fine to do, based on rather 
flimsy evidence."

While it may be true that marijuana could be medically beneficial for 
some patients, there hasn't been enough research to confirm this, 
Krinsky said. "The science is not quite there yet."

The fact that federal regulations do not recognize medical marijuana 
also causes some concern.

"That's a very difficult position to put a physician in," he said.

In 2009, U.S. Attorney General Eric Holder said he would not 
prosecute physicians or patients acting under state medical marijuana 
laws, as long as they did so in good faith. The federal government 
maintained a hands-off approach to state marijuana laws until late 
last year, when federal agents began cracking down on California dispensaries.

"I think there's some anxiety about what the federal government's 
attitude will be about it," said Dr. Andrew Salner, chief of the 
department of radiation oncology at Hartford Hospital, who has long 
been an advocate for medical marijuana.

Salner said he doesn't believe federal regulations will be a problem 
in Connecticut.

"Clearly, there's a groundswell that this is the right thing to do 
for people who don't respond to other medications," he said.

The federal actions in California caused Delaware Gov. Jack Markell 
to end the state's regulated marijuana dispensary program in 
February, less than a year after the state created it.

But the California crackdown hasn't caused any concern in Maine, 
which has allowed marijuana dispensaries since 2009, said Andrew 
MacLean, deputy executive vice president at the Maine Medical 
Association. For one thing, he said, Maine is much smaller than 
California. Also, he said, Maine has kept much tighter control over 
the dispensaries and the relationship between medical marijuana 
practitioners and patients.

Since 1999, Maine had allowed doctors to issue certificates for the 
use of medicinal marijuana, but there was no place for patients to 
legally obtain it until 2009. Originally, MacLean said, his 
organization and most doctors in the state opposed medical marijuana. 
But the move toward regulated dispensaries - plus 10 years of public 
discussion - changed that.

"I would say that, yes, [doctors] were resistant," MacLean said. "We 
opposed the legislation the first time around, but I think opinions 
among physicians, as among the general public, have evolved."

While conventional medications go through a rigorous approval process 
from theU.S. Food and Drug Administration, Krinsky said, marijuana 
hasn't had the same kind of scrutiny. He also wonders how dosages of 
marijuana would be prescribed.

"Does a physician prescribe one toke or two?" he said.

As for dosages, Salner said, "I think each person needs to do that by 
trial and error to see what works for them. Generally speaking, a 
small amount will work."

Salner said he estimates that 1 percent of the patients he sees can 
benefit from medical marijuana. He has for the last few years 
occasionally suggested it to patients.

"I'll recommend it, and some patients say, 'Oh, yeah, I know where I 
can get it,'" he said. "Others have said they've already tried it. 
And other patients say, 'I wouldn't dare, that's illegal and I 
wouldn't put myself or family at risk by going to someone on the street.'"

A law allowing medical marijuana would eliminate that risk, Salner said.

"If I tell a patient that they might benefit from medical marijuana 
for their nausea and pain, I put myself at risk and making that 
recommendation puts [patients] at risk," he said.

Dr. Kelly Johnson-Arbor, a toxicologist at Hartford Hospital, said 
allowing medical marijuana in the state "is a good idea in 
principle," but adds that she has several questions about it. For 
instance, how would pharmacies dispensing marijuana protect 
themselves against robberies, and how would residents react to a 
marijuana dispensary in their neighborhood?

"I think there are so many details that have to be worked out," she said.

As the bill is written, doctors would be allowed to issue a 
certificate for marijuana to patients diagnosed with cancer, 
glaucoma, HIV, AIDS, Parkinson's disease, multiple sclerosis, damage 
to the nervous tissue of the spinal cord with objective neurological 
indication of intractable spasticity, epilepsy, cachexia, wasting 
syndrome,Crohn's disease orpost-traumatic stress disorder. 
Pharmacists licensed by the state would dispense the marijuana.

If Gov.Dannel P. Malloysigns the bill, as expected, officials from 
the state Department of Consumer Protection will devise details about 
how dispensaries would be run and regulated. Claudette Carveth, 
spokeswoman for the department, said those details would be available 
by summer, if the bill is signed. The law would take effect Oct. 1.

Dr. Angela Kueck, a gynecologic oncologist at the University of 
Connecticut Health Center, said she practiced medicine in Michigan 
shortly after that state passed its own medical marijuana law.

"Among a lot of the physicians who were not in support of it, there 
was a fear of abuse," she said, adding that these concerns were 
unfounded. "Things were running pretty smoothly. There were not a lot 
of signs of abuse or misuse."

Kueck said opinions may be different in other fields of medicine, but 
among oncologists she has spoken to, most are overwhelmingly in favor 
of allowing medical marijuana. And with more education about the 
medical use of marijuana, Kueck said, she expects more doctors to be 
in favor of it.
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