Pubdate: Sun, 21 Oct 2012
Source: Morning Sentinel (Waterville, ME)
Copyright: 2012 MaineToday Media, Inc.
Contact: http://drugsense.org/url/tLMIEnz1
Website: http://www.onlinesentinel.com/
Details: http://www.mapinc.org/media/1474
Author: Eric Russell

MEDICAL MARIJUANA: IS IT WORKING?

Two years ago, Sharon Gagne of Greenbush discovered she had two 
herniated disks in her neck. Her doctor told her surgery was not an 
option and instead encouraged physical therapy and prescribed a painkiller.

"I didn't like that," she said. "I know too many people who got hooked."

Gagne, 44, eventually asked about other options. Her doctor referred 
her to Dr. Dustin Sulak, an osteopath who has become known throughout 
Maine for his willingness to certify patients for medical marijuana. 
Gagne's physician sent her medical records to Sulak, who then spoke 
twice on the phone with Gagne.

Without ever having met her face to face, Sulak certified Gagne as a 
medical marijuana patient. Now, whenever she feels pain, she smokes a 
little or nibbles a baked good fortified with cannabis.

Gagne's case illustrates the seeming ease with which Mainers with 
certain conditions can receive medical marijuana. Gradual changes to 
state law in the past three years have deregulated medical marijuana 
to the point that there is no way to know how many people are using 
it, how many doctors are certifying patients for it, and whether the 
number of users is growing.

Indeed, some doctors are actively recruiting patients. Sulak's 
practice recently placed an ad in a weekly newspaper offering a $50 
discount to students for medical marijuana evaluations.

On Sept. 28, 2011, according to data collected by the state, 263 
Maine doctors had certified a total of 2,833 patients. The next day, 
a law took effect that rendered Maine's medical marijuana reporting 
requirements optional. That means patients and doctors don't have to 
check in with the state. Police say the loosened system has made 
their jobs harder too, because they no longer have access to 
information that tells them whether someone caught with marijuana 
plants is growing it legitimately.

There also is no way to know how many patients are being treated for 
a diagnosis such as terminal cancer, which has been a permissible 
condition since medical marijuana became legal in Maine in 1999, or 
for something like intractable pain, which was added as a condition 
in 2009 as part of a broad expansion of the state's medical marijuana law.

Gordon Smith, executive director of the Maine Medical Association, 
said recent changes have made it nearly impossible to assess the program.

"Before, we had a handle on it; we could track progress," he said. 
"Now, we have nothing."

John Thiele, who oversees the medical marijuana program for the 
Department of Health and Human Services, conceded that the system is 
far less regulated than it was two or three years ago, but he said it 
seems to be working. To date, no complaints have been made to the two 
boards that licenses doctors and no penalties have been handed down 
for improper use, state officials said.

Thiele did say, however, that a small percentage of Maine doctors 
appear to be prescribing the majority of medical marijuana in the state.

"I'm not sure that's what the law intended," he said.

History in Maine

Medical marijuana has been legal in Maine since 1999, when more than 
60 percent of voters approved a statewide citizens' initiative. The 
goal was to allow patients with certain debilitating conditions to 
grow and possess a small amount of medical marijuana for therapeutic use.

Some studies show that marijuana is safe and effective as a treatment 
for certain conditions. Other studies are not as conclusive. Last 
week a federal appeals court for the first time heard arguments about 
whether marijuana should be reclassified from a dangerous drug to a 
drug with potential medical benefits. That wouldn't necessarily lead 
to its legalization, but it would change public perception, advocates say.

Only a handful of states preceded Maine in legalizing marijuana for 
medical use. Now 19 states, including four in New England, allow it. 
Massachusetts could be next. Voters there will decide Nov. 6 on an 
initiative that would create a system similar to Maine's.

For the first decade, Maine's medical marijuana program ran smoothly 
but quietly, state officials said. The original list of diagnoses 
allowed under the law included cancer, HIV/AIDS, glaucoma, Crohn's 
disease, amyotrophic lateral sclerosis (Lou Gerhig's disease), 
hepatitis C and Alzheimer's. Only a few hundred patients were certified.

That changed in 2009 after Maine voters overwhelmingly approved an 
expansion of the original law to create nonprofit dispensaries 
throughout the state and allow certified caregivers to grow marijuana 
for other patients. The change also added a few more allowable 
conditions - seizure disorders, severe muscle spasms and intractable pain.

Intractable pain is difficult to define and hard to argue against. 
The state defines it as pain that has not responded to traditional 
treatment for at least six months.

The changes took time to implement, but within two years the medical 
marijuana program exploded, according to data provided by DHHS. In 
the first year after the law change, when the state required 
registration, the number of patients jumped from a few hundred to 
almost 3,000. All eight dispensaries created by the 2009 law have 
opened, and the most recent number of registered marijuana caregivers 
was just shy of 800.

Just as the state was beginning to get a handle on those growing 
numbers, though, the law changed again. Legislators last year 
approved a bill that created privacy restrictions. Now patients and 
doctors no longer have to register with the state.

Alysia Melnick, public policy analyst with the Maine Civil Liberties 
Union and the author of that law, said the goal was to protect 
patients from scrutiny by the public and doctors from scrutiny by 
federal authorities. "We didn't think that patients who are being 
treated for serious illnesses needed to have their names out there on 
a public list," she said. "No other types of medical treatment have lists."

But doctors are now protected at the same level as patients. The 
state now has no way of knowing whether a doctor is certifying one 
patient or a thousand.

Thiele said the confidentiality language insulates doctors from being 
flooded with patients who are looking specifically for medical marijuana.

However, Smith said the relaxed laws also have allowed for the 
creation of de facto medical marijuana specialists. If a patient's 
primary doctor is unwilling to certify, there is a short list of 
doctors who will.

Thousands of patients

Dr. Dustin Sulak, 32, who has practices in Hallowell and Falmouth, is 
perhaps the best known of Maine's cannabis specialists, and he's OK with that.

He speaks publicly and often about the benefits of medical marijuana. 
He employs three other "like-minded" practitioners. All are young. 
All are DOs -- osteopaths -- not MDs, which means they are trained to 
adopt a holistic approach to treating patients, as opposed to 
treating symptoms or performing surgeries. Many are trained in 
alternative forms of medicine. Sulak has studied acupuncture, 
hypnotism and Reiki, which aims to heal through the transfer of 
energy from the hands of the practitioner.

Asked whether he uses marijuana himself, either medicinally or 
recreationally, Sulak said, "I don't think the personal use question 
is relevant." But he did say "learning all I can about cannabis and 
the cannabinoid system of physiology has deepened my understanding of 
health and how to foster it."

Sulak said the expansion of conditions under which patients can be 
certified has increased his client base. He declined to say how many 
patients he treats with cannabis but said it was "thousands."

Many of his current patients are using cannabis to treat chronic 
pain. He said he would much rather see that than prescription narcotics.

"I'm always surprised by the number of people, young people, who are 
given opioids to treat chronic pain," he said. "They should be 
healthy, but they have already been down the road of Vicodin and OxyContin."

Sulak said the number of doctors in Maine who are certifying patients 
is low but growing.

"I think a lot of doctors are telling patients that it would violate 
their license (if they certify), but that's just something they can 
say," he said, adding that many doctors are prohibited from 
certifying patients because their employer does not allow it.

As more and more people become comfortable with cannabis as a form of 
treatment, he said, the stigma will wear off.

Count Catherine Lewis among the converted skeptics. She said medical 
marijuana was not in her "comfort zone" even a few years ago. Then, 
she saw how it worked. She saw her husband, who was seriously injured 
in a car accident 20 years ago, go from taking 17 prescriptions a day 
for pain and various side effects and still feeling lousy to using 
cannabis only and feeling great.

Lewis, now 44 and living in Manchester, was badly injured in the same 
accident. Like her husband, she took other medications over the 
years, often powerful narcotics. She hated them. She wondered whether 
medical marijuana would work for her, too.

Her pain specialist encouraged Lewis to consult with Sulak. He used 
Reiki and hypnotherapy first. Then they discussed Sulak's specialty.

Now, Lewis said she would recommend medical marijuana to anyone.

Abuse potential?

To become certified for medical marijuana, a patient needs to be 
diagnosed with one of the original conditions spelled out in the 1999 
law. To certify someone for pain or severe nausea or seizures, a 
doctor must demonstrate and document that the patient has not 
responded to traditional treatment for at least six months.

Once those six months are up, and a patient's doctor is willing, 
little stands in the way. Doctors have full discretion to certify 
patients. There is no additional state oversight. The only barrier is 
that insurance doesn't cover medical marijuana. Sulak charges $300 
for a first visit.

The other variable in certifying for medical marijuana is that pain 
is subjective. Doctors often cannot legitimately withhold treatment 
for pain. Some doctors prescribe painkillers; Sulak favors cannabis.

Brad Feuer, CEO of Sulak's practice, Integr8 Health, said he has seen 
and heard of practitioners who are certifying patients who don't have 
qualifying conditions.

"It upsets us because it gives the program a bad name," he said. "We 
take a lot of risk to provide this service."

The state has not fielded a single complaint against Sulak or any 
other medical marijuana practitioner. However, when told about 
Sulak's certification of Gagne without ever meeting her, Ken Albert, 
director of licensing and regulatory services for the Department of 
Health and Human Services, said that would raise a red flag. Albert 
said it's never good medical practice for a doctor to prescribe any 
medication without having a relationship with a patient.

Feuer said an exception was made for Gagne because she lived so far 
away (about 25 miles north of Bangor, in Greenbush). She still needed 
to meet the necessary requirements for medical marijuana certification.

"Not everyone that comes to us is certified," Feuer said. "We're not 
just giving it to anyone."

Feuer also argued that treating patients remotely is sometimes 
essential in a rural state like Maine. That no other doctor in 
Gagne's area was willing to certify her for medical marijuana is part 
of the problem, he said.

Sulak's practice recently placed an unusual advertisement in an 
alternative Portland weekly newspaper, offering $50 discounts to 
students who wanted to receive a medical marijuana evaluation. Asked 
about the ad, Sulak and Feuer paused before answering.

"That was just a test actually, to give them more of a discount," 
Feuer said, explaining that students are often on tight budgets and 
insurance does not cover medical marijuana. "But they would still 
have to have a qualifying condition."

Several state officials, when asked about the ad, said they hadn't 
seen it. Thiele said it sounded strange and likely would warrant a 
referral to the proper licensing board for an investigation.

Susan Strout, executive secretary of the Board of Osteopathic 
Licensure, said she could not offer opinions on specific practices.

Of course, many doctors refuse to get involved in medical marijuana.

Brian Pierce, a family physician in Rockport, has not certified any 
patients for medical marijuana and does not plan to do so. He said 
he's not convinced of its benefits.

"I have had patients who have run off to Portland or somewhere to get 
certified for medical marijuana and the certifying physician never 
requests that patient's records," he said. "The enthusiasm seems to 
exceed the evidence at this point. There are patients I know who have 
become certified who I'm not convinced should be using a hallucinogenic drug."

'Not reefer madness'

Cumberland County Sheriff Kevin Joyce said the relaxed laws have been 
problematic for his deputies. In several instances over the past 
year, his office has investigated marijuana-growing operations, only 
to find out later that they were certified. Having a database of 
certified users and growers would help, he said.

Joyce also said deputies see a lot of people who don't appear to need 
medical marijuana.

"There are some people we have dealt with in the past who have a 
history of using marijuana illegally and don't seem ill," he said. 
"Now they have a card saying they can use it legally."

Possession and distribution is still against federal law, but 
authorities have mostly looked the other way at the growing number of 
states that have legalized the drug for medicinal purposes. However, 
this year, dispensaries have been shuttered in California and 
Colorado because of violations. Maine's dispensaries are still new 
and tightly regulated.

Maine U.S. Attorney Thomas Delahanty said the state is not in danger 
of becoming California or Colorado, which have lax medical marijuana laws.

"There has been some monitoring of the program," he said.

Would it be easier if there were a database of doctors and patients?

"Of course," Delahanty replied.

Tony Pettigrew, regional spokesman for the U.S. Drug Enforcement 
Agency, declined to comment on Maine's medical marijuana program 
because it's not within the DEA's purview to assess it. The agency's 
position is that marijuana possession is against the law, he said.

Conflict between state and federal law created problems recently when 
the Maine State Housing Authority banned Section 8 housing clients 
from growing or using medical marijuana. Last week, the authority's 
board voted to suspend the ban for six months to gather more 
information and develop a clearer policy.

Last week, an appeals court in Washington, D.C., reviewed for the 
first time scientific evidence on the therapeutic value of marijuana. 
Supporters made their case that marijuana should be reclassified from 
dangerous drug to drug with potential medical benefits. The Justice 
Department argued that the drug is still widely abused. The 
three-judge panel is expected to rule in the coming weeks. Even if 
marijuana is reclassified, it would not be legalized.

Still, there has been a steady shift in states like Maine that 
continue to expand medical marijuana. Sulak is not the only doctor 
taking advantage of a deregulated industry.

Jeremy Spiegel opened a practice, Casco Bay Medical, in Portland this 
March. Since then, he has been seeing an increased number of medical 
marijuana patients. Most, he said, come to him because their own 
doctor will not certify them. Spiegel said he thinks it's actually 
better if certain practitioners act as specialists because it spares 
others doctors who are worried about being labeled "pot doctors."

Most doctors likely went through medical school and their residency 
without ever learning about medical marijuana as a form of treatment, 
Spiegel said.

If doctors want to learn about medical marijuana, Sulak said, they 
have to attend conferences, keep current on studies and observe patients.

But as more learn about its benefits, more might be willing to 
recommend it, Spiegel said.

"It's not a reefer madness mentality here," he said. "It really is 
more scientific."

Still, Maine's medical marijuana laws would change even more if some 
doctors get their way. Sulak and other advocates want to add 
conditions like post traumatic stress disorder.

And not everyone's happy about that. Gordon Smith, of the Maine 
Medical Association, said that if any more conditions are added, "you 
might as well just go ahead and legalize it."
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MAP posted-by: Jay Bergstrom