Pubdate: Wed, 06 Mar 2013
Source: Taunton Daily Gazette (MA)
Copyright: 2013 Taunton Daily Gazette
Author: Richard Aghababian
Note: Richard Aghababian, M.D. is president of the Massachusetts 
Medical Society, the statewide professional association of physicians 
with more than 24,000 members in the commonwealth.


Contrary to this newspaper's position that "the silence has been 
deafening from the majority of medical providers" (Our View: 
"Respecting marijuana as medicine," March 3), physicians have been in 
the forefront of communicating their views on medical marijuana, both 
on the referendum and on the subsequent regulatory process.

The Massachusetts Medical Society, which has long supported 
reclassifying marijuana so it can be legally tested for safety and 
effectiveness, was highly vocal in opposing the referendum. We 
pointed out that marijuana has not been subjected to the same 
scientific testing as other drugs approved by the Food and Drug 
Administration, that claims for its medical effectiveness have been 
anecdotal and not scientifically proven, and that smoking marijuana 
poses health risks, as marijuana smoke contains toxic substances as 
tobacco smoke does.

The notion that "no one seems willing to come forward with actual 
medical facts" about marijuana is not surprising. The facts are few, 
as there is still much that we do not know. Physicians who choose not 
to certify patients should not be criticized for admitting they have 
no expertise and, therefore, are not reliable sources about medical 
marijuana use. A review of the studies at shows 
the evidence on marijuana as a safe and effective treatment to be sparse.

The passage of the referendum has prompted the Medical Society to 
raise concerns about multiple provisions in the law. These concerns 
have been shared publicly and with the Department of Public Health. Among them:

- - What is the nature of the physician-patient relationship under the 
law? We think it should be defined by the State Board of Registration 
in Medicine, the state agency that licenses physicians and issues 
regulations for the practice of medicine.

- - How is the term "licensed physician" defined?  Are online 
certifications or those from physicians outside the Commonwealth 
allowed? We propose limits, to include only those physicians with an 
active license from the State Board of Registration in Medicine, a 
Massachusetts Department of Public Health Controlled Substances 
Registration, and a Federal Drug Enforcement Agency Registration.

- - What is the meaning of "other conditions as determined in writing 
by a qualifying patient's physician"? We consider that too broad a 
definition. Certification should be based on the patient's diagnosis 
and the physician's assessment that the patient's symptoms of 
spasticity, neuropathic pain or other symptoms are not best 
controlled with conventional medical therapy.

- - What are the standards of care relative to medical marijuana? None 
exist now. We believe physicians who choose to certify patients 
should follow the recommendations of the American Society on 
Addiction Medicine on the professional tenets of proper patient care.

- - Should not medical marijuana become part of the state's 
Prescription Monitoring Program to prevent abuse? We think so.

We have raised other questions as well: What are the implications of 
use on occupational health and safety? What dosages are appropriate 
for treatment? How, exactly, is it to be dispensed? For how long 
should certification be valid? What constitutes an appropriate supply 
for an individual? Should minors be allowed to use it when scientific 
studies have shown marijuana to be toxic to the developing brain?

Physicians know that prescribing marijuana has serious legal 
implications for them, as under federal law, the possession, growing 
or sale of marijuana remains illegal as does aiding such activity. 
State law allowing for physician certification of patients to use 
marijuana is designed to get around federal court decisions' apparent 
prohibition of prescribing marijuana. It remains classified by the 
Drug Enforcement Administration as a Schedule I controlled drug, 
meaning it currently has no accepted medical use and has high 
potential for abuse. The implications for physicians who need a 
federal DEA license to practice are significant.

These are critical questions for both physicians and patients, none 
of which are answered by the law. It is vague on many counts and 
raises questions that, we hope, the Department of Public Health will 
provide well-reasoned answers to when it issues regulations.

The fact that the law now recognizes medical marijuana simply does 
not make marijuana a safe medicine. We appreciate the compassion for 
suffering patients that prompted the public's endorsement of the 
referendum, and we understand that some physicians will make good 
faith efforts to certify some patients despite the law's shortcomings 
and lack of clinical data on marijuana use. We agree the discussion 
must continue, but we also believe that whether marijuana is a 
medicine comparable to other well-studied pharmaceuticals must be 
determined by rigorous, scientific, evidence-based testing.
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MAP posted-by: Jay Bergstrom