Pubdate: Mon, 01 Jul 2013
Source: Union Leader (Manchester, NH)
Copyright: 2013 The Union Leader Corp.


Dr. P. Thomas Harker, a Concord physician, is president of the New
Hampshire Medical Society and holds both a medical degree and a
master's degree in public health.

He responded to these questions from the New Hampshire Union Leader
about the state's newly enacted medical marijuana legislation.

How was the medical society involved in the drafting of the

We wanted to have a very limited and narrow scope for this legislation
because we believe that therapeutic cannabis is an unproven therapy.
Studies have not been done to confirm that this would be a useful
intervention or to say it would not be a useful intervention. We
thought for some people with life-threatening illnesses that were not
responding to treatment that this might be something worth
considering. We're very concerned about the risk of diversion and the
message we send to the children and adolescents of New Hampshire about
cannabis. We wanted to make sure we did not send a message that it is
a safe product to be used in a recreational way.

Are there any possible uses of cannabis that you specifically

We played a very active role in getting the scope narrowed; the
biggest example is post-traumatic stress disorder, where there is some
evidence that cannabis can be disruptive to appropriate treatment.Are
providers writing prescriptions for marijuana under the bill?They are
not. When I write a prescription, I've made a diagnosis, I look at
FDA-approved therapies and I prescribe a medication that is approved
by the Food and Drug Administration. This allows the doctor to certify
that (the patient) has that condition. The patient then takes that
certification to a dispensary, which can dispense to a person who has
a certifying diagnosis.

Is it troubling to you as a practitioner that you are being asked to
diagnose a condition, but the patient decides that medical marijuana
is the way to treat it?

It is somewhat concerning; there is lot of question of how it will
play out in practice, We in the medical society are going to work with
the Board of Medicine and work with the Drug Enforcement
Administration to understand what is legally appropriate, but also
what is morally and ethically appropriate for our providers within the
scope of the law and actually do the right thing for our patients.

Can a doctor be a conscientious objector and say,"No, I'm not doing

I think they could. In the same way that some doctors choose not to
prescribe birth control, some doctors could decide not to certify
certain diagnoses.Will continuing education be recommended or required
for physicians about what to do when someone comes in looking for a
diagnosis that will allow use of medical marijuana.There is nothing
required in the legislation, but the Medical Society is going to work
very aggressively to make sure we have information out to the
physicians of the state. It is a critically important issue that
physicians do it right, and we want to make sure they have the right
information to make the best decisions when they are with their patients.

Do you have concerns over the type, dosage and manner in which
cannabis will be administered once someone qualifies to use it?

Smoking marijuana is clearly bad for people's lungs. If I had a
patient certified for a diagnosis, I would recommend against smoking
it unless they had no other way of getting it into their system.

What is the beneficial part of medical marijuana, is it the THC? Can
that be given as a pill instead of self-dosing through marijuana use?

There is a medicine that is a purified form of THC -- it is called
Marinol -- to help stimulate appetite in people with wasting disorders
like HIV/Aids. It is something that we've been able to prescribe for a
number of years. We have argued that (Marinol) probably would have
been a better route than to legalize an unproven therapy, but there
was political will in the state that it was going to pass. If (medical
marijuana) was going to be a therapeutic option in the state, we
wanted to minimize the risk to people.

As this bill was considered, did you have to silence your professional
reservations about the concept of medical marijuana?

No. We were very upfront that we didn't think moving forward with
therapeutic cannabis was the right thing, but we followed up with, "If
you are going forward, these are the things that we think will make
your bill better." We did not keep silent on things we cared about.

Are you concerned that the program has potential to be abused by
people receiving medical marijuana, since there are no prescribed
dosages for someone who qualifies to use it?

I don't think there is any control on that, and that is one of the
concerns about it -- that some people will use it in a more
recreational sense than a therapeutic sense and use it to be
intoxicated as opposed to ease their pain or stimulate their appetite.

Is the availability of marijuana as a treatment a distraction from
alternatives that might be a better option for the patient? Will its
availability mean people don't follow a regimen that their doctor
might recommend?

That certainly is a risk, and I think the Legislature decided this is
a risk we're going to have. I do hospice and home calls (for
terminally ill patients) and we have excellent medications to treat
their pain and to keep them comfortable in the last days, weeks or
months of their lives when they have a terminal illness. I don't
believe we need an additional therapy of marijuana. I'm open to having
more research on this, but don't think we should be having research
done on patients in New Hampshire in an uncontrolled fashion.
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