Pubdate: Mon, 22 Jul 2013
Source: Telegraph, The (Nashua, NH)
Copyright: 2013 Telegraph Publishing Company
Author: Danielle Curtis

Cannabis Care


Editor's note: New Hampshire will become the 19th state to allow some 
form of medical marijuana with Gov. Maggie Hassan's signature. The 
Telegraph's six-day series, Cannabis Care, examines New Hampshire's 
therapeutic marijuana legislation and how the law will work, 
including who can get the drug, how much it will cost, and what needs 
to happen before the first batch of marijuana is legally distributed 
in the state.

When Dr. John Gorman visited his son in Los Angeles, he was shocked 
by what he found nestled among the ice cream and souvenir shops along 
Venice Beach: a medical marijuana office.

The office was marked by a large green neon sign, shaped like a 
marijuana leaf. On the door, a list of various conditions - from 
chronic pain to nausea - that could make someone eligible for the 
drug, and the proclamation: "The doctor is in."

And while Gorman, a Nashua-based rheumatologist with Foundations 
Medical Partners, part of Southern New Hampshire Medical Center, 
doubts New Hampshire will see these kinds of shops in the near 
future, he does believe the legalization of therapeutic marijuana 
could open the doors for more recreational use.

Here's the catch: he doesn't necessarily think that's a bad thing.

"I favor decriminalization of marijuana across the board," he said. 
"I favor medical marijuana ... I treat chronic pain in a lot of 
people, and I think if they came to me and expressed an interest in 
going that route, I would be willing to discuss it and cooperate."

Gorman is one of hundreds of doctors across the Granite State who 
will now be facing the prospect of helping their patients get 
therapeutic marijuana.

And while Gorman's view is more relaxed than some, there are plenty 
of mixed emotions among the medical community.

Some, like doctors and leaders at St. Joseph Hospital, refused to 
talk about how the legalization of the therapeutic treatment could 
impact their practices and patients.

The Telegraph reached out to the hospital, in addition to SNHMC, but 
received only one response: officials there had no interest in 
talking. The hospital has traditionally been quiet on similar 
debates, including birth control issues.

For Dr. Travis Harker, a Concord-based family physician and president 
of the New Hampshire Medical Society, the legalization of medical 
marijuana opens up a slew of concerns for medical professionals.

The medical society "didn't want doctors to become the gatekeepers 
for recreational use of marijuana," Harker said. "We don't want 
doctors becoming marijuana mills."

That's exactly what's happened in Oregon, Harker said  a state with a 
medical marijuana program similar to that proposed for the Granite State.

Data released by Oregon officials this month shows that there are 
more than 55,000 patients in the state with certified diagnoses, 
eligible to receive marijuana.

And while there are more than 1,000 doctors with at least one patient 
certified, nine of those physicians have certified more than half the 
medical marijuana patients in the state.

But Harker said New Hampshire's law will keep this from happening.

In addition to stricter eligibility requirements, the legislation 
also requires that a patient and doctor have an at least three-month 
medical relationship, including an in-person exam, diagnoses and 
recommended treatment plan.

That, Harker said, will stop the "doctor-shopping" some other states 
have seen after legalizing medical marijuana.

Still, he said many doctors in the state are still uncomfortable 
about the law, which asks doctors not to prescribe marijuana to their 
patients, but to simply certify that the patient has an illness that 
could be aided by the drug.

"We don't know what dose we're giving, we don't know if someone is 
taking it to the point of impairment," Harker said. "When I prescribe 
a medication to manage diabetes or blood pressure, I can make good 
predictions on the kind of impact it's going to have. With this, it's 
unresearched therapy."

But for Gorman, the legalization of medical marijuana is a good thing 
for patients, and potentially for others.

While he said he does believe that its legalization could make it 
easier for people not medically in need of the drug to gain access to 
marijuana, he said there are worse things that could happen.

"It opens the flood gates," he said. "It opens the possibility if 
people want to get high, they could go see certain doctors and get 
certified. I suppose it's a concern, but to me, I guess it's better 
than buying it on the street and having some drug trafficker make out on it."

Gorman said participating in the medical marijuana program will be a 
personal decision for doctors.

And while he is supportive of the law, he said he'll still need some 
time to adjust.

"I don't know if it's something I would initiate with a patient, at 
least right away," he said. "But I have an open mind about it. And I 
think it clearly can help chronic pain in people."

For those doctors who do object to the program, Harker said they 
don't have to be involved. Marijuana use is still illegal under 
federal law, he said, and like birth control, doctors can 
conscientiously object to helping their patients get the drug.

"That's what doctors in the state are going to have to figure out, 
what their comfort level is in participating," he said. "You may 
choose not to participate, or to do so on a limited scale and not 
advertise it. There's the risk of promoting that you are a physician 
that certifies these, you might get a lot of people knocking on your door."

Donna Schlachman, the prime sponsor of the state's medical marijuana 
legislation, said there's nothing in the law that requires a doctor 
to certify their patient for medical marijuana, and she expects some 
in the state will refuse.

"There will definitely be some doctors hesitant to participate in the 
certification process," she said. "But there are also those who are 
thrilled the bill is going to happen. It's widespread."

Harker said the medical society plans to conduct a survey to 
determine just what doctors think of the legislation, and what their 
concerns may be. The medical society will also be working to advise 
doctors on how to handle the new law.

While the group does not expect to provide a recommendation for or 
against medical marijuana, it does plan to provide a series of 
educational seminars in the state on what the law means, and how to 
comply with it.
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