Pubdate: Sun, 18 May 2014
Source: Reno Gazette-Journal (NV)
Copyright: 2014 Reno Gazette-Journal
Contact: http://www.rgj.com/letters
Website: http://www.rgj.com/
Details: http://www.mapinc.org/media/363
Author: Ray Hagar

SOME DOCTORS WILL PRESCRIBE PAINKILLERS - BUT NOT POT

Julie Hornsby lives in constant pain. She suffers from peripheral
neuropathy, a painful condition that attacks the body's nervous
system. She also has degenerative disk disease in her lower back,
painful enough on its own.

There's no cure for it, so Hornsby's life centers on managing her pain
with strong narcotics, including morphine and Percocet.

"I'm 49 years old, unable to work," Hornsby said. "I quit (working)
full time in 2008 and have been on disability for almost four years
now. I don't work outside of the home. I can't. I can't get out of
bed."

Hornsby is eager for Nevada's medical marijuana dispensaries to get up
and running. She hopes to qualify for a medical marijuana card. She
hopes it will lessen her pain and allow her to get off some of her
current medications.

"I'm looking at a shelf in my bedroom and I have 12 pill bottles up
there, and I'm hoping I will be able to cut that down," Hornsby said.

Hornsby has a dilemma. Her primary care physician won't give her a
recommendation for medical marijuana. Regular pharmacies could not
fill it, anyway, because it remains a Schedule One drug, subject to
abuse and of no medical value, according to the federal government.

"Most doctors won't prescribe it because of insurance and contracts
with hospitals," she said.

"But maybe once they have dispensaries open up a little more, maybe
the doctors will feel more comfortable doing it."

A Reno business, however, has sprung up to help Hornsby obtain a
medical marijuana card. It's called Elements, and its owner describes
it as "a full-service medical-marijuana evaluation center" -- a place
that will help you obtain a prescription and a medical marijuana
patient card for a $200 fee. State fees raise the overall charge to
$300.

"We have a doctor in the building who comes in a couple of times a
week, and he will actually to the medical evaluation there," said
owner Shane Smith, a transplant from Arizona. "Also, our secretary is
a notary officer, so she can notarize the paperwork and send that to
the state to review the applications."

Many of those who have come into his storefront since it opened in
January have a similar problem to Hornsby's -- their doctor won't
write them a prescription.

"What we do is provide a service that, typically, your primary care
physician won't do," Smith said. "Your primary care physician may say,
hey, medical marijuana may be great for you and I'd love to do it, but
I am not going to write that for you. They can't jeopardize that. And
so what we do is provide a doctor to facilitate that need."

Hermann Jonak, an osteopathic physician, does the consulting at
Elements about three days a week. But wanting a medical marijuana card
doesn't mean you'll get one, Smith said.

"First, in order to even come in and see the doctor, you already have
to have records from your primary care physician or your chiropractor
stating your diagnosis for the last year," Smith said. "Our doctor
doesn't say, 'Hey, I think you qualify for marijuana so I'll give you
marijuana.

"But we really evaluate your paperwork from your primary-care
physician and all of the paperwork before we say that you qualify and
we're going to go ahead and sign off on it."

About 5,600 Nevadans are registered medical marijuana cardholders,
according to the Nevada Division of Public and Behavioral Health. Most
reside in Southern Nevada.

"I can tell you right now that there will be a lot more people getting
them (marijuana cards) when the dispensaries come out," he said.

"We get about 30 calls a day, people asking about medical marijuana
cards," Smith said. "There is a lot of curiosity. But if you came into
the store, you'd probably only see a few people a day."

Primary care physicians are wary of prescribing medical marijuana,
partially in fear of losing their license to practice.

"I can't even imagine what the pharmacy board would do," said Dr. Tom
O'Gara of Ralston Family Physicians. "They crawl up our backside for
early refills on a couple of Percocet or narcos. I can't image what
would happen with marijuana."

The Nevada State Board of Pharmacy oversees the state's doctors and
they way they prescribe controlled substances, said Cheryl Blomstrom,
the public member of the board.

The board is not involved in any medical marijuana issue for the same
reasons pharmacies don't sell it: medical marijuana is still a
Schedule One drug by the federal government and off-limits to those
business who sell controlled substances.

For that reason, Blomstrom said it was important to note that doctors
don't write prescriptions for medical marijuana, only
recommendations.

The board has discussed issues involving doctors abusing or writing
too many medical marijuana recommendations, Blomstrom said.

"We have talked about that at the pharmacy board and the action (to
revoke license) would come through the state medical board (Nevada
State Board of Medical Examiners) first," Blomstrom said. "If there
was an over-prescribing situation, the license that would be at risk
is not the controlled substance license; it would be the actual
medical license."

If the board of medical examiners took action against a doctor, the
pharmacy may follow, Blomstrom said.

"It would make sense to me that if the medical board found a doctor
was being really bad and wanted to pull his license, we would probably
also pull the controlled substance registration also," she said. "We
would work in connection with our sister boards."

Although O'Gara feels uncomfortable writing recommendations for
marijuana, it doesn't stop his patients from asking.

"Just in the last two weeks, I've been asked a lot," O'Gara said.
"Maybe I should be turning on the news or reading the paper more. I
don't know what has happened in the past two weeks."

When asked about it, O'Gara hands patients a copy of a business card
for Nevada Medical Marijuana Consultants, a Reno-based company that is
similar to Elements.

"I actually got that guy's card, printed it up and I just hand it out
on a piece of paper," he said.

O'Gara has a strict interpretation of Nevada's medical marijuana laws
and will only write prescriptions if the patient suffers from ALS or
Lou Gehrig's disease, multiple sclerosis, cancer or nausea from
chemotherapy or some other terminal condition. He says the law also
allows him to prescribe it for chronic pain. But he interprets reads
the law that as meaning chronic pain from mostly terminal issues.

"Now, if you have chronic pain because of these other diagnosis (ALS,
MS, cancer and chemotherapy), then game on," O'Gara said. "Other than
that, you can go see that guy" at Nevada Medical Marijuana
Consultants.

That suits Smith and his Elements business.

"I am not opposed to there being more medical marijuana evaluation
clinics out there to help spread the word," he said.

How to apply for a medical marijuana card.

GET THE APPLICATION: Those interested must write or
visit:

Nevada Division of Public and Behavioral Health

ATTN: Medical Marijuana Division

4150 Technology Way, Suite 104

Carson City, Nevada 89706

A $25 processing fee must accompany the request for an application.
The check or money order should be made out to Nevada Division of
Public and Behavioral Health (DPBH). Included in the letter must be:

* The address to mail back the application,

* If applicant has a caregiver, it must include a request for a
caregiver packet

* If applicant is requesting an application for someone other than
them, include that person's name and address

* If the applicant is requesting an application for a minor, include a
request for a minor release

The application is then mailed and should arrive within three weeks.
The application will be given to those who visit office at the time.

FILLING OUT THE APPLICATION: The applicant needs to go to a licensed
physician and get the recommendation for medical marijuana and comply
with all of the elements of the application. A $75 processing fee must
accompany the application when it is sent back. If it is not
completely filled out, the $75 fee and application is mailed back to
the applicant, who must fill it out completely.

THE CHECK OF YOUR BACKGROUND: Once the application is approved, the
applicant will get a 30-day temporary acceptance letter. The state
will request a name-based check of an applicant, caregiver or the
parent of a child from the Central Repository for Nevada Records of
Criminal History and, if such check is inadequate to determine the
criminal history of an applicant, caregiver or parent of a child, the
state may request a complete set of the fingerprints of the applicant
and the designated primary caregiver, if any. The application will be
denied if there are any convictions of selling a controlled substance.

GETING THE CARD: If the application is approved, the applicant will
receive an acceptance letter. Then, the applicant must take that
letter to an office of the Department of Motor Vehicles and sit for a
photo. An $11 fee is charged. The DMV then mails them the card. It is
similar to a Nevada driver's license but clearly states it is a
medical marijuana card. If the state discovers a prior criminal
conviction, it can revoke the card.

Source: Nevada Division of Public and Behavioral Health
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