Pubdate: Sun, 03 Jul 2016
Source: Boston Globe (MA)
Copyright: 2016 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Kay Lazar

MOST MASS. DOCTORS WARY OF APPROVING MARIJUANA USE

A small circle of physicians - 13, to be precise - has provided the 
vast preponderance of approvals needed by Massachusetts patients to 
gain access to medical marijuana, state records show, a pattern that 
underscores the continued growing pains of a new industry.

These doctors certified nearly three-quarters of the 31,818 patients 
who had received permission to use medical marijuana by early June.

The concentration of approvals in the hands of so few physicians is a 
story of both opportunity and fear. For the baker's dozen of doctors, 
medical marijuana certifications provide a robust stream of patients, 
who typically pay $200 out of pocket for an initial office visit.

But their grip on such a large share of patient certifications 
illustrates that many other physicians in the state are reluctant to 
sign off on patients using the drug, according to the Massachusetts 
Medical Society.

The hesitance reflects persistent concerns about the possible legal 
repercussions for their medical licenses if they prescribe a drug the 
federal government classifies as dangerous, with "no currently 
accepted medical use." It also underscores the lingering doubts about 
marijuana's health risks and benefits, said Dr. James Gessner, 
president of the society. View Story

Scrutiny for medical marijuana shops

State rules prohibits waiting lists, but many patients apparently 
were not aware the practice was illegal.

These worries only intensified when state regulators in May and June 
yanked the licenses of two physicians accused of improperly 
certifying thousands of patients for marijuana use. Both suspended 
doctors worked in offices that specialize in issuing marijuana certificates.

Some major teaching hospitals forbid their physicians from certifying 
patients for marijuana use, but in some cases, doctors have been 
circumventing restrictions by referring patients to clinics that 
specialize in granting certification.

One such clinic is Integr8 Health, a Maine medical marijuana 
physicians practice that opened an office in Burlington about three 
years ago. The office includes two doctors who have certified roughly 
2,000 Massachusetts patients since October 2014, when the state 
launched its online registration system for patients and physicians 
and started tracking the growth.

Brad Feuer, Integr8's chief executive, said his company follows 
strict rules in certifying patients, and is committed to establishing 
strong ties between doctors and patients, despite its volume of 
cases. He said his physicians and nurses typically spend about one 
hour evaluating a patient on the first visit, in addition to 
reviewing a patient's medical records before issuing a certification.

The clinic, he said, has recently seen a striking increase in 
referrals from medical practices with physicians who are hesitant to 
issue patient certifications or forbidden by their own companies.

"Doctors are very scared of the [medical] board and very reluctant to 
recommend medical cannabis in Massachusetts, because the 
Massachusetts Medical Society has come out against it," Feuer said.

The society opposed the 2012 state law that legalized marijuana for 
medical use in Massachusetts, and Gessner said the organization 
remains frustrated by a lack of studies regarding marijuana's 
potential health risks and benefits.

State rules require physicians to complete one course about 
marijuana, including its side effects and signs of substance abuse, 
if they want to recommend the drug to patients.

Physicians then must register online with the state Health 
Department, which grants them permission to certify patients as 
eligible for medical marijuana use. Patients must also register with 
the online system to complete the certification process.

State regulations list nine diseases and conditions that can qualify 
a patient for marijuana use, including cancer, multiple sclerosis, 
Parkinson's disease, and Crohn's disease, but also gives physicians 
wide latitude to recommend use for any other "debilitating 
condition," such as nausea and pain.

One physician who has referred patients to Integr8 is Dr. Andrea L. 
Seek, a 52-year-old senior staff psychiatrist at Lahey Hospital & 
Medical Center, just down the street from Integr8.

Lahey's policy for physicians states that it prohibits "the 
certification of patients or written patient recommendation of any 
kind for purposes of the patient obtaining medical marijuana."

Some physicians at Lahey are not keen on the idea of a nearby 
marijuana physician's practice, Seek said, but she was intrigued. 
Seek walked into Integr8 a few months after it opened in October 
2013, asked for a tour, and spoke with its physicians. Then, she 
invited them to Lahey to present information about marijuana to 
Lahey's medical staff.

The Lahey psychiatrist treats patients with serious mental health and 
medical problems, patients with depression and cancer, post-traumatic 
stress, and gnawing neurological pain. An increasing number were 
asking her questions about medical marijuana.

"There is a fair amount of literature suggesting some benefit of 
medical marijuana," Seek said. "I feel it is appropriate to provide 
patients with the information they ask for in the same way I might 
refer them to a chiropractor, and I give them the number of the 
Integr8 practice."

Seek, who said she does not suggest marijuana as a first-line 
treatment, estimated she has referred 20 to 50 patients to Integr8.

Unlike Lahey, Partners HealthCare allows physicians to certify 
patients for marijuana use. Partners' largest hospital, Massachusetts 
General Hospital, informed staff members in a newsletter last year 
that it was attempting to develop a referral resource for physicians 
who prefer not to get involved with marijuana certifications, but who 
might be "approached by patients who may be appropriate for therapy."

Michael Morrison, a hospital spokesman, said the referral resource 
has not yet been launched and was unable to say whether many Mass. 
General physicians were referring patients to outside marijuana practices.

One physician who is receiving scores of referrals is Dr. Jill 
Griffin, who opened a medical marijuana practice in Northampton in 
2013. State records show Griffin, 56, has certified the most patients 
in Massachusetts - 3,284 by early June.

Griffin's attorney, Michael Cutler, said many of the certifications 
Griffin has issued were for patients referred to her by other 
physicians. Griffin, who directed the emergency department at one 
Springfield hospital and worked in the emergency department of 
another facility, is well known in the region, Cutler said.

"Almost all of the doctors out here are part of group practices, and 
for a long time, all of the group practices prohibited their doctors 
from writing marijuana certifications," Cutler said. "So, the only 
way a patient could be certified, for virtually all the doctors out 
here, was to refer patients out of their practice."

But state records suggest sentiment among doctors may be slowly 
changing. The number of physicians registered with the state to 
certify patients for medical marijuana use has nearly doubled in the 
past year, to 150 - although that still represents only a tiny 
fraction of the more than 30,000 doctors practicing in the state.

Dr. Anne Rogal, a 61-year-old Milton primary care physician, said she 
certified her first patient in December. She has approved seven 
patients to use medical marijuana, according to state records.

"Patients were asking me about" marijuana, Rogal said. "Rather than 
saying forget it, I started reading about it."

Rogal said the drug is especially helpful for a patient experiencing 
severe nausea caused by powerful medications prescribed for her 
sarcoidosis, an inflammatory disease that typically produces abnormal 
growths in patients' lungs.

In Southbridge, 63-year-old family physician John Howland said he 
decided to start certifying patients because he worries that clinics 
churning out thousands of certifications may not fully understand 
each patient's medical history. He has certified seven, state records show.

"It's quite effective in certain patients, and it's a much safer 
alternative than opiates," Howland said. His handful of 
recommendations for marijuana use have been for patients with chronic pain.
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MAP posted-by: Jay Bergstrom