Pubdate: Thu, 28 Jul 2016
Source: Honolulu Star-Advertiser (HI)
Copyright: 2016 Star Advertiser
Author: Kristen Consillio


Many Doctors Are Adopting a Risk-Averse Attitude and Want to Wait 
Until Dispensaries Are Established

Health care providers have been slow to embrace the medical marijuana 
industry even though July 15 was the legal opening date for the 
state's first dispensaries. The number of doctors certifying medical 
cannabis patients only climbed slightly over the past six months. 
There were 88 physicians who certified 14,492 patients as of June 30, 
up from 79 doctors and 13,150 patients on Dec. 31, according to the 
state Health Department.

Despite a nationwide push to legalize pot, Hawaii doctors are still 
reluctant to join the movement, said Dr. Chris Flanders, executive 
director of the Hawaii Medical Association, representing 1,100 physicians.

"According to the federal government, it's illegal. For years we were 
threatened with the possibility of losing Medicare privileges for 
recommending or certifying medical marijuana patients," he said. "The 
possibility always existed that a federal agency could come into your 
office and prosecute a physician criminally for activities related to 
the use of marijuana. Although they never really did that, a lot of 
the physicians feel like it's not worth the risk."

The U.S. Drug Enforcement Administration lists marijuana as one of 
the most dangerous drugs, along with heroin, with a high potential 
for abuse, though there has been a major push to change that as more 
states legalize the drug.

Persuading more physicians to buy into the medical marijuana program 
also is difficult because of a lack of research to prove the efficacy 
of cannabis treatment, said HMA President Dr. Scott McCaffrey.

"The majority of doctors are viewing this cautiously. We don't have 
enough good clinical research and more needs to be done," he said. 
"There's hesitation because there's just not enough clinical research 
and we don't know what we're recommending in terms of potency and 
purity of cannabis when it's bought illegally on the streets. For 
those reasons doctors are holding back."

HAWAII legalized medical marijuana 16 years ago, but patients did not 
have a legal way to obtain the drug. Act 241, passed in 2015, allowed 
the state to issue eight licenses for a total of 16 medical marijuana 
dispensaries statewide. The law allowed dispensaries to open July 15, 
but licensees have said they will not be ready to open until late 
this year or early next year.

"Doctors are waiting until dispensaries are really established before 
they will be comfortable writing more certifications for medical 
marijuana use," McCaffrey added. "There is considerable interest in 
this area from a lot of doctors, but I think they've taken a 
waitand-see stance until dispensaries actually come into being. Once 
the dispensaries are open, there will at least be some level of 
quality control on medical cannabis and ... I believe doctors will be 
more comfortable on coaching and advising their patients on this matter."

Dr. Scott Miscovich, a primary care doctor who certifies medical 
marijuana patients, said educating physicians and patients is crucial 
to legitimizing the industry.

"The hesitation is pure education. Doctors are still fearful to 
certify patients. They're not prescribing or putting their Medicare 
license or federal DEA license at risk. It's kind of an urban myth," 
he said. "We are not telling them what to buy or how much to use. 
It's a big confusion that doctors don't understand. To a lot of 
people it's taboo to even ask their patients if they're using medical 

Gov. David Ige signed a bill into law earlier this month that allows 
nurses to certify patients for medicinal marijuana, a move advocates 
say is necessary because of a shortage of doctors willing to join the program.

Change is difficult in the constantly evolving health care community, 
so it may take awhile for providers to become comfortable with 
marijuana as medicine, Flanders said.

"The majority are going to wait and see what happens. And make sure 
it's safe, easy and doesn't cause problems for their practice," he 
said. "We see that with a lot of different things: new technology, 
new procedural issues, new policy issues. A lot of physicians, 
they'll wait and see how new things work out for the people that are 
using them before they start using those technologies or those 
procedures. They're a conservative bunch. They want to keep the risks 
as low as possible."
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MAP posted-by: Jay Bergstrom