Pubdate: Fri, 27 Apr 2018
Source: Times-Picayune, The (New Orleans, LA)
Copyright: 2018 The Times-Picayune
Author: Maria Clark



Louisiana's nine future medical marijuana dispensaries have been
selected. The two grow sites, managed by LSU and Southern University,
are preparing to start growing and processing the drug by next
February at the latest.

Legislators have been focused on the issue, too. Two bills are making
their way through the Legislature that would potentially expand the
number of medical marijuana patients.

But after all these preparations are made, will there be doctors for
medical marijuana patients to go to?

Despite the interest in Louisiana's budding new industry, the number
of doctors that actually have been licensed to recommend medical
marijuana lingers at 10, according to the Louisiana State Board of
Medical Examiners which approves the therapeutic marijuana license.
Only 15 have applied. Federal regulations could also limit the growth
of physician participation by the time Louisiana's medical marijuana
program is up and running.

"I am really worried about the lack of medical support so far," said
Jacob Irving, a law student from Baton Rouge living with congenital
spastic quadriplegia. He has been a vocal advocate of Louisiana's
medical marijuana program since its inception, testifying in favor of
the bills being considered that would expand the use of the drug for
patients with chronic pain, glaucoma, post-traumatic stress disorder
and severe autism.

Louisiana is one of 29 states plus Washington D.C. that have legalized
comprehensive medical marijuana programs, according to the National
Conference of State Legislatures. Louisiana passed its law in 2016
allowing the use of medicinal marijuana for people with cancer, a
severe form of cerebral palsy, epilepsy, muscular dystrophy, HIV/AIDS,
and other specific diseases. It can only be sold in oils, topical
creams, and sprays and cannot be sold in a form that can be smoked.

But just because a state legalizes medical marijuana doesn't mean that
physicians will necessarily recommend the drug to their patients. In
2016 the Drug Enforcement Administration announced it was not
loosening restrictions on marijuana, keeping it in the same regulatory
category as heroin - schedule 1.

In order for the DEA to change its classification, scientific research
needs to prove that the plant has medicinal value. However, the
federal restriction makes it difficult to conduct that research.

A "prescription" for medical marijuana is illegal under federal law
because Marijuana is a controlled substance. However, in states where
medical marijuana is legal doctors can "recommend" or "certify" that a
patient has a qualifying condition and could benefit from the drug,
Irving explained.

"It's not a prescription so they can't specify a dose under federal
law. It could be a reason why physicians are scared of signing up," he

So, although the state has legalized the production, sale and use of
medical marijuana for specific medical purposes, many health providers
are wary of jumping in before it becomes legal at the federal level.

These rules also restrict training and research on marijuana for its
medicinal benefits.

Dr. Peter Winsauer, a professor of pharmacology at LSU Health New
Orleans School of Medicine, is required to have a Schedule 1 license
from the DEA to research the illicit effects of marijuana, which he
has been doing for 30 years.

"We are taught to be scientific as possible--the door is opening to a
drug we don't know enough about," he said. "The federal government
isn't making it any easier to help us conduct this research."

Going from studying a drug for its illicit effects to studying it for
its medicinal benefits represents a huge paradigm shift, he said.

Ochsner Health System will not comment on whether or not it will allow
its physicians to get licensed to recommend medical marijuana, or if
Ochsner has set up guidelines on how this should be done. A
spokesperson for LCMC Health System said their system has not set up
guidelines for doctors who wish to register to recommend the drug to
patients, but "doctors that work in LCMC hospitals and clinic can
apply for the permits if they wish."

East Jefferson General Hospital has taken a similar stance.

"At this time, we don't have a specific policy regarding this. And,
like any other legal medicine, we don't dictate what independent
physicians prescribe in a clinic setting," said a spokesperson for the

Tulane Medical Center is also being cautious before jumping in.

"As this is a new area of medical practice in Louisiana, we are
studying the ramifications but have not yet come to a determination on
policy," said a spokesperson for Tulane University.

Among Federally Qualified Community Health Centers, the divide between
state and federal regulations on marijuana could also limit the number
of participating physicians. FQHC's are outpatient clinics that
qualify for specific reimbursement systems under Medicare and Medicaid.

Federal law prohibits a health center from prescribing or dispensing
medical marijuana, according to a sample policy distributed by the
National Association of Community Health Centers in July 2017.

FQHC's receive federal grants and are required to publish a statement
notifying employees that the "manufacture, distribution, dispensation,
possession or use of a controlled substance" is prohibited under the
Drug-Free Workplace Act of 1988.

Violating this law could result in a clinic losing grant funding and a
ban on future federal contracts for up to five years, according to the

Low physician participation rates in medical marijuana programs have
been reported in many other states. In November 2016, only 1 percent
of the 16,000 doctors who treat patients in Maryland had signed up for
the state's program, according to a report in the Baltimore Sun. New
Jersey legalized the program in 2010, but seven years later fewer than
2 percent of that state's licensed doctors were participating,
according to the Henry Kaiser Foundation and Marijuana Policy.

To get his therapeutic marijuana license Dr. Victor Chou, a physician
based in Baton Rouge, left his job at an urgent care center. He is one
of the 10 physicians who have been licensed so far to recommend
medical marijuana in Louisiana.

"There is no way I could work with urgent care and do this. Big
institutions don't want to lose their licenses--they don't want to
touch this," he said.

Although it will be several months before the dispensaries open, Chou
is in the process of setting up a private practice where he will
specifically focus on working with medical marijuana patients. So far,
he has completed 35 hours of continuing medical education on medical

Doctors who are licensed to recommend medical marijuana are only
allowed to work with 100 medical marijuana patients at a time.
Patients are also required to visit the doctor after three months,
where they will determine whether or not they should continue taking
the drug.

"I felt that this is a valuable service and patients can benefit from
this," Chou said. "I see this as a chance to be a pioneer in an
industry that is going to keep growing."
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