Are Doctors Ill-Prepared for Medical Marijuana?
Posted by Marijuana Doctors on 01/26/2016 in Medical Marijuana
Twenty-three states across the country have approved the medicinal use of marijuana, for medical purposes. Although medical marijuana program specifics vary state to state, they all require that the qualifying patient be evaluated and certified, by a qualified physician, in order to register. However, as more states pass measures legalizing medical pot, more physicians are finding themselves in unknown, unchartered, clinical and legal territory.
Scott Hammer, MD, a family physician in Milford, Delaware, says that some of the requests he has received were clearly for recreational purposes. But others, including a patient diagnosed with metastatic cancer, and suffering from a myriad of related symptoms, including severe nausea and pain, might benefit from marijuana, says Dr. Hammer. However, “People start popping up with these state forms to fill out – I’m just not [personally] ready to fill these forms out yet,” explains Dr. Hammer, citing the drug’s Schedule 1 status amongst his concerns.
Many physicians have grave concerns about the federal legality’s involved in their participation, leaving their patients to obtain certification from another doctor. “That’s a dangerous scenario,” says the assistant professor of psychiatry at Harvard Medical School, Kevin Hill, MD. If physicians aren’t informed of their patients medical marijuana use, they can’t be monitored for any potential issues, like possible interactions with other prescribed drugs, explains Dr Hill. “Whether or not they [doctors] want to write for medical marijuana certification, they need to have their eyes open to this issue.”
“It’s kind of unusual to have a new treatment introduced to the public by ballot initiative,” says Doris Gundersen, MD, medical director of the Colorado Physician Health Program. “My concern for the public is when something is legal, that might translate into an opinion or belief that it’s completely safe and that’s not necessarily the case with marijuana.”
“You must engage your patients,” says Scott Miscovich, MD, a family physician in Kaneohe, Hawaii. “We believe that there’s no one better to have this conversation than the long-term treating physician who has that relationship with the patient. Because they are going to have the best ability to influence the appropriate change, whether that’s seeking medical marijuana or perhaps seeking another alternative.”
Authored by Dr. Hill, a 2015 article published in the Journal of the American Medical Association entitled, “Marijuana : The Unbiased Truth About The World’s Most Popular Weed,” has attempted to provide physicians with some guidelines and guidance, for recommending and evaluating medical marijuana. It includes a list of the conditions for which randomized studies have indicated some benefit, i.e. chemotherapy induced vomiting and nausea; cachexia from wasting illnesses like HIV/AIDS; chronic pain; neuropathic pain; and spasticity associated with multiple sclerosis, to name a few.
Dr. Hill says that among other considerations when evaluating patients, it is important to identify whether patients have tried (and failed) first and second-line medications for the related condition. It is also important to consider whether the patient has an active substance use disorder, anxiety disorder, psychotic disorder, or unstable mood disorder.
Steven Wright, MD, a family physician and addiction medicine specialist in Littleton, Colorado, says that with time, and adequate training and education, more doctors will become comfortable with incorporating medical marijuana recommendations into their practice. “Even if you’re convinced that marijuana works in certain individuals, don’t recommend it until you understand how to use it. It’s not off-label prescribing. It’s off-off label,” cautions Dr. Wright.
Although physicians are weary of the federal implications of recommending medical marijuana, the federal government has displayed no interest in prosecuting healthcare professionals, who are in accordance with state law. Several memorandums have now been issued by the Justice Department, explaining that the federal prosecution of medical marijuana-related issues, is not an efficient use of federal prosecutorial resources.
The only solution to this apparent doctor dilemma, is the federal rescheduling of cannabis – which will finally grant the scientific and medical world legal access, to fully understand and research, all the pharmacological benefits of marijuana.