Editorial: Medical marijuana’s Catch-22

Tuesday, May 06, 2014
Massachusetts became the 18th state to legalize the use of medical marijuana in a voter referendum in November 2012. Since then, two more states legalized its use and others are considering doing so.

But it’s been a long, slow road to develop regulations that will govern the opening of marijuana dispensaries and establish protocols for patients to obtain the treatment.

And as a group, physicians largely are not on board with this change in social policy as it relates to medical practice.

Who will suffer? Patients.

In recent months, Baystate Medical Practices, one of the largest physician groups in the Pioneer Valley, adopted a policy forbidding doctors from certifying patients as eligible to obtain cannabis. Other physician groups are considering adopting a similar approach.

The backdrop: Huge contradictions between state and federal laws, as well as a perceived lack of scientific data supporting the efficacy and safety of medical marijuana.

The step of certification is the most important one patients take in a multi-step process to obtain medical marijuana. Certification by a doctor tells the Department of Public Health that a patient has a debilitating medical condition such as cancer, glaucoma, ALS, Crohn’s and Parkinson’s diseases and multiple sclerosis.

Patients must also apply for a registration card, which allows them to buy marijuana from a dispensary — the only Hampshire County outlet plans to open on Conz Street in September.

Dispensaries are required to provide education to patients that includes information about dosage and methods of using the drug.

Under the new state law, physicians don’t actual prescribe the drug, nor are they required to get involved with questions of dosage. But if they do plan to certify patients to use medical marijuana, they must register with the state, take instruction related to medical marijuana and have a genuine relationship with the patient in question.

If physicians refuse in large numbers to get on board with the process, this system is broken on arrival. Dr. Jill Griffin of Northampton is certifying patients and has become a referral option for other doctors. She is a critical resource for patients who don’t feel their wish to use medical marijuana is supported by their own physicians.

The Massachusetts Medical Society has raised concerns about so-called “certification centers” created solely to help people obtain medical marijuana treatment, saying they sidestep the DPH requirement for an ongoing physician-patient relationship. There are at least a dozen such centers around the state.

This is just one of many Catch-22s in the rocky road to medical marijuana. If physicians won’t certify patients, people who want this option will be forced to go to these centers.

Though there are federal laws against medical marijuana use, Washington has stated it will not prosecute doctors and dispensaries that certify, prescribe or supply patients with the drug.

That promise understandably does not satisfy many medical providers, which means the feds must come up with a policy that does not penalize providers for taking steps that are legal in the state where they practice.

As for the missing science, the feds can help on that score by getting rid of laws that make no sense in a country where 20 states have legalized the use of medical marijuana. These laws prohibit testing of medical marijuana.

As with other controversies in medicine, change in provider attitudes and action may to some degree be driven by the consumer.

Meanwhile, even doctors who refuse to certify patients as eligible for medical marijuana treatment admit they believe it helps people. Yet another contradiction.

We urge doctors to be bold. It seems cruel and inhumane to withhold treatment of a legal drug to people who are suffering and with it may find relief.