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Dr. Alan Berkenwald: Why I won’t prescribe medical marijuana



Saturday, May 10, 2014
NORTHAMPTON — In a recent Gazette editorial on the subject of medical marijuana, we doctors are told to be “bold” and rise to the challenge of the newest medical emergency in our community — the urgent need to certify patients for medical marijuana.

I will try to answer this community-wide “Call to Arms.” The problem is not one of simply “withholding” a needed treatment for cancer care, ALS, glaucoma, Crohn’s and Parkinson’s Disease. There are too many issues with this law, whose intent is good but whose details are bad, that prevent me, as a practicing physician, from prescribing marijuana.

Get the backstory: Head over to the Gazette's medical marijuana Special Coverage page.

The more you learn, the more complex the issue becomes. Perhaps the Gazette editors can help me act boldly by advising me on the following issues that I struggle with:

• My malpractice insurance only covers me for the use of FDA-approved medications and treatments. If a patient I certify falls off a balcony while smoking marijuana and his family sues me for inappropriately prescribing it, who will cover my legal fees and monetary damages?

• Certifying a patient means he is eligible for up to 10 ounces of marijuana every 60 days. One ounce of marijuana rolls out to about 80 joints. That’s 800 joints for 60 days, or 13 high potency joints a day. Nobody can smoke that much by themselves. How do I, the certifying physician, ensure that none of this excess marijuana is diverted to the streets? Or sold at $500 an ounce?

• The newest “cause” behind the current narcotic epidemic is being laid at the feet of doctors who are being told they over-prescribe opiate pain killers. (Never mind that the roots of opiate dependency in this country started in the 19th century — that’s history and Americans are very forward thinking people.) Just a few years ago we doctors were told that pain was “the fourth vital sign” (after blood pressure, pulse and temperature). We were directed to treat pain aggressively.

Now, I am asked to be the gatekeeper for a mood- and mind-altering drug that has both recreational and (presumed) medical use, and directed to use my judgment in sorting out legitimate need. I have no medical literature to guide me for complaints that are not straightforward, like cancer or HIV. Who, or what, do I rely on for guidance? How do I know I am not over-prescribing?

• The medical marijuana laws are the first medical therapies that we, as a society, voted on. I am not aware of any other medical treatments that were decided by popular vote.

Up till now it has been research and clinical studies that guided therapeutic decisions. Is this the new scientific method that we doctors are to follow? In the future are we going to vote on each new blood pressure pill or cancer chemotherapeutics and retire the Food and Drug Administration?

These are just a few of the many issues that prevent me, and I suspect my colleagues, from prescribing medical marijuana at this time.

Help me act boldly, editors of the Gazette. What advice do you have for me?

Alan Berkenwald, M.D., practices in Northampton.