Monday, 22 July 2013

Cannabis Care: Doctors are allowed to object to state’s marijuana program and refuse patients.

When Dr. John Gorman visited his son in Los Angeles, he was shocked by what he found nestled among the ice cream and souvenir shops along Venice Beach: a medical marijuana office.

The office was marked by a large green neon sign, shaped like a marijuana leaf. On the door, a list of various conditions – from chronic pain to nausea – that could make someone eligible for the drug, and the proclamation: “The doctor is in.”

And while Gorman, a Nashua-based rheumatologist with Foundations Medical Partners, part of Southern New Hampshire Medical Center, doubts New Hampshire will see these kinds of shops in the near future, he does believe the legalization of therapeutic marijuana could open the doors for more recreational use.

Here’s the catch: he doesn’t necessarily think that’s a bad thing.

“I favor decriminalization of marijuana across the board,” he said. “I favor medical marijuana … I treat chronic pain in a lot of people, and I think if they came to me and expressed an interest in going that route, I would be willing to discuss it and cooperate.”

Gorman is one of hundreds of doctors across the Granite State who will now be facing the prospect of helping their patients get therapeutic marijuana.

And while Gorman’s view is more relaxed than some, there are plenty of mixed emotions among the medical community.

Some, like doctors and leaders at St. Joseph Hospital, refused to talk about how the legalization of the therapeutic treatment could impact their practices and patients.

The Telegraph reached out to the hospital, in addition to SNHMC, but received only one response: officials there had no interest in talking. The hospital has traditionally been quiet on similar debates, including birth control issues.

For Dr. Travis Harker, a Concord-based family physician and president of the New Hampshire Medical Society, the legalization of medical marijuana opens up a slew of concerns for medical professionals.

The medical society “didn’t want doctors to become the gatekeepers for recreational use of marijuana,” Harker said. “We don’t want doctors becoming marijuana mills.”

That’s exactly what’s happened in Oregon, Harker said – a state with a medical marijuana program similar to that proposed for the Granite State.

Data released by Oregon officials this month shows that there are more than 55,000 patients in the state with certified diagnoses, eligible to receive marijuana.

And while there are more than 1,000 doctors with at least one patient certified, nine of those physicians have certified more than half the medical marijuana patients in the state.

But Harker said New Hampshire’s law will keep this from happening.

In addition to stricter eligibility requirements, the legislation also requires that a patient and doctor have an at least three-month medical relationship, including an in-person exam, diagnoses and recommended treatment plan.

That, Harker said, will stop the “doctor-shopping” some other states have seen after legalizing medical marijuana.

Still, he said many doctors in the state are still uncomfortable about the law, which asks doctors not to prescribe marijuana to their patients, but to simply certify that the patient has an illness that could be aided by the drug.

“We don’t know what dose we’re giving, we don’t know if someone is taking it to the point of impairment,” Harker said. “When I prescribe a medication to manage diabetes or blood pressure, I can make good predictions on the kind of impact it’s going to have. With this, it’s unresearched therapy.”

But for Gorman, the legalization of medical marijuana is a good thing for patients, and potentially for others.

While he said he does believe that its legalization could make it easier for people not medically in need of the drug to gain access to marijuana, he said there are worse things that could happen.

“It opens the flood gates,” he said. “It opens the possibility if people want to get high, they could go see certain doctors and get certified. I suppose it’s a concern, but to me, I guess it’s better than buying it on the street and having some drug trafficker make out on it.”

Gorman said participating in the medical marijuana program will be a personal decision for doctors.

And while he is supportive of the law, he said he’ll still need some time to adjust.

“I don’t know if it’s something I would initiate with a patient, at least right away,” he said. “But I have an open mind about it. And I think it clearly can help chronic pain in people.”

For those doctors who do object to the program, Harker said they don’t have to be involved. Marijuana use is still illegal under federal law, he said, and like birth control, doctors can conscientiously object to helping their patients get the drug.

“That’s what doctors in the state are going to have to figure out, what their comfort level is in participating,” he said. “You may choose not to participate, or to do so on a limited scale and not advertise it. There’s the risk of promoting that you are a physician that certifies these, you might get a lot of people knocking on your door.”

Donna Schlachman, the prime sponsor of the state’s medical marijuana legislation, said there’s nothing in the law that requires a doctor to certify their patient for medical marijuana, and she expects some in the state will refuse.

“There will definitely be some doctors hesitant to participate in the certification process,” she said. “But there are also those who are thrilled the bill is going to happen. It’s widespread.”

Harker said the medical society plans to conduct a survey to determine just what doctors think of the legislation, and what their concerns may be. The medical society will also be working to advise doctors on how to handle the new law.

While the group does not expect to provide a recommendation for or against medical marijuana, it does plan to provide a series of educational seminars in the state on what the law means, and how to comply with it.

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