Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Sunday, July 3, 2016

Detailing the (disconcerting?) doctor dynamics in a state with (strict?) medical marijuana rules

This lengthy new Boston Globe article, headlined "Most Mass. doctors wary of approving marijuana use," reports on the distinctive and arguably disconcerting dynamics that have developed in the Bay State with respect to doctors making medical marijuana recommendations. Here are the highlights:

A small circle of physicians — 13, to be precise — has provided the vast preponderance of approvals needed by Massachusetts patients to gain access to medical marijuana, state records show, a pattern that underscores the continued growing pains of a new industry.  These doctors certified nearly three-quarters of the 31,818 patients who had received permission to use medical marijuana by early June.

The concentration of approvals in the hands of so few physicians is a story of both opportunity and fear.  For the baker’s dozen of doctors, medical marijuana certifications provide a robust stream of patients, who typically pay $200 out of pocket for an initial office visit.  But their grip on such a large share of patient certifications illustrates that many other physicians in the state are reluctant to sign off on patients using the drug, according to the Massachusetts Medical Society.

The hesitance reflects persistent concerns about the possible legal repercussions for their medical licenses if they prescribe a drug the federal government classifies as dangerous, with “no currently accepted medical use.”  It also underscores the lingering doubts about marijuana’s health risks and benefits, said Dr. James Gessner, president of the society.

These worries only intensified when state regulators in May and June yanked the licenses of two physicians accused of improperly certifying thousands of patients for marijuana use. Both suspended doctors worked in offices that specialize in issuing marijuana certificates. Some major teaching hospitals forbid their physicians from certifying patients for marijuana use, but in some cases, doctors have been circumventing restrictions by referring patients to clinics that specialize in granting certification....

State rules require physicians to complete one course about marijuana, including its side effects and signs of substance abuse, if they want to recommend the drug to patients.  Physicians then must register online with the state Health Department, which grants them permission to certify patients as eligible for medical marijuana use. Patients must also register with the online system to complete the certification process.

State regulations list nine diseases and conditions that can qualify a patient for marijuana use, including cancer, multiple sclerosis, Parkinson’s disease, and Crohn’s disease, but also gives physicians wide latitude to recommend use for any other “debilitating condition,” such as nausea and pain....

One physician who is receiving scores of referrals is Dr. Jill Griffin, who opened a medical marijuana practice in Northampton in 2013.  State records show Griffin, 56, has certified the most patients in Massachusetts — 3,284 by early June.  Griffin’s attorney, Michael Cutler, said many of the certifications Griffin has issued were for patients referred to her by other physicians. Griffin, who directed the emergency department at one Springfield hospital and worked in the emergency department of another facility, is well known in the region, Cutler said.

“Almost all of the doctors out here are part of group practices, and for a long time, all of the group practices prohibited their doctors from writing marijuana certifications,” Cutler said. “So, the only way a patient could be certified, for virtually all the doctors out here, was to refer patients out of their practice.”

But state records suggest sentiment among doctors may be slowly changing.  The number of physicians registered with the state to certify patients for medical marijuana use has nearly doubled in the past year, to 150 — although that still represents only a tiny fraction of the more than 30,000 doctors practicing in the state.

http://lawprofessors.typepad.com/marijuana_law/2016/07/detailing-the-disconcerting-doctor-dynamics-in-a-state-with-strict-medical-marijuana-rules.html

Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink

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