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As the Pennsylvania Department of Health works to finalize regulations for the state’s now-legal medical marijuana program, one important question looms: Will physicians be willing to participate?

The U.S. Drug Enforcement Administration classifies marijuana as an illegal Schedule I drug with no accepted medical use and a high potential for abuse. With physicians’ opioid prescription practices already under scrutiny, adding marijuana to the list of services they provide may give doctors pause.

“What I suspect is that the vast majority of physicians are not going to prescribe it,” said Montgomery County-based cardiologist Scott Shapiro, current president of the Pennsylvania Medical Society, which has about 16,800 physician and medical student members.

Most troubling to physicians, said Dr. Shapiro, is the dearth of scientific evidence that would demonstrate whether marijuana actually helps patients – a point that medical society officials and others have made throughout the more than two years the state legislature considered legalization.

In addition, because of its Schedule 1 classification that groups it with the likes of heroin, LSD and ecstasy, federally funded research seems out of the question although Pennsylvania’s new law promises unspecified funding for research.

None of that has slowed the medical marijuana movement. Ohio last month became the 25th state to legalize medical marijuana to some degree. Including recreational use, estimates are that legal pot could generate $6.8 billion in sales nationally this year.

For physicians, though, the concerns remain, starting with the base product. “Aspirin is one component,” said Dr. Shapiro. “Marijuana is hundreds of components that can vary from batch to batch and from grower to grower.”

That puts the physician in the position of recommending a drug that may carry negative side effects without knowing it will benefit the patient, he said. “Without benefits, side effects are very intolerable in medicine.”

It’s not that doctors are unsympathetic to the appeal of the drug, he continued. “The most uncomfortable part of our profession is when we have a patient who is suffering and we lack the ability to treat them. But just because marijuana is legal and will be available doesn’t mean it fits that bill or that it’s a magic bullet.”

Still, those issues can be seen in a different light on the front lines. Adele Towers, associate professor of medicine and psychiatry at the University of Pittsburgh, intends to seek credentialing to certify patients, if only to bring some control and regulation to something that is happening already.

Pennsylvania’s medical marijuana act allows the drug only to be dispensed in specific forms such as pills, oils, creams, vaporized concentrates or liquids. The dry leaf variety of marijuana for smoking and confectionary edibles associated with recreational marijuana use are not allowed.

Dr. Towers, too, wants more research on the efficacy of medical marijuana. She’s disappointed with a resolution passed by the state medical society’s House of Delegates last year that called for research funding while still opposing legalization of medical marijuana.

With that move, she believes the state’s leading physician organization is missing an opportunity to guide, if not lead, the discussion.

“We either have to get on the train or it’s going to leave without us.”

The train is already preparing to depart: the state Department of Health expects to have regulations set by year’s end, with the program launching by 2018.

Under temporary regulations, physicians will not have to write prescriptions per se for medical marijuana in order for their patients to access the drug. Instead, credentialed doctors need only to certify that a patient has one of 17 specific conditions – such as uncontrolled seizures or intractable pain – which will allow that person to buy the product at a registered dispensary.

But that technicality does not entirely remove physicians from being an active participant in the process, as only those doctors who undergo a four-hour training session and agree to annual reviews will be credentialed.

Similar requirements in New York and New Jersey may have slowed participation in those states. For example, one week after New York’s program went live in January, only about 200 of the state’s nearly 80,000 doctors had been approved to certify patients. As of last week, the number had grown to 692 physicians who had certified 7,627 patients, according to the state’s medical marijuana website.

In Dr. Shapiro’s view, the difference between writing a prescription and certifying a patient’s qualifying condition is largely one of semantics. “It is still the recommendation of a treatment plan.”

All of this plays out against the background of a debate surrounding physicians’ role in the opioid crisis.

Historically, physicians have been trained to address and ameliorate their patient’s pain, Dr. Shapiro said. Now that approach is being questioned in light of the growing number of opioid overdoses, which resulted in about 2,800 deaths statewide last year.

The timing, he said, “is definitely not going to make people more likely to engage” in a medical marijuana program.


News Moderator: Katelyn Baker 420 MAGAZINE ®
Full Article: Pennsylvania’s Legalization Of Marijuana Gives Doctors Pause
Author: Steve Twedt
Contact: (412) 263-1100
Photo Credit: Jason Henry
Website: Pittsburgh Post-Gazette