Pubdate: Sun, 20 May 2012 Source: News Journal, The (Wilmington, DE) Copyright: 2012 The News Journal Contact: http://drugsense.org/url/1c6Xgdq3 Website: http://www.delawareonline.com/ Details: http://www.mapinc.org/media/822 Author: Doug Denison, The News Journal MEDICAL MARIJUANA CAUGHT IN A STANDOFF Federal Objections Delay State's Program Last spring, after the governor signed into law a measure legalizing the possession of marijuana for medical use, cancer patient Diane Jump and hundreds of Delawareans suffering from serious health problems were relieved to know that the drug they had been using to treat the crippling nausea and pain of chemotherapy would not land them in jail. Doctors, who must consent and write the prescriptions for medical marijuana, are holding back their approval. And the state is locked in a s talemate with the federal government over plans for distributing the drug. Some physicians say they' re simply not convinced marijuana is an effective treatment for certain conditions, while others worry that they could face legal action if they permit their patients to use the drug, since marijuana remains an illegal substance at the federal level. The mixed feelings of Delaware's medical community have left patients like Jump in an even more uncertain position. Doctors who deal with patients who are curious about medical marijuana or, like Jump, have been using marijuana on their own, say they're worried about signing off on their use of the drug. "I would think most are waiting to see what happens. Most doctors are waiting for the conflict to play out between the federal and state government," said Dr. Dan Depietropaolo, national medical director of Compassionate Care Hospice, who works out of the group's branch at St. Francis Hospital in Wilmington. To be in compliance with Delaware's medical marijuana law, a patient must suffer from one of the serious medical conditions outlined in the law, and be under the continuing care of a doctor who has sworn, in writing, that the patient's treatment is enhanced by marijuana after other treatment options have been tried. Pending the approval of draft regulations, a medical marijuana patient, with a doctor's approval, will be able to obtain a special identification card from the state Department of Health and Social Services that can be presented to law enforcement. Without a doctor's approval, the legal protections afforded to a medical marijuana user do not apply, meaning the patient can be arrested, charged and tried for drug possession. In the last year, the federal government has cracked down on state-sanctioned medical marijuana distribution networks in other states where medical marijuana is legal, including California and Colorado. Implementation of Delaware's law, which envisioned state-regulated dispensaries in each county, was stopped in its tracks earlier this year when U.S. District Attorney Charles M. Oberly III informed Gov. Jack Markell that the Department of Justice could and would prosecute state workers who participate in the distribution system. Oberly maintained the federal government's stance on not pursuing criminal cases against patients who use medical marijuana. That has left most doctors conflicted about approving a patient's use of marijuana, then sending that patient out on the streets to obtain the drug. "Your patient can use it, you can recommend it, but they have to obtain it illegally on the street corner from a dangerous person," Depietropaolo said. "To me, that is not a solution." Jump's cervical cancer, which was diagnosed in 2008, is being treated by a team of physicians, but not all of them feel the same way about her decision to use marijuana as part of her therapy. "I've been very honest and upfront with all of my doctors," she said. "I've had some who are very OK, and have said it's OK and believe I am receiving palliative benefits from marijuana. "I have another doctor and she is completely against it ... almost to the point where she won't even hear of it because she believes it may put her at risk." Jump, who lives in Pike Creek, would not name the doctor she referred to, but said she understands the physician's position. "I agree with her; I don't want anyone to be at risk," she said. "I'm going to smoke anyhow, with or without the blessings of my doctors." Doctors wary Depietropaolo, who gave a presentation on medical marijuana Friday to the palliative care staff at Christiana Hospital, said d octors want an all-clear from every level of government before moving ahead with medical marijuana. They're worried about their careers, especially in light of the tighter controls placed on the medical field after the Earl Bradley child-rape case that unfolded in Delaware in 2010. "This is a hard time for doctors to push the envelope because of all the things that have happened in the past two years," he said. "Doctors have been placed under a lot of scrutiny since the Bradley thing happened." Depietropaolo also said physicians are facing tighter controls on their ability to prescribe powerful prescription drugs, put forth by lawmakers in an effort to curb illegal use and abuse. "Prescription drug abuse is a big problem right now," he said. "There's a monitoring program that's going to go into effect; doctors are going to be watched carefully." Dr. Alan Gonzalez-Cota, a pain management specialist in Dover, said he's concerned about how his patients' use of marijuana could affect his federal license to prescribe narcotics. "The problem is that the physicians that prescribe narcotics are regulated by the [Drug Enforcement Administration ]," he said. "I tell my patients I don't want to lose my license. "I tell them that if they're testing positive for any illegal substance, I won't be able to prescribe them narcotics anymore." Skepticism remains Doctors like Cota also aren't convinced that marijuana is as effective a treatment for pain and other symptoms as some claim. Though human trials for medical marijuana have b een conducted in Europe, Cota said, the results are spotty and the research is suspect. "The positive medical literature about the effects of marijuana on pain are not well-developed, they' re not well-controlled," Cota said. "The literature is not there, and I review the literature before I prescribe anything." Depietropaolo agreed, and said the dearth of American research on the subject stems from the fact that researchers cannot get permission to give trial patients marijuana to use. Although there are approved pills that contain a synthetic form of one chemical compound found in marijuana, they have to be taken orally. Patients who are suffering from nausea don't do well with oral treatments, Depietropaolo said. "When you go to look for studies about how good marijuana is for nausea, vomiting and pain, you can't find any," he said. Comfort levels Depietropaolo and Cota don't feel comfortable right now providing patients with the documentation they would need to lawfully participate in Delaware's medical marijuana program, but they're content to wait until the legal ambiguities and medical research evolve. Other physicians feel caught in the middle of a fight they never asked to join. "The medical standards are now combined with the social and political standards," said Dr. Ganesh Balu, who practices with Cota in Dover. "We can stay out, but somehow we are pulled into this in making the judgment calls we have to constantly make, and there is significant scrutiny." Balu said he wants to continue to treat patients as he always has, on a case-by-case basis. That's hard with medical marijuana, he said. "There are some patients who want to push the envelope," he said. "They want us to be the conduit." Jump, the cancer patient who uses marijuana medicinally, said she thinks doctors will have to pick a side in the medical marijuana debate, whether they want to or not Patients may have to take it into their own hands, she said. "If this is something where they believe they are honestly receiving benefit from the marijuana, and they honestly believe it's so much better on their system than the pills, they need to find a doctor that believes," she said. "I would like to see everybody feel safe and comfortable knowing we have doctors who believe in medical marijuana as a treatment." - --- MAP posted-by: Jo-D