Pubdate: Sun, 21 Oct 2012
Source: Maine Sunday Telegram (ME)
Copyright: MaineToday Media, Inc.
Contact: http://drugsense.org/url/J9R991Zc
Website: http://www.pressherald.com/
Details: http://www.mapinc.org/media/256
Author: Eric Russell

MEDICAL MARIJUANA: MORE PRIVACY, FEWER CONTROLS

Laxer limits raise fears of doctor shopping and make it impossible to
track the number of legitimate users

Two years ago, Sharon Gagne of Greenbush discovered she had two
herniated disks in her neck. Her doctor told her surgery was not an
option and instead encouraged physical therapy and prescribed a painkiller.

"I didn't like that," she said. "I know too many people who got
hooked."

Gagne, 44, eventually asked about other options. Her doctor referred
her to Dr. Dustin Sulak, an osteopath who has become known throughout
Maine for his willingness to certify patients for medical marijuana.
Gagne's physician sent her medical records to Sulak, who then spoke
twice on the phone with Gagne.

Without ever having met her face to face, Sulak certified Gagne as a
medical marijuana patient. Now, whenever she feels pain, she smokes a
little or nibbles a baked good fortified with cannabis.

Gagne's case illustrates the seeming ease with which Mainers with
certain conditions can receive medical marijuana. Gradual changes to
state law in the past three years have deregulated medical marijuana
to the point that there is no way to know how many people are using
it, how many doctors are certifying patients for it, and whether the
number of users is growing.

Indeed, some doctors are actively recruiting patients. Sulak's
practice recently placed an ad in a weekly newspaper offering a $50
discount to students for medical marijuana evaluations.

On Sept. 28, 2011, according to data collected by the state, 263 Maine
doctors had certified a total of 2,833 patients. The next day, a law
took effect that rendered Maine's medical marijuana reporting
requirements optional. That means patients and doctors don't have to
check in with the state. Police say the loosened system has made their
jobs harder, too, because they no longer have access to information
that tells them whether someone caught with marijuana plants is
growing it legitimately.

There also is no way to know how many patients are being treated for a
diagnosis such as terminal cancer, which has been a permissible
condition since medical marijuana became legal in Maine in 1999, or
for something like intractable pain, which was added as a condition in
2009 as part of a broad expansion of the state's medical marijuana
law.

Gordon Smith, executive director of the Maine Medical Association,
said recent changes have made it nearly impossible to assess the program.

"Before, we had a handle on it; we could track progress," he said.
"Now, we have nothing."

John Thiele, who oversees the medical marijuana program for the
Department of Health and Human Services, conceded that the system is
far less regulated than it was two or three years ago, but he said it
seems to be working. To date, no complaints have been made to the two
boards that license doctors and no penalties have been handed down for
improper use, state officials said.

Thiele did say, however, that a small percentage of Maine doctors
appear to be prescribing the majority of medical marijuana in the state.

"I'm not sure that's what the law intended," he said.

HISTORY IN MAINE

Medical marijuana has been legal in Maine since 1999, when more than
60 percent of voters approved a statewide citizens' initiative. The
goal was to allow patients with certain debilitating conditions to
grow and possess a small amount of medical marijuana for therapeutic
use.

Some studies show that marijuana is safe and effective as a treatment
for certain conditions. Other studies are not as conclusive. Last
week, a federal appeals court for the first time heard arguments about
whether marijuana should be reclassified from a dangerous drug to a
drug with potential medical benefits. That wouldn't necessarily lead
to its legalization, but it would change public perception, advocates
say.

Only a handful of states preceded Maine in legalizing marijuana for
medical use. Now 19 states, including four in New England, allow it.
Massachusetts could be next. Voters there will decide Nov. 6 on an
initiative that would create a system similar to Maine's.

For the first decade, Maine's medical marijuana program ran smoothly
but quietly, state officials said. The original list of diagnoses
allowed under the law included cancer, HIV/AIDS, glaucoma, Crohn's
disease, amyotrophic lateral sclerosis (Lou Gehrig's disease),
hepatitis C and Alzheimer's disease. Only a few hundred patients were
certified.

That changed in 2009 after Maine voters overwhelmingly approved an
expansion of the original law to create nonprofit dispensaries
throughout the state and allow certified caregivers to grow marijuana
for other patients. The change also added a few more allowable
conditions -- seizure disorders, severe muscle spasms and intractable
pain.

Intractable pain is difficult to define and hard to argue against. The
state defines it as pain that has not responded to traditional
treatment for at least six months.

The changes took time to implement, but within two years the medical
marijuana program exploded, according to data provided by DHHS. In the
first year after the law change, when the state required registration,
the number of patients jumped from a few hundred to almost 3,000. All
eight dispensaries created by the 2009 law have opened, and the most
recent number of registered marijuana caregivers was just shy of 800.

Just as the state was beginning to get a handle on those growing
numbers, though, the law changed again. Legislators last year approved
a bill that set privacy restrictions. Now patients and doctors no
longer have to register with the state.

Alysia Melnick, public policy analyst with the Maine Civil Liberties
Union and the author of that law, said the goal was to protect
patients from scrutiny by the public and doctors from scrutiny by
federal authorities. "We didn't think that patients who are being
treated for serious illnesses needed to have their names out there on
a public list," she said. "No other types of medical treatment have
lists."

But doctors are now protected at the same level as patients. The state
now has no way of knowing whether a doctor is certifying one patient
or a thousand.

Thiele said the confidentiality language insulates doctors from being
flooded with patients who are looking specifically for medical marijuana.

However, Smith said the relaxed laws also have allowed for the
creation of de facto medical marijuana specialists. If a patient's
primary doctor is unwilling to certify, there is a short list of
doctors who will.

ONE DOCTOR, THOUSANDS OF PATIENTS

Dr. Dustin Sulak, 32, who has practices in Hallowell and Falmouth, is
perhaps the best known of Maine's cannabis specialists, and he's OK
with that.

He speaks publicly and often about the benefits of medical marijuana.
He employs three other "like-minded" practitioners. All are young. All
are DOs -- osteopaths -- not MDs, which means they are trained to
adopt a holistic approach to treating patients, as opposed to treating
symptoms or performing surgeries.

Many are trained in alternative forms of medicine. Sulak has studied
acupuncture, hypnotism and Reiki, which aims to heal through the
transfer of energy from the hands of the practitioner.

Asked whether he uses marijuana himself, either medicinally or
recreationally, Sulak said: "I don't think the personal use question
is relevant." But he did say that "learning all I can about cannabis
and the cannabinoid system of physiology has deepened my understanding
of health and how to foster it."

Sulak said the expansion of conditions under which patients can be
certified has increased his client base. He declined to say how many
patients he treats with cannabis but said it was "thousands."

Many of his current patients are using cannabis to treat chronic pain.
He said he would much rather see that than prescription narcotics.

"I'm always surprised by the number of people, young people, who are
given opioids to treat chronic pain," he said. "They should be
healthy, but they have already been down the road of Vicodin and OxyContin."

Sulak said the number of doctors in Maine who are certifying patients
is low but growing.

"I think a lot of doctors are telling patients that it would violate
their license (if they certify), but that's just something they can
say," he said, adding that many doctors are prohibited from certifying
patients because their employer does not allow it.

As more and more people become comfortable with cannabis as a form of
treatment, he said, the stigma will erode.

Count Catherine Lewis among the converted skeptics. She said medical
marijuana was not in her "comfort zone" even a few years ago. Then,
she saw how it worked. She saw her husband, who was seriously injured
in a car accident 20 years ago, go from taking 17 prescriptions a day
for pain and various side effects and still feeling lousy to using
cannabis only and feeling great.

Lewis, now 44 and living in Manchester, was badly injured in the same
accident. Like her husband, she took other medications over the years,
often powerful narcotics. She hated them. She wondered whether medical
marijuana would work for her, too.

Her pain specialist encouraged Lewis to consult with Sulak. He used
Reiki and hypnotherapy first. Then they discussed Sulak's specialty.

Now, Lewis said she would recommend medical marijuana to
anyone.

POTENTIAL FOR ABUSE?

To become certified for medical marijuana, a patient needs to be
diagnosed with one of the original conditions spelled out in the 1999
law. To certify someone for pain or severe nausea or seizures, a
doctor must demonstrate and document that the patient has not
responded to traditional treatment for at least six months.

Once those six months are up, and a patient's doctor is willing,
little stands in the way. Doctors have full discretion to certify
patients. There is no additional state oversight. The only barrier is
that insurance doesn't cover medical marijuana. Sulak charges $300 for
a first visit.

The other variable in certifying for medical marijuana is that pain is
subjective. Doctors often cannot legitimately withhold treatment for
pain. Some doctors prescribe painkillers; Sulak favors cannabis.

Brad Feuer, CEO of Sulak's practice, Integr8 Health, said he has seen
and heard of practitioners who are certifying patients who don't have
qualifying conditions.

"It upsets us because it gives the program a bad name," he said. "We
take a lot of risk to provide this service."

The state has not fielded a single complaint against Sulak or any
other medical marijuana practitioner. However, when told about Sulak's
certification of Gagne without ever meeting her, Ken Albert, head of
licensing and regulatory services for DHHS, said that would raise a
red flag. Albert said it's never good medical practice for a doctor to
prescribe any medication without having a relationship with a patient.

Feuer said an exception was made for Gagne because she lived so far
away (about 25 miles north of Bangor). She still needed to meet the
necessary requirements for medical marijuana certification.

"Not everyone that comes to us is certified," Feuer said. "We're not
just giving it to anyone."

Feuer also argued that treating patients remotely is sometimes
essential in a rural state like Maine. That no other doctor in Gagne's
area was willing to certify her for medical marijuana is part of the
problem, he said.

Sulak's practice recently placed an unusual advertisement in an
alternative Portland weekly newspaper, offering $50 discounts to
students who wanted to receive a medical marijuana evaluation. Asked
about the ad, Sulak and Feuer paused before answering.

"That was just a test, actually, to give them more of a discount,"
Feuer said, explaining that students are often on tight budgets and
insurance does not cover medical marijuana. "But they would still have
to have a qualifying condition."

Several state officials, when asked about the ad, said they hadn't
seen it. Thiele said it sounded strange and likely would warrant a
referral to the proper licensing board for an investigation.

Susan Strout, executive secretary of the Board of Osteopathic
Licensure, said she could not offer opinions on specific practices.

Of course, many doctors refuse to get involved in medical
marijuana.

Brian Pierce, a family physician in Rockport, has not certified any
patients for medical marijuana and does not plan to do so. He said
he's not convinced of its benefits.

"I have had patients who have run off to Portland or somewhere to get
certified for medical marijuana, and the certifying physician never
requests that patient's records," he said. "The enthusiasm seems to
exceed the evidence at this point. There are patients I know who have
become certified who I'm not convinced should be using a
hallucinogenic drug."

'NOT REEFER MADNESS'

Cumberland County Sheriff Kevin Joyce said the relaxed laws have been
problematic for his deputies. In several instances over the past year,
his office has investigated marijuana-growing operations, only to find
out later that they were certified. Having a database of certified
users and growers would help, he said.

Joyce also said deputies see a lot of people who have been prescribed
medical marijuana but don't appear to need it.

"There are some people we have dealt with in the past who have a
history of using marijuana illegally and don't seem ill," he said.
"Now they have a card saying they can use it legally."

Possession and distribution is still against federal law, but
authorities have mostly looked the other way at the growing number of
states that have legalized the drug for medicinal purposes. However,
this year, dispensaries have been shuttered in California and Colorado
because of violations. Maine's dispensaries are still new and tightly
regulated.

Maine's U.S. attorney, Thomas Delahanty, said the state is not in
danger of becoming California or Colorado, which have lax medical
marijuana laws.

"There has been some monitoring of the program," he
said.

Would it be easier if there were a database of doctors and
patients?

"Of course," Delahanty replied.

Tony Pettigrew, regional spokesman for the U.S. Drug Enforcement
Agency, declined to comment on Maine's medical marijuana program
because it's not within the DEA's purview to assess it. The agency's
position is that marijuana possession is against the law, he said.

Conflict between state and federal law created problems recently when
the Maine State Housing Authority banned Section 8 housing clients
from growing or using medical marijuana. Last week, the authority's
board voted to suspend the ban for six months to gather more
information and develop a clearer policy.

Also last week, an appeals court in Washington, D.C., reviewed for the
first time scientific evidence on the therapeutic value of marijuana.
Supporters made their case that marijuana should be reclassified from
dangerous drug to drug with potential medical benefits. The Justice
Department argued that the drug is still widely abused. The
three-judge panel is expected to rule in the coming weeks. Even if
marijuana is reclassified, it would not be legalized.

Still, there has been a steady shift in states like Maine that
continue to expand medical marijuana. Sulak is not the only doctor
taking advantage of a deregulated industry.

Jeremy Spiegel opened a practice, Casco Bay Medical, in Portland this
March. Since then, he has been seeing an increased number of medical
marijuana patients. Most, he said, come to him because their own
doctor will not certify them. Spiegel said he thinks it's actually
better if certain practitioners act as specialists because it spares
others physicians who are worried about being labeled "pot doctors."

Most doctors likely went through medical school and their residency
without learning about medical marijuana as a form of treatment,
Spiegel said.

If doctors want to learn about medical marijuana, Sulak said, they
have to attend conferences, keep current on studies and observe patients.

But as more learn about its benefits, more might be willing to
recommend it, Spiegel said.

"It's not a reefer madness mentality here," he said. "It really is
more scientific."

Still, Maine's medical marijuana laws would change even more if some
doctors get their way. Sulak and other advocates want to add
conditions, such as post-traumatic stress disorder.

And not everyone's happy about that. Gordon Smith, of the Maine
Medical Association, said that if any more conditions are added, "you
might as well just go ahead and legalize it."
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