Pubdate: Sun, 02 Dec 2012
Source: Boston Globe (MA)
Copyright: 2012 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Liz Kowalczyk

PHYSICIANS WON'T SEEK MARIJUANA DELAY

WALTHAM - The state's largest physicians organization decided 
Saturday that it will not push to delay a new law allowing the 
medical use of marijuana. Instead, the group will lobby for tighter 
protections for doctors whose patients want to use the drug.

The Massachusetts Medical Society also will advocate to include 
medical marijuana patients in an online state database that helps 
doctors and pharmacists monitor over-prescribing of addictive drugs.

Some groups, including the Massachusetts Municipal Association, are 
calling for the Legislature to postpone the medical marijuana law, 
which takes effect Jan. 1. During a two-day meeting of the medical 
society attended by several hundred doctors, some physicians urged 
the organization to do the same, but ultimately, they decided the 
voters had spoken.

"The voters want it and our patients want it," said Dr. Eric Ruby, a 
pediatrician in Taunton. "You cannot put the Massachusetts Medical 
Society above the law."

Ruby and several other physicians said some of their patients who 
suffer from severe pain, anxiety, and other debilitating medical 
conditions already have asked for permission to use marijuana. Under 
the law, patients who qualify will have to get a certificate from 
their doctors to buy the drug from state-sanctioned distribution centers.

'We want to be clear . . . that the doctor has a relationship with 
the patient.'

Patrick Lowe, 23, a medical student at the University of 
Massachusetts in Worcester, said he did not want the medical society 
"to appear to be hindering the process," especially when a delay is 
likely anyway as the Department of Public Health develops detailed regulations.

"This is overwhelmingly favored by the people in the state," he said. 
"It's important that we be at the table."

Dr. James Broadhurst, who headed the medical society's opposition to 
the ballot initiative, proposed a broad policy to the organization 
that included supporting a delay. The society voted on two dozen 
resolutions during its two-day meeting, which are used to guide its 
policy and lobbying agenda. The rest of Broadhurst's proposal on 
medical marijuana was largely approved and signal how doctors will 
seek to shape implementation of the law.

While the law allows physicians to provide marijuana certificates to 
patients with whom they have bona fide relationships, Broadhurst said 
The Board of Registration in Medicine, which licenses doctors in 
Massachusetts, needs to better define what this means.

"I am very concerned that the board of medicine was not mentioned in 
the initiative," he said. The physicians group wants patients who are 
given permission to use medical marijuana to be reevaluated at 
specific intervals and for doctors to be trained in substance abuse 
and addiction.

The physicians organization also voted to push for inclusion of 
medical marijuana in the state's Prescription Monitoring Program. The 
program is intended to prevent potential abusers from "doctor 
shopping" to obtain multiple prescriptions from several prescribers 
who are unaware of each other's relationship with the patient. The 
medical society is investigating whether this change would require 
legislation because of patient privacy protections.

But Broadhurst said protecting patients from overuse or dangerous 
combinations of drugs also is important.

"You are asking [physicians] to make a judgment about the risks and 
benefits of marijuana" for a patient, Broadhurst said. "If I'm 
prescribing a benzodiazepine, which has sedative effects, I need to 
know if the person is taking medical marijuana."

Ultimately, he said, doctors want to make sure that only patients who 
are very sick and have exhausted all other remedies have access to marijuana.

"In California, you can basically walk into a clinic with a medical 
ailment, or fabricate one, and get a prescription for marijuana," 
said Dr. Richard Aghababian, president of the medical society. "We 
want to be clear on the indications for this and that the doctor has 
a relationship with the patient."

Doctors have argued all along that medications should be used only 
after rigorous study and approval by the US Food and Drug 
Administration. But now that Massachusetts has become the 18th state 
to legalize marijuana for medical use, physicians will have to make a 
personal decision whether to make the drug available to their patients.

Ruby said he has kept a list of a half-dozen patients at least 18 
years old who have requested the drug or who might qualify. He said 
he will make the drug available to certain patients.

"I have kids who can't go outside their house because they are so 
anxious with social anxiety," he said. "They are on Ativan, which is 
so much more addicting or on Prozac, which is very difficult for them 
to get off."

Broadhurst said that for him "it's a very tough call. I'll have to 
learn a great deal more," he said.
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