Pubdate: Wed, 06 Mar 2013 Source: Herald News, The (Fall River, MA) Copyright: 2013 The Herald News Contact: http://www.heraldnews.com/ Details: http://www.mapinc.org/media/3604 Author: Richard Aghababian Note: Richard Aghababian, M.D. is president of the Massachusetts Medical Society, the statewide professional association of physicians with more than 24,000 members in the commonwealth. Referenced: http://www.mapinc.org/drugnews/v13/n103/a01.html DOCTORS HAVE LEGITIMATE CONCERNS ABOUT MEDICAL MARIJUANA Contrary to this newspaper's position that "the silence has been deafening from the majority of medical providers" ( Our View: "Respecting marijuana as medicine," March 3 ), physicians have been in the forefront of communicating their views on medical marijuana, both on the referendum and on the subsequent regulatory process. The Massachusetts Medical Society, which has long supported reclassifying marijuana so it can be legally tested for safety and effectiveness, was highly vocal in opposing the referendum. We pointed out that marijuana has not been subjected to the same scientific testing as other drugs approved by the Food and Drug Administration, that claims for its medical effectiveness have been anecdotal and not scientifically proven, and that smoking marijuana poses health risks, as marijuana smoke contains toxic substances as tobacco smoke does. The notion that "no one seems willing to come forward with actual medical facts" about marijuana is not surprising. The facts are few, as there is still much that we do not know. Physicians who choose not to certify patients should not be criticized for admitting they have no expertise and, therefore, are not reliable sources about medical marijuana use. A review of the studies at clinicaltrials.gov shows the evidence on marijuana as a safe and effective treatment to be sparse. The passage of the referendum has prompted the Medical Society to raise concerns about multiple provisions in the law. These concerns have been shared publicly and with the Department of Public Health. Among them: - - - What is the nature of the physician-patient relationship under the law? We think it should be defined by the State Board of Registration in Medicine, the state agency that licenses physicians and issues regulations for the practice of medicine. - - - How is the term "licensed physician" defined? Are online certifications or those from physicians outside the Commonwealth allowed? We propose limits, to include only those physicians with an active license from the State Board of Registration in Medicine, a Massachusetts Department of Public Health Controlled Substances Registration, and a Federal Drug Enforcement Agency Registration. - - - What is the meaning of "other conditions as determined in writing by a qualifying patient's physician"? We consider that too broad a definition. Certification should be based on the patient's diagnosis and the physician's assessment that the patient's symptoms of spasticity, neuropathic pain or other symptoms are not best controlled with conventional medical therapy. - - - What are the standards of care relative to medical marijuana? None exist now. We believe physicians who choose to certify patients should follow the recommendations of the American Society on Addiction Medicine on the professional tenets of proper patient care. - - - Should not medical marijuana become part of the state's Prescription Monitoring Program to prevent abuse? We think so. We have raised other questions as well: What are the implications of use on occupational health and safety? What dosages are appropriate for treatment? How, exactly, is it to be dispensed? For how long should certification be valid? What constitutes an appropriate supply for an individual? Should minors be allowed to use it when scientific studies have shown marijuana to be toxic to the developing brain? Physicians know that prescribing marijuana has serious legal implications for them, as under federal law, the possession, growing or sale of marijuana remains illegal as does aiding such activity. State law allowing for physician certification of patients to use marijuana is designed to get around federal court decisions' apparent prohibition of prescribing marijuana. It remains classified by the Drug Enforcement Administration as a Schedule I controlled drug, meaning it currently has no accepted medical use and has high potential for abuse. The implications for physicians who need a federal DEA license to practice are significant. These are critical questions for both physicians and patients, none of which are answered by the law. It is vague on many counts and raises questions that, we hope, the Department of Public Health will provide well-reasoned answers to when it issues regulations. The fact that the law now recognizes medical marijuana simply does not make marijuana a safe medicine. We appreciate the compassion for suffering patients that prompted the public's endorsement of the referendum, and we understand that some physicians will make good faith efforts to certify some patients despite the law's shortcomings and lack of clinical data on marijuana use. We agree the discussion must continue, but we also believe that whether marijuana is a medicine comparable to other well-studied pharmaceuticals must be determined by rigorous, scientific, evidence-based testing. the discussion must continue, but we also believe that whether marijuana is a medicine comparable to other well-studied pharmaceuticals must be determined by rigorous, scientific, evidence-based testing. - --- MAP posted-by: Jay Bergstrom