Pubdate: Tue, 16 Aug 2016
Source: Albuquerque Journal (NM)
Copyright: 2016 Albuquerque Journal
Contact:  http://www.abqjournal.com/
Details: http://www.mapinc.org/media/10
Author: Shefali Luthra, Kaiser Health News

CANNABIS EDUCATION NEEDED, DOCTORS SAY

Legal Limbo Limits Training on Subject

Medical marijuana has been legal in Maine for almost 20 years. But 
Farmington physician Jean Antonucci says she continues to feel 
unprepared when counseling sick patients about whether the drug could 
benefit them.

Will it help my glaucoma? Or my chronic pain? My chemotherapy's 
making me nauseous, and nothing's helped. Is cannabis the solution? 
Patients hope Antonucci, 62, can answer those questions. But she said 
she is still "completely in the dark."

Antonucci doesn't know whether marijuana is the right way to treat an 
ailment, what amount is an appropriate dose, or whether a patient 
should smoke it, eat it, rub it through an oil or vaporize it. Like 
most doctors, she was never trained to have these discussions. And, 
because the topic still is not usually covered in medical school, 
younger doctors, as well as seasoned ones, often consider themselves 
ill-equipped.

Even though she tries to keep up with the scientific literature, 
Antonucci said, "it's very difficult to support patients but not know 
what you're saying."

As the number of states allowing medical marijuana grows - the total 
has reached 25 plus the District of Columbia - some are working to 
address this knowledge gap with physician training programs. States 
are beginning to require doctors to take continuing medical education 
courses that detail how marijuana interacts with the nervous system 
and other medications, as well as its side effects.

Though laws vary, they have common themes. The conditions that can be 
treated with cannabis are specified on a state-approved list, and the 
role of doctors is often to certify that patients have one of those 
ailments. But many say that, without knowing cannabis' health 
effects, even writing a certification makes them uncomfortable.

This medical uncertainty is complicated by confusion over how to 
navigate often contradictory laws. While states generally involve 
physicians in the process by which patients obtain marijuana, 
national drug policies have traditionally had a chilling effect on 
these conversations.

In an Aug. 9 JAMA editorial, leaders noted that federal law 
technically prohibits prescribing marijuana, and tasks states that 
allow it for medical use to "implement strong and effective ... 
enforcement systems to address any threat those laws could pose to 
public safety, public health, and other interests." If state 
regulation is deemed insufficient, the federal government can step in.

That's why many doctors say they feel caught in the middle, not 
completely sure of where the line is now drawn between legal medical 
practice and what could get them in trouble.

In New York, which legalized marijuana for medicinal purposes in 
2014, the state health department rolled out a certification program 
last October. The course, which lasts about four hours, is part of a 
larger physician registration process. So far, the state estimates 
656 physicians have completed the required steps.

Pennsylvania and Ohio are also developing similar programs.

Physicians appear to welcome such direction. A 2013 study in 
Colorado, for instance, found more than 80 percent of family doctors 
thought physicians needed medical training before recommending marijuana.

But some advocates worry that doctors may find these requirements 
onerous and opt out, which would in turn thwart patients' access to 
the now-legal therapy, said Ellen Smith, a board member of the U.S. 
Pain Foundation, which favors expanded access to medical cannabis.

Education is essential, given the complexity of how marijuana 
interacts with the body and how little physicians know, said Stephen 
Corn, an associate professor of anesthesiology, perioperative and 
pain medicine at Harvard Medical School.

"You need a multi-hour course to learn where the medical cannabis 
works within the body," Corn said. "As a patient, would you want a 
doctor blindly recommending something without knowing how it's going 
to interact with your other medications? What to expect from it? What 
not to expect?"
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MAP posted-by: Jay Bergstrom