As Minnesota approaches the June 1 roll-out of the state’s medical cannabis program, doctors are grappling with the fact they will have little say in their patients’ use of their medicine .
The law governing medical marijuana use in Minnesota leaves prescription and dosing decisions to pharmacists rather than physicians. Verifying that a patient is eligible to use medical cannabis to treat a condition—by simply checking the “yes” box on a Health Department form—is the only roll a physician will play.
Dr. Gregory Plotnikoff, an internal medicine specialist at Abbott Northwestern Hospital in Minneapolis explained what happens after a doctor confirms a patient to be eligible for medical marijuana:
“Someone else is then actually prescribing and adjusting the dose, and it’s not a physician with clinical experience. … It’s literally a pharmacist following an algorithm.”
The barrier separating physicians from patients who receive cannabis was put up partly at the request of doctors themselves. When the bill was being drafted, physicians expressed concern and the need for protection from the legal consequences of prescribing cannabis, which remains a Schedule 1 drug under federal law. Though they have gained legal cover by removing themselves from the decision, doctors will soon be in the awkward position of relying on patients to share whether they are receiving medical cannabis. Pharmacies plan to provide patients with medical records of cannabis prescriptions, which they can then share with their doctors if they choose.
Some doctors report being concerned with the lack of cannabis research and clinical studies to reference before suggesting it to patients. Dr. David Thorson, a family practice physician in St. Paul and president-elect of the Minnesota Medical Association, believes that there is ” a lot of controversy on the drug for lots of different reasons.” Although he views cannabis to be a promising medical treatment, he explained:
“The science behind its benefit is not very strong; in most disease states, it’s anecdotal at best.”
Doctors in Minnesota say that without rigorous studies to look at possible positive and negative outcomes of marijuana therapy, they are left to rely on anecdotal evidence when gauging the potential incorporation of concentrated forms of the plant into a patient’s treatment plan.
“Some clinicians, some physicians are going to have a hard time with that.”
Stated Dr. Thomas Wyatt, president of the Minnesota chapter of the American College of Emergency Physicians,
“We’re trained to be really evidence-based in our thinking when we’re prescribing medications.”
The program in Minnesota will make medical marijuana available to only the sickest patients, many of whom have exhausted conventional treatment options, so physicians may be willing to relax their demands for scientific evidence before confirming that a patient is eligible.
In the meantime, as the data that doctors expect to have before trying new therapies slowly becomes available, Minnesota’s medical community will consider evidence coming from states where medical marijuana has already been legalized.
photo credit: Glen Stubbe, Star Tribune