While medical marijuana will be legalized (with limitations) in Minnesota in July, a survey recently conducted by the Minnesota Medical Association (MMA) suggests that state physicians are still reluctant to prescribe it to their patients.
Two-thirds of the physicians surveyed reported that they would not take part in the state’s medical marijuana registry, raising concerns among residents as to how they will be able to procure their medicine once it becomes legal. To be eligible for inclusion in Minnesota’s medical cannabis program, patients must receive certification from a doctor ensuring they have one of nine qualifying conditions.
Some Minnesotans are finding that a doctor’s support of cannabis is not always enough. Resident Shelly Rapp shared that she sought certification from the neurologist who treats her 18-year-old son, who has epilepsy. While the neurologist believed the boy would benefit from treatment with medical marijuana, his practice collectively opted out of the program, leaving the neurologist with no choice but to do the same.
Rapp’s next attempt involved the family physician.
“He said he was going to think about it, but I kind of doubt he will,”
Rapp said of her request.
She may be correct. Of the 457 medical professionals who participated in the survey, only 9 percent openly admitted they would be willing to certify patients for the program. Fewer than 20 percent of respondents were undecided.
While doctors are responsible for certifying that a patient qualifies and may benefit from the program, pharmacists will be responsible for prescribing the recommended dose to patients. Some doctors have reported having an issue with not being able to oversee a patient’s use and care throughout the process of medical marijuana therapy.
MMA president-elect Dr. David Thorson was disappointed by the survey results, but believes they stem from the fact that medical professionals are concerned about a system in which physicians have been forced to take the back seat.
“That’s alarming to me. It shows that access is going to be an issue,”
said Thorson, who plans, at some point, to register with the Office of Medical Cannabis.
“I understand why people say they won’t certify. I don’t think it’s anything malicious. I think it’s just saying, ‘Based on my knowledge, I don’t see a value to doing this.”
Registration with Minnesota’s Office of Medical Cannabis began in June, and on the first day, 30 physicians had signed up. The MMA plans to conduct a more thorough survey in the near future to ascertain more information about physicians’ reluctance to prescribing medical marijuana.
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