The Colorado Medical Board has been directed to consult “with the Department of Public Health and Environment and physicians specializing in medical marijuana,” for the purpose of establishing “guidelines for physicians making medical marijuana recommendations.”
This all sounds well and good, but…
I’m not one to stir up patients’ fears unnecessarily without talking with a lot of people first. And I did. When it comes to this issue, the opinions range from “it’s no big deal” to “the sky is falling.” I suspect the reality is somewhere in the middle.
I can appreciate that the Medical Board wants to make medical marijuana more “medical,” but they’re trying to write guidelines for something they know little if anything about. How many recommendations for medical marijuana have they written? Any? How much time did they spend “consulting” with the doctors who do write recommendations every day? Do they really understand the potential ramifications of their decisions, especially for the patients they’re trying to protect?
Patients have asked me what their motivation is in implementing these policies. Are they trying to scare doctors out of writing recommendations? Are they trying to shut down medical marijuana altogether? Are they trying to force everyone into the recreational system?
In my conversations with people at the CDPHE and others, they claim they are trying to protect patients by implementing policies that, in ordinary circumstances, would be considered quality medical care. But when it comes to medical marijuana, these aren’t ordinary circumstances, and the CDPHE and Medical Board need to understand that.
It drives me crazy that I have to explain why it should be acceptable for medical marijuana patients to get what might otherwise be considered less than optimal medical care, and why the rules that may fit other specialties shouldn’t apply to medical marijuana. Under ordinary circumstances, why would a parent take their child to a pathologist instead of a pediatrician, or why would a man see an OB/GYN for care? But like I said, these aren’t ordinary circumstances.
The answer is simple: These are the doctors we’ve got, and THANK GOD we’ve got the doctors we do! These doctors are relieving suffering and saving lives every day!
I’m not suggesting in any way that the doctors who regularly recommend medical marijuana are unqualified to do so. They are licensed physicians who have taken the initiative to become educated on medical marijuana, recognize the benefits, and put their careers at risk to step forward and help desperate patients when others have turned their backs. Amendment 20 doesn’t require that they be specialists; only that in the context of a bona fide doctor-patient relationship, the doctor thinks the patient’s condition might benefit from the use of medical marijuana.
The pool of recommending physicians is really quite small. There are only a dozen or so doctors across the state who make it their regular practice to write recommendations for medical marijuana. Most others who write them only do so occasionally, and certainly don’t advertise that service.
The fact is that the majority of doctors are unwilling or unable to “officially” recommend medical marijuana. Unwilling because they have competing interests, don’t believe in medical marijuana or don’t have the knowledge they need to feel comfortable doing so. The benefits of cannabis and the endocannabinoid system have not been embraced by the medical community at large and are not part of standard medical school curriculum. Unable because they are restricted from writing recommendations by the hospital, healthcare network or insurance provider they are associated with. Even if these doctors believe that a patient might benefit from the use of medical marijuana, they have to send patients to a medical marijuana specialist to get the official recommendation they need. It’s even harder for parents of patients under 18 who have to find two doctors to sign, if they can.
Medical marijuana patients already lack continuity of care. Out of options, doctors in other states where access to medical marijuana isn’t allowed or hasn’t been implemented tell patients to go to Colorado for help. I wish there were more pediatricians and neurologists and oncologists willing and able to sign recommendations, but there aren’t. Until there are, we need to protect what access patients have now and not penalize those doctors who are satisfying the need and filling this gap in care.
These policies lack clarity where clarity is really needed. What constitutes “competence” and how might a physician demonstrate that they are, indeed, competent? Are these guidelines for best practices or mandatory policies? Will physicians risk being investigated by the Medical Board and losing their license if they don’t check off every box? Is every physician required to do complete risk and pain assessments on every patient? Are things like pregnancy tests, urine tests, x-rays and other tests required, whether the patient can afford them or not?
The underlying fear for patients and parents of patients is that they will lose access to the doctors they rely on now and there won’t be anyone to take their place, or that, through over-regulation, the cost of life-saving services will become completely unaffordable and out of reach. Often a patient’s last hope, these doctors are easing suffering and saving lives each and every day by signing recommendations for medical marijuana. For patients who choose medical marijuana, there is no insurance coverage or prescription drug program to assist with costs.
Some people tell me that these guidelines will help make medical marijuana more legitimate, and ordinarily I might agree with them. But we’re not there yet. We have not built the infrastructure needed to support patients when even a temporary decline in recommending physicians can significantly interfere in patients’ access to legal, safe and affordable medicine. Baby steps are in order here.
The results of previously released guidelines have not been encouraging. The number of physicians willing to sign recommendations has declined over the past year, making it even more difficult for patients to get the care they need.
Has the Medical Board asked doctors whether or not these new policies will give them the comfort and confidence they need to recommend medical marijuana, as intended? Will they be more or less likely to recommend medical marijuana with these policies in place? Or will doctors be more fearful and reluctant?
Finally, an excerpt from my letter to the Medical Board:
In a perfect world, we’d have lots of research into the efficacy of medical marijuana. Doctors would be trained in the medical use of marijuana in medical school. Physicians would be able to specialize in cannabinoid therapy. Patients and physicians wouldn’t have to face stigma and additional scrutiny because they choose medical marijuana as their best option. Patients would be allowed to use medical marijuana in hospitals and hospice centers. Doctors across Colorado would feel comfortable recommending medical marijuana without fear of reprisal by local communities or the state.
But this isn’t a perfect world.
Marijuana doesn’t fit neatly into the traditional medical model. It suffers from decades of prohibition and conflicts in legal status with the federal government. Medical marijuana patients and doctors are discriminated against at every turn. Conducting quality research is nearly impossible. Doctors aren’t getting the information they need. And yet, none of that precludes the medicinal benefits of marijuana for the patients who choose it; nor should it.
In the modern version of the Hippocratic Oath, doctors are reminded that medicine is as much an art as a science. We may not have all the information and research we might like, but with over 113,000 patients currently on the registry, we have living proof that medical marijuana is relieving suffering each and every day. The use of marijuana for medical purposes is a legal activity in Colorado, and should be treated as such. I am grateful for the brave physicians who have taken the bold step to serve patients by learning about and recommending medical marijuana as a treatment option because they are saving lives.
I believe that, in 2000, when the voters of Colorado passed Amendment 20, their intent was to relieve suffering and provide healing to those who had been failed by the medical community. Please, don’t fail patients now by implementing guidelines so stringent that doctors are discouraged from providing the relief to the thousands of patients across the state that depend on them. Please don’t fail patients now by requiring unnecessary and expensive tests and assessments that patients, often those with the greatest need, cannot afford.
I’d like to remind you of the quote from Epidemics, Book I, of the Hippocratic school: “Practice two things in your dealings with disease: either help or do not harm the patient.”
It is unfair to doctors and patients to continue to hold medical marijuana to a higher standard than other specialties. Overly restrictive guidelines may lead to unintended consequences that could reduce legal, safe and affordable access to medical marijuana for the patients across the state. Rather than helping patients, you will likely harm those who need cannabis most but can afford it the least.
Let me commend you for taking on a task that is obviously outside your realm of expertise. You are at a distinct disadvantage in trying to write policies for a field of specialty you are unfamiliar with.
I encourage you to carefully consider how you move forward with these policies so that Colorado can lead the way and continue to be a beacon of hope to desperate patients and parents across the state and the country.
Without these guidelines up to now, what harm has been done to patients that would elicit such a quick and restrictive response? What patients have suffered or died because an unqualified physician recommended medical marijuana? I can assure you that even a temporary decrease in the number of physicians willing to sign recommendations will undoubtedly harm patients, and, at the risk of sounding melodramatic, patients will suffer.
Ultimately, the Medical Board and all those in positions to make policy around medical marijuana must be cautious in their approach so as not to inadvertently make it more difficult for patients to find the care and relief they desperately need.
You can read the proposed guidelines here: Guidelines for the Recommendation of Medical Marijuana Stakeholder Meeting Notice, Agenda, Draft Policy
Read my letter to the Medical Board in its entirety here: Medical Board Letter re Guidelines
— Rx MaryJane (Teri Robnett)
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