Doctors bone up on medical marijuana
Doctors seek answers
for doctors, accustomed to prescribing drugs only after they have been thoroughly researched and run through clinical trials, marijuana is a problem. The drug has been illegal in the United States for so long that tracking down top-notch medical research is a challenge.
Medical marijuana sales may be coming to Massachusetts, but the federal Drug Enforcement Administration still classifies marijuana as a “Schedule 1” drug, a category that includes substances the agency regards as dangerous, likely to be abused, and of no medical use. The Massachusetts Medical Society, the statewide professional association for doctors and medical students, opposed the legalization of medical marijuana and recently cautioned patients that there is “insufficient scientific information” available about the drug’s safety.
To help doctors learn about marijuana and decide which patients might benefit from the drug, Massachusetts is the first state in the country requiring physicians to take at least a two-hour course before they can recommend the drug to their patients. (Doctors issue certificates, not prescriptions, for medical marijuana because prescriptions are used only for drugs approved by the Food and Drug Administration.)
Stephen Corn, a Harvard Medical School associate professor, offers an online education course that meets the state’s specifications. Corn, an anesthesiologist, cofounded The Answer Page, a respected medical education website, nearly two decades ago to keep the residents he mentored sharp on subjects such as anesthesia and pain control. In addition to the latest advances in certain medical fields, Corn added subject-specific crossword puzzles and quizzes to soothe the guilty consciences of people who preferred to play games in their down time instead of reading medical literature.
Corn and his wife, who is also a doctor, had to search hard for the answers to the questions. Corn realized then that doctors and other health professionals would have some of the same questions his son asked, especially since they could not rely on the Food and Drug Administration, pharmaceutical companies, or any of the other usual sources of information about new drugs.
“There aren’t that many resources for quality, unbiased research in this area,” says Corn. He says the greatest challenge for doctors is trying to decide if a patient can benefit from medical marijuana, which can be smoked, inhaled through a vaporizer, or eaten as part of cookies or candy. Without federal guidelines on daily dosages or side effects, doctors are pretty much on their own.
The Answer Page course, entitled “Medical Marijuana: Medical, Legal, Social, and Political Issues,” includes information about the marijuana plant, potential side effects, and how the drug may alleviate the symptoms of diseases such as cancer and hepatitis C and certain conditions such as chronic pain. The course also reviews the often conflicting state and federal laws dealing with medical marijuana and the FDA approval process.
Anyone can register and use the site, but doctors must pay a subscription fee to get their continuing education credits.
Corn has no plans to certify patients himself or work with dispensaries. He plans to stick with education and is putting the finishing touches on a new course for patients and caregivers scheduled to launch in May.
The Massachusetts Medical Society co-sponsors Answer Page content and links to the medical marijuana course. Dr. Ronald Dunlap, the society president, sees no contradiction between the group’s opposition to medical marijuana and its support for the course. “Given that [medical marijuana] has been approved, we wanted to try to help the state make sure it was appropriately dispensed, that the indications for doing it were valid and consistent with the law, and that the people who were certified were knowledgeable,” Dunlap says.
The Department of Public Health’s medical marijuana program, which has no connection to the Answer Page medical marijuana course, is also working on gathering information to help educate doctors.
Some doctors are studying the drug independently. Mark Weiner, a neurologist and sleep specialist diagnosed with brain cancer in 2012, is studying the medical literature with a goal of helping doctors evaluate treatment options and identify the patients who may benefit. He also wants to visit dispensaries and learn about the plant itself. Although he suffered severe nausea during his treatment, Weiner did not want his wife out on the streets trying to find dealers, so he never used marijuana.
Weiner says Massachusetts doctors will be very cautious about recommending medical marijuana because of the legal issues involved. “Somebody is going to have to put their toe in the water first and begin to evaluate patients in this field while other doctors…are going to let time pass.”
The Boston Globe reported in March that a handful of psychiatrists, anesthesiologists, obstetrician-gynecologists, internists, and pain specialists have already set up offices to evaluate patients for marijuana use. Under state law, patients can get medical certifications from these doctors. However, all doctors must register with the state and comply with the state’s new education requirement starting on July 1.
Medical marijuana is likely the first drug approved by state legislatures, and not the FDA, in response to public demand. None of the medical professionals interviewed for this article could name a drug that has followed a similar route to widespread medical use without first being approved by the federal government.The only state that comes close to the Bay State education model is Arizona, which developed a voluntary five-hour continuing education course in conjunction with the University of Arizona’s College of Public Health. It is “purely a resource for doctors,” according to an Arizona Department of Health Services spokeswoman. Medical marijuana is legal in 19 other states and the District of Columbia.
Dr. David Bearman of the Society of Cannabis Clinicians/American Academy of Cannabinoid Medicine, a research institute that offers a medical marijuana certification program for doctors, suggests that other states consider mandating some form of continuing medical education. “If a physician is going to be doing more than 25 recommendations per year, it should be required,” he says.