A ‘niche business’: Mainstream doctors are wary of prescribing medical marijuana

Marijuana ‘clinics’ are certifying patients for medical cannabis as doctors remain on the fence.

Salem Ma 6/24/2015 Chuck Grant (cq) displays his medical marijuana that he picked up from Massachusetts first medical marijuana dispensary in Salem. It is about 7 grams of marijuana that was in his bottle. He suffers from sleeplessnes and arthritis. Staff/Photographer Jonathan Wiggs Topic: Reporter
A medical marijuana patient displays his medicine outside the dispensary in Salem.
Jonathan Wiggs / The Boston Globe

Looking for a medical marijuana prescription? Your general practitioner probably won’t help you get it.

Most doctors aren’t approved to certify Massachusetts residents as medical-marijuana patients, which is the first step toward receiving legal marijuana from one of the state’s two open dispensaries. In fact, there are only 108 certified doctors in the entire state.

Because of the prevailing stigma among general practitioners, prescribing medical cannabis is a niche business for many clinics. Those who certify patients say it’s a “specialty medicine,” similar to a podiatrist, chiropractor or ear-nose-and-throat doctor. But some experts are concerned that this system encourages a culture of drive-by doctors who prescribe marijuana on an a la carte basis, rather than in the context of a valid doctor-patient relationship.

Advertisement - Continue Reading Below

“Those clinics are not set up to deal with a specific medical disease,” said Dr. Dennis Dimitri, current president of the Massachusetts Medical Society, a statewide professional association for physicians and medical students. “They’re set up to prescribe a drug. And I cannot think of other examples of physicians who have a clinic whose only purpose is to prescribe a specific medication or drug.”

Dimitri said he doesn’t like the idea of “marijuana clinics,” where a patient goes in, gets their certification, and never sees that doctor again.

Mainstream doctors are wary of marijuana for various reasons: Because it’s federally banned, there’s little research on the drug’s effectiveness for treating certain medical conditions. They worry about liability and lawsuits. Because of that federal illegality, physicians’ medical licenses could be at risk. So the doctor you see for antibiotics or pain relievers or allergy meds likely can’t give you the same sort of recommendations when it comes to medical marijuana either because they don’t have the knowledge or don’t feel entirely comfortable with it.

In some cases, your doctor may actually be discouraged by their hospital or other employer from talking to you about the benefits of medical cannabis.

Officials at the Cambridge Health Alliance directed their providers not to certify patients “pending better evidence about the benefits and risks of marijuana,” according to spokesman David Cecere.

“I think at this point, for many physicians, they feel like the jury is still out on medical marijuana,” Dimitri said.

Clinics that prescribe medical cannabis say they’re providing a holistic level of care. At Canna Care Docs, clinicians discuss with patients what strains might work best for certain conditions, how to ingest the drug, and what kind of dosage to take, said Marta Downing, COO of Canna Care Docs. In a sense, they are specialists, she said.

“You have something in your throat, we’re going to send you to the ENT,” said Kathleen McKinnon, operations manager of Canna Care Docs, which has eight clinic locations across Massachusetts. “We’re the same.”

McKinnon said some patients are referred to Canna Care by their doctors. Others show up at Canna Care because their doctor “doesn’t want anything to do with it,” or the patient is worried about discussing it with their general practitioner.

“That’s what distinguishes us,” she said. “Spending time with the patients on these things.”

When voters were considering whether to approve the medical marijuana ballot question in 2012, the Mass. Medical Society was against it. The group felt there wasn’t sufficient evidence for marijuana as medical therapy, Dimitri said.

But once it was approved, they shifted from opposition to education, with continuing education and resources for physicians.

Dr. Alan Ehrlich, an assistant professor of family medicine at UMass Medical School, was a presenter at the medical society’s continuing education course on medical marijuana in June 2014.

Screenshot from Ehrlich’s presentation to doctors.

He looked out at the doctors in front of him and, on the projector, showed a cartoon of a man with his head in the sand.

“Most of us look like the gentleman on the right,” he said. “It doesn’t matter if you think the law is a good idea or a bad idea. Your patients have been using marijuana to control symptoms for a long time.”

Three-quarters of doctors surveyed by the New England Journal of Medicine in 2013 favored the use of marijuana for medicinal purposes. More than half of doctors surveyed by Medscape last year thought medicinal marijuana should be legalized nationally.

But they’re not clamoring to start certifying patients, Ehrlich said.

“As a rule, most mainstream doctors are cautious people,” he said. “They want to stay in the mainstream medical thinking and treatment. Unless there’s very compelling evidence, they change practices slowly.”

Most physicians want more scientific data on medical marijuana to know with more certainty for which conditions it works. But not all doctors feel the same way.

“If you talk to an oncologist dealing with terminally ill patients, they’ll have very different attitudes than primary care doctors dealing with substance abuse patients,” Ehrlich said. “I don’t think you can paint all physicians one way or the other.”

Though they’re wary of marijuana, Ehrlich said he thinks many doctors actually want to see the drug completely legalized. They don’t want to be caught in the middle, making a determination about a medicine they’re not entirely comfortable with.

“No matter the social benefits or costs,” Ehrlich said, “physicians would be more than happy to not be in the certifying business.”