Health

HEALTH • Fall 2016 19 hours of continuing medical education credits on the proper use of medical marijuana, and utilize the state prescription monitoring program, among other things. State records show that the number of doctors registered with the state to provide certifications has grown steadily. Six doctors were certified as of October 2014; by the following July, 99 doctors were in the system. The most recent count included 167 registered physicians as of August 2016. Two of the state's top marijuana doctors by num- ber of certifications recently had their licenses sus- pended for allegedly improperly certifying patients for use of medical marijuana. That example contributes to a concern within the medical community -- that some medical marijua- na doctors see issuing certifications as a business opportunity, rather than as a way to treat patients, Gessner said. A certification appointment can cost about $200. Pushback for doctors and patients? But doctors involved with certifying patients and patient advocates disagree. Pressure from the state and from the so-called "medical establishment" led the state's top cannabis certifying physician, Dr. Jill Griffin, to shut down her Northampton practice last month. In a letter that has since been taken down from her website, Griffin, who certified 6,997 patients as of Aug. 22, said although her interest was only in helping her patients feel better, it had gotten to the point where she was afraid she would lose her ability to practice medicine. "Although I know, as a matter of my experience and training, that I have done nothing wrong in caring for you, the risk of losing my medical license is a peril I can no longer endure," Griffin wrote in the letter. That same pressure is felt by patients who use medical cannabis, said Nichole Snow, executive director of the Massachusetts Patient Advocacy Alliance. Although medical marijuana is legal, there is a stigma around using it, she said. Even patients who are certified sometimes get pushback from law enforcement or child protective services, she said. "[Patients] might experience further harassment or inappropriate commentary, even though it's their choice and it's legal," she said. Though Griffin felt pressure from the state and ultimately decided to close her practice, other medi- cal offices specializing in medicinal marijuana certi- fications reported different experiences. At Canna Care Docs, which has eight locations in Massachusetts including one in Worcester, doctors issue certifica- tions for patients with chronic pain or seizure disor- ders, among other things. Kevin Kafka, the compa- ny's managing director, said Canna Care Docs has no issues with the state's oversight of the program. "We believe we provide a vital service to patients in need in a way that is both convenient and profes- sional. We also have the expertise in cannabis thera- py that other clinicians don't necessarily have," Kafka said in an email. That's a sentiment shared by Brad Feuer, CEO of Integr8 Health, which is based in Maine and bills itself as the leading medical marijuana doctor group in Massachusetts; it has an office in Burlington. Feuer said doctors at Integr8 see themselves as spe- cialists in cannabinoid medicine, which makes them well-positioned to provide consultations to patients. As their name implies, Integr8 is focused not just on medical marijuana, but also on other integrative ways to improve health, such as diet and exercise changes as well as pain and inflammation therapy. Patients who do come in wanting a certification usually meet with a doctor for an hour, Feuer said. "We require medical records, we require follow up visits, we require ongoing consultations, we require an ongoing relationship," he said. "We kind of live by trying to set these standards in the industry." Health systems Larger health care systems have taken varying approaches to medical marijuana. UMass Memorial Health Care in Worcester, Central Massachusetts' largest health system, allows its physicians to issue certifications. "Since the questions surrounding this issue are complex, we recommend that our physicians who are considering certifying one or more of their patients familiarize themselves with the law before Good Chemistry, an Aurora, Colo. based medical marijuana dispensary company, received a letter of non-opposition from the city of Worcester to open a dispensary at 9 Harrison St. An interior shot from the company's Aurora dispensary is shown. proceeding," UMass Memorial spokesman Anthony Berry said in a statement. At Saint Vincent Hospital in Worcester and MetroWest Medical Center in Framingham and Natick, hospital employed doctors do not certify medical marijuana, according to Erica Noonan, a spokeswoman for Tenet Health, the hospitals' parent company. The same rings true at Harrington HealthCare System in Southbridge. Over 50 percent of Harrington's income comes from government sourc- es, so there's a fear that money could go away if the federal law that makes marijuana illegal was enforced, said chief medical officer Dr. Arthur Russo. The Obama administration has indicated that it won't pursue legal action in any state where medical mari- juana is legalized, according to the Massachusetts Medical Society. But Russo said one of his biggest concerns is that unlike with other medicines, there aren't known therapeutic levels or doses of marijuana for doctors to go by when issuing certifications. Since medical marijuana is classified as a Schedule 1 drug by the U.S. Drug Enforcement Administration, doing research on its medical effectiveness up until this point has been difficult. But in August, the D.E.A. said it planned to expand the number of reg- istered marijuana manufacturers that can grow and distribute the plant for F.D.A.-approved research. The idea is to facilitate research concerning mari- juana and its components, according to the D.E.A. Snow from the Patient Advocacy Alliance said her group sees marijuana as an alternative medicine, and so in that sense it shouldn't have to go the tradi- tional, F.D.A. approval route that other medicines have to complete. "To say we don't have enough research, that's all language we would like to forget, because it's never going to go that route. Its an alternative medicine, we have to treat it that way," she said. P H O T O / C O U R T E S Y P H O T O / C O U R T E S Y

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