Island health care professionals not sold on medical marijuana

Island health care professionals not sold on medical marijuana

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Medical marijuana plants abound at t Greenleaf Compassionate Care Center on Aquidneck Island just outside Portsmouth, Rhode Island. — File photo by Michelle Gross

It’s been more than a year since Massachusetts became the 18th state to legalize the dispensing of marijuana for people with medical conditions. However, the referendum question voters approved authorizing medicinal marijuana dispensaries gave only a loose framework for what would become the dispensary business. Now physicians Island-wide are now beginning to grapple with the moral, legal, and ethical implications of recommending a substance, legal in Massachusetts but illegal federally, for medicinal purposes.

State law allows doctors to recommend up to 10 ounces of marijuana as a 60-day supply after determining that a patient has a “debilitating condition.” which may include intractable pain, nausea, impaired strength or ability, extending to such an extent that one or more of a patient’s major life activities is substantially limited.

Physicians who choose to certify patients for marijuana use must have an active Massachusetts licence, at least one established place they practice, register as a certifying physician with the Department of Public Health (DPH,) and take a two-hour online certification course.

As the DPH continues to fine tune the rules and regulations before the opening of the first registered marijuana dispensary (RMD, several Island health care professionals have expressed varying opinions concerning their participation.

Not medical treatment

Dr. Charles Silberstein, a psychiatrist based at Martha’s Vineyard Hospital, said he is strongly opposed to the idea of marijuana being used for medicinal purposes. “It’s hard for me to see this as medical treatment,” he said. “One reason is that this is something that’s poorly regulated. There is not good medical monitoring of dosage, side effects, or the effects of marijuana, like other medications.”

Dr. Silberstein also noted the long-term effects of marijuana, particularly in people who are prone to anxiety and psychotic disorders.

“Every single patient who I have seen in the last ten years who had a psychotic disorder, developed it after using marijuana heavily,” Dr. Silberstein said. “It doesn’t mean that most people who use marijuana will develop psychotic disorders, but some will, and it’s really a huge tragedy in a series of lives of people that I’ve worked with.”

In addition, Dr. Silberstein said the cognitive risks in adolescents are cause for great concern. “The bigger concerns for me are it’s going to increase access to marijuana both for the general population but particularly for adolescents,” he said. “Because no doubt, marijuana will be shared, and it sends the message to adolescents that marijuana is something that’s safe and reasonable to use, when in fact, for the developing brain, it can be dangerous and a gateway towards other drugs.”

Veteran physician says no

Henry Nieder, a longtime primary care doctor at Martha’s Vineyard Hospital, also opposes marijuana for medicinal use.

In his op-ed essay in this week’s print edition of The Times, called “Medicinal marijuana, mostly a fiction,” Dr. Nieder writes:

“I suggest we try to be the last county in Massachusetts to have a dispensary. See what happens elsewhere first. If Dukes County must have a dispensary, it should have only one. We should discourage the establishment of any medical office whose primary purpose would be to prescribe medical marijuana.”

Mr. Nieder also addresses the legal issue patients could face if caught taking a controlled substance. “Unfortunately marijuana is not legal in Massachusetts. Possession of less than an ounce is now a civil offense, on par with a parking ticket, in this state. But those who use marijuana in greater quantities risk arrest and a felony charge. It is also still a criminal offense to cultivate or distribute the drug.”

Dr. Nieder says he will not get certified to recommend marijuana use to patients.

A place for pot

Hyannis-based ear, nose and throat doctor Edward Caldwell, who regularly sees patients at Martha’s Vineyard Hospital, says that while medicinal marijuana is not for everyone, it does have a place, and serve a purpose.

“I think that it’s going to have a limited role,” he said. “Traditional physicians have been slow to adapt to it, but I think there’s certain patients who are going to benefit, particularly chronically ill patients.”

In particular, Dr. Caldwell noted its efficacy for patients undergoing chemotherapy who don’t respond to more traditional forms of treatment.

“To a limited extent, because of the nature of what I do as an ear, nose and throat physician, less of these are chronic pain patients,” he said. “But I do have some head and neck cancer patients who have tried it, and it’s been successful. But it’s not for everybody.”

Dr. Caldwell, who is building an office in West Tisbury, said he plans to become certified to prescribe marijuana, when the time comes.

“I think, like anything new, it’s going to take a while for it to be integrated into their own practices,” he said. “Everybody’s different, and it’s nice to have that alternative.”

Both sides

Carol Forgione, nurse practitioner and clinical director at Vineyard Medical Services in Vineyard Haven, said she sees both sides of the medical marijuana argument.

“The problem from my perspective is that there is the option for abuse,” Ms. Forgione said. “And the question of how do we screen people properly, how do we deal with the demands? And then there’s the issue of federal approval.”

Without the blessing of the U.S. Food and Drug Administration (FDA), marijuana is still considered to be an illegal, schedule I drug along with cocaine, heroin, hallucinogens, inhalants, painkillers, tranquilizers and stimulants. Schedule I drugs, by legal definition, have no medical use and a high potential for abuse.

“A lot of us have worked very hard for a long time to get where we are, and we don’t want to lose that,” Ms. Forgione said. “I think there is a place for medical marijuana; the problem is we’re not sure how that place is going to look.”

On one issue Ms. Forgione was not ambiguous – smoking marijuana exposes the user to harmful carcinogens. “I’m certainly opposed to anybody smoking anything,” she said. “I don’t think there’s been many studies to show the side effects of long-term smoking, and there must be other ways of administering this.”

A learning experience

One commonality for physicians The Times spoke with, is the lack of awareness and education including the short-term and long-term effects of using marijuana for medicinal purposes.

“When I was in medical school, and I learned how to treat patients with cancer, it (marijuana) wasn’t exactly something that was around,” Dr. Ellen McMahon, who practices geriatric medicine said.

Dr. McMahon said that while she’s not opposed to recommending marijuana to certain patients and can see instances where it would be beneficial, she hesitates because of the lack of awareness surrounding the drug.

“I wouldn’t be against recommending. I can see how there would be instances, like cancer or anorexia related to cancer, or patients in severe pain who would benefit from its use,” Dr. McMahon said. “But it’s unclear what the benefits are going to be.”

Like many physicians, Dr. McMahon is uncertain of the medicinal benefits.

“There’s a lot of confusion. I’ve had a lot of people, both old and young, who have asked for prescriptions for different reasons,” she said. “So one way or another, we will be dealing with this very soon.”

Education campaign

Britain Nicholson, chief medical officer at Massachusetts General Hospital, who also has ties to the Martha’s Vineyard Hospital, is currently in the process of getting his staff up to speed in preparation of the first state-approved dispensary.

“We’re in the process of coming up with common prescription practices,” Dr. Nicholson told The Times. “We want to make sure we have a consistent approach.”

Through the use of an online medical training website called, Dr. Nicholson said he is now in the process of compiling a list of criteria as well as other guidelines and materials as they pertain to recommending marijuana for medicinal use. The list will be made available to physicians to use in the coming months. “We can’t anticipate every particular situation, but this should help as a guide and we’re encouraging physicians to utilize that,” he said.

As far as the response from physicians in the face of prescribing the drug for medical use, Dr. Nicholson said he sees the benefits in treating oncology patients suffering from nausea as well as glaucoma. “I think it’s a very effective way to treat certain symptoms in patients,” he said. “But I think the general response so far has been that we just don’t know that much about it.”

Ancient history & marijuana milestones

Cannabis has a long and varied history that dates as far back as 2700 B.C.

Historians have found that cannabis and hemp was used for everything from making rope, paper and clothing to a potent herbal Chinese tea.

Marijuana has since been prescribed for everything from glaucoma and arthritis to HIV and epilepsy.

It didn’t take long before the popularity of medicinal marijuana spread throughout Asia, the Middle East, and parts of Africa, but it wasn’t until the late 18th century that marijuana use took hold in the United States.

In 1996, California was the first state to legalize marijuana for medicinal use with proposition 215 which allows for the sale and medical use of marijuana for patients with AIDS, cancer, and other serious and painful diseases.

Today, 20 states across the U.S. have approved marijuana for medicinal purposes.

According to a 2012 report by the National Survey on Drug Use and Health, marijuana was found to be the most commonly used illicit drug in the United States, with an estimated 18.9 million users nationwide. That figure is on the rise.


  1. “Every single patient who I have seen in the last ten years who had a psychotic disorder, developed it after using marijuana heavily,” ~ Are you sure this is not an overstatement? I’m wondering about his client base, and is tit the Marijuana, The Island or perhaps this is somehow related to his assessment or treatment methods…….. Just asking……..

  2. “Every single patient who I have seen in the last ten years who had a psychotic disorder, developed it after using marijuana heavily,” ~ Are you sure this is not an overstatement? I’m wondering about his client base, and is it the Marijuana, The Island or perhaps this is somehow related to his assessment or treatment methods…….. Just asking……..

    1. I am not a fan of medical use of pot, (it’s dangerously hyped to fit every illness known to man and I agree with Dr. McMahon,) but the “every single patient” statement is not a fact of patients with psychotic issues who see Dr Silberstein. This same doctor, in an article in the Gazette, extols the virtues of buprenorphine for his heroine addict patients while minimizing the damaging abuse of this addictive opiate. One of his major concerns about medical marijuana is because it is unregulated, unlike how the drug companies and doctors regulate and over-prescribe xanax, valium, ativan, klonopin, anti-psychotics, and pain-killers, –and buprenorphine–which we all know are NO problem here on MV. Cut me a break.

      1. Benefits of Cannabidiol (CBD): Attenuates (slows the effects of) cardiac dysfunction, oxidative stress, fibrosis, and inflammatory and cell death signaling pathways in diabetic cardiomyopathy. Retards beta cell (-cell) damage in type 1 diabetes. Manages obesity and its associated cardiometabolic sequelae, and should remain open for consideration. Prevents type 1 in mice and protects against diabetic retinopathy in animals (American Diabetes Association funded a $300,000 study looking into it). Protects nerves and preserves retinal barrier. Offers therapeutic opportunities for a variety of inflammatory diseases such as multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, atherosclerosis, allergic asthma, and autoimmune type 1 diabetes. Has a therapeutic role in managing neurological complications of diabetes.

        1. a recent study (2011?) by Harvard School of Medicine indicates that cannabis oil, when fed to mice, attacked cancer cells and stopped them from spreading.

          1. Right you are. The medical community is way behind the times because they have been brainwashed into thinking that there is no value to plant-derived medicines, unless they are sold by a handful of drug companies.

            The most absurd claim made by Dr. Silberstein here is that ‘medical marijuana increases access for kids’ and ‘it is a gateway drug’. Both concerns have been proven as unfounded.

    2. There are several studies that show that marijuana use is not causally linked to the initiation of marijuana use.

      Martin Frisher, PhD, Senior Lecturer in Health Services Research at Keele University, et al., stated the following in their Sep. 2009 article titled “Assessing the Impact of Cannabis Use on Trends in Diagnosed Schizophrenia in the United Kingdom from 1996 to 2005,” published in Schizophrenia Research:

      “The results of this study indicate that the incidence and prevalence of diagnoses of schizophrenia and psychoses in general practice did not increase between 1996 and 2005…

      This study does not therefore support the specific causal link between cannabis use and the incidence of psychotic disorders…

      The most parsimonious explanation of the results reported here are that the schizophrenia/psychoses data presented here are valid and the causal models linking cannabis with schizophrenia/psychoses are not supported by this study.”

    3. It is well known that the cape and islands have a disproportionate population of substance abusers. Is it because the pilgrims stopped at Plymouth to make more beer as they wrote about or because the weather blows most of the year? Just positing….

  3. “Mr. Nieder also addresses the legal issue patients could face if caught taking a controlled substance. “Unfortunately marijuana is not legal in Massachusetts. Possession of less than an ounce is now a civil offense, on par with a parking ticket, in this state. But those who use marijuana in greater quantities risk arrest and a felony charge. It is also still a criminal offense to cultivate or distribute the drug.”

    Ummm, not if it is prescribed, which would be his role in all this. Also, isn’t this an article on medical marijuana, not the illegal usage of the substance? MV’s health professionals aren’t coming across particularly well in this article.

    1. Dr. Silberstein appears to be quite ignorant of the positive benefits of marijuana and instead parrot drug war propaganda. The idea that medical laws make it ‘easier’ for adolescents to get marijuana is ridiculous. Medical marijuana laws protect legitimate patients. Anyone else that would obtain marijuana for recreational use would just buy it from an illegal dealer, like they always have.

      Researchers compared teens in Rhode Island, where medical marijuana was legalized in 2006, with adolescents in Massachusetts, which doesn’t allow medical marijuana sales. The analysis included 32,570 teens who completed surveys on drug use between 1997 and 2009. The study showed no statistically significant differences regarding marijuana use between the two states in any year.

      1. Re read Dr Neiders essay, At the end he says the reason he is against Medical Marijuana is because it should be outright legalized without the sham of drug company’s and doctors being involved at all.

          1. Your Welcome,
            And it is wonderful to finally start seeing educated posts from people on the Marijuana issue. Some of these well studied comments are from people who a year ago were absolutely against it. Thank you everyone for taking the time to learn the truth.

        1. I never read his essay in the first place. I was commenting on his quote in this article, and I’m assuming kevin_hunt is also. I might go read it now however.

          1. Hmmm, after reading the essay, it seems that the aforementioned quote was lifted from his essay and placed quite awkwardly without proper context (typical for the Times) into this article, twisting his original meaning. Thanks for the heads up.

  4. “The classification of marijuana as a Schedule I drug as well as the continuing controversy as to whether or not cannabis is of medical value are obstacles to medical progress in this area. Based on evidence currently available the Schedule I classification is not tenable; it is not accurate that cannabis has no medical value, or that information on safety is lacking.”

    Source: Medical Marijuana: Clearing Away the Smoke

    Open Neurol J. 2012

  5. The reality is that the same kind of perqs that comes with prescribing other drugs probably won’t exist with medical marijuana. The big drug companies will not benefit from the sale and that will mean less in the way of seminars (in nice places), training dinners (in expensive restaurants) and all the other little bonuses that the medical profession enjoys from big-time pharma. Yes, they don’t get free notepads anymore, but the benefits continue to flow quite generously.

    Hey, it’s always a better idea to prescribe morphine-based narcotics…certainly they cause no harm to the patient or society.

    Obviously, there are situations where marijuana should not be prescribed, but to not consider it over much stronger and more dangerous alternatives is simply wrong. It’s almost 2014…isn’t it time to forget that Reefer Madness movie from 1936?

  6. I think Dr. Silberstein is ACTUALLY referring to that tragic disorder “Reefer Madness” that all his patients suffer from. No known cure unfortunately………

  7. I’m not a proponent of psychotropics, or the pharmaceutical industry in in any way shape or form – in fact I detest them and am pretty sure that the the increased incidence of mental illness is because of them rather than in spite of them – but as a child of the 60s, having been in the front lines and now with more than 40 years of retrospection under my belt, along with personal and family experience and that of good friends whose briIliance never amounted to much thanks to the 60s, I will say that I agree with Charlie Silberstein absolutely and 100%. The other issue I have is with the concept of normalizing this dulled-down way of life. Instead of pushing for greatness and success, we settle for the idea that being stoned is normal and okay. What a shame.

    1. You contradict yourself. How can you agree 100% with a person who prescribes, on a daily basis, all the drugs you say you detest and are “pretty sure” caused the “increase in the incidence of mental illness”? And by the way, I realize this is MV, but not everyone with mental illness is a substance abuser, or ever has been.

    2. Do you support the war on drugs?

      Traffic Stop leads to Body Cavity Search for Marijuana

      The Texas Department of Public Safety (DPS) has settled a lawsuit with two women from Irving who filed a lawsuit claiming they were humiliated and the victims of an illegal “cavity search”, during a traffic stop last July.

      Attorney Scott Palmer said his client Angel Dobbs and her niece, Ashley Dobbs, received a settlement of $185,000 in the federal civil rights case. “I think DPS came to the table, they did the right thing,” Palmer said. “They recognized this was a bad case that needed to go away.”

      The Dobbs women were pulled over while taking a ‘road trip’ to Oklahoma. Trooper David Farrell said he stopped the pair because they had thrown cigarette butts out of their car window and were acting weird.

      Trooper Farrell claimed he smelled marijuana coming from the vehicle and performed a search, but turned up nothing. He then called female Trooper Kelly Helleson, who proceeded to do a very personal cavity search to see if the women were hiding illegal items.

    3. “We settle for the idea that being stoned is normal and okay.” I don’t think medical marijuana is about that at all. Maybe some folks are just looking to take advantage of medical cannabis to get high legally, but you have to remember that this issue is also about helping folks with serious illnesses relieve pain and deal with treatment-related inappetence. In Massachusetts, over 100,000 people dealt cancer treatment alone between 2000-2010. Assisting those patients with all the resources we can, traditional and non-traditional, is imperative.

      And with genuinely no disrespect meant to you, your experiences, or your friends, from my view, more than just marijuana led to the casualties of the ’60s and ’70s. It was a period of huge tumult and change – war, social revolutions, massive changes to the American family structure, etc. Many people had difficulty finding their way in the world during and after all that. And many substances other than marijuana were imbibed.

  8. If there’s no benefit why is Mayo Clinic in Minnesota doing extensive testing? How many people that Dr. Silberstine seen that smoke that are not crazy and hearing voices? He’s not releasing those stats. I don’t believe a court would prosecute someone with a prescription. I mean come on we have child rapists doing 1.5 years, maybe Dr. Silberstine should be counseling them too, oh but wait, I’m sure they r rapists because of marijuana too? Right? To Dr. Silberstine, believe it or not, some people r just crazy and some illnesses r caused from childhood trauma not cuz they puffed on a marijuana cigarette.

    1. Agreed.

      If there is no benefit, then why did the feds license their medical marijuana patent to a medical marijuana company?

      NEW YORK, July 9, 2012 /PRNewswire/ — KannaLife Sciences, Inc. (“KannaLife”) Signs Exclusive License Agreement With National Institutes of Health – Office of Technology Transfer (“NIH-OTT”) for the Commercialization of U.S. Patent 6,630,507, “Cannabinoids as Antioxidants and Neuroprotectants” (the “‘507 Patent”).

      The ‘507 Patent includes among other things, claims directed to a method of treating diseases caused by oxidative stress by administering a therapeutically effective amount of a non-psychoactive cannabinoid that has substantially no binding to the NMDA receptor. Cannabinoids are any of a group of related compounds that include cannabinol and the active constituents of cannabis (marijuana).

  9. New Hampshire prison official calls to ‘legalize, control, regulate, tax’ marijuana

    The head of one jail in New Hampshire said on Monday that his experience in the prison system had made him sure that it was time to legalize marijuana.

    “If we legalize, control, regulate, tax in the same way that we do for alcohol, we put the illegal drug dealer out of business.”

    The 20-year veteran of law enforcement pointed out that it costs about $32,000 to keep each non-violent drug offender incarcerated every year.

    “The fact is policies like mandatory minimum sentencing, drug war issues have meant that the United States has had to build over 900 jail beds every two weeks for the last 20 years”

    Van Winkler observed that both Washington and Colorado had legalized marijuana and “guess what? The sky is not falling.”

    1. Why tax a plant? If I grow an oak from an acorn should it be taxed? I’m not a dope smoker but should everything be taxed?

        1. I also would like to see it made legal but…You should care. We declared our independence over taxes. Everyone is taxed enough already and our government wizzes it away. Is being taxed over 50% of income and labor “your fair share”?
          By taxing pot more tax dollars will be whizzed away by our government on worthless projects.