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Medical marijuana

You may remember an Essay by Dr. Henry Nieder, [Medical marijuana, mostly a fiction, November 14, 2013] discussing the issues presented to physicians by the law allowing marijuana dispensaries in Massachusetts.

“I had hoped,” he wrote, “that when medical marijuana was approved in Massachusetts the provisions of the law would have allowed only limited prescribing of the drug. Unfortunately the Massachusetts law, after naming the serious diseases such as advanced cancer and multiple sclerosis, in which a marijuana prescription could be considered, then says but also may be prescribed for ‘other conditions as determined in writing by a qualified patient’s physician.’”

Dr. Nieder, skeptical about the new state law and about its implementation and particularly the role of physicians in certifying use by patients, added, “If other states that have legalized medical marijuana are examples, then the majority of prescriptions for marijuana will not be for patients who have grave medical diseases but for patients with diagnoses such as anxiety, chronic insomnia, and chronic pain. These patients will for the most part be requesting prescriptions because using marijuana makes them feel better.

“Prescribing medications is complicated. To do it as safely as possible, doctors must know effective doses and duration of effect so that they can determine the correct initial dose and frequency of use with the original prescription and then can adjust in a logical fashion if the dose requires adjustment. Prescribed marijuana has no reliable dosage. In states with legal medical marijuana, patients are generally advised to adjust the amount of marijuana they purchase to obtain the desired result and to repeat the dose as needed. That is no different than buying marijuana on the street and being told to stop smoking when you feel the way that you want to feel.”

Massachusetts, mired in the throes of permitting dispensaries across the state —  and, as the process continues in fits and starts, curiously reminiscent of the disappointing complications attached to the permitting of casino gambling in the state, also pursuant to new law — has made a wise move. The state has become the first in the nation to require physicians to take a course — at least two hours of instruction — before being allowed to certify or recommend marijuana use to their patients. Certification is the mechanism that state law employs to govern the interaction between patients and physicians when marijuana is at issue, because prescriptions may only be written for Federal Drug Administration approved medications by physicians following appropriate guidelines for diagnosis and prescribing. Not every physician will participate in certifying patients for marijuana purchase and use, but at least those who choose to do so will have the opportunity to learn whatever there is to be learned about how it might be wisely done.


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To the Editor:

On January 31, the Department of Public Health (DPH) selected 20 of 100 applicants to receive provisional licenses for an RMD (registered marijuana dispensary). Because the DPH established a qualifying score, no applicant was selected in Dukes or in three other counties (Berkshire, Franklin and Nantucket). We, Patient Centric of Martha’s Vineyard, scored the highest among the Dukes County applicants and highest among the four counties.

However, there were six applicants who received a qualifying score and were not selected in the county for which they applied. This was due to either geography or another applicant receiving a higher score. These six applicants have been “invited to seek alternate locations” in the four counties. Among this group of applicants are operators of dispensaries in Colorado and Arizona.

As part of the application process, we exercised our option to have our application reviewed, and we met with the DPH on February 14. We reviewed each question where we did not score maximum points and provided information that appeared to have been overlooked in the initial evaluation. It was pointed out that we lacked a letter of support or non-opposition from the town in which we proposed our RMD. This would have added several points to our score.

Subsequently, we were advised by a DPH official that gaining a letter of support or non-opposition would do no harm in the review. Returning to the West Tisbury selectmen to request the letter, we pointed out that, 1) not issuing such a letter would assure that an off-Island applicant would be awarded the license, and that 2) there would be a significant reduction in job creation. These off-Island applicants have cultivation sites elsewhere and would operate a dispensary only. Our staffing projections showed a difference at the end of the third year of operation of between five full-time employees for an off-Island operator and almost 14 for Patient Centric of Martha’s Vineyard. The selectmen agreed and issued a letter of non-opposition, which was forwarded to the DPH. The letter stated that the selectmen believe that “local management of an RMD is important to the integrity and overall success of the operation.”

On Friday, March 21, we received a letter from the DPH that the review process is moving forward. We will continue our efforts to keep the RMD Local. We hope that all others involved in this process will do the same.

Geoff Rose

Chief Executive Officer

Patient Centric of Martha’s Vineyard

West Tisbury