A wise step


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.