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In Practice

Doctors unprepared for medical marijuana

Adapted from the In Practice blog on Boston.com.

Now that medical marijuana is legal in Massachusetts and licenses have been awarded for the first 20 dispensaries, you’d guess that my practice is busily preparing to meet the demands of patients seeking marijuana for several debilitating conditions including chemotherapy-related nausea and AIDS-related weight loss.

You’d guess wong.

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Since Massachusetts voters approved legalization in 2012, I’ve received no special training (required for physicians to certify patients as eligible for marijuana treatment), been invited to no seminars or lectures, and have little more information than that which the state has provided to my fellow citizens.

Marijuana has been used for medicinal purposes for millennia. Modern proponents of medical marijuana tout its ability to relieve symptoms of a variety of conditions including cancers, HIV infection, hepatitis, glaucoma, and ALS (Lou Gehrig’s Disease).

Still, many doctors have not embraced the idea of marijuana as a legitimate therapy. A fascinating recent study in the Journal of Family Practice found that 46 percent of family physicians in Colorado, where medical marijuana has been legal since 2000 and recreational marijuana is now also legal, believed doctors should not prescribe it. A majority thought marijuana presented health risks, and a minority thought it beneficial.

Why is there a disconnect between the voting booth and the exam room when it comes to medical marijuana?

A few thoughts:

1) The Massachusetts Medical Society strongly opposed the referendum to legalize medical marijuana, citing lack of FDA oversight and concerns about the safety and efficacy of the drug.

2) The epidemic of prescription narcotic abuse may make doctors uneasy about prescribing a new psychoactive drug. This is probably illogical, given lack of strong evidence that marijuana, unlike narcotics, is addictive, and that marijuana, unlike narcotics, does not cause death by overdose.

3) Marijuana is perceived as alternative medicine. Even though legal, it is out of the medical mainstream.

4) Doctors are conservative -- not politically, but when it comes to adopting new therapies. I think our very busy schedules combined with our Hippocratic Oath to “to do no harm” often makes us stick with ideas and treatments with which we are familiar and comfortable.

We don’t know yet how popular or effectively regulated medical marijuana will be in Massachusetts. What’s certain is that, at least for now, patients requesting certification for medical marijuana here may be surprised to find their physicians ill-prepared or reluctant to provide it.

Dr. Suzanne Koven practices internal medicine at Massachusetts General Hospital. Read more of her blog at www.boston.com/inpractice.
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