The most common problem we hear about from patients
concerns the difficulties they face in obtaining a signed
recommendation from a physician. Many patients have
clear and long-standing documentation of medical conditions
approved by Montana’s medical marijuana law –
and yet they can’t obtain a formal
recommendation. Below we list the most common reasons
for this difficulty, and our best current suggestions for
overcoming these problems. (Let us know your
experiences and ideas – we want our advice to be as
good as possible. Email us at info@mtmjpatients.org.)
No Personal Physician
Many
Montanans, especially those in rural parts of the state,
receive their ordinary continuing healthcare services not
from physicians but from physician assistants (PAs) and
nurse practitioners (NPs). Unfortunately, neither PAs
nor NPs can make medical marijuana recommendations under
Montana law. Patients thus must make an appointment
with a physician who may not know them in order to obtain a
recommendation – and this will require extra funding
for travel costs and for the appointment
itself.
To
maximize success with a physician who doesn’t already
know you, we recommend that you take copies of medical
records confirming your diagnosis. This might save
you the costs that could be involved in conducting tests
needed to make a diagnosis that already has been
made. In addition, a signed statement from your PA
and/or NP – while not sufficient to register with the
state health department – could assist in your
communications with a new physician. Further, we
recommend that before your appointment, you acquaint
yourself with the other items of advice offered
here.
Patients
who are members of Patients & Families
United can talk with other patients in hopes of
learning about physicians in their region of the state who
are known to have made medical marijuana
recommendations.
Common Problem: Physicians
Mistakenly Feel Legally Vulnerable
Many
physicians do not understand basic facts about state and
federal law regarding medical marijuana. A group
called Montana Physicians Advocacy has
published a brochure for physicians that can help educate
your doctor. If you join Patients &
Families United, we will send you a free copy,
which also can be downloaded/printed from:
www.mtmedmjscience.org.
The
most important facts about Montana’s law for
physicians to understand are as follows:
·
Any physician’s recommendation is completely
confidential, fully subject to all the protections
of patient-physician privilege. Making a medical
marijuana recommendation to a bona fide patient who has
been diagnosed with a condition specified in the law is
legally no different than making any other kind of
appropriate recommendation to a patient.
·
Montana’s medical marijuana law makes it a crime for
anyone – including staff at the state health
department – to disclose the identity of a patient,
caregiver or physician. This crime is punishable by a
fine of up to $1,000 and/or by up to 6 months in
jail.
·
While law enforcement agencies can confirm the legal
registration of a patient or caregiver whose identity they
already know, the state health department WILL
NOT confirm the identity of any recommending
physician. The identities of recommending physicians
are protected.
·
The state’s medical marijuana registry and other
records are NOT available for review by any state or
federal law enforcement agency or agent.
·
Montana’s medical marijuana law expressly protects
recommending physicians from any adverse action by a
licensing board or any other entity as a consequence of
having made an appropriate medical marijuana
recommendation.
·
The federal government is similarly enjoined from
taking any action against a physician for making a
medical marijuana recommendation. A U.S. Supreme
Court decision affirms the ruling established in Conant
v. Walters, 309 F.3d 629 (9th Cir. 2002)
– which held that physician recommendations do not
violate federal law. The Conant decision
explicitly prevents the federal government from taking any
adverse actions against a physician for recommending
medical marijuana.
·
Neither state nor federal law places a limit on the number
of medical marijuana recommendations any physician can
make.
Common Problem: Physicians Object to
“Smoking” of Medicine
Some
physicians mistakenly believe that smoking is the only
means of ingesting marijuana – and they will not
recommend medical marijuana, because they understand that
smoking can have negative health effects.
We
believe it is important for physicians to know and consider
the following:
·
Smoking is NOT the only means of using
marijuana as effective medicine. Other means can work
just as well, and completely avoid any problems associated
with smoking.
·
Research documents that smoking marijuana DOES
NOT increase the risk of lung cancer – and
that in fact, marijuana may function as an
anti-cancer agent.
·
The potential negative effects of smoking marijuana should
be weighed fairly against the unique relief it can provide
to patients in need, particularly in the case of patients
suffering from terminal conditions.
First, smoking is NOT the only means of
ingesting medical marijuana. In fact, recent
scientific study has documented that vaporizers offer
all the advantages of smoking
– with NONE of the adverse
effects [link to the recent study or a report].
(Advantages include near-immediate relief and the ability
to titrate, or control dosage, carefully and
accurately.)
In
addition, marijuana can be used for medicinal purposes via
cooking and eating. (Patients interested in learning
more about this can get a good start by visiting the
following: [links?].)
Second,
many physicians mistakenly believe that the health effects
of smoking marijuana are similar to those of smoking
cigarettes. In fact, scientific research has recently
documented a very different finding – that
marijuana DOES NOT heighten the risk of
acquiring lung cancer and that it may, in fact,
reduce this risk [link].
Science suggests that the negative health effects of
smoking marijuana may be limited to irritation of the
throat and lungs and an increased eventual risk of
emphysema. These findings may seem counter-intuitive
after generations of anti-smoking and anti-marijuana
propaganda – but they actually conform to the
scientific community’s steady documentation of the
broad medicinal values of marijuana. Contrary to
popular belief, a wealth of recent research suggests that
marijuana offers a variety of anti-cancer
values [link to a couple summaries or reports].
Finally,
it is important also to note that many of the patients for
whom medical marijuana provides vital relief
already suffer from very serious and severely
“life-reducing” medical conditions. The
patients we tend to work with at Patient &
Families United would much rather experience the
potential health risks of smoking marijuana than the
certain and debilitating suffering they feel when
not using marijuana. These patients report
that medical marijuana provides superior relief when
compared to “ordinary” drugs their physicians
prescribe – and that the marijuana’s side
effects are much milder and preferable as well.
Common Problem: Many Physicians Are
Unaware of Cannabis Science
One
of the greatest ironies of this problem is that when the U.
S. government made marijuana illegal in the 1930s, it
was the American Medical Association that protested
most vehemently. At the time, cannabis
was the active ingredient in many of the healthcare
profession’s most common remedies, and the medicinal
benefits of marijuana had been understood and accepted for
generations. (Indeed, at one time in American
history, it had been illegal for property owners in
Virginia to not grow marijuana – perhaps one
reason that leaders such as George Washington and Thomas
Jefferson are known to have been marijuana growers!)
But generations of intensive anti-marijuana
propaganda and deliberately erroneous claims have now
overwhelmed awareness of the facts. And the
present-day physician cannot be blamed when he or she is
largely unfamiliar with the now fast-growing body of modern
scientific findings on the matter of medical marijuana.
In fact, the body of published, peer-reviewed
science affirming marijuana’s remarkable – and
unusually broad – medicinal values is truly daunting
in scope. The Internet abounds with sites offering
factual information – so much information is
available that even conducting a search of the facts can be
overwhelming.
That’s
why Patients & Families United was
delighted to learn of the existence of Montana
Physicians Advocacy, a network of physicians whose
goal is to help other physicians find needed information
more easily. This organization’s website
focuses solely on the most credible, easiest-to-use,
fact-based information available on the Internet, in order
to provide both physicians and patients a basic starting
point for learning more about what researchers have been
documenting about medical marijuana: www.mtmedmjscience.org.
Patients Can – and Should – Help
Educate Physicians and Others
Patients
and their families can play an invaluable role in helping
physicians and others acquire a better understanding of the
facts about medical marijuana. If your physician
won’t make a medical marijuana recommendation, we
recommend that you ask why. Talk with him or her
about it in more detail. If you have been diagnosed
with one of the conditions identified in Montana’s
medical marijuana law, make sure your physician understands
the facts we have outlined here, dispelling the common
myths behind many physician attitudes. Refer your
physician to the research findings available on the
Internet affirming the value of marijuana in treating or
relieving your medical suffering. Do some of
the research for your physician – make it
easier by giving him or her copies of an article or two
related to your medical condition. And if you have
questions, please do not hesitate to write to us at
info@mtmjpatients.org.
We’d like to hear about your experiences
talking with physicians and others, too.
