medical marijuana

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Ethicist To DEA: Mass. Docs Who Prescribe Medical Pot Are Not ‘Dealers’

Marijuana plant
“Game over,” I thought when I saw The New York Times defense of marijuana as less harmful than alcohol or tobacco last month. This from an institution so traditional it’s known as “the gray lady.”

And now, yet another institution with deeply traditional roots is shaking its finger at overzealous enforcement of federal marijuana laws that no longer jibe with public opinion in more and more states. In The New England Journal of Medicine, Boston University ethicist George Annas takes the feds to task for reportedly visiting at least seven Massachusetts doctors and telling them they have to either “give up their DEA registration or sever formal ties with proposed medical-marijuana dispensaries.”

Read his full article, which includes some clear and fascinating legal history, here. Perhaps the juiciest excerpt:

The DEA seems to be treating at least some Massachusetts physicians who are medical officers or board members of new marijuana dispensaries as drug dealers; I believe that in doing so, it is going too far. Unless a physician seeks to be paid by the dispensary on the basis of sales or volume, it’s difficult to see how acting as a medical officer or member of a dispensary’s board could constitute drug dealing. Massachusetts regulations specifically prohibit “a certifying physician” (one authorized to determine for specific qualifying patients that, in his or her professional opinion, “the potential benefits of the medical use of marijuana would likely outweigh the health risks”) from getting paid or accepting “anything of value” from a marijuana dispensary (which must be a not-for-profit entity). On the other hand, it is possible for physicians to act more like entrepreneurs than physicians in the not-for-profit sector. The DEA might, for example, even argue (if unpersuasively, given today’s health care market) that any business activity a physician engages in is outside the practice of medicine and could constitute drug trafficking.

Readers, thoughts?

Medical Marijuana 101: Doctors, Regulators Brace For ‘Big Marijuana’

The argument that marijuana is poised to become Big — as in Big Tobacco — begins more than a hundred years ago, argues Dr. Sharon Levy, a pediatrician at Boston Children’s Hospital.

Changes in curing made tobacco easier to inhale, additives made it more addictive, and machines began to churn out inexpensive, readily available cigarettes, she says. With these “innovations” and lots of market savvy ads, tobacco use and addiction rose dramatically.

“Is there anything to prevent innovative products with marijuana that will do the exact same thing?” asked Levy, who runs the adolescent substance abuse program at Children’s.

Levy described her concerns about Big Marijuana in the New England Journal of Medicine last month. She acknowledges that marijuana is nowhere near as harmful as is tobacco, and that marijuana has some health benefits. But Levy worries that marijuana addiction rates, now around 9 percent of users, could climb to those seen among tobacco users (32 percent) without strict controls on growers and manufacturers. Growers are already producing strains of marijuana with stronger and stronger concentrations of THC, the ingredient that makes people high. It’s also the ingredient that seems to trigger depression, anxiety and sometimes psychosis in Levy’s adolescent patients.

“At the heart of it,” Levy said, “the drive to make a profitable market out of marijuana is at odds with protecting the public health because the way to make marijuana profitable is to sell more and more of it.” Continue reading

Medical Marijuana 101: 10 Things You Should Know Before Using The Drug

As medical marijuana is introduced in Massachusetts, here are 10 things to know about using it.

Whether you are using marijuana for the first time, or trying it for a new ailment, those who praise its benefits say you should be prepared for a period of trial and error. Because:

1) What works for one patient may not work for you. The difference may be in the marijuana, but patients also respond to drugs differently based on age, race, gender, genetics and other factors. (The Food and Drug Administration takes many of these factors into account when testing legal drugs.)

2) All pot is not alike. Every strain of marijuana has a different balance of cannabinoids, the chemical compounds that are unique to marijuana, some of which have medicinal value. The two most common are THC, which can make people high, and CBD, which offsets the effects of THC and is believed to prevent muscle spasms and seizures.

3) Even within the same strain, the intensity of cannabinoids will vary. Take Blue Dream, one of the more popular strains these days. Blue Dream from one grower might have 5 percent THC, but if you change buyers, your next batch of Blue Dream might have 25 percent THC and produce a strong high. Continue reading

Medical Marijuana 101: What’s In Your Drug?

Jack Boyle reaches across the marble island in his kitchen for a small blue glass bottle with a black rubber cap. He holds it to the light, shaking the liquid, a marijuana concentrate.

“The person who made this didn’t make it properly,” Boyle says.

Boyle’s wife Susan Lucas uses the marijuana concentrate, or tincture, to prevent epileptic seizures. The first batch helped, so Boyle went back for more.

But then, “Sue started seeing her symptoms coming back,” he says. “We immediately took [the new batch] to the lab, had it tested. It didn’t have the CBD in it.”

The second batch, it seems, wasn’t heated enough to activate CBD, one of the compounds in marijuana that supporters say helps with muscle spasms and seizures.

Now Boyle is learning how to make a perfect concentrate on his own, in his kitchen in Stow. He bought a Crock-pot and found a recipe for marijuana tinctures online.

“I’ll make a batch and have Michael Kahn test it again, and if [it] matches up to at least as strong as the first batch then we’re good to go for six months to a year,” Boyle says. “It’s my wife, I just want to do the best I can.”

Michael Kahn is an analytical chemist and president of Massachusetts Cannabis Research, or MCR Labs, in Framingham. It’s the first marijuana testing lab to open in Massachusetts.

“We provide quality control,” Kahn says.

With all the attention to dispensaries that will grow and sell marijuana for medical use, the question of who will test the drug has been largely overlooked. The state Department of Public Health (DPH) is expected to issue testing protocols soon, but they may be a work in progress — at least for the first few years — as this industry takes shape across the country.
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Medical Marijuana 101: Mass. Doctors Head To The Classroom

“I’d like to start helping people get their mind wrapped around what are we talking about today with a case,” Dr. Alan Ehrlich said, looking out over an auditorium packed with doctors, lobbyists and advocates for medical marijuana. They’d gathered for the Massachusetts Medical Society’s first continuing education course on the use of marijuana to treat medical issues.

“Marilyn is a 68-year-old woman with breast cancer,” said Ehrlich, the senior deputy editor at DynaMed, a website that reviews medical research for doctors.

Marilyn’s cancer had spread and she was undergoing chemotherapy. She did not have any energy, she’d lost her appetite and she was having a lot of back pain.

“So she comes in to a visit with you as a primary care physician,” Ehrlich continued, and “wants to talk about the possibility of using marijuana to alleviate the symptoms of nausea, pain and fatigue. How many people think this is a good woman to certify for the use of marijuana?”

About three-quarters of the audience raised a hand. Well, Ehrlich said, let’s look at the evidence.

For this course, Ehrlich gathered studies on the benefits and risks of marijuana for medical treatment. The U.S. government controls the use of medical marijuana for medical research. There are more studies on the risks than on the benefits.

For Marilyn, who wants to relieve nausea and vomiting, two effects of chemotherapy, there are “no randomized trials of smoked cannabis versus placebo,” Ehrlich said. “So everything I’m going to present from now on, if you’re thinking about using smoked marijuana for this, you’re talking about extrapolations.”

In other words, tests the FDA would require before approving a drug to treat Marilyn’s nausea have not been done for marijuana. Doctors may hear stories from patients who find that marijuana helps, Ehrlich said, but there is almost no scientific proof.

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Could Medical Marijuana Help Stem The Opiate Addiction Crisis?

Marijuana is touted as a treatment for chronic pain, multiple sclerosis and anxiety — and some say it may be a way to help alleviate Massachusetts’ opiate crisis. But that idea is causing some tension in the addiction treatment community.

A Less Potent Alternative? 

Shelley Stormo is a clinical psychologist at Gosnold, the largest addiction treatment facility on Cape Cod. She has secured provisional approval to open a medical marijuana dispensary in Fairhaven called Compassionate Care Clinics, and the state is now verifying her application. Stormo hopes by this fall, she’ll be able to help patients avoid opiates by using marijuana.

“I’m changing my efforts a bit to really focus on how to prevent addiction,” Stormo said. “Through offering the medical use of marijuana as an alternative to potentially much more harmful and deadly opioids.”

Stormo says marijuana is safer for several reasons.

“Marijuana does not have the physical addictive components that opiates do,” she said. “It does not have the propensity, as opiates do, for overdoses. There’s no documented death by overdose of marijuana.”

Although Stormo does not advocate using marijuana to treat addiction, other medical marijuana professionals say the so-called gateway drug may one day be used as part of an exit strategy.

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House Moderates Stance On Medical Marijuana Dispensaries

The Massachusetts House has backed away from a call for the state to start over in its review of medical marijuana dispensary applications. But House leaders are recommending that the Department of Public Health (DPH) stop and make some changes before continuing what they say is a flawed process.

In a letter released Thursday, Rep. Jeffrey Sanchez, the House chairman of the Joint Committee on Public Health, listed three recommendations:

1) Go back and verify all the information submitted by every applicant who scored 137 or more points. This would add eight groups to the list of 20 that were cleared for provisional status.

2) In the future, verify information submitted before selecting applicants for provisional licenses.

3) Close loopholes that might let “non eligible persons” maintain an interest in a dispensary.

“We want to make sure that we are responsible to this voter-approved law that was passed and that we’re able to identify any problems relative to who these folks are,” Sanchez said.

Before Sanchez sent the letter, House Speaker Robert DeLeo told the Greater Boston Chamber of Commerce that he doesn’t understand why DPH checked some information, but not all the paperwork, before narrowing the list of applicants.

“My problem,” DeLeo said, “is I would have preferred that you [DPH] do all vetting upfront before any decisions are made.”

DPH issued a statement saying it will continue to work with the Legislature and will consider the recommendations in an effort “to ensure a thorough and transparent licensing process.”

But the department and the House are overlooking the main objection raised by those who were not selected: the way applications were scored.

“Much more needs to be done to a process that’s revealing itself to be flawed and inadequate in every respect,” said Joshua Resnek, spokesman for the Centers for Alternative Medicine, whose application to open a dispensary in East Boston was rejected.

Resnek and his group have asked DPH to recalculate their score. Several other groups who were rejected have filed suit against the state.

While some applicants are fighting to overturn the application process, others with provisional approval have millions invested in leases, planned renovations and growing facilities where they anticipated planting marijuana next month.

With all this wrangling, patients are left wondering if they will, as the state has said, be able to purchase marijuana at a legal dispensary sometime this summer.

Mass. Approves 20 Medical Marijuana Dispensaries

CLICK TO ENLARGE: Dispensary locations across Massachusetts (Mass. DPH)

CLICK TO ENLARGE: Dispensary locations across Massachusetts (Mass. DPH)

A small grocery store and a former warehouse are among the buildings that may soon be redesigned to open for a very different purpose: selling marijuana to qualifying patients.

The Massachusetts Department of Public Health on Friday approved 20 medical marijuana dispensary licenses in 19 communities.

Voters approved the use of marijuana for medical purposes in 2012. The law said the state could OK up to 35 dispensaries, with at least one, but not more than five, in each county.

Boston, in Suffolk County, has two licenses. Four licenses were awarded in Middlesex County, with two licenses each in Barnstable, Bristol, Essex, Norfolk, Plymouth and Worcester counties. Hampden and Hampshire counties each got one license.

The dispensaries are in the following cities and towns: Ayer, Boston (2), Brockton, Brookline, Cambridge, Dennis, Fairhaven, Haverhill, Holyoke, Lowell, Mashpee, Milford, Newton, Northampton, Plymouth, Quincy, Salem, Taunton and Worcester.

Four counties do not yet have a dispensary. Six qualifying dispensary applicants were invited to seek an alternate location, in order to serve the remaining counties. State officials said they may issue additional licenses in June.

Owners who were notified they cleared state approval will now have to begin the local approval process, which includes zoning, inspection and public health rules in some communities.
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National Survey Suggests Medical Pot Trickles Down To Teens

In this Oct. 16 file photo, Monique Rydberg, left, packages medical marijuana as Jeff Clark awaits patients at The Joint, a medical marijuana cooperative in Seattle. (Ted S. Warren/AP, File)

In this Oct. 16 file photo, Monique Rydberg, left, packages medical marijuana as Jeff Clark awaits patients at The Joint, a medical marijuana cooperative in Seattle. (Ted S. Warren/AP, File)

The federal government today released Monitoring The Future, its annual reams of data on teen vices — alcohol, drugs, tobacco — and here’s perhaps the freshest new data point on the press release:

In 2012, the survey added questions about where students get marijuana. Looking at the last two years combined, 34 percent of marijuana-using 12th-graders living in states with medical marijuana laws say that one of the ways they obtain the drug is through someone else’s medical marijuana prescription. In addition, more than 6 percent say they get it with their own prescription.

Hmmm. So if students in medical-marijuana states (like Massachusetts, soon) are getting their pot from friends with medical marijuana cards, does that mean they’re smoking more of it in general? Does legalizing medical pot lead to more stoners? Or just a shift in supply?

I put that question to R. Gil Kerlikowske, former police chief of Seattle and now director of the Office of National Drug Control Policy — better known as the country’s drug czar.

“What we saw in the survey instruments, and across the country, is that the states that have medicalized marijuana have higher youth use than the states that have not done that, so that is very clear,” he said.

‘In Mass., if somebody uses the medical marijuana system for distribution, they’re looking at a felony.’

But of course, it could be that those states that are already more lax on marijuana, and have more users, are more likely to pass medical marijuana laws. I asked Kerlikowske, whose office opposes pot legalization: Is there any sign that legalizing medical marijuana causes more teen pot use?

“You know, I wouldn’t want to go that far,” he said, “because we’re not saying this is causal effect but the correlation is clear: that youth use is higher in the states that have medical marijuana. And then when you add in the information about where do you obtain it, and you obtain it from a person who does have a medical marijuana card, in my old job as a police chief, I’d call that a clue.”

Another clue: weed is not looking very killer-like to high-schoolers: 60 percent of seniors say they don’t see regular pot use as harmful.

But again, is there any causation? Are teens less negative about pot because it’s now described as medicine?

I spoke with Matthew Allen, executive director of the Massachusetts Patient Advocacy Alliance, which advocated for the medical marijuana law that passed here last year and continues to work on how it plays out. He says the federal study looks at general trends for the nation, but several state-by-state studies have found that there is no causal correlation — that passing a medical marijuana law doesn’t boost teen pot use.

He also points out that there are ways to put strict laws in place to prevent diversion of medical marijuana to teens. Continue reading

Mass. Hospitals Weigh Medical Marijuana Liability Risk

As Massachusetts lays the groundwork for medical marijuana, new clashes between the state law and a continuing federal ban on marijuana use are emerging. Hospitals, hospice care organizations and nursing homes are weighing the balance of serving their patients and protecting billions of dollars in federal funding.

(“Caveman Chuck” Coker/flickr)

(“Caveman Chuck” Coker/flickr)

Here’s the dilemma: Towards the end of long forms that authorize federal payments to hospitals, an executive has to certify that yes, the hospital is in compliance with federal law. But that statement would not be true if patients at the hospital are using marijuana for medical purposes and a doctor at that hospital is helping them.

“It’s really challenging for the practitioners,” says Larry Vernaglia, an attorney at Foley & Lardner who wrote a memo laying out the issues for the Massachusetts Hospital Association. If doctors say to themselves “‘even though we have this new pathway under state law, we’re not going to help our patients for fear of our liability,’ I think that’s a terrible position to be in,” Vernaglia says.

And hospitals face significant possible risks. Tim Gens, executive vice president at the Massachusetts Hospital Association, says violating federal law could get hospitals in trouble with the IRS over their nonprofit status. Grants through the National Institutes of Health and the Department of Defense fund most of the research at Boston hospitals. And there’s the billions of dollars in payments hospitals receive through Medicare and Medicaid. Continue reading