STATE'S CHIEF MEDICAL OFFICER PROMOTES RESTRICTIVE LAW

Medical Marijuana: Remedy or Smoke Screen?

The days of one-stop-shopping to "get legal" and buy marijuana may
soon be over. The Colorado General Assembly is close to passing a
bill intended to put the emphasis on medical need rather than legal marijuana.

In other words, it's intended to put a stop to abuse and fraud going
on statewide, on the part of some applicants to the registry and
doctors who have signed registry applications for hundreds of
patients, according Dr. Ned Calonge, chief medical officer at the
Colorado State Department of Public Health and Environment.

Calonge said earlier this week that SB109 is intended to end the
practice of physicians conducting "clinics" at marijuana dispensaries
- -- usually for patients they've never seen before and often without
performing an exam or even asking to see medical records to back up
applicants' claims of medical need.

The measure would require that all doctors who recommend marijuana
use for patients and sign state registry application forms have a
"bona-fide relationship" with those patients before the medical
marijuana evaluation takes place.

Calonge said the proposal would ensure that only patients who can
provide proof of medical conditions that qualify them for use of
medical marijuana will be added to the state registry.

"What we're really trying to do is make this a medical care program
rather than what it's become, which is not really a medical care
program at all," he said.

The proposed law, based in large part on recommendations from Calonge
and other top state health officials, is intended to help patients
and doctors and ensure that "medical marijuana patients' care can be
regulated like any other patient in Colorado. The desired outcome is
that if a physician diagnoses pain, the source of the pain has to be
identified" and verified through acceptable medical means.

In addition, the evaluating doctors often don't ask for medical
records or even take applicants' blood pressure and heart rate.

"In any other setting, diagnosing a debilitating condition and making
a recommendation for a therapy with a Schedule I drug -- marijuana is
in the same federal classification with heroin, methamphetamine and
other things that have no medical use -- requires more than a
two-minute consultation," Calonge said.

"We believe there should be an existing relationship between the
evaluating doctor and patient. The way we see the constitutional
amendment, and my medical colleagues agree, is that medical marijuana
should be part of the armamentarium for a physician taking care of
patients," but should be recommended and used with the same careful
consideration -- and regulation -- that apply to other drugs.

"This bill will require doctors to legitimize diagnoses, with a
complete history and a full physical exam that would meet the typical
standard of care," Calonge said.

The patients who qualify for marijuana under the law, he said, are
cancer patients who haven't responded "to pain medications or who
need symptom relief in end-of-life care," as well as patients with
chronic pain who are unable to tolerate or function under the
influence of prescribed painkillers.

"There will be a discreet group of patients who need something else
or something for palliative care, and those people are the ones
envisioned (to be helped) by this amendment." Calonge said.

"But the best person to make that decision is a doctor you have a
relationship with," he said, but many doctors simply aren't willing
to sign registration application forms, so the proposed bill also
makes allowance for doctors to refer patients to others who have been
cleared for evaluating medical marijuana patients in a medical
setting, and for providing follow-up care.

"Being able to have access to a clinician who specializes in
marijuana is a scenario envisioned by this bill, but we want to make
sure that person has the time and expertise to look at your medical history.

"Marijuana use carries potential long-term side effects, and even if
your doctor doesn't recommend marijuana, he needs to know if you're
using it so he can check for pulmonary changes and other potential
problems on a regular basis.

"What we put in is really the minimum of what we would expect for
diagnosis and management of a debilitating condition. The idea is,
can't we create a system where legitimate patients can get marijuana
safely, and in settings that ensure privacy and dignity?

"We're approaching this from the standpoint of trying to make this a
real medical program, to match what we believe the amendment says and
was intended to do," Calonge said.

Provisions in SB109 also would bar the practice of dispensaries
referring applicants to physicians who have agreed to provide
evaluations off-site.

"The co-location practice is a conflict of interest that the
physician has with the dispensary, and we don't allow that with any
other area of medicine," Calonge explained.

"Physicians who contact me are very upset about this program because
they really believe some of their colleagues are practicing ethically
poor and fraudulent medicine. And it's not just a matter of, 'Boy, I
could be making that kind of money.' What's going on in some places
right now detracts from the stature and status and trust of our profession.

"We hope we're going to stop the unethical and fraudulent activity.
At the same time, clinicians should feel better protected in the
legality of it, and maybe more will be willing to sign patients'
applications themselves," so the market for dispensary clinics will disappear.

Calonge said doctors who fear legal ramifications need to remember
that they are not prescribing marijuana use, but recommending it.

"There is language in the Constitution that was very carefully put
forward that prevents them from breaking the law. And if they're
doing it within the context of genuine medical care, they have
nothing to fear."

Patients who buy marijuana at dispensaries -- at much higher cost
than what they'd pay on the streets -- also need to understand that
the state has no mechanism for verifying that the dispensary products
are any more effective, or safer, than marijuana bought from illegal dealers.

"There is no expertise in the state for doing this. There is no drug
for which this is done at the state level. There is no science to
bring to bear on this issue. It's a gap for which no one is
responsible. The (federal Food and Drug Administration) would have to
take action to move it from a Schedule 1 to at least a Schedule 2
substance to allow research into the area," Calonge said.

"We're caught in this quandary unless federal law changes. I respect
the view of the Colorado electorate that the substance is useful, but
unfortunately, the way it's set up, there's not a mechanism" for
guaranteeing product safety or effectiveness.

The lack of human studies regarding both -- illegal because the drug
is illegal at the federal level -- is one reason so many physicians
are reluctant to recommend marijuana use for their patients, Calonge said.

Studies done in other countries have proven that marijuana contains
numerous dangerous toxins, especially when smoked. One study also has
shown that marijuana use hastens mental decline among users who have
multiple sclerosis -- one of the conditions that qualify patients for
inclusion on the Colorado registry, Calonge said.

"It's interesting that advocates say we don't have evidence of the
benefits because of federal laws, but I would also point out that we
don't have evidence of the harms, and this is not a harm-free substance."

But, unless the federal government changes its laws, the state is
helpless to study the effects of marijuana on patients here.

"It's a problem we have but can't solve, since we're using an illegal
substance as a medicine. It's not a good situation to be in."