DOCTORS DEFEND OR DISPARAGE MEDICAL MARIJUANA

Two doctors who have certified hundreds of Coloradans as medical
marijuana patients believe that a bill pending in the state
Legislature to more strictly regulate that process will only hurt
people who truly would benefit from the medicine.

The proposal, SB109, would effectively ban the current practice of
doctors offering certification "clinics" at medical marijuana
dispensaries by requiring that doctors have a "bona-fide
relationship" with any patient they approve for the state's patient
registry. The proposal says the doctors must have met with each
applicant at least once before an evaluation exam to receive medical
marijuana and be available for follow-up care.

Dr. Rita Starritt, a Denver-area internist, started working with
dispensaries last year, after her triplets started school and she had
extra time on her hands around her part-time practice.

Aside from the ability to choose her own hours and avoid dealing with
insurance companies and paying office staff (and earning $100 per
exam, doing 20 to 50 during an average dispensary clinic), Starritt
said she believes in the medicinal value of marijuana for some people
and suspected there were many patients who couldn't get certified for
its use, either because their own doctors wouldn't sign the forms or
because they don't have access to primary health care.

"Some people don't have a doctor, or they don't have insurance.
They're already getting the medicine illegally. Many people have
already tried this medicine before they get a license. I think it is
a cruel and burdensome thing for patients who are in need of help to
deny them access to pain relief because the last time they saw a
doctor was five years ago in some ER," Starritt said.

The proposed law "will be more burdensome for the patients than for
the doctors. They're trying to legislate something that's pretty
difficult to legislate -- the relationship between doctors and
patients. What about the ER doctors? You don't have to see one five
times to get painkillers for a broken limb and get the limb set. They
only see a patient once, usually, but they can prescribe painkillers.
Specialists see people on referral, and usually only once or twice,
but they can prescribe painkillers."

Starritt said many of the medical marijuana applicants she has
evaluated are people for whom traditional painkillers aren't
effective, or who find they can't function well when using them. Many
also claim a history of addiction to opiates or other painkillers and
are seeking pain relief without the risk of addiction.

She said she doesn't doubt that some marijuana registry applicants
are recreational users who want to register as patients to eliminate
the risk of being arrested for possession. But she's also seen plenty
of patients in her private practice who fraudulently try to obtain narcotics.

"It's not my job to figure out who's lying to me. If I think people
are lying to me, I'll deny them. But let's take migraines, for
instance. If someone comes into my (private) office and says they
have migraines, unless they're throwing up in front of me, I have no
evidence. It doesn't show up on MRIs and there are no other
definitive tests that show migraines. Same with fibromyalgia. We have
to take the patient's word about a lot of things.

"I think it's cruel to tell someone who has migraines, 'Wait until
you're having one and come into my office.' But if someone comes in
and says, 'I need 500 Vicodin a month for my migraines,' that ain't
gonna happen. I'm sure there are people who have pulled the wool over
my eyes. It's gonna happen. But on some level, we have to believe
what patients tell us because that's all we have to go on."

Starritt said she always requests medical records, but few applicants
have them for a variety of reasons. Usually, it's because they have
no insurance or regular doctor, she said, so their only care is
delivered in emergency rooms and most patients don't know how to
access those records, or can't afford them.

She agrees that some regulation of the evaluation process is logical
because, "there are some doctors that are never seeing patients --
they're just signing the papers. And some are doing it with
tele-medicine or over a computer. But there are hospice patients
whose doctors won't sign for it," and many of those patients could
enjoy a higher quality of life if their pain is controlled by
marijuana instead of morphine, which often dulls the brain so much
that they can't interact with others in a meaningful way during their
last days.

"Even with newer pharmaceuticals, a lot of doctors get on board right
away and others hang back until they see more evidence. We're seeing
the same thing with medicinal marijuana," Starritt said. "A lot of
doctors are just afraid, but I think the law as written offers plenty
of protection."

Bottom line, Starritt said the government spends too much money
trying to regulate a substance that's readily available on the street
anyway, especially given that alcohol and nicotine are both more
addictive and dangerous than marijuana is.

"It's safer than alcohol. You don't have people getting in bar fights
and beatin' the crap out of each other," she said.

"As for the theory that it's a 'gateway' drug and all that, I'm not
sure that it is. But putting all these people in jail for their
second or third drug offense -- paying all this money to keep people
in jail because of two joints -- it's a misappropriation of funds."

Dr. James Satt of Rocky Ford says he's no crusader for legalization,
but he believes marijuana is a viable alternative to narcotics for
many patients and has no qualms about signing evaluation forms at
dispensary clinics in Pueblo West, Colorado Springs and Denver.

But Satt would be prohibited from providing that service at
dispensaries, or in his private La Junta practice, if SB109 passes.

The bill would prohibit any doctor who has ever lost his or her
federal Drug Enforcement Administration certification (needed to
prescribe narcotics) from recommending medicinal marijuana to any
patient under any circumstance.

Satt lost his DEA certification twice in the 1980s and was placed on
probation by the state Department of Regulatory Agencies for
over-prescribing narcotics.

He has since regained his prescribing privileges, but his current
license status is valid "with conditions" because of a case in which
the state Board of Medical Examiners found him guilty of malpractice
for failing to diagnose and treat pneumonia in a La Junta patient.

Satt said he started recommending marijuana to some of his own
patients in 2007 and began working with dispensaries last year.

"I was looking for an alternative for treating pain. What can a
doctor do except give you pills or give you a prescription for
physical therapy? I had read about it and thought it was a legitimate
alternative to painkillers and arthritis medicine," Satt said, adding
that he's never worried about facing legal trouble over his practice.

"To be honest, I worry more about license problems with prescriptions
for narcotics. I'm not prescribing marijuana, I'm just validating
that (patients) have a condition that would benefit from its use, so
the threat to my license is less than the problems other people have
with misusing narcotic prescriptions," he said.

Like Starritt, Satt said he asks marijuana applicants for medical
records and documentation from primary care physicians, but doesn't
always get them and doesn't deny patients if he believes their
reasons for requesting inclusion on the patient registry.

"It's nice to validate that they do have a legitimate condition. I do
like to have medical records, but there a lot of people who don't
have a doctor. They may have a chiropractor as their only previous
care provider, so sometimes I'll take records from a chiropractor.
But I like to validate it with my own exam when I see the patient," he said.

"I want to make it clear that I don't have a marijuana business. I'm
a medical doctor and I don't have a business relationship with any of
the dispensaries I work for. I don't advertise the registry as part
of my business. I'm a legitimate primary care doctor who just happens
to have no objections to the medical use of marijuana and for some
reason, I guess, that makes me different from many of my peers. I'm
not a crusader. I don't even use it."

It's difficult to know how most doctors feel about medical marijuana
or determine why so many are reluctant to recommend it to their patients.

Only three Pueblo doctors responded to a brief survey about the
issue, sent via e-mail under the auspices of the Pueblo County Medical Society.

Dr. Robert McLean, president of the society, said he believes there
are some limited legitimate uses for marijuana -- calming severe
nausea in cancer patients, and stimulating appetite for AIDS patients
among them -- but that doctors who sign off on registry applications
for patients they've never met is engaging in a highly unethical
practice, if not outright malpractice.

"The potential for abuse is extremely high, but people can abuse
Oxycontin. What happens when a physician is basically dealing
Oxycontin? We have checks and balances in place and those guys get
their licenses yanked -- and rightfully so," McLean said.

"The abuse potential for the pill form of marijuana (Marinol) is much
less. We don't have people setting up pill dispensaries. Patients get
it from a pharmacy. The whole business where they're having marijuana
in brownies and all that stuff -- it's insane. We've just opened the
door to a huge mess. Medicine is supposed to be protecting the health
of the citizenry, and this is just not doing that, and a two-minute
exam is insufficient. It's medical malpractice. Those practitioners
should get their licenses yanked.

"I think that we, as physicians, should have been on top of this and
the American Medical Association and other organizations dropped the
ball. We should have been controlling this much more tightly" since
Colorado voters approved the medicinal use of marijuana in 2000.

Dr. Wes Boucher, a longtime Pueblo urologist, agreed.

He said in an e-mail that "As a physician in the Navy, over 10 years
as a surgeon and as an ER doctor and a board-certified urologist for
40 years, I can tell you that I never saw or heard of any patient
needing marijuana. It is total baloney and there are no legitimate
people prescribing it. Our Legislature worded the vote so people just
accepted it and didn't think. Why would this drug do anything for
pain that you couldn't do with an aspirin? There can be no license to
rip off the public. Try and fight it. I wish I could."

Dr. Paul Rastrelli, a Pueblo eye specialist, said marijuana does
temporarily ease eye pressure involved in glaucoma, but the effect
only lasts for four to six hours "and therefore the patients need to
take it almost 24 hours a day. There are much safer medications --
prescription eye drops -- that do a much better job."

Pharmaceutical companies "have tried to extract the active
ingredients of marijuana -- THC and some other components -- and use
that as an eye drop, and they don't work. The other reason why you
don't want to prescribe marijuana is because of the other issues,
mainly lung cancer, etcetera," Rastrelli said.

Starritt said some of her partners "aren't fans" of what she's doing
outside her office hours, so she wouldn't consider seeing registry
applicants in her private practice if a new law shuts her out of dispensaries.

"We don't do it out of our regular office, and couldn't. If we did,
we'd never have time to see our private patients," she said.