DOCTORS RACK BRAINS OVER POT

PORTLAND -- Some AIDS patients in Portland hoping to have legal access
soon to medical marijuana may be disappointed.

A medical team at the city's India Street Public Health Center,
Maine's largest HIV practice, notified most of its 170 patients last
week that it won't grant medical marijuana certificates to everyone
who asks for one. The drug is potentially harmful and often not
medically justified, the team said.

"In this current era of effective medications for HIV/AIDS, we are
delighted that most of our patients are able to enjoy a very good
quality of life and for the majority, medical marijuana will not be
necessary," the center said in a letter to patients. "We ... can only
provide a certificate to those who genuinely need this substance."

Maine's medical community -- from small family practices to large
hospitals -- is busy sorting out how to handle medical marijuana and
what to tell the growing number of patients asking for a doctor's
blessing to buy the drug.

"Doctors are talking about it a lot right now," said Gordon Smith,
vice president of the Maine Medical Association. "They've had a lot of
calls from patients ever since the referendum passed back in November."

That's because the new law approved by voters says patients must have
both a qualifying medical condition and a doctor's signed
recommendation before registering as a legal medical marijuana user.
Registered patients are allowed to grow their own marijuana, obtain it
from a caregiver or buy it from a dispensary, eight of which are
expected to open around the state this winter.

It's a tricky area for physicians, Smith said. Unlike other
medications, marijuana is not FDA-approved as safe and effective and
it's not measured out in prescribed, limited doses by a licensed pharmacist.

"They have to be as careful with prescribing medical marijuana as they
are prescribing a new drug that they may know nothing about," Smith
said. "They may shy away from this because of their inability to have
any control over the dosage, the quality or the strength."

Some physicians have said they will write recommendations, while
others say they won't - at least until there is more scientific
evidence about effectiveness and side-effects, according to Smith.

Most, like Portland's HIV clinic, are taking a case-by-case approach,
he said.

HIV and AIDS rank high on the list of disabling conditions that can
qualify a patient to legally use medical marijuana. By reducing nausea
and increasing appetite, the drug can help control wasting syndrome, a
common complication of AIDS marked by weight loss and weakness,
according to patients and doctors.

But even AIDS may not be enough on its own to get a doctor's
recommendation.

"I don't think anybody wants to withhold it. It all comes down to
clinical judgment," said Caroline Teschke, program coordinator at
Portland's India Street clinic, also known as Positive Health Care. "I
think it's really like any other decision - it's made on an individual
basis."

The program sent the letter last week to the majority of its patients
after getting a number of requests for marijuana recommendations,
according to Teschke.

"It's going to be a complex issue for everybody, I think," she said.
For one thing, she said, "it's hard for a provider to recommend
anybody to smoke anything."

The letter to patients says smoking marijuana long term may contribute
to development of cancer, and that smoking is "the least desirable
method of using this substance." Patients also can eat marijuana in
food or drinks and can inhale the drug using smokeless vaporizers.

The letter also implies that some patients are asking for the
certificates for non-medical reasons. "Although we recognize that many
of you enjoy using marijuana, much as someone would enjoy a glass of
wine, this use is not covered by the new law," the letter says.

Anybody who is granted a recommendation, it says, will have to sign a
contract agreeing not to abuse or sell the drug.

Teschke said the health center is not limiting medical marijuana
access out of any fear that it could lose federal funding. All
marijuana use remains a federal crime. "That has not been an issue,"
she said.

Resistance and dismissive attitudes in the medical community are
discouraging, said Charles Wynott of Westbrook, a medical marijuana
advocate. Wynott was diagnosed with AIDS more than two decades ago,
though he is not a patient at the city's health center.

"I have been a regular marijuana user for 25-plus years and I have no
signs of cancer. It is the reason that I'm still alive, without any
doubt in my mind," Wynott said. "It helps with nausea, it helps keep
my medicine down and it helps with wasting and eating. Those are the
two main things you need to do as an HIV patient in order to survive -
keep your medicine down and maintain your weight."

Wynott said he hopes patients are not denied access to marijuana
because it might make them feel good. "That in itself is a good thing
for people who are sick," he said.

Owen Pickus, a Westbrook doctor who specializes in AIDS and cancer
treatment, said he also wishes marijuana would be studied and
controlled like other medicines. "I see nothing about marijuana that
would make it a sacred cow that shouldn't be in the same group."

But, in the meantime, he recommends medical marijuana for a number of
HIV patients if they have complications and need help managing weight
loss and wasting syndrome.

"It's not just having an HIV diagnosis, it's wasting and vomiting," he
said. "The drug doesn't work for everybody, but for a substantial
number of people, it does."

Maine's medical marijuana law says patients must have a physician
recommendation and one of the following debilitating medical
conditions: cancer; glaucom; HIV/AIDS; hepatitis C; amyotrophic
lateral sclerosis; Crohn's disease; agitation of Alzheimer's disease;
nail-patella syndrome; a disease, condition or treatment that produces
intractable pain; or a disease, condition or treatment that produces
wasting syndrome, severe nausea, seizures, or severe and persistent
muscle spasms.

More conditions may be added to the list by a state review panel. The
panel has yet to meet but is required to review the list at least once
a year.

Patients also must pay a $100 fee and register with the state in order
to be a legal marijuana user.

For more information or application forms, go to:
www.maine.gov/dhhs/dlrs/index.shtml