PATIENTS REQUESTING MEDICAL MARIJUANA OFFERED ADDITIONAL FORMS OF TREATMENT

Practice offering alternatives thriving

HALLOWELL - Dustin Sulak probably has the fastest growing medical
practice in Maine.

The osteopathic doctor, who's been licensed for just over a year, had
30 patients last fall. Now, he treats 1,300.

On the wall of Sulak's examination room, next to his diplomas and
state license, are framed certificates naming him a Reiki master and a
clinical hypnotherapist.

All patients, on their first visit, get a hands-on healing treatment
from either Sulak or a nurse practitioner, he said between bites of
quinoa, a grain-like seed that he ate from a mason jar.

The 31-year-old doctor is tall and lean, with a long dark ponytail. An
advocate for alternative medicine, Sulak gives his patients advice
about healthier lifestyle choices, and many of them leave his office
with bottles of supplements sold at the reception desk. Before and
after appointments, patients get a hug from Sulak.

But that's not why they come to see him. Since voters approved medical
marijuana dispensaries in 2009, his office has become a destination
for people from York to Fort Kent in search of a doctor's
certification to legalize their marijuana use. He estimated he's
written 100 recommendations for marijuana every week for the past two
months.

Patients have to see Sulak every six months to establish a bona fide
relationship - a requirement of the new law. Most, however, are coming
back sooner.

"I'm using marijuana as the hook to connect people to a better method
of medicine, and it's working," he said.

Under the new law, medical marijuana patients have to register with
the state by Jan. 1 to be protected from prosecution for possessing
the drug. Applicants must submit a doctor's certification and a $100
fee to get a state-issued identification card, which they need in
order to buy marijuana from the soon-to-open dispensaries.

Last week, the Department of Health and Human Services had issued 163
cards and received another 174 applications. Those numbers are
increasing every day, said Catherine Cobb, director of licensing and
regulatory services for the department.

The applicants so far have received certification from 56 different
doctors, which surprised both Cobb and Gordon Smith, executive vice
president of the Maine Medical Association. Smith said he hopes the
higher-than-expected number is an indication that the association's
effort to educate physicians about the new law is working.

Still, Smith suspects that most of those doctors only certified a
couple of patients each. Cobb wouldn't release the names of the
doctors or the number of certifications each wrote because of patient
confidentiality laws.

According to Smith, most of the certifications are coming from Sulak
and his former teacher, John Woytowicz, a medical doctor and member of
the faculty at Maine Dartmouth Family Medicine Residency in Augusta.

"Without Dr. Woytowicz and Dr. Sulak, I would almost go so far as to
say the law would be ineffective in the state," Smith said.

Woytowicz, who's practiced family medicine in central Maine for 20
years, has been writing recommendations for medical marijuana since a
law passed in 1999 allowing people with certain debilitating diseases,
like cancer and HIV, to grow their own plants or appoint a caregiver
to do it for them. In 10 years, he said, he wrote about 30
recommendations. In the last 12 months, he's written more than 160.

Woytowicz said medical marijuana patients account for about 10 percent
of his practice. For Sulak, they're just about everyone he sees.

Some of Sulak's patients won't register with the state because they're
opposed to having their name on a list and are willing to risk the
consequences, he said. Many others haven't submitted their paperwork
yet.

Sulak said most of his patients already use marijuana and, in light of
the new law, have decided to get the legal protection the state
offers. He does have to turn down patients who he believes benefit
from the drug but don't qualify under the law. Most of them suffer
from post-traumatic stress disorder, Sulak said.

Adding that disorder to the list of qualifying conditions is among
needed changes to the law identified by the Medical Marijuana
Caregivers of Maine, said Jonathan Leavitt, the group's chairman and a
leading advocate for medical marijuana in Maine. The group plans to
send a letter to legislators this week, he said.

Sulak said most of his patients use marijuana to treat chronic pain -
a condition that wasn't included in the state's old medical marijuana
law. The single most common problem Sulak said he sees is persistent
pain following back surgery, called failed back syndrome.

While the drug doesn't completely eliminate the pain, Sulak said,
patients say it keeps them from thinking about it, making day-to-day
living more tolerable.

In order to receive a recommendation for marijuana, those patients
must have medical records documenting intractable pain that hasn't
responded to ordinary medical or surgical measures for more than six
months.

Those records are what Sulak would have to produce if his practice was
challenged by the state's Board of Licensure in Osteopathy. Any
licensed physician may certify medical marijuana use, Cobb said, but
doctors have hesitated to recommend it.

"Most of them are too scared to do it because they have some false
belief that it will jeopardize their license," Sulak said.

Sulak said he almost expects to be questioned by the board at some
point and keeps that in mind as he documents his patients' histories.
He said all doctors are taught to be meticulous about their
record-keeping for that reason.

"I just feel that a little more intensely than others might," he
said.

Smith said doctors do have legitimate concerns about recommending the
drug. Some say they don't know enough about it as medicine, like what
the proper doses are, to be responsible for patients who are using it.
Others worry about the quality and purity of the marijuana that
patients will get, because the sources of the drug - both caregivers
and dispensaries - aren't federally regulated the way pharmacies and
pharmacists are. Some physicians are afraid of enabling drug addicts
or dealers.

Another set of doctors is hamstrung by their employers. Smith said
there are 20 federally-qualified health care centers in the state that
prohibit their physicians from certifying medical marijuana patients.

Those include the U.S. Department of Veterans Affairs hospital at
Togus and its clinics throughout the state and HealthReach Community
Health Centers, which serve rural central and western Maine. Smith
said their insurance won't cover claims against doctors recommending a
drug that's illegal under federal law.

But most doctors have open minds about medical marijuana, Smith said.
On behalf of the Maine Medical Association, Smith - sometimes with
Woytowicz - has been speaking at hospitals statewide to teach doctors
about the new law. He said the talks are well attended. Doctors want
to learn; most just aren't ready to make recommendations yet.

"It takes a little time," Smith said.

Another fear physicians have is that writing a couple of
recommendations could earn them a reputation - and a slew of new
patients who just want their signature. That's a concern Sulak and
Woytowicz can understand.

Meanwhile, the two physicians have been bridging the gap between
patients' demands and most doctors' reluctance to fulfill them.
Woytowicz, however, said he's accepting few new patients. Sulak is
near his maximum capacity, as well. He hopes to hire another doctor
soon.

New patients have to book their appointments with Sulak at least two
months in advance. Last week, his schedule was already full through
February. Sulak used to take payments at the time of appointments, but
now patients have to pay in full - $300 for a first visit - before
their name goes into the schedule book.

Ten percent of Sulak's patients are put on a sliding payment scale,
with a maximum discount of 50 percent, and he doesn't accept insurance.

The entrance to Maine Integrative Healthcare, Sulak's practice, is at
the back of an office building on Water Street, just outside of
downtown Hallowell. Walking into the waiting room, there's a bulletin
board to the left where caregivers have tacked up Post-It notes with
their names and phone numbers. Business cards tout reasonable prices
and a variety of marijuana strains, and pamphlets from garden centers
advertise hydroponics supplies and grow room installations. A large,
white cubby case against the wall holds bottles of dietary
supplements, hemp seed bars, and jugs of coconut oil.

The clean, white walls in the waiting room, and in the corridor of
exam rooms beyond it, show that Sulak's practice hasn't been there
long. He first started seeing patients in an acupuncturist's office
down the road, where he rented a room for $100 a month. He moved to
the larger office in July and has since hired three receptionists, who
answer constant phone calls and file paperwork behind a high,
semi-circular desk.

Past the receptionists are two large brown leather couches for waiting
patients. There are only a few people in the room at a time and they
sit quietly, perhaps heeding a paper sign in the corridor outside the
room. "SSSHHHHHHH! HEALING IN PROGRESS," it says.

Sulak takes his time with appointments and, because of that, he tends
to run behind schedule. On the coffee table is a laptop with Internet
access, a print out on the benefits of Vitamin D and books about
alternative medicine, including "Spontaneous Healing," by Dr. Andrew
Weil. The copy is from Sulak's freshman year of college.

Sulak, who grew up in the suburbs of Chicago, first became interested
in alternative medicine when he was teenager experimenting with
marijuana. He said the drug "had some positive effects on my psyche,"
and opened his mind to more creative thinking. He declined to say if
he uses marijuana now.

After high school, Sulak studied biology and applied health science at
Indiana University, where he led an activist group that called for the
legalization of marijuana. He then enrolled at Arizona College of
Osteopathic Medicine at Midwestern University and did his internship
at Maine Dartmouth Family Medicine Residency in Augusta, where he met
Woytowicz.

Sulak immediately stood out among his classmates because of his
training in Reiki and hypnotherapy, Woytowicz said. Although Sulak
left the program after his first year, he made a lasting impression.

"Dustin came with a lot of extraordinary skills ... a larger
repertoire than any resident has ever come with," he said.

Because Sulak never finished his residency in family medicine, he's
technically considered a general practitioner. But, essentially, he's
a specialist.

"He's good at what he does," Woytowicz said.