3 years after Mass. legalization, still very much a niche industry
In capital, block letters printed larger than the name of the company, the clinics' signs and home page declare Canna Care Docs' unofficial slogan: "WE ARE IN COMPLIANCE."
Three years after medical marijuana became legal in the commonwealth, it remains a niche industry dominated by a handful of physicians working out of specialty clinics, like Canna Care Docs, that are devoted to the drug.
The Massachusetts Hospital Association, citing federal laws against
prescribing marijuana, has advised its member institutions to be
cautious about certifying patients, and many physicians still question
marijuana's efficacy as a treatment.
The upshot is a landscape -- considered problematic by both advocates
and opponents of medical marijuana -- where most qualifying
Massachusetts patients are forced to bypass their primary care
physicians and pay $200 or more for consultations at specialty clinics
before they can purchase marijuana at a dispensary.
"It should be something that should be treated just like any other medicine," said Mark Ward, a Lowell medical marijuana activist. "You should be able to go to your regular doctor and not spend outside funds.
"During a one-year period beginning October 2014, 20 doctors -- in a state with more than 32,000 licensed physicians -- accounted for 94 percent of the medical marijuana certifications in Massachusetts, according to Department of Public Health records. All of the top certifiers appear to work at least part time out of clinics devoted to marijuana consultations.
"It should be something that should be treated just like any other medicine," said Mark Ward, a Lowell medical marijuana activist. "You should be able to go to your regular doctor and not spend outside funds.
"During a one-year period beginning October 2014, 20 doctors -- in a state with more than 32,000 licensed physicians -- accounted for 94 percent of the medical marijuana certifications in Massachusetts, according to Department of Public Health records. All of the top certifiers appear to work at least part time out of clinics devoted to marijuana consultations.
"If your primary-care physician can recommend (marijuana) for
you, then that's in fact the way you should go because you already have a
relationship for them," said Dr. John Nadolny, who works part time at
Canna Care Docs.
Miscues in law's roll-out
In a sign of the miscues that have characterized the three-year roll-out of Massachusetts' medical marijuana program, in data provided to The Sun the Department of Public Health listed Nadolny as the physician who certified the most patients during the one-year period beginning October 2014.
Nadolny estimated that the number of patients attributed to him, 2,392, is probably double the number he has actually certified. By contrast, another Canna Care Docs physician, Dr. Gary Witman, is listed in the Department of Public Health data as certifying fewer than 10 patients during that time frame. He told The Sun he has certified hundreds of patients.
Canna Care Docs confirmed that its company records do not match up with the data as presented by the Department of Public Health. Physicians at other clinics said the certifications attributed to them appear to be accurate.
Despite apparent inconsistencies in the record-keeping, patients and doctors agree that very few primary care physicians have completed the required training and obtained a certification allowing them to recommend marijuana for medical use.
"One of our concerns from the very start with this was about the true, ongoing doctor-patient-relationship," said Dr. Dennis Dimitri, president of the Massachusetts Medical Society.
It's possible for doctors at specialty marijuana clinics to be sufficiently involved in their patients care, he added, but that doesn't always seem to be the case.
"It does seem, based on the numbers, that these clinics exist for one reason and one reason only, and that is certifying patients for marijuana," Dimitri said.
Under state regulations, a physician must have a "bona fide" relationship with a patient before recommending marijuana for them. There is no definition in the regulations, however, of what that entails.
At Integr8 Health in Burlington, patients bring in medical records documenting their condition when first applying for a certification, said Dr. Daniel Einstein, the medical director. The physicians there conduct physical exams, discuss the effects of marijuana, and patients must return six months after their initial appointment for a follow-up, which is not required by law.
"We see new patients for 45 minutes and follow-ups for half an hour," Einstein said. "And for me that's enough time to have a bona fide patient relationship, much more than I ever got in primary care."
Specialty clinics point out that, beyond simply assessing whether a patient would benefit from medical marijuana, they also inform patients how best to use the plant as medicine.
There are more than 800 different strains of medical marijuana, broken down into two major groups -- indica and sativa -- with dramatically different effects. Different varieties of the plant are more effective at treating different symptoms, and different methods of taking in the core compounds in marijuana -- such as ointments, edible products, and vaporizers -- produce different results, said Witman, of Canna Care Docs.
"Recognition of methods of action and potential benefits of these strains requires extensive knowledge of the pharmacopics," he said.
Concern with standards
The Massachusetts Medical Society and physicians who are leery of medical marijuana do not outright reject that the plant may help with certain symptoms. Their main concern is that marijuana is not standardized the way other medicines are, to ensure that the patient will always experience the same effects, and that not enough research has been done to determine when and how it should be used.
Marijuana is federally classified as a Schedule I drug, which means research into its medicinal uses is banned in the United States and many other countries. The classification also prohibits doctors from prescribing marijuana, even in states where it is legal.
Physicians in Massachusetts can recommend that marijuana will be beneficial for patients and certify them so they can buy it from a dispensary. But unlike a prescription, which clearly defines how much and what kind of a medicine a patient receives from a pharmacy, there is no mechanism to ensure that patients will follow their doctor's advice once they are in a dispensary.
It falls to the specialty clinics to do the best they can in follow-up appointments, which may happen only once a year, if at all, to ensure that patients are using their marijuana correctly.
"This is for people in need of access to medicine, many of whom are disabled in some way, and it just doesn't make sense," said Ward, the Lowell activist. "How can you call something a medicine and then not treat it like other medicines?"
Miscues in law's roll-out
In a sign of the miscues that have characterized the three-year roll-out of Massachusetts' medical marijuana program, in data provided to The Sun the Department of Public Health listed Nadolny as the physician who certified the most patients during the one-year period beginning October 2014.
Nadolny estimated that the number of patients attributed to him, 2,392, is probably double the number he has actually certified. By contrast, another Canna Care Docs physician, Dr. Gary Witman, is listed in the Department of Public Health data as certifying fewer than 10 patients during that time frame. He told The Sun he has certified hundreds of patients.
Canna Care Docs confirmed that its company records do not match up with the data as presented by the Department of Public Health. Physicians at other clinics said the certifications attributed to them appear to be accurate.
Despite apparent inconsistencies in the record-keeping, patients and doctors agree that very few primary care physicians have completed the required training and obtained a certification allowing them to recommend marijuana for medical use.
"One of our concerns from the very start with this was about the true, ongoing doctor-patient-relationship," said Dr. Dennis Dimitri, president of the Massachusetts Medical Society.
It's possible for doctors at specialty marijuana clinics to be sufficiently involved in their patients care, he added, but that doesn't always seem to be the case.
"It does seem, based on the numbers, that these clinics exist for one reason and one reason only, and that is certifying patients for marijuana," Dimitri said.
Under state regulations, a physician must have a "bona fide" relationship with a patient before recommending marijuana for them. There is no definition in the regulations, however, of what that entails.
At Integr8 Health in Burlington, patients bring in medical records documenting their condition when first applying for a certification, said Dr. Daniel Einstein, the medical director. The physicians there conduct physical exams, discuss the effects of marijuana, and patients must return six months after their initial appointment for a follow-up, which is not required by law.
"We see new patients for 45 minutes and follow-ups for half an hour," Einstein said. "And for me that's enough time to have a bona fide patient relationship, much more than I ever got in primary care."
Specialty clinics point out that, beyond simply assessing whether a patient would benefit from medical marijuana, they also inform patients how best to use the plant as medicine.
There are more than 800 different strains of medical marijuana, broken down into two major groups -- indica and sativa -- with dramatically different effects. Different varieties of the plant are more effective at treating different symptoms, and different methods of taking in the core compounds in marijuana -- such as ointments, edible products, and vaporizers -- produce different results, said Witman, of Canna Care Docs.
"Recognition of methods of action and potential benefits of these strains requires extensive knowledge of the pharmacopics," he said.
Concern with standards
The Massachusetts Medical Society and physicians who are leery of medical marijuana do not outright reject that the plant may help with certain symptoms. Their main concern is that marijuana is not standardized the way other medicines are, to ensure that the patient will always experience the same effects, and that not enough research has been done to determine when and how it should be used.
Marijuana is federally classified as a Schedule I drug, which means research into its medicinal uses is banned in the United States and many other countries. The classification also prohibits doctors from prescribing marijuana, even in states where it is legal.
Physicians in Massachusetts can recommend that marijuana will be beneficial for patients and certify them so they can buy it from a dispensary. But unlike a prescription, which clearly defines how much and what kind of a medicine a patient receives from a pharmacy, there is no mechanism to ensure that patients will follow their doctor's advice once they are in a dispensary.
It falls to the specialty clinics to do the best they can in follow-up appointments, which may happen only once a year, if at all, to ensure that patients are using their marijuana correctly.
"This is for people in need of access to medicine, many of whom are disabled in some way, and it just doesn't make sense," said Ward, the Lowell activist. "How can you call something a medicine and then not treat it like other medicines?"
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