Physicians chime in on medical pot

Shawn Raymundo

Of the many uncertainties facing Guam’s budding medicinal cannabis program, one question often commands the circle: Which doctors will recommend marijuana to their patients?

Qualified cannabis patients tracking the island's slow growing medicinal program know that they can't legally self-medicate -- that process is only sparked by a phyiscian's signature.

The form’s declaration of statement certifies that the physician has a “bona fide practitioner-patient relationship with the qualified patient” and that in the doctor’s “professional opinion, the qualified patient has a debilitating medical condition” and believes “that the potential health benefits of the medical use of cannabis would likely outweigh the health risks for the qualified patient.”

Dr. Chris Dombrowski, a family practice doctor, with PMC Island Health System, is also a member of the Society of Cannabis Clinicians, a scientific group of physicians committed to advancing research of medical cannabis.

Dombrowski focused on the study of the endocannabinoid system and how cannabinoids affect a person’s metabolism, appetite and pain sensation. Cannabinoids are some of the chemicals, or natural components of cannabis, and he said his interest on the matter stretches back to his college years.

So yes, he's discussed certification with patients since the application process opened in late January.
“I’ve only given out three certifications so far," he said. “Most of the people I’m prescribing this to, or giving them the certification, already have a history of using it, because they’ve been honest with me up front. They don’t want any medicines.”

Dombrowski stressed that he’s not just handing out marijuana recommendations and certifications like “candy." Each certificate he signed was for patients he'd already been treating, he said.

According to Public Health Director James Gillan, the department received zero applications for business licenses and just two patients applied for the registry card. Both patients, he mentioned, were certified by the same practitioner.

Gillan would not say if Dombrowski is the certifying physician. He did say that he has regularly consulted with Dombrowski.

“I have discussed medical use of cannabis with him many times … He has stated that since what is on the table now is cannabis as medicine he will not automatically sign any certification,” Gillan stated in an email. “Complete work ups and appropriate diagnostics would be required before he would sign any certification.”

During last year’s series of public hearings on the measure to establish the rules and regulations for the medicinal pot program under the Joaquin “KC” Concepcion II Compassionate Cannabis Use Act, concerns were raised that there would be a lack of physicians willing to recommend the drug to patients.

When asked if he believes there would be shortage of doctors on island who would recommend medical marijuana to qualified patients, Dombrowski said he couldn’t be sure.

“Am I the only physician who feels comfortable with it? I can’t answer for the other doctors of the (Guam Medical Association) or (Guam Medical Society),” he said.

Dr. Thomas Shieh, president of the Guam Medical Association, said the organization plans to hold a discussion on medical marijuana later this month.

“The majority of our doctors have always been willing to work with our patients to ensure the best and most effective treatment plan for their illnesses,” Shieh said in an email.  “Should this include the use of marijuana especially for those patients with terminal illness, we will work with them. Until then, we will continue to focus on the most effective treatment plan to ensure we are following evidence based medicine.”

The Guam Medical Society, an affiliate of the American Medical Association, has taken the stance on medical marijuana that believes more studies should be done on marijuana and advocates the federal government placement of cannabis as a Schedule I drug. According to the US FDA's official site, Schedule I drugs:

• have a high potential for abuse,
• has no accepted medical use in treatment in the U.S., and
• there is a lack of accepted safety for its use under medical supervision.
Other Schedule I drugs include various opiates as well as heroin.

“This should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product,” the Society notes.

Pacific Daily News reached out to several local physicians who specialize in the debilitating conditions listed under Guam’s Cannabis Use Act. A handful didn’t want to comment, while many others weren’t readily available for interviews.

Dr. Hyo Ji, an anesthesiologist with the Guam Surgicenter, considers himself a “big proponent of medical marijuana” and believes it should also be decriminalized.

Noting that he hasn’t had a chance to read the certification letter Public Health requires, Ji reasoned that if there’s a fear of scrutiny from the federal government there’s a difference between prescribing and recommending it.

“I’m not prescribing it. I recommend it – versus prescribing it. Then you can go away from the legal aspect,” Ji said.

Ophthalmologists also added views. They treat patients with glaucoma – one of the conditions that qualify for cannabis treatment.

While they acknowledged marijuana’s medical value, noting that it has its place in medicine, they all agreed that weed is not as effective as other drugs available to treat glaucoma.

“I do think there’s a role for medical marijuana, but not for glaucoma,” said Dr. David Parks, who’s licensed to practice medicine on Guam as well as in California, where marijuana is legal medicinally and recreationally.

Dr. Marjorie Debenedictis of St. Lucy’s Eye Clinic said there are more effective forms of treatment for glaucoma.

Dr. Robert Wresch, an ophthalmologist with the Seventh-Day Adventists Guam Clinic, explained that studies of marijuana’s treatment for glaucoma dates back to the 1970s, when it showed that “smoking marijuana lowered the intraocular pressures of people with glaucoma."

“This research was supported by the National Eye Institute, a division of the federal National Institutes of Health,” he wrote in an email. “These studies found that when marijuana is smoked or when a form of its active ingredient is taken as a pill or by injection, it does lower the pressure.

However, it lowers the pressure for a only short period of time – about three or four hours.”

Public health has recently said it’s possible patients could have medical cannabis access by this summer, but Dombrowski doubts it.

“I wouldn’t hold my breath,” Dombrowski said, adding it was a "complex" issue. Though Dombrowski said he’s avidly supported the legalization of marijuana for adults, he thought Guam should have followed states that decriminalized it for medicinal use.

“I was like ‘why don’t we just do the opposite like what was done in the states?’ All the states medicalized first, then recreational use,” he explained. “I said ‘why don’t we just legalize it recreationally, get the taxes flowing in and then we can start the medical program?’”

Gov. Eddie Calvo last month submitted a bill to the Legislature that could legalize and tax marijuana.

Under the bill, only licensed dispensaries would be able to sell marijuana to those 21 years and older.

An excise tax of 15 percent would also be imposed on the sale of the drug.

To address the $10 million cost Guam is expected to incur to regulate the medicinal program, Calvo intends to legalize it and use the tax revenue to sustain the new medical industry while also providing more funds to Guam Memorial Hospital.

Debenedictis echoed Calvo’s sentiments in support of the bill, noting that the medicinal cannabis program will be costly.

The element standing in the way of the medical pot market from growing to its full potential is the U.S. Drug Enforcement Administration, Dombrowski said. If the DEA removes marijuana as a Schedule I substance, more scientists and research labs can openly study the drug.

“Cannabis needs to be de-scheduled. Not rescheduled, de-scheduled!” Dombrowski said. “It should be just like coffee, tobacco, alcohol: there should be no restrictions. Once there’s no restrictions, everything will go out the roof. Studies will be phenomenal.”

Dombrowski said if such a thing were to occur, Big Pharma would take over cannabis, which would lead to standardized dosages for patients who will develop personal medication plans.