Pennsylvania is still more than a year away from having its medical marijuana system up and running, but local physicians are already thinking about how they will prescribe the drug.
Jack Kabazie is head of the pain medicine division at Allegheny Health Network and is a member of a network-wide task force exploring the issue. He said AHN wanted to bring together physicians in all disciplines potentially impacted by the medical marijuana law, and currently includes representatives from neurology, neurosurgery, pain medicine and hospital administration. Kabazie said they also want to bring in representatives from gastroenterology and psychiatry.
“It’s early,” he said. “We’re trying to figure out who is going to apply for credentials in the system, who wants to. Essentially any physician that’s in good standing can apply for those credentials to prescribe*, if they treat one of the disease entities that medical marijuana is approved for.”
Conditions for which medical marijuana could be prescribed include epilepsy, multiple sclerosis, HIV/AIDS, post-traumatic stress disorder and Crohn’s disease. But Kabazie said a qualifying diagnosis won’t necessarily translate into a prescription for medical marijuana.
“Just because the state says that a certain disease entity can be treated, doesn’t mean that a physician has to treat or will treat for that disease entity,” he said.
One reason, Kabazie said, is that the research demonstrating the potential medical benefits of marijuana is “soft,” so it will be difficult for doctors to know what dosages and forms of the drug to prescribe.
Antoine Douaihy, medical director of addiction medicine services at UPMC’s Western Psychiatric Clinic, said there is enough research to suggest that marijuana could be an effective medication in some circumstances.
Douaihy is part of a statewide physicians’ working group that is developing guidelines for prescribers to follow once they find themselves in the difficult position of being expected to prescribe a drug that hasn’t gone through the traditional clinical trials that would garner it FDA approval.
“There are a lot of questions that are still unanswered,” Douaihy said. “We’re trying to look at all these challenges and figure out how we can make it an easier, smoother process for physicians and healthcare practitioners to prescribe it adequately, appropriately with the right regulations and guidelines.”
He said the working group of about a dozen physicians will base guidelines on the research that does exist showing both the medicinal benefits and potential risks of using marijuana. Additionally, Douaihy said he wants to see robust training for physicians on how to prevent diversion, which is when a patient sells or gives a prescription to another person for whom it wasn’t intended.
Douaihy said UPMC will likely base its own prescribing guidelines on whatever comes out of the state working group. But he admitted that before the system goes live in late 2017 or early 2018, it will be impossible to anticipate every potential outcome or unintended consequence.
“Obviously there are a lot of factors that are totally unfamiliar to us,” he said. “It’s new territory.”
*While the term “prescribe” is often used interchangeably with the term “recommend” in casual conversation, they have different legal meanings according to the federal government. Doctors can lose their federal prescribing privileges if they are found to prescribe illegal narcotics such as marijuana. However, a 2000 federal court case upheld doctors’ rights to recommend medical marijuana.
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