“My oncologist thinks I should try medical marijuana, but he won’t give me a certification because of the group he works for.”
“I’m a hospice social worker, and one of the families I work with wants to try cannabis for their mom. But none of her doctors will certify her. What can I tell them?”
I can’t count the number of conversations I have had which included statements similar to these. In too many cases, patients in dire need of cannabis therapy are barred from accessing it. And all too often, the gatekeeper defending that barrier is a health care organization.
No doubt, these patients’ individual MDs, DOs, and nurse practitioners want to act compassionately. They want to help mitigate the suffering of their stage 3 and 4 cancer patients, their patients suffering from agitation due to Alzheimer’s. It must be immensely frustrating for these health care providers to have to say to a seriously ill patient, “You need to try this stuff because it might improve your quality of life. But I can’t help you access it.”
These denials of certification happen for many reasons. Some practitioners fear losing their DEA licenses if they “recommend” this non-FDA-approved treatment. Others may be skeptical of the plant’s efficacy, or uncomfortable recommending a therapy that puts control over dosing and titration into the patient’s hands.
But the majority of physicians who are willing to suggest cannabis, yet unwilling to write the certification, have one thing in common: They are employed by federally-funded agencies. And these agencies fear losing that valuable funding if they so much as appear to endorse the use of a Schedule I drug.
Any entity that is involved with Medicare or Medicaid must sign an agreement to comply with federal laws. This includes hospitals and the medical practices affiliated with them, plus many nursing homes and hospice care facilities. Doctors, osteopaths, and nurse practitioners who work for these agencies are discouraged, if not outright forbidden, to issue cannabis certifications.
Due to the consolidation of health care services that has taken place in Maine over the last 20 years, there are fewer and fewer independent practitioners. And so, a small percentage of independent care providers in Maine and other medical cannabis states are responsible for the majority of the certifications issued.
Too often, these providers are dismissively referred to as “pot docs.” Instead, these brave independent practitioners should be lauded for providing a service that is only necessary due to failed federal policy and fear of federal sanction on the part of consolidated organizations.
But by far the most troublesome consequence of this situation is that the most seriously ill patients in Maine often have to pay out of pocket for the certification—literally, a wallet-sized piece of paper—that allows them to legally use medical cannabis.
Most independent cannabis specialists offer reduced fees or fee waivers for those most in need. But for patients who don’t qualify for rate reduction, it can cost as much as $300 for a specialist consultation that could otherwise take place in the primary care doctor’s office (or via the hospice medical director, or during a visit to the oncologist). Visits that could, and should, be covered by health insurance for those patients who have it.
And for desperately ill patients—certainly for those in hospice care—the mere logistics of finding and then physically visiting an independent cannabis-specialist practitioner are overwhelming, even before the question of payment arises. These patients are justified to feel abandoned or betrayed by their primary care physicians, their specialists, their hospice medical directors, when they hear those health care providers say, “You should definitely try cannabis. But I can’t help make it legal for you to do so.”
Current federal policy on cannabis is a failure in many ways. One of the cruelest aspects of this failure is the barrier it places between a plant and the suffering and dying people whose quality of life that plant could improve, even in states where medical use is technically “legal.”
Source: BDN Cannabis