Some health care providers en­ter­ing mar­i­juana busi­ness

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - DAN HOLTMEYER

Med­i­cal pro­fes­sion­als across Arkansas are join­ing the state’s bud­ding med­i­cal mar­i­juana busi­ness, though many health care providers re­main am­biva­lent or are op­posed to par­tic­i­pat­ing.

Med­i­cal mar­i­juana isn’t yet legally avail­able in Arkansas, and the first dis­pen­saries or cul­ti­va­tion fa­cil­i­ties could be months away from open­ing. But Arkansans are ap­ply­ing to be able to use the sub­stance, with al­most 300 ap­proved as of Fri­day, ac­cord­ing to the state Health Depart­ment. Sev­eral physi­cians and at least one phar­ma­cist are tak­ing up their roles in the med­i­cal mar­i­juana process as well.

“I see it as le­git­i­mate health care,” said Dr. John House with the Eureka Springs Fam­ily Clinic, who has re­cently cer­ti­fied sev­eral pa­tients to use med­i­cal mar­i­juana. “There’s been pain, HIV, can­cer, a cou­ple peo­ple with Parkin­son’s who have spasms.”

Arkansas vot­ers ap­proved a con­sti­tu­tional amend­ment al­low­ing mar­i­juana use for 18 con­di­tions and symp­toms. The state is now tak­ing ap­pli­ca­tions for pa­tients and busi­nesses.

Pa­tients’ physi­cians must cer­tify their pa­tients have at least one of the qual­i­fy­ing con­di­tions, but the cer­ti­fi­ca­tion doesn’t en­dorse or pre­scribe the sub­stance. A phar­ma­cist con­sul­tant un­der state law must also be on hand at dis­pen­saries to help en­sure the mar­i­juana doesn’t in­ter­act with other med­i­ca­tions or get mis­used.

A DI­VIDED PRO­FES­SION

Thou­sands of stud­ies in the past two decades have found ev­i­dence that mar­i­juana or in­di­vid­ual com­pounds in the plant pro­vide re­lief from pain, mus­cle spasms as­so­ci­ated with mul­ti­ple scle­ro­sis and nau­sea in­duced by che­mother­apy, an anal­y­sis from the Na­tional Acad­e­mies of Sciences, En­gi­neer­ing and Medicine con­cluded ear­lier this year.

On the other hand, re­search also has found mar­i­juana use can im­pair learn­ing and at­ten­tion and in­crease the risk of de­vel­op­ing some men­tal health dis­or­ders and of be­ing in a car ac­ci­dent, ac­cord­ing to the anal­y­sis.

Sev­eral doc­tors and med­i­cal or­ga­ni­za­tions pointed to how much re­search nonethe­less re­mains to be done into mar­i­juana’s many com­pounds, their dosages, the ways they can be in­gested and other de­tails typ­i­cally de­ter­mined long be­fore tra­di­tional med­i­ca­tions go on the mar­ket. Mar­i­juana is il­le­gal un­der fed­eral law, and re­search into it re­quires spe­cial per­mits.

The Arkansas Med­i­cal So­ci­ety, a pro­fes­sional or­ga­ni­za­tion for physi­cians, and the state sur­geon gen­eral op­posed the mar­i­juana amend­ment, as did the Arkansas Phar­ma­cists As­so­ci­a­tion, which later fa­vored the law re­quir­ing phar­ma­cists’ in­volve­ment at dis­pen­saries.

Some physi­cians in North­west Arkansas and Lit­tle Rock have said they’d be re­luc­tant to sign off on mar­i­juana use be­cause their role es­sen­tially ends there. They can set an amount of time, up to a year, for a pa­tient’s mar­i­juana per­mit, but they can’t con­trol the par­tic­u­lar va­ri­ety of the plant or its ex­tracts the pa­tient buys, as they could with a pre­scrip­tion.

“That would make me very cau­tious about who I pur­sue this process with,” Dr. Greg Sharp, a pro­fes­sor in pe­di­atrics at the Univer­sity of Arkansas for Med­i­cal Sciences, said ear­lier this year. Sharp works with Arkansas Chil­dren’s Hos­pi­tal to re­search how a mar­i­juana-based com­pound called cannabid­iol af­fects sev­eral seizure dis­or­ders.

Other groups are re­luc­tant to pub­licly join the de­bate on any side. Mercy North­west Arkansas has said a physi­cian’s de­ci­sion to cer­tify a qual­i­fy­ing pa­tient is be­tween them, as with any other treat­ment. Wash­ing­ton Re­gional Med­i­cal Cen­ter and North­west Health spokes­peo­ple didn’t re­spond to emailed re­quests for com­ment last week.

“As long as our physi­cians are com­ply­ing with the law as it stands and they’re in good stand­ing with the state med­i­cal board, that’s what mat­ters,” said Fra­zier Ed­wards, ex­ec­u­tive di­rec­tor of the Arkansas Os­teo­pathic Med­i­cal As­so­ci­a­tion.

Nonethe­less, House in Eureka Springs and other physi­cians are jump­ing in. The Arkansas Cannabis In­dus­try As­so­ci­a­tion is com­pil­ing a list of doc­tors will­ing to sign the cer­ti­fi­ca­tions. Six are on the list so far, in­clud­ing House.

Dr. Tammy Post, an­other on the list, has a lo­ca­tion in Spring­dale. A com­pany called the Fort Smith Med­i­cal Group is also in­cluded. Nei­ther re­turned phone mes­sages last week ask­ing for com­ment.

“We’re get­ting a lot of calls and emails from peo­ple who just don’t know who to go to,” said Storm Nolan, the cannabis as­so­ci­a­tion’s pres­i­dent. “We still have an ed­u­ca­tion prob­lem in that a lot of doc­tors still think they are rec­om­mend­ing cannabis to treat th­ese con­di­tions.”

The orig­i­nal amend­ment ap­proved by vot­ers re­quired physi­cians to weigh the po­ten­tial ben­e­fits and risks of mar­i­juana use in their cer­ti­fi­ca­tions, but the leg­is­la­ture struck that re­quire­ment this year.

Melissa Fults with the Drug Pol­icy Ed­u­ca­tion Group, an Arkansas group that sup­ported the amend­ment, called it a “tragedy” if fam­ily doc­tors won’t sign cer­ti­fi­ca­tions for long-time pa­tients.

“Th­ese are very ill pa­tients, and they are fi­nally hav­ing the op­por­tu­nity to get this medicine that we fought so hard to get,” she said.

SET­TING UP SHOP

House isn’t tak­ing new pa­tients, so his cer­ti­fi­ca­tions don’t rep­re­sent a new mar­ket for his clinic. Oth­ers are fo­cus­ing specif­i­cally on mar­i­juana. A re­tir­ing col­league of House’s, Dr. Dan Bell, hopes to open a dis­pen­sary in town, for ex­am­ple.

Josh Win­ning­ham, a phar­ma­cist in Cabot, re­cently set up a com­pany that will pro­vide the re­quired phar­ma­cist con­sul­ta­tion ser­vices to sev­eral dis­pen­saries so that they won’t each have to hire a phar­ma­cist. Phy­toPharm.D will com­pile pa­tients’ med­i­cal his­to­ries, watch out for their med­i­ca­tions that mar­i­juana might am­plify or oth­er­wise af­fect, and work with the pa­tient to see if the mar­i­juana is help­ing, he said.

He’s had some reser­va­tions about mar­i­juana and said the nascent in­dus­try needs ex­perts in­volved. Last week he held in­for­ma­tion ses­sions about the law and med­i­cal pro­fes­sion­als’ roles in Fayet­teville and Lit­tle Rock for other phar­ma­cists, physi­cians and mar­i­juana en­trepreneurs.

“I re­ally felt like some­body

needed to step up,” Win­ning­ham said in an in­ter­view. “It’s hap­pen­ing in Arkansas; it’s been passed, it’s go­ing for­ward.”

Dr. Dane Flip­pin in Jones­boro took an even more en­thu­si­as­tic tack. He quit the fam­ily medicine he’d prac­ticed for 20 years and started Arkansas Pro­gres­sive Medicine in April to cer­tify qual­i­fy­ing pa­tients for mar­i­juana. More than 100 pa­tients have come in so far for vis­its for which he charges $250, he said, and busi­ness is gain­ing speed. The state charges $50 for a pa­tient’s per­mit.

Doc­tors who fo­cus mainly on mar­i­juana some­times draw ac­cu­sa­tions of be­ing preda­tory or fo­cused on money, but Flip­pin said he wants to help Arkansans while fol­low­ing state law. He goes through pa­tients’ med­i­cal his­to­ries and ail­ments and de­cides whether to cer­tify them in one visit.

“We’re not cer­ti­fy­ing ev­ery­one who comes through the door — it’s none of that crap,” he said. About half of his pa­tients haven’t used mar­i­juana in any form, re­ly­ing on tra­di­tional pain med­i­ca­tions or other treat­ments.

Ev­ery­one is dif­fer­ent and might see dif­fer­ent re­sults with mar­i­juana use, Flip­pin said, but he said, “I think a lot of peo­ple are suf­fer­ing with what’s cur­rently avail­able.”

Jack Cross, a Eureka Springs real es­tate agent, said he was one of those peo­ple. The opi­oid painkillers he used af­ter a late-stage, metastatic prostate can­cer di­ag­no­sis last year left him like “a veg­etable” in his chair with­out tak­ing away the pain.

“The can­cer was still eat­ing me up, and it hurt,” he said.

Cross re­searched che­mother­apy’s ef­fec­tive­ness and learned about oil that can be ex­tracted from mar­i­juana plants. He thought med­i­cal mar­i­juana could be a “ploy,” an ex­cuse to smoke the plant. But he tried a drop of the oil in his mouth be­fore bed.

In the morn­ing, the pain was gone. Cross cred­its God and mar­i­juana for the change and said it has al­lowed him to live nor­mally. He plans to sign up for a pa­tient per­mit and doesn’t ex­pect any re­luc­tance from his doc­tor.

“I was danc­ing on New Year’s Eve when I should have been dead,” Cross said.

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