As Medical Marijuana Regulations Take Effect, Questions Remain for Doctors, Patients

Regulations for medical marijuana in Massachusetts officially go into effect Friday. But the federally illegal drug has been legal for medical use in the state since January, after voters approved it in a ballot measure last November. Even without formal regulations in place – or any registered dispensaries in the state – one Northampton doctor has begun writing marijuana recommendations for patients.

In an unassuming office building across the street from Cooley Dickinson Hospital are a few specialty medical facilities: a chiropractor, a cancer treatment center, and a tiny sign with a pot leaf and a red arrow promising “medical marijuana evaluations.” This is the office of Dr. Jill Griffin, a former urgent care doctor. Griffin says she was not immediately sold on marijuana’s medicinal use, seeing it as an excuse for people to legally get high. After the law passed, she says patients started asking her about the drug. At first she disregarded those questions. But then she says she decided to take a chance by writing one recommendation for an elderly cancer patient.

“She was able to eat and get up and go out and go shopping, and prior to that, she had really been housebound,” says Griffin.

After that initial success, Griffin says she did more research, and decided to open her small office, exclusively for medical marijuana. For $200 a visit, she meets with patients, examines their medical records, and decides if they’re eligible. The law states that a patient must have a “debilitating medical condition,” such as cancer, Parkinson’s disease, or HIV. But under the new regulations, a doctor can determine “other” debilitating conditions that could respond to the drug. Griffin says that’s where most of her patients fall.

“Most common is chronic pain, and amongst the chronic pain, is low back pain,” says Griffin.

She says part of the reason she’s chosen to open her office is the hesitance of many primary care doctors to recommend marijuana to patients. And though Griffin says many of her patients are new to her, she maintains the required “bona-fide” relationship with them through follow up calls and visits. Alan Berkenwald is a physician at Cooley Dickinson Hospital. He says he was initially open to the idea of medical pot, but now he’s skeptical, due to the lack of scientific research.

“My fear is that our rush to embrace medical marijuana now, well in advance of thought-out studies, is an example of that phenomenon where we’re embracing a cultural belief, and trying to squeeze it into a medical application, well before the data supports it,” Berkenwald says.

Berkenwald is particularly concerned about the open-ended ability of doctors to decide what conditions qualify. But Griffin says she is careful to weed out patients who may be trying to get a recommendation just to get high.

“There are certain qualities and characteristics of those diseases that a patient should be able to explain to you,” she says, “and if that’s not there, they can’t qualify.”

She says she’s turned away several patients, but approves over 90 percent who come to her office. And she has prescribed the drug to patients with conditions that some may find dubious. Tim, one of Griffin’s patients who declined to give his last name, was given a prescription for ADD and insomnia. He says he’s now concerned about access to the drug he’s been prescribed. 

“You can’t get it if you don’t have the avenue to get it, and plus there’s so many places that are not doing the right thing. So they may be adding certain chemicals or pesticides which you definitely don’t want.”

Tim won’t say how he currently gets marijuana. Up to 35 marijuana dispensaries can open in the state. But none will likely open until the end of the year. Griffin says she’s worried about the current legal gray area for her patients.

“What I tell my patients is, you could go into a known area where people purchase marijuana, and you can legally buy the marijuana if you take your letter with you, and you can buy it, but the person selling it to you can be arrested.”

Once a patient does get their hands on the drug, they’re allowed to have up to 10 ounces every sixty days. Alan Berkenwald says that’s far too much for one person, and could result in patients selling off their excess pot – a practice known as diversion.

 “History has shown this happens, you don’t control the prescriptive narcotics, they get diverted,” saysBerkenwald. “Why would we not think that this would happen to marijuana, which has a high street value?”

Berkenwald says he hopes to see stronger regulations, limiting its use to patients with serious and terminal conditions. Griffin says for now, she’s trying to stay cautious in her practice. She hopes to see more clarification in the law and qualifying conditions, particularly because marijuana is still federally illegal. 

“I don’t want to put my license at risk, I want to have a great practice with wonderful people, and I do have wonderful patients, but that’s a little bit scary.”

Ultimately plenty of questions remain about how medical marijuana will be used and enforced in the state, but unless lawmakers make future changes to the law, the current regulations are here to stay.