Doctors' unease puts medical marijuana patients in a bind

Sarah Wellington thought she had everything squared away to register for Minnesota's medical marijuana program.

Her multiple sclerosis fit the narrow list of conditions that qualify. Her neurologist was on board with trying medical marijuana. Just check back in a month and we'll get your paperwork started with the state, she was told.

But the follow-up was a shock: Her clinic decided it doesn't want a part in the state's new program yet. Her primary care clinic doesn't, either.

"There are a lot of unanswered questions here. ... It will be a work in progress. We just have to realize that."

As Minnesota officials start signing up patients on Monday, Wellington's predicament underscores a logistical hurdle for the state and the patients hoping to get the medicine come July. For all the talk about Minnesota's medically based approach to marijuana, some hospitals, clinics and physicians are still unsure about its value as a treatment and are leery of sending clients to a medicine the federal government frowns upon. "It kind of throws it in limbo," Wellington, a St. Paul middle school teacher, said of her clinic's denial. "Now I don't know what to do."

Some health care providers are sitting out completely while others are ready to start certifying patients. But Minnesota Medical Association president-elect Dave Thorson said most are waiting to decide whether they'll play a role, hoping for answers to concerns that range from dosing and side effects to the risk of losing out on funding by violating federal law, which still bans dispensing marijuana. "There are a lot of unanswered questions here," said Thorson, a family practice physician in St. Paul. "It will be a work in progress. We just have to realize that."

Doctors won't be writing prescriptions but still play a critical role in getting Minnesota residents in the door for medical marijuana. Patients need a doctor's certification that their ailment fits the state's short list of qualifying conditions to get started.

Unease within the medical community to sign off isn't just a barrier for people like Wellington. It's a potential challenge for the state's two manufacturers, which need a healthy amount of customers to keep their businesses running.

State officials started reaching out to health care providers soon after a medical marijuana law was passed in spring 2014, explaining the ins and outs of the legislation and its tight restrictions: no plant material but pills, liquids and vapors; just eight dispensaries across the state; and only nine conditions like cancer, glaucoma and epilepsy would qualify.

Representatives from the state-approved marijuana manufacturers have stressed their operations won't hand out a baggie of marijuana, but a measurable and scientific treatment in pill jars and vials with specific dosages for different ailments. Dr. Andrew Bachman of Leafline Labs said he hopes doctors come to think of it as "nothing but boring old medicine."

"This is not California. This is not Colorado," said Dr. Kyle Kingsley, chief executive of Minnesota Medical Solutions. "I think physicians are going to buy into this when they see our process."

But Thorson said there's still not enough research on medical marijuana's efficacy in treating individual conditions to earn many physicians' approval for a patient. And even after state lawmakers added extra protections for hospitals and their employees to handle medical marijuana, health care systems are concerned about federal law and funding, Minnesota Hospital Association spokeswoman Wendy Burt said.

In Wellington's case, her neurology clinic is waiting to see how the first few months of legalized medical marijuana go before giving patients the OK. Dr. Rupert Exconde of her clinic's group, Noran Clinics, said he's optimistic they'll start certifying some patients by the end of the year.

"It takes a lot of patient exposure before we see the problems," he said. "We're treating it like a new drug that came out of the market."

That hesitance puts Wellington in a frustrating spot that prompts larger questions about the future of Minnesota's medical marijuana program. After trying countless remedies for multiple sclerosis, should she seek out a new clinic that will give her the OK to try a drug she hopes will finally work? And will others in her shoes do the same, creating 'pill mills' for patients to access medical marijuana?

"I'm going to spend the next four weeks doctor shopping?" she asked incredulously. "That's not the way health care should work."