Nearly every major hospital in Northeast Ohio has come out against medical marijuana. Yet most have at least one doctor interested in the drug to treat everything from intractable seizures in children to end-of-life comfort for terminally ill cancer patients.
An estimated 80 percent of doctors certified to recommend marijuana in Ohio are not fully participating. Some just signed on to keep up on the regulations around the controversial drug. Concerned about drug abuse, others are turning away new patients seeking cannabinoids.
Ohio is among 23 states now permitting medical marijuana with a doctor's consent; 10 states allow recreational use. Ohio's physicians are in the common "Catch 22" of considering a new state-approved treatment beset by lingering stigmas and hindered by insurance companies and hospitals, which take their cues from federal regulators who in 1970 put marijuana, once prescribed freely a century ago, in a category of the most dangerous drugs.
With scant research, trailblazing physicians rely on the expertise of those who ventured before them, like Dr. Dustin Sulak, who founded Healer.com and led the live webinars that certified many of Ohio’s marijuana doctors, some of whom lack employer support and must look outside of Ohio to understand the drug's effects.
Emergency medicine doctor Steven Davis turned to Green Compassion Network for that expertise.
Tired of seeing patients suffer the “zombie” effect of opioids, or worse, Davis got state-certified to sign up patients for marijuana cards in August and opened an office in North Canton. Patients around a dozen major Ohio cities, including Akron, Canton, Cleveland and Columbus, are funneled to Davis’ and other doctor’s offices through GCN’s website.
Finding a doctor is only half the problem. Doctors need reliable research, which is stifled by funders who won’t touch a drug still considered illegal by federal officials.
"If we could deregulate marijuana to the point where it could be fully tested the way we do for any medication, it would be very different than this weird program of recommending in Ohio,” said Dr. Sarah Friebert, director of pediatric palliative care at Akron Children's Hospital, one of the few institutions in Ohio that lets doctors decide whether marijuana is right for chronically ill patients.
“This is a thorny subject and there is unfortunately a big stigma around medical marijuana. This became even worse after the Cleveland Clinic and University Hospitals statement” prohibiting staff doctors from participating, explained Dr. Samer Narouze, chairman of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls.
From Lake Erie to Tuscarawas County, the Akron Beacon Journal and Canton Repository could find no other large health institutions that give their doctors free range to verify patients for medical marijuana cards issued by the State of Ohio Board of Pharmacy.
Unwilling to participate
Of the 353 doctors who took the two-hour online training and became "certified to recommend" (CTR) their patients for medical marijuana, industry insiders say maybe 70 are actively taking new patients.
Many participating physicians, like Friebert, treat a very specific population, in her case, very ill children currently in the care of her pediatric hospital.
Others doctors took the $250 online course to stay informed or participate at a later date. “I took the course to better educate myself so that I can educate my patients,” said one of 39 doctors certified to recommend medical marijuana in Medina, Portage, Stark and Summit counties.
In responses to an Akron Beacon Journal survey of the 39 local doctors who are certified to recommend medical marijuana, only seven provided a phone number and address for their professional offices.
Several worried about being swamped by patients seeking marijuana for recreational or other reasons not on the state’s list of 21 eligible conditions.
“I am looking to retain my ability to prescribe medical marijuana when appropriate,” said one doctor from Canton. “However, I do not wish to be published because I would like to avoid being inundated with people seeking medical marijuana for conditions that may not be appropriate for its use.” The doctor described her training in non-opioid management of pain, which she would prioritize over medical marijuana.
Either in public statements or internal communications cited by staff doctors, hospitals that are part of Summa Health, Cleveland-based University Hospitals, Cleveland Clinic, MetroHealth, Aultman Hospital and Mercy Medical Center have blocked physicians and patients from accessing or using medical marijuana at their facilities or network offices.
"Summa Health System hospitals prohibit the use of medical marijuana within the hospitals including patients who attempt to bring marijuana as a home medication," spokesman Mike Bernstein said. "In addition, the Summa Health Medical Group prohibits its (nearly 300) physicians and other practitioners from recommending medical marijuana for patients and SummaCare will not provide coverage for medical marijuana. We will continue to monitor state and federal laws to determine if modifications to the policy are needed in the future.”
In its statement, the Cleveland Clinic says it's not permitting its doctors to recommend medical marijuana because the drug is poorly researched, treatments are not dosed and the chemical compounds and potency can vary from one dispensary to the next.
Consequently, some doctors wonder if they'll be reprimanded for simply discussing the subject with their patients. “I did obtain my CTR, but I am also hospital-employed,” said a Stark County doctor, who asked not to be named for fear he could be disciplined or fired. “My hospital has not made a decision on whether their physicians will offer marijuana CTR as an outpatient service yet. Many other physicians that have obtained their CTR are under this same dilemma. The CTR educational component is extremely valuable for all physicians regardless of whether they choose to practice or not.”
Some doctors equated their current predicament to that of colleagues reluctant to prescribe medication to treat addiction despite being educated and registered to do so with the Drug Enforcement Administration.
“I have already discussed my limitations with my patients already in practice,” a doctor said. “They all understand that it's a waiting process and boils down to hospital administration and employee contracts and legal liability issues.”
Akron Children's convened a medical marijuana committee for months before settling on an open policy.
“Unlike some of the other hospitals, Children’s recognizes that it’s still against the federal law, but in keeping an open mind and wanting to do what’s right for kids, they have not prohibited us to apply for a CTR and they permit families to use their home supply of marijuana while being treated at Akron Children’s,” Friebert said.
Friebert is one of two doctors at Akron Children's certified to recommend medical marijuana. So far, she has registered one patient and plans to recommend two more, all suffering chronic illness, including end-stage brain cancer.
"I understand that people are desperate and they see this as a be-all-end-all. I share some optimism and there is a lot that we do not know,” she said. “Medicine is an art and not a science. And I want to be on the open-minded end of that. But in my world, we are talking about some very vulnerable patients with families who are willing to do anything to help their children.”
Reach Doug Livingston at email@example.com or 330-996-3792.