D.C. Council approves medical marijuana, posing challenges for doctors

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The exact dosage and means of delivery -- as well as the sometimes perplexing process of obtaining a drug that remains illegal under federal law -- will be left largely up to the patient. And that, Chopra said, upends the way doctors are used to dispensing medication, giving the strait-laced medical establishment a whiff of the freewheeling world of weed.

Even in states that allow for marijuana's medical use, doctors cannot write prescriptions for it because of the drug's status as an illegal substance. Physicians can only recommend it. And they have no control over the quality of the drug their patients acquire.

The District's measure, like those elsewhere, specifies certain conditions and illnesses that qualify for medical marijuana. A patient who has HIV, glaucoma, multiple sclerosis, cancer or a chronic debilitating condition will be able to receive a doctor's recommendation to possess up to four ounces in a 30-day period.

Unlike in many states, the District law would not allow patients and caregivers to grow their own marijuana, at least initially; an advisory committee would later decide whether to permit cultivation. Until then, patients could only acquire the drug illegally or from five to eight government-regulated dispensaries.

Under Michigan's law, all 200 of Sandro Cinti's HIV patients at his University of Michigan clinic would qualify for marijuana. But in the year since the law took effect there, he has signed off on just three or four patients suffering extreme pain in their fingers and toes.

Chopra has approved the drug for five patients since Rhode Island's program began four years ago, he said. He recently turned down a request from a man in his 40s complaining of back pain. The man said he had tried chiropractors and physical therapy, but Chopra found no documented evidence. The patient then asked for a medical marijuana recommendation. Chopra refused.

Some patients decline the drug, he said, for fear of sending the wrong message. Last week, when he suggested pot to a patient after narcotics and surgery had failed to ease excruciating head and facial pain, she broke down in tears.

Her teenage son uses marijuana and she wants him to stop, she told him. " 'How am I going to look if I start taking it?' " he recalled her saying.

Some doctors describe finding themselves acting as intermediaries in families that have mixed feelings about marijuana use. Todd Handel, a Rhode Island rehabilitation specialist, recalls recommending marijuana to Chris Snow, 23, who has spina bifida and used the drug as a teenager. Yes, he would get stoned, Snow said, but pot also made the pain bearable. Only after consulting with Snow's mother and father -- a police sergeant -- did Handel recommend marijuana.

Snow, who lives with his parents, grows 12 plants -- the state's maximum allowed -- in the basement. He uses a vaporizer that heats the drug, releasing a mist that he inhales four breaths per session, two to three times a day.

His father, who did not want to be identified, said he was conflicted about his son's marijuana use initially, as was Snow's older brother, also a police officer, who moved out of the house in protest. But the father now supports the son because he is doing much better.

http://www.washingtonpost.com/wp-dyn/content/article/2010/05/04/AR2010050405305.html