As Medical Marijuana Program Moves Forward, Louisiana Doctors ‘Gun Shy’ About Recommending Drug

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Only a handful of doctors have become licensed to recommend medical marijuana to patients in Louisiana, raising concerns of a “bottleneck” when the drug becomes available in the coming months.

The 15 doctors who have applied for licenses in the state are shrugging off a lingering stigma associated with recommending marijuana, physicians say, especially in a conservative state that only recently authorized a narrowly tailored, highly restrictive program. As of Friday, 15 doctors had applied for the license, with 10 of them now holding active licenses, according to Louisiana Board of Medical Examiners figures.

“I think people are a little bit gun-shy, quite frankly,” said Dr. Vincent Culotta, executive director of the board.

The physician side of the marijuana industry here is shadowed by the same underlying worry faced by those in the production and distribution side: that tight state restrictions on the program will hamstring the businesses driving the nascent industry.

Those limitations include just 10 treatable medical conditions and a 100-patient limit for doctors, on top of the fact that marijuana is illegal under federal law and the potential that medical institutions doctors work for will frown on their involvement.

“It does not surprise me we have not seen more doctors lining up at this point,” said Kevin Caldwell, founder of the marijuana advocacy group CommonSenseNOLA. “(But) I do think we’re going to see more doctors getting involved.”

Dr. Stephen Jones, a family medicine physician in New Orleans, has signed up to recommend the drug but is unsure what his practice will look like once the program begins in earnest. He said he is optimistic about the program and thinks the restrictions eventually will be loosened and doctors will sign up in greater numbers as they see the program work.

“We still live in a world, especially in the South in this political landscape, where these things are kind of taboo,” Jones said. “It will eventually blow the doors off. It will just take a little time and some headaches.”

Doctors will issue “recommendations” as opposed to prescriptions, an effort to protect physicians from putting their medical licenses in jeopardy because marijuana remains illegal under federal law, although many states have legalized the drug in various iterations. The Trump administration’s position toward it is not entirely clear.

Many involved in Louisiana’s medical marijuana program expect there could be an adequate number of physicians once the program gets off the ground. Some of the physicians who have applied for the marijuana license say they could take a wait-and-see approach to how others handle medical marijuana recommendations.

Already, pharmacies in nine designated regions throughout the state received licenses earlier this month to dispense the drug. The grower partnered with the agricultural center at LSU anticipates having the plant available later this fall. An official at the Southern University Agricultural Center said its production facility will have the plant ready by February.

Meanwhile, lawmakers have introduced several bills expanding and loosening restrictions on the program. The drug is available only to people with a handful of serious conditions: cancer, HIV, AIDS, cachexia or wasting syndrome, seizure disorders, epilepsy, spasticity, Crohn’s disease, muscular dystrophy or multiple sclerosis. The drug will be available only in certain nonsmokable forms.

Caldwell said the Board of Medical Examiners rules on recommending the drug concern some doctors, who think they too closely resemble prescriptions, which are not allowed for marijuana. Caldwell and others also say the state’s marijuana pharmacies likely will band together to form a trade association, which will do advocacy work and outreach to doctors.

Industry leaders and advocates also worry that the 100-patient limit each will prevent doctors from opening the types of medical marijuana clinics that have helped define programs in other states. Doctors can apply to the state board to lift the cap on a case-by-case basis.

Despite that rule, Dr. Vincent Chou, a Baton Rouge physician, has opened what appears to be the first — and, so far, only — medical marijuana clinic in Louisiana. Chou said he created a website for the Medical Marijuana Clinic of Louisiana about a month ago and already has had 100 people contact him to see if they qualify. He has enrolled 25 for consultations.

That “overwhelming” amount of interest is cause for concern, given the relatively few doctors signing up, Chou said.

“The truth of the matter is if we don’t get more doctors who are licensed to recommend it, there will be a huge bottleneck at the beginning where patients can’t even get recommendations,” Chou said.

About 75 of the 100 people who reached out to Chou were inquiring about medical marijuana for chronic pain. Although that is not currently allowed, legislation that would expand treatments that qualify for the drug to include intractable pain is pending state Senate approval. If that passes, the doctor shortage would be even more acute, Chou said.

Chou said lifting the 100-patient cap would be a good move to loosen the restrictions and help with the anticipated shortage. But doctors also are reluctant to sign up for other reasons.

“There’s a stigma attached to getting involved in medical marijuana,” Chou said. “A lot of the big hospital institutions, they may not outright forbid their doctors from doing it, but they may frown upon it.”

Several of the doctors listed as having licenses to recommend marijuana appeared to be affiliated with Ochsner Medical Center, and another is affiliated with Our Lady of the Lake Regional Medical Center. None of the doctors responded to messages seeking comment, and Ochsner officials declined to comment on the hospital’s position or policies on medical marijuana.

Dr. Anand Roy, a longtime Lake Charles physician, has a host of questions before he will be ready to recommend the drug. He is unsure of his exposure, given that the drug is federally outlawed. He also said he thinks there should be a way to ensure patients aren’t also on opioids.

Roy said he plans to wait and see how other doctors handle it and whether there are any consequences before he begins recommending the drug.

Medical marijuana programs in places like Colorado and Maryland are generally defined by specialized clinics devoted to marijuana, said Brian Ruden, founder and CEO of the Colorado-based marijuana dispensary chain Starbuds. But the 100-patient cap in Louisiana likely will discourage doctors from opening those types of clinics.

“Louisiana needs to up that cap,” said Ruden, who also is one of the owners of the medical marijuana pharmacy licensed for the Lafayette area. “Most doctors won’t recommend marijuana because it’s federally illegal. So the doctors who are willing to do it are few and far between.”

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