Louisiana’s nine future medical marijuana dispensaries have been selected. The two grow sites, managed by LSU and Southern University, are preparing to start growing and processing the drug by next February at the latest.
Legislators have been focused on the issue, too. Two bills are making their way through the Legislature that would potentially expand the number of medical marijuana patients.
But after all these preparations are made, will there be doctors for medical marijuana patients to go to?
Despite the interest in Louisiana’s budding new industry, the number of doctors that actually have been licensed to recommend medical marijuana lingers at 10, according to the Louisiana State Board of Medical Examiners which approves the therapeutic marijuana license. Only 15 have applied. Federal regulations could also limit the growth of physician participation by the time Louisiana’s medical marijuana program is up and running.
“I am really worried about the lack of medical support so far,” said Jacob Irving, a law student from Baton Rouge living with congenital spastic quadriplegia. He has been a vocal advocate of Louisiana’s medical marijuana program since its inception, testifying in favor of the bills being considered that would expand the use of the drug for patients with chronic pain, glaucoma, post-traumatic stress disorder and severe autism.
Louisiana is one of 29 states plus Washington D.C. that have legalized comprehensive medical marijuana programs, according to the National Conference of State Legislatures. Louisiana passed its law in 2016 allowing the use of medicinal marijuana for people with cancer, a severe form of cerebral palsy, epilepsy, muscular dystrophy, HIV/AIDS, and other specific diseases. It can only be sold in oils, topical creams, and sprays and cannot be sold in a form that can be smoked.
But just because a state legalizes medical marijuana doesn’t mean that physicians will necessarily recommend the drug to their patients. In 2016 the Drug Enforcement Administration announced it was not loosening restrictions on marijuana, keeping it in the same regulatory category as heroin – schedule 1.
In order for the DEA to change its classification, scientific research needs to prove that the plant has medicinal value. However, the federal restriction makes it difficult to conduct that research.
A “prescription” for medical marijuana is illegal under federal law because Marijuana is a controlled substance. However, in states where medical marijuana is legal doctors can “recommend” or “certify” that a patient has a qualifying condition and could benefit from the drug, Irving explained.
“It’s not a prescription so they can’t specify a dose under federal law. It could be a reason why physicians are scared of signing up,” he said.
So, although the state has legalized the production, sale and use of medical marijuana for specific medical purposes, many health providers are wary of jumping in before it becomes legal at the federal level.
These rules also restrict training and research on marijuana for its medicinal benefits.
Dr. Peter Winsauer, a professor of pharmacology at LSU Health New Orleans School of Medicine, is required to have a Schedule 1 license from the DEA to research the illicit effects of marijuana, which he has been doing for 30 years.
“We are taught to be scientific as possible–the door is opening to a drug we don’t know enough about,” he said. “The federal government isn’t making it any easier to help us conduct this research.”
Going from studying a drug for its illicit effects to studying it for its medicinal benefits represents a huge paradigm shift, he said.
Ochsner Health System will not comment on whether or not it will allow its physicians to get licensed to recommend medical marijuana, or if Ochsner has set up guidelines on how this should be done. A spokesperson for LCMC Health System said their system has not set up guidelines for doctors who wish to register to recommend the drug to patients, but “doctors that work in LCMC hospitals and clinic can apply for the permits if they wish.”
East Jefferson General Hospital has taken a similar stance.
“At this time, we don’t have a specific policy regarding this. And, like any other legal medicine, we don’t dictate what independent physicians prescribe in a clinic setting,” said a spokesperson for the hospital.
Tulane Medical Center is also being cautious before jumping in.
“As this is a new area of medical practice in Louisiana, we are studying the ramifications but have not yet come to a determination on policy,” said a spokesperson for Tulane University.
Among Federally Qualified Community Health Centers, the divide between state and federal regulations on marijuana could also limit the number of participating physicians. FQHC’s are outpatient clinics that qualify for specific reimbursement systems under Medicare and Medicaid.
Federal law prohibits a health center from prescribing or dispensing medical marijuana, according to a sample policy distributed by the National Association of Community Health Centers in July 2017.
FQHC’s receive federal grants and are required to publish a statement notifying employees that the “manufacture, distribution, dispensation, possession or use of a controlled substance” is prohibited under the Drug-Free Workplace Act of 1988.
Violating this law could result in a clinic losing grant funding and a ban on future federal contracts for up to five years, according to the document.
Low physician participation rates in medical marijuana programs have been reported in many other states. In November 2016, only 1 percent of the 16,000 doctors who treat patients in Maryland had signed up for the state’s program, according to a report in the Baltimore Sun. New Jersey legalized the program in 2010, but seven years later fewer than 2 percent of that state’s licensed doctors were participating, according to the Henry Kaiser Foundation and Marijuana Policy.
To get his therapeutic marijuana license Dr. Victor Chou, a physician based in Baton Rouge, left his job at an urgent care center. He is one of the 10 physicians who have been licensed so far to recommend medical marijuana in Louisiana.
“There is no way I could work with urgent care and do this. Big institutions don’t want to lose their licenses–they don’t want to touch this,” he said.
Although it will be several months before the dispensaries open, Chou is in the process of setting up a private practice where he will specifically focus on working with medical marijuana patients. So far, he has completed 35 hours of continuing medical education on medical marijuana.
Doctors who are licensed to recommend medical marijuana are only allowed to work with 100 medical marijuana patients at a time. Patients are also required to visit the doctor after three months, where they will determine whether or not they should continue taking the drug.
“I felt that this is a valuable service and patients can benefit from this,” Chou said. “I see this as a chance to be a pioneer in an industry that is going to keep growing.”