If you ask Dr. John Metcalf a question about medical marijuana, buckle in—you’re in for a 100 mile-a-minute ride with dips and turns that might leave your head spinning.
But the 67-year-old, recently retired physician turned medical marijuana doctor doesn’t mean to confuse.
“I’m just passionate about this stuff,” he said recently in a dimly lit rented space in a Monroeville chiropractic office as he waited for his first of 10 patients of the day.
“When I first started certifying patients, I would give them a speech about it, and half way in, you could see their eyes sorta glaze over,” Metcalf said, laughing. “Now, I just try to go over the highlights and then allow them to ask questions.”
Metcalf, who retired in January 2017 after a nearly 30-year career in primary care, urgent care and occupational medicine, certifies patients as eligible for the purchase of medical marijuana. He personifies the eagerness of a nascent industry to expand.
According to the state Department of Health, 433 of the state’s 58,000 physicians as of March had undergone the required four-hour training to become medical marijuana doctors. Now, 716 physicians have done so. Certified doctors verify that patients meet the eligibility requirements to use medical marijuana, a step required by the state to get a medical marijuana card.
For Metcalf, the process involves verifying a patient’s identification by looking at a driver’s license or other form of government-issued ID. He reviews the patient’s medical history to verify the patient has one or more of the 21 qualifying medical conditions, which include Lou Gehrig’s, Huntington’s and Parkinson’s disease, autism, cancer and PTSD.
He also reviews the state’s Prescription Drug Monitoring Program, which reveals a patient’s prescription drug history.
“Then I let them ask questions and I give them a quick speech about medical marijuana,” Metcalf said. The process, he said, takes about 30 minutes.
About 37,000 patients have registered for the state’s medical cannabis program, according to the state, with about 15,000 certified by physicians as eligible.
Medical marijuana became legal in Pennsylvania in April 2016.
John DeFlavio, 33, of Penn Hills was Metcalf’s first patient one recent rainy morning in Monroeville. DeFlavio was recovering from an opiate addiction by taking methadone. DeFlavio said he wanted to use medical cannabis to wean off the opioid. He said he’s already used pot for some time.
“I use (marijuana) for relaxation and meditation in the mornings. And so sometimes I forget to dose,” DeFlavio told Metcalf, referring to his daily prescribed dose of methadone.
Metcalf said there are different strands of medical cannabis DeFlavio can use to help get off methadone, which, he said, is another narcotic that is linked to thousands of overdose deaths.
Instead of getting his pot off the street, where it’s a “roll of the dice” of what might be laced in it, DeFlavio can be sure that the medical marijuana will work to reduce his opioid dependency, Metcalf said.
The state-issued card would be available in about five days in the mail, he added.
DeFlavio’s 10 a.m. appointment ended 25 minutes later with a smile from the doctor and a firm handshake.
The state issued permits for 27 dispensaries and 12 grower processors earlier this year. In March, it announced it would issue permits for 23 new dispensaries and 13 additional growers. Each dispensary can have up to three locations, making it possible for 150 to operate in the state.
More forms of the drug are becoming available to patients, too.
The state’s health secretary, Dr. Rachel Levine, approved a recommendation in April from the state Medical Marijuana Advisory Board to allow dispensaries to sell dry leaf marijuana to certified patients starting this summer for vaporization. State law prohibits the smoking of medical cannabis.
Before the move, the drug was only available in capsules, ointments, tinctures and oils.
Levine also allowed cannabis to be used as a treatment for opiate abuse and added four qualifying medical conditions to bring the total from 17 to 21.
“A lot of things are changing,” Metcalf said, which is one reason he has a lot to say when someone asks him about it.
Another reason, he said, is personal. He diagnosed himself with pre-diabetes, or metabolic syndrome, a couple years ago.
The doctor never used medical marijuana to treat his symptoms. Instead, he said, he changed his lifestyle by tweaking his diet and he exercised regularly.
As a result, he said, he is no longer pre-diabetic – but he was left with a fascination with medical cannabis, “because it’s a simple herbal supplement, and it became obvious to me that it could be used for many ailments.”
Metcalf received his Ph.D. in medical sociology from Provo, Utah’s Brigham Young University in 1981. After interning at a hospital in Salt Lake City, he realized he wanted to study medicine. So he enrolled in the medical program at Mexico’s Autonomous University of Juarez and graduated in 1986. He did his residency at St. Francis Medical Center in Lawrenceville, which closed in 2002 to become Children’s Hospital of Pittsburgh.
The state gave eight Pennsylvania medical schools the nod in May to research cannabis. Metcalf hopes this leads to more physicians becoming medical marijuana certifiers.
“I like being part of the movement,” Metcalf said. “They’re making it easier for patients to have healthier lifestyles,” he said.