News » Cover Stories

Many Arkansas docs say no to medical marijuana

The legal pot industry is budding, but doctors are declining to OK forms for users.

by

11 comments
NEW ARKANSAN: Erich Laufer, shown here with wife Angela and daughter Acelyn, moved to Bull Shoals so he could legally treat his cancer pain.
  • NEW ARKANSAN: Erich Laufer, shown here with wife Angela and daughter Acelyn, moved to Bull Shoals so he could legally treat his cancer pain.

Erich Laufer has cancer, but he considers himself a lucky man. He was able to get a doctor, Dr. Dane Flippin of Jonesboro, to certify for the state Department of Health that he has a medical condition that makes him eligible for medical marijuana.

The $250 he was charged by the doctor wasn't off-putting. Laufer, who moved to Arkansas from Wisconsin because of the state's legalization of medical marijuana, said he'd taken far more expensive drugs to treat the back pain and leg spasms his cancer causes.

But, according to people who contacted the Arkansas Times and medical marijuana supporter Melissa Fults, the $250 fee — which is the standard charge — is just too much, given that the patient must also pay $50 to the state to obtain a Medical Marijuana Registry Identification card based on the information provided by the doctor, and recertification must be done yearly, if not more frequently. Even if they can afford the fee, it's not a certainty they can find a doctor who'll agree to sign the form.

Nancy Young, 51, of Hot Springs is one of those people having difficulty on both counts. She's on disability for post-traumatic stress disorder and other medical problems. Her psychiatrist in Little Rock would not sign the Medical Marijuana Physician Written Certification form; his group, Psychiatric Associates of Arkansas, had voted not to sign.

Here's why: "Medical marijuana is baloney," Psychiatric Associates' Dr. Richard Owings said. "And the people who advocate for it know that." The medical group's Facebook page includes a link to a Reuters Health story that says there's little evidence that marijuana alleviates pain or helps with PTSD.

Not surprisingly, Fults and users of marijuana who've gotten relief would disagree that medical marijuana is "baloney," and want more doctors to help their patients obtain the drug by consenting to sign the form.

By signing, doctors verify they are licensed as medical doctors or osteopaths and that their patient has one or more of the 18 qualifying medical conditions listed on the form. The form is not a prescription, nor does it require the doctor to recommend medical marijuana as be appropriate for the condition, though an earlier version of the form would have. (The legislature amended that language out.) Doctors do not have to have had a previous relationship with a patient seeking certification, but must review the patient's records to be able to attest to the fact that the patient has a qualifying condition. Qualifying diagnoses are cancer, glaucoma, HIV/AIDS, Hepatitis C, amyotrophic lateral sclerosis (Lou Gehrig's disease), Tourette's syndrome, Crohn's disease, ulcerative colitis, PTSD, severe arthritis, fibromyalgia, Alzheimer's disease, cachexia (wasting), peripheral neuropathy, intractable pain that does not respond to ordinary medications or treatments for more than six months, severe nausea, seizures and severe and persistent muscle spasm, such as those characteristic of multiple sclerosis and others.

With the exception of Owings and another doctor who would only speak on condition of anonymity, doctors who aren't signing the forms aren't taking calls from the press inquiring why, either. Most specialists in rheumatology, ophthalmology, gastroenterology and cancer contacted by the Times declined to comment. One oncologist told the Times he was going to be extremely careful, that it would not be a first course of treatment, and that's all he wanted to say besides, "Good luck with your story."

The doctor who asked his name not be used said the forms were tantamount to giving a prescription for a substance that he says doctors have little experience with. "I don't want to be monitored by the government," the doctor said. "Also, we have so much to deal with as it is, with regulations, I don't want to add a headache to everyday busy life."

The doctor acknowledged that marijuana may alleviate nausea and stimulate appetite in patients who might otherwise waste, but said there are "better treatments with a scientific basis."

Most of the doctors who are certifying patients are family practice and general practice doctors, and many of them are in Northwest Arkansas, though a list on the Arkansas Cannabis Industry Association website and information supplied by patients shows willing doctors cast all over Arkansas. There is one doctor in each of the following cities: Little Rock, Benton, Van Buren, Crossett, Jonesboro, Paragould, Blytheville, Ashdown, Eureka Springs, Bentonville, Fort Smith, Fayetteville and Mountain Home. Springdale has three. (The concentration in Northwest Arkansas likely reflects the retirement community there, though a cynic might wonder if it's in anticipation of a number of University of Arkansas students beginning to complain of pain or stomach woes.) That does not mean that there are only 16 doctors certifying patients in Arkansas, but few physicians are openly advertising that they will sign the certification forms. As of Sept. 2, 863 applications for cards had been approved, according to the health department, which at one point said it expected 30,000.

Fults, who works with the Drug Policy Education Group and describes herself as a "62-year-old grandma goat farmer," is distressed by the lack of participation by the state's physicians. "We worked so hard trying not to label people as pot doctors," but that's what has happened, she said.

Fults figures some doctors are worried about not being reimbursed by insurance for the service, but suggests those that are could sign the forms during physicals and other checkups, which insurance will cover.

"Say you are my doctor and have been for the last 10 years, you know everything about my medical history. ... So if you won't write a certificate, I have to get a copy of my medical records, and then go to someone I know nothing about, never met and won't see again until next year. To me that creates a problem, because you have a relationship with your doctor. You will not have a relationship with Dr. Tammy."

Fults was referring to Dr. Tammy Hale Post, D.O., who, thanks to videos on Facebook and the cannabis industry website and through public relations firm outreach, is perhaps the best known doctor in Arkansas who advocates for marijuana and will sign certifications for the state's medical marijuana cards.

Post charges $287 to patients who come to her seeking verification of their eligible illnesses. She gives a discount to veterans and low-income patients. Unlike many doctors, Post's practice is all cash. Doctors affiliated with insurance companies can't bill for the visit, since marijuana is still illegal. The federal Drug Enforcement Agency classifies it as a Schedule 1 illegal substance, along with heroin and other drugs.

"I think a lot of doctors don't understand" that by signing the form they are neither prescribing marijuana nor advocating its use, Post said. The Springdale doctor, who is writing a book on medical marijuana, noted that the plant has been used "since the dawn of time" as a medicine.

A native of Mountain Home, Post said she did not use pot growing up; she believed it to be a gateway drug. "I was totally against it." But she began to be "passionate" about the drug because of benefits she believes it offers for the treatment of seizures. "My father had a brain tumor that caused a seizure disorder. ... He would have 300 [seizures] a day; his life was controlled by them." His medicines not only did not control the seizures, she said, their side effect was bone cancer. He died when she was 19. She doesn't know if it could have helped her father, but it spurred her to study the plant.

LECTURER ON MARIJUANA: Dr. Tammy Hale Post has made several videos on topics related to medical marijuna, including the one shown here in a capture from her Facebook page: jobs that will be created by the industry.
  • LECTURER ON MARIJUANA: Dr. Tammy Hale Post has made several videos on topics related to medical marijuna, including the one shown here in a capture from her Facebook page: jobs that will be created by the industry.

Medical marijuana is not without its risks, she said, because it can cause mood changes, "but it should not be demonized. ... I have become a real advocate. ... I really believe we should look at this — or at least be open-minded."

Post said she has signed over 200 forms. Her patients know it works, she said, because they have been using marijuana. "So many patients have told me so many stories about how it's changed the quality of their lives." She believes marijuana extracts have "huge potential" for pain, depression and Alzheimer's. (Depression is not a qualifying condition, but the Drug Policy Education Group would like that illness, along with anxiety, autism, Lupus, anorexia, migraines, Parkinson's and others, added to the list.)

Dr. Archie Hearne, a family medicine doctor in Little Rock who will certify patients with qualifying diagnoses, supports the use of medical marijuana "under limited circumstances." He said he has talked to colleagues in California and asked if the availability of marijuana had changed people's behavior. "They say things are no different than from before. There are people who use pot and people who don't."

But Hearne says the system is not perfect. He questions some of the clinical indicators on the list, like HIV. "HIV can be asymptomatic," he said, so what would the medical marijuana be treating? He said marijuana's appetite stimulation would be contraindicated in people with diabetes, and that people with pulmonary disease must not smoke the drug. Too, he said, "I don't know that it's a great analgesic," though it may help conditions related to pain, like anxiety. "Whoever is deciding to put [those illnesses] on the list has taken it on themselves" to define them as conditions that can be helped by marijuana, he said.

Hearne would like to see Little Rock pass an ordinance that would ban the use of marijuana in public, though state law already prohibits its use in "any public place where an individual could reasonably be expected to be observed by others." Restricting its use to a private residence and away from children would keep young people from being influenced, mentally and physically, he said. (A study in the scientific journal Substance Abuse and Misuse that compared results of school-age health surveys from before and after the legalization of recreational marijuana found no difference in marijuana use, but children were more aware of the ease of access to the drug.)

DR. ARCHIE HEARNE: He has certain concerns, but will certify patients if his review of their medical records indicates eligibility.
  • DR. ARCHIE HEARNE: He has certain concerns, but will certify patients if his review of their medical records indicates eligibility.

Another concern of Hearne's is dosage. Dispensaries "are going to provide a quantity of marijuana" subject to no scientific evaluation as to efficacy, though the state law does require testing for amounts of cannabinoids in the products. "Any drug I give you has been studied, approved, its pharmacology is well defined, and I know exactly how much to use. There's a science as to quantity. It's a big issue with me," he said.

Hearne has signed 15 or so forms, he said. He expects that once the state actually begins to issue the cards — one month before the medical marijuana dispensaries open, likely in spring 2018 — he'll see 10 requests a week.

Medicinal marijuana can be prepared in a variety of ways. CBD, or cannabidiol, is the agent that acts on seizures and anxiety disorders, pharmacist Josh Winningham said. Extracts containing THC (tetrahydrocannabinol) are used for pain. CBD does not cause euphoria; THC does. It is, as Post put it, "catnip for humans," acting on the brain's cannabinoid receptors.

Dispensaries will be required to affiliate with pharmacists. Winningham, who is based in Cabot and has the OK of his employer to move into medical marijuana consulting, said he is already working with applicants for dispensary licenses. He'll train dispensary staff in what forms of medical marijuana are best for what conditions. If someone who has never used cannabis comes to a dispensary, or is taking other medications, the staff should consult with their pharmacist, Winningham said.

Dispensary applicants get extra merit points for having a working relationship with a pharmacist at the time of application. So far, the Alcohol Control Board has received five applications for licensure by dispensaries and two by growers, Department of Finance and Administration spokesman Scott Hardin said last week. Up to 32 dispensary licenses will be issued, four in each of the eight regions created by the Arkansas Medical Marijuana Commission. Application deadline for both dispensaries and growers is Sept. 18. Hardin said the state Freedom of Information Act exempts the applications from public release until after the commission has reviewed and voted on the licenses to be awarded.

"There are disease states that [marijuana] is effective for," Winningham said. "The research is hard to come by because it's a Schedule 1, but you can find evidence that it does have health benefits. Coming from a science background, I was able to find stuff that showed to me the efficacy of the program. I am excited about the program. A lot of people are going to get a lot of benefit, those that have run out of traditional options."

***

Erich Laufer, 33, formerly of Fond du Lac, Wis., and now living in Bull Shoals, was born with a rare condition called myxopapillary ependymoma, or spinal tumors. When he was in his teens, the tumors began to swell. He recalls sitting at a football game and suddenly getting hit with intense pain and the loss of sensation in his legs. "I had to crawl to the emergency room," he said. He had surgery, but 10 years later, the tumors came back. He had more surgery, radiation and chemotherapy. This time, the treatment reduced, but did not eliminate, the tumors. "The hospital had me on morphine and oxycontin. I came out of that hospital and two months later I was addicted to those pills. I quit cold turkey — a bad idea. I was puking and shaking. It's a terrible way of life, to take a pill to cure pain." The drugs made him "high as a kite" and constipated. They killed his appetite and quality of life.

Laufer reached out to an old friend from high school. He told him he didn't want to be high; he just wanted relief from his leg and back spasms. "So I started self-medicating."

First he bought marijuana. Then his mother, a gardener, started growing plants in her basement for him. "She took the risk. It was a game changer. I didn't have to deal with people in the street."

But Laufer didn't want to put his family — he has a wife and two little girls — in jeopardy, and he wanted to set a good example for his children, and he began considering a move to a state where he could obtain marijuana legally.

When he learned that Arkansas had legalized medicinal marijuana, "I said, 'What? You gotta be kidding me.' "

Arkansas was perfect: Laufer's grandmother owned a home at Bull Shoals that the family could move into. Laufer and family came to Arkansas a month ago.

Laufer got his certification from Arkansas Progressive Medicine in Jonesboro, Dr. Dane Flippin's practice; he found Flippin on marijuanadoctors.com. Laufer had his records sent to Flippin from the Wisconsin cancer center where he'd been treated, got an Arkansas driver's license and went to his appointment. He showed Flippin a video of his leg spasms. "I told him I'd been on pretty much every painkiller under the sun and I had found the perfect medicine for me and this is it." Laufer said he'd paid $500 a month for one drug, so the $250 charge was fine with him. "I understand it's a business. I don't think [the office visit] was overly priced."

***

That marijuana can let people stop using opioids is one reason Dr. Roger Tilley of Benton is agreeing to sign the certification forms. "I feel like if it's available for these people that are in pain and it's another treatment modality they can use, I'd much rather they use something like this than the hydrocodones or oxycodones they're starting to use."

Tilley, 63, said the number of forms he'd signed were "in the double digits." He said he tells people who come to him with the forms that he does not want to take them away from their regular doctors, but he will work with them on medical marijuana certification. Most of the people who've come to him have lumbar disease — back pain caused by degenerative discs, etc., Tilley said. He's also seen some veterans with PTSD. (Veterans Administration hospitals are not allowing their doctors, who are federal employees, to certify their patients.) "So far, everybody seems to be legit," he said.

"I don't use the stuff," Tilley, who has been in practice in Benton since 1980, said. "But we allow alcohol, and marijuana has some benefit medically for patients. The way the trend is going, it's probably going to be legal [nationally]." He also thinks access to doctors will increase.

The forms require doctors to indicate how long the certification for a card is good: Patients must be recertified after 12 months, but doctors can require recertification after months or weeks. Hearne said he's signed some for three months only. If someone has nausea, he said, it could go away; there's no need for a 12-month card. "When we limit, we are actually practicing a little medicine," he noted, since the doctor is making a decision on how long the patient may need his registry card.

The doctor who would only speak to the Times anonymously believes the state should shoulder the burden of certification.

"The state should be the ones to review our charts and make the decision so we don't have the liability. That makes more sense. It's not a standard treatment."

WILL TRAIN DISPENSARY WORKERS: Pharmacist Josh Winningham is already working with dispensary applicants.
  • WILL TRAIN DISPENSARY WORKERS: Pharmacist Josh Winningham is already working with dispensary applicants.

As far as the state is concerned, Kevin O'Dwyer, counsel for the Arkansas Medical Board, doctors incur no liability by signing the forms. He said he could not speak for the DEA, however.

Nancy Young, the woman with PTSD whose psychiatrist wouldn't sign a certification, said that because she doesn't have the financial ability to pay a doctor $250 for a visit and the state is not yet issuing cards, she's not in a hurry. She'll try again when "everything gets set up."

Growers will have to build and outfit their facilities and it takes at least three months to grow a flowering marijuana plant, and none of that can start until after the state awards licenses, which would be October at the earliest.

The cards will be issued one month before medical marijuana becomes available, according to the health department, and will be good for a year, or whatever term was indicated on the form by the certifying physician, at issuance.

Another would-be card holder, who would only identify himself as "Mike" and who lives in Conway, said a Little Rock doctor who treats his rheumatoid arthritis had declined to sign the certification form, and the Conway doctor who is signing forms — Dr. Betsy Hendricks — required a $100 deposit; he feared he might pay the $100 and then get turned down for the certification. (Hendricks had not returned a call for comment by press time.)

Mike gets infusion therapy every six weeks for his RA and is looking at a knee replacement "in the not-too- distant future, and I'm sure that as the pain gets worse, they're going to say, 'Take this, take that.' I don't want to run the risk of getting addicted to the opioids, so I would be more likely to suffer than to take the heavy-duty painkillers." But he's not sure medical marijuana is the answer. "I'm kind of the opinion that it may not do any good. ... But if it makes you feel better, you shouldn't risk going to jail for it." And that's really why he would think about getting a card. "Being bullheaded, I want the card and I want to carry it around with me and say 'nanny nanny' to a society that has long allowed an intoxicant like alcohol but has denied people the use of cannabis.


Comments (11)

Showing 1-11 of 11

Add a comment
 

Add a comment

Clicky