Jeff G.* is a Columbus, Ohio resident who has suffered from chronic pain for about 15 years due to an incurable neurological condition called complex regional pain syndrome. His chronic pain has worsened over time despite treatments like the installation of a spinal cord stimulator designed to block pain signals from his nerves. He has been on disability for the past few years, and has been unable to work due to his pain.
“The wires in my first spinal cord stimulator broke and poked out through my skin,” he says. “I landed in the hospital with a drug-resistant staph infection and they had to do emergency surgery to pull it out. I got a newer model after that. It works better than the old one did, but it doesn’t ever completely take care of the pain. On bad days it’s like Sammy Sosa took a swing at my leg with his baseball bat. I pretty much just lie on the couch those days; I can’t sit or stand or really do anything.”
He claims his medical situation got much worse after Ohio’s crackdown on opioid pain medication.
“I had been taking Percocets for ten years. Sure, they had side effects, but the thing was, I could hold down a job when I was taking them. I could function. Now, I have to beg my doctor for gabapentin, which doesn’t work nearly as well and isn’t that safe long-term from what I’ve read. And I can’t work.”
Jeff says that after draconian legislation was passed that threatened doctors with heavy fines if they mis-prescribe opiates, his then-doctor abruptly forced him to stop taking his regular medication.
“He made me quit cold turkey. I asked him what I was supposed to do about the pain and withdrawal symptoms, and he said, ‘Well, opioid withdrawal won’t kill you.'”
It nearly did, though. He was in so much pain, and said he felt like such a burden on his family that he tried to kill himself about two months later. After spending a week in a psychiatric hospital, the social worker there got him connected to a new doctor at a low-cost clinic.
For a while, he says, things were looking up.
“My new doctor is young, and he has a really big heart. He has a lot of chronic pain patients, and he could see the toll that the opioid crackdown was taking on folks. He was excited about medical marijuana becoming legal here … he was ready to go get his certification so he could recommend it for patients who needed it. ”
But then, the clinic threatened to fire Jeff’s doctor if he pursued certification.
“I asked him why. They said that they couldn’t allow it because the clinic serves a ‘vulnerable population.’ The only thing the clinic’s rule is doing is preventing people from consuming it legally if they need to. They’re preventing people from getting access to safer cannabis. It’s not helping anyone’s health. It’s just keeping people who are already sick at-risk of using contaminated products and getting arrested.”
Patients who might benefit from cannabis products need a physician’s approval to access Ohio’s dispensaries. After I spoke with Jeff, I sent the following letter to Ohio clinics and hospitals to find out how serious the problem of physicians being forced by their employers to deny access might be:
Physician participation in Ohio’s new medical cannabis program has been extremely low so far. If this does not change, it will almost certainly present a healthcare bottleneck for patients with intractable conditions who could be aided by medical cannabis.
I’m working on an article identifying the causes of low physician participation. Most of the physicians who have thus far pursued certification are independent practitioners who are not affiliated with hospitals or healthcare service groups.
I know that your facility serves patients who are disabled due to chronic pain and other severe disorders that would make them eligible for medical marijuana recommendations.
Does your group encourage or discourage its physicians from seeking certification in Ohio’s new medical marijuana program?
If your policy is to discourage physician participation:
- What professional consequences will it levy against physicians who seek certification?
- What is the medical rationale for discouraging certification?
- Would that rationale/policy change if more peer-reviewed studies are released that indicate cannabis-derived drugs are a viable, safer alternative to opioid medications and existing epilepsy medications?
- Would that rationale/policy change if the federal government removed marijuana from the list of Schedule 1 drugs?
TriHealth, Southeast Healthcare Services, Genesis HealthCare, Inc., Oracle Pain Clinic, the University of Cincinnati Medical Center, Mount Carmel Health System, and Licking Memorial Health Systems all declined to address the questions.
Three hospitals did respond to my query, and I shared their responses with Jeff G.
Dr. Andrew Thomas, chief medical officer of The Ohio State University Wexner Medical Center, says:
“The Ohio State University Wexner Medical Center has not finalized our policies and procedures related to the medical cannabis issue. We are attempting to take a comprehensive approach to this issue including topics related to human resources, medical staff credentialing, training/education, clinical documentation and employee health in order to make sure that our policies and procedures are internally consistent across our organization. We are also beginning to have discussions with other local health systems to compare and contrast each institution’s policies. Because we have many providers in the area that work in more than one health system, we feel that having as much consistency as possible will be a benefit to our patients and our providers.”
Jeff finds the OSU response discouraging.
“They didn’t actually answer most of the questions. OSU has spent a ton of money advertising how much of a cutting-edge health care leader they are. That’s not a leadership response, is it? That’s a ‘we are waiting to see what everybody else does while we cover our butts’ response.”
The Cleveland Clinic issued this response:
“Cleveland Clinic joins most major medical centers and medical societies in opposing the legalization of marijuana. There is a significant amount of scientific literature, including short and long term studies that unequivocally show that marijuana use has both short and long term health effects on behavior and cognitive function.
“The Cleveland Clinic continues to recognize the FDA process as the current best route for evaluating and approving medications. Prescription medicines containing synthetic cannabinoids are currently available, and additional medications containing synthetic cannabinoids are currently in clinical trials. The United States Drug Enforcement Agency continues to classify marijuana as a Schedule 1 drug (substances or chemicals with no currently accepted medical use and a high potential for abuse). Under federal law marijuana cannot be knowingly or intentionally distributed, dispensed or possessed.
“The US Department of Justice marijuana enforcement policy (updated in 2013) indicates that the federal government reserves the right to challenge the regulatory structures of any states or local governments that authorize marijuana-related conduct and enforce actions against individuals, such as physicians, who may be violating federal law.”
Jeff is angered by the Cleveland Clinic’s statement.
“They do ketamine therapy! I checked that out hoping it might be something I could try to help with my pain situation, but it’s too expensive. Insurance doesn’t cover it. If they do ketamine, which has been a street drug for decades and has a ton of side effects, why not cannabis?”
Ohio Health provided this response:
“We are currently finalizing our policies related to medical marijuana. Our guiding principle throughout this process has been to let our physicians and patients decide on the treatment that is right for them. To that end, we plan to offer guidance and education to any physician on our medical staff who expresses interest in becoming a recommender to ensure they maintain state and regulatory compliance.”
“Well, that’s the best response of the three. It’s not great, still vague. But it’s more reasonable than what I was hearing before, which was people saying that Ohio Health was preventing their doctors from making recommendations.”
He hopes that doctors and health systems will come around.
“It would suck if everyone had to seek out one of those sketchy-looking pot doctors you see advertising online instead of just going to a provider they know and trust. But that doesn’t suck nearly as much as ending up trying to kill yourself because your quality of life is completely gone due to illness.”
* Jeff G.’s name has been changed because he was concerned that his clinic might refuse him care.
If you have an experience you’d like to share concerning your healthcare provider and medical cannabis, please reach out to Lucy [@] CannaHealth.org