Maggi O’Brien has seen the same doctor for nine years. A brain and spinal cord specialist, Dr. Kent Yundt first performed surgery on her spine in 2005. Then he inserted a tube into her brain when the pressure inside her skull increased dangerously.
All told, Yundt has performed five surgeries on O’Brien, who, at 58, is disabled and struggles with constant pain and fatigue from rheumatoid arthritis and fibromyalgia.
O’Brien, who worked as a nurse for 20 years until her health problems rendered her disabled, guesses she’s smoked marijuana for four decades: first as a typical child of the ’70s and later to ease her pain.
“I smoke pot every single day, and it makes such a difference in my life,” she said. “It’s the one thing that actually makes me feel better.”
In 2010, she decided to make it legal. She asked Yundt to sign the form that allows her to buy medical marijuana, which has been legal in Oregon since 1998. Yundt, who did not return a request for comment, declined, telling her he was afraid of getting swarmed with patients looking for weed.
Like the majority of Central Oregon’s more than 4,000 medical marijuana patients, the Redmond resident was forced to turn to high-volume specialty clinics that advertise medical marijuana approvals because many doctors refuse to sign off on their patients’ marijuana use.
For O’Brien, going around her regular doctor was expensive and lodged a barrier between her and the person who knows her and knows her medical condition.
“There is a relationship,” she said. “We have to circumvent that process to get a medicine that’s relatively harmless.”
Unless doctors work in a clinic whose policy forbids it, they can choose whether or not to sign an attending physician’s statement, the form that confirms a patient has one of the conditions that renders them eligible for the Oregon Medical Marijuana Program. Although Oregon’s medical marijuana law intended for the statements to be signed by patients’ long-term primary care providers, things haven’t shaken out that way.
In many cases, the doctors refuse out of fear they’ll be labeled a “pot doc” and flooded with patients seeking weed. There’s also a powerful stigma within the medical community that causes some doctors look down upon colleagues who sign the forms. Others simply don’t see medical marijuana as an efficacious therapy given the lack of scientific research supporting its health benefits.
In some cases, patients’ own fear of what their doctor will think drives them elsewhere, said Tom Burns, director of pharmacy programs for the Oregon Health Authority, which administers the Oregon Medical Marijuana Program. The same thing happens with HIV patients, he said.
“There are certain stigmas that still exist in medicine,” Burns said, “and the fear of a stigma sometimes causes people to want to go someplace where they think they will be treated in a more friendly and sympathetic environment.”
Road trips for weed
There are 4,071 medical marijuana patients in Deschutes, Jefferson and Crook counties, according to OHA data. Doctors with addresses in Central Oregon, however, have only signed a total of 1,772 attending physician’s statements. The latter number is misleading, as some of Central Oregon’s highest-volume marijuana approvers — doctors Brian Dossey, Andrew Dorfman and Christopher Hatlestad — are actually based elsewhere.
Still, the numbers show that most Central Oregonians seeking medical marijuana either go across the state to get approved or they see doctors who visit every now and then to sign approvals.
For the clinics specializing in marijuana — such as The Hemp & Cannabis Foundation and Mothers Against Misuse & Abuse, both of which have clinics in Bend — other doctors’ refusal to approve has been a boon to their businesses.
Dossey has more medical marijuana patients in Deschutes County than any others in the county: 405. All told, Dossey, who did not return a request for comment, has at least 2,251 medical marijuana patients spread across six counties in Oregon. Dorfman, who has 292 marijuana patients in Deschutes County, has 900 patients in seven counties. Dorfman recently moved to California and is no longer seeing patients in Oregon, but said he used to travel around the state specifically to evaluate patients’ eligibility for medical marijuana.
They’re still a far cry from the state’s top marijuana physicians. Dr. Sanjeev Sharma, whose license says he’s in Ashland, has 7,444 medical marijuana patients. Dr. Shaun Hedmann, of Portland, has 6,099 patients.
The law as it’s written does not provide the OHA recourse against doctors who clearly have built businesses around medical marijuana, despite the fact that patients may not be getting the medical care they need, Burns said.
“I’ve got one doctor here has written 6,000 of these prescriptions a year,” he said. “That’s 500 prescriptions per month. … That’s a pretty darn heavy workload, and it does give me pause for concern. Is this doctor really understanding the needs of the patient?”
Docs in the dark
Many of the physicians in Central Oregon who do approve their patients for medical marijuana do so reluctantly. And most — as evidenced by the more than a dozen physicians who declined to comment for this article — don’t want their name associated with doing so.
“I’ve been surprised and disappointed by how polarized physicians have been about it,” Dr. Christopher Hatlestad, a physician at the Center for Environmental Medicine in Portland. A longtime proponent of alternative therapies such as medical marijuana, Hatlestad is not shy about helping patients get it. He has 103 medical marijuana patients who live in Deschutes County and 430 statewide.
When primary care physicians do agree to approve their patients for medical marijuana, they’re rarely able to offer guidance with respect to how much they should take, how they should take it or how often. That’s because many doctors simply don’t have experience with the drug. Not only that, marijuana is a lot different than the blood pressure or other pharmaceutical medications they’re used to prescribing. There are many different strains with different levels of active ingredients tetrahydrocannabinol (THC) and cannabinoids (CBD), and scientific research currently doesn’t offer solid data around what levels help with what.
“It’s pretty hard for a doctor to say, ‘You want to go get a product that has 20 percent THC,’ because that might work for one person or not another,” said Burns, of the OHA. “The industry is so new and the studies are just not there to answer those types of questions.”
Dr. Keith Harrington, an urgent care physician with Mountain Medical Immediate Care in Bend, usually doesn’t give patients much instruction when he signs their marijuana approvals. Most of the patients he sees tell him they’re using it for chronic pain, and most know plenty about the drug already.
If they don’t, they’re not going to learn about it in Harrington’s office.
“Honestly, I wouldn’t be able to tell a patient how often they should be using it — three puffs versus five puffs or whatever,” said Harrington, who has six marijuana patients. “I don’t use the stuff myself, so I don’t have any personal experience on how to dose it.”
Patients usually ask Harrington to sign the forms; he said he would never suggest it unless all other options had failed. He said he views marijuana similarly to alcohol in that people use them to self-medicate, but both have serious consequences if they’re overused.
Doctors also are sensitive to being used by patients who don’t have legitimate medical conditions and simply want to get marijuana.
Hatlestad, who often sees patients in clinics designed for marijuana approvals, said he mostly sees middle-aged adults with chronic pain who they tell him they’re not interested in getting high.
“How much of what they’re telling me is so they can get through the system?” he said.
Among doctors who treat cancer patients, there is far less stigma around approving marijuana. Their patients are experiencing severe pain and side effects from chemotherapy.
“There’s absolutely no way I’m going to be taken advantage of as a doctor,” said Dr. Stephen Kornfeld, an oncologist with the St. Charles Cancer Center who has 19 marijuana patients on his roster. “I think oncologists would have no hesitation.”
Such dynamics pose difficulties for patients who are new to marijuana but feel it could ease their symptoms. Even if their primary care physician approves them, he or she probably won’t offer much advice on getting started.
Staff members at dispensaries know the products, but they’re also running a business.
“Some of them are very good, they’re nonprofit, patient-oriented businesses, but some are profit-motivated,” said Dorfman, the high-volume approver who now lives in California.
Doctors like Dorfman and Hatlestad, who work in clinics that specialize in marijuana, are often the best bet for patients looking for informed advice on using the drug. Dorfman, for example, said he suggests newbies try strains with lower THC content — the substance that products psychoactive effects — and higher CBD contents, which he’s observed to have anti-inflammatory properties. He also advises patients start with a very low dose and work their way up.
These doctors, however, are not going to see patients regularly and provide follow-up care like a primary care physician would. Dorfman said he has been working to devise physician education programs that would teach primary care physicians to talk to patients about marijuana.
“At least if there was some good physician education on good ways to use it and ways to track problems that develop on it,” Dorfman said. “If the whole thing could be made transparent, we’d have a better situation.”
If Oregon voters approve recreational marijuana in November, it’s likely to shift the dynamic of the medical program as medical patients are given the option of simply buying legal marijuana. O’Brien said she thinks people will do whatever is less expensive. Getting medical marijuana ends up costing her about $400, including the fees, doctor visits and the product itself.
“It’s going to be a simple matter of economics,” she said.
Kornfeld, the St. Charles oncologist, said he worries that if patients bypass doctors, doctors won’t be able to contradict the constant stream of baseless claims he hears supporters make about marijuana’s benefits. Lately, he’s had more and more patients asking him about marijuana’s anti-cancer properties, a claim he said is not supported by research.
“As it becomes more of a commodity, as people can sell it — people make a lot of claims about products,” he said. “It will be interesting as more and more claims are made about the health benefits, are the sellers and the advertisers going to be required to prove these benefits in order to make the claims?”
— Reporter: 541-383-0304, firstname.lastname@example.org