PHOENIX – Just 25 doctors are responsible for allowing more than 25,000 Arizonans to legally obtain marijuana, according to a new report Friday.
State Health Director Will Humble said the evidence shows development of “certification mills” since voters approved a law in 2010 that allows those with a doctor's recommendation to obtain up to 2 1/2 ounces of marijuana every two weeks. Overall, those 25 doctors – out of more than 27,000 licensed in Arizona – are responsible for 70 percent of the recommendations issued in a one-year period.
Humble said he is troubled by the findings, but he told Capitol Media Services there may not be much he can do about it.
The health chief said it may be that all of the 36,346 recommendations issued during that one-year period are justified. But Humble said it would be better if these patients actually worked with their regular primary care physicians who are familiar with the person and can offer ongoing treatment.
He acknowledged, though, many family doctors have been reticent to recommend marijuana, possibly because they lack information about the drug. Others, said Humble, don't want to deal with what they see as an administrative hassle of certifying patients, a process different than simply writing a prescription.
That, said Humble, “pushes the patients to the certification mill physicians.”
Overall, the state found that just 472 doctors statewide had issued the more than 36,000 medical marijuana recommendations. And of that, 27,275 came from naturopaths, who make up fewer than 7 percent of all physicians in Arizona.
“It's unfair to say this is a problem with naturopaths,” Humble said. “It's a problem with about 20 to 25 naturopaths.”
And he said the interests of the legitimate patients are not being served.
“Let's face it: The certification mills are there to take the money and they never see the patient again until the year comes around and their (annual) card expires,” Humble said. “And that's not the best way for this program to operate.”
But Mason Tvert, spokesman for the Marijuana Policy Project that crafted the 2010 Arizona law, said the findings of the report should come as no surprise.
“It is not rare for physicians to specialize in specific treatments,” he said. And Tvert agreed with Humble's conclusion that some doctors are either unfamiliar with potential benefits of marijuana or choose not to issue recommendations.
“Given the many benefits of medical marijuana and the growing demand for it, it comes as little surprise that doctors are opting to specialize in it,” he said.
Humble actually had tried to craft the program to prevent the pattern found in the report.
The 2010 initiative set out the basics for operation of the medical marijuana program. That includes a “full assessment” of the patient's medical history and condition and mandates there be a “bona fide physician-patient relationship.”
But the law did not define exactly what that means, leaving it to Humble.
He used his authority to craft a rule that patients who want marijuana would have had to visited their doctor four times during the prior year before they could get the required recommendation. Humble withdrew the proposal following a storm of protest from people who said four visits are unnecessary and inappropriate.
The Health Department report does not name the doctors who made the most recommendations, and a review of records from the state Naturopathic Physicians Medical Board shows only one case where a practitioner was suspended for issuing medical marijuana certifications without having the required medical records to show the patients needed the drug.
The 2010 law lists a series of conditions for which a doctor can recommend marijuana, like glaucoma, seizures, cancer and nausea. But the report shows the vast majority of those who get state-issued medical marijuana cards are for “severe and chronic pain.”
Humble said that is not supposed to be a catch-all category, saying it is supposed to be linked to some “debilitating medical condition.” But he said there's probably no way to police that.
“I think we're just going to have to live with that the way it is,” he said.
And Humble said he is not necessarily alarmed by the numbers, pointing out that the alternatives for some patients may be far worse.
“We have a thousand people that die every year from overdoses of opiates,” he said, with the majority due to misuse. Humble said he wants to study whether some patients are trying to move away from those more powerful painkillers, replacing them with medical marijuana.
“And if that's the case, you could argue that, for severe and chronic pain, this is harm reduction,” he said.
One thing standing in the way of that research, Humble said, is a provision in the voter-approved law which prohibits his agency from comparing its list of medical marijuana patients to any other database, such as one of those who are being prescribed opiates. Humble said he may ask lawmakers to remove that provision, something they can do with a three-fourths vote.
That change could also pave the way for other research.
For example, his agency has a record of trauma patients. Humble wants to see if medical marijuana patients are more or less likely than the general public to wind up in hospital emergency rooms.