Arkansas physicians prepare for medical marijuana; 6 willing to certify patients

Medical professionals across Arkansas are joining the state's budding medical marijuana business, though many health care providers remain ambivalent or are opposed to participating.

Medical marijuana isn't yet legally available in Arkansas, and the first dispensaries or cultivation facilities could be months away from opening. But Arkansans are applying to be able to use the substance, with almost 300 people approved as of Friday, according to the state Health Department. Several physicians and at least one pharmacist are taking up their roles in the medical marijuana process as well.

"I see it as legitimate health care," said Dr. John House with the Eureka Springs Family Clinic, who has recently certified several patients to use medical marijuana. "There's been pain, HIV, cancer, a couple people with Parkinson's who have spasms."

Arkansas voters last year approved a constitutional amendment allowing marijuana use for 18 conditions and symptoms. The state is now taking applications for patients and businesses.

Patients' physicians must certify their patients have at least one of the qualifying conditions, but the certification doesn't endorse or prescribe the substance. A pharmacist consultant under state law must also be on hand at dispensaries to help ensure the marijuana doesn't interact with other medications or get misused.

Thousands of studies in the past two decades have found evidence that marijuana or individual compounds in the plant provide relief from pain, muscle spasms associated with multiple sclerosis and nausea induced by chemotherapy, according to an analysis from the National Academies of Sciences, Engineering and Medicine earlier this year.

On the other hand, research also has found marijuana use can impair learning and attention and increase the risk of developing some mental health disorders and of being in a car accident, according to the analysis.

Several doctors and medical organizations pointed to how much research nonetheless remains to be done into marijuana's many compounds, their dosages, the ways they can be ingested and other details typically determined long before traditional medications go on the market. Marijuana is illegal under federal law, and research into it requires special permits.

The Arkansas Medical Society, a professional organization for physicians, and the state surgeon general opposed the marijuana amendment, as did the Arkansas Pharmacists Association, which later favored the law requiring pharmacists' involvement at dispensaries.

Some physicians in Northwest Arkansas and Little Rock have said they'd be reluctant to sign off on marijuana use because their role essentially ends there. They can set an amount of time, up to a year, for a patient's marijuana permit, but they can't control the particular variety of the plant or its extracts the patient buys, as they could with a prescription.

"That would make me very cautious about who I pursue this process with," Dr. Greg Sharp, a professor in pediatrics at the University of Arkansas for Medical Sciences, said earlier this year. Sharp works with Arkansas Children's Hospital to research how a marijuana-based compound called cannabidiol affects several seizure disorders.

Other groups are reluctant to publicly join the debate on any side. Mercy Northwest Arkansas has said that certifying someone for marijuana is a decision between a physician and a qualifying patient, as with any other treatment. Washington Regional Medical Center and Northwest Health spokesmen didn't respond to emailed requests for comment last week.

"As long as our physicians are complying with the law as it stands and they're in good standing with the state medical board, that's what matters," said Frazier Edwards, executive director of the Arkansas Osteopathic Medical Association.

House in Eureka Springs and other physicians are jumping in. The Arkansas Cannabis Industry Association is compiling a list of doctors willing to sign the certifications. Six are on the list so far, including House.

Dr. Tammy Post, another on the list, has a location in Springdale. A company called the Fort Smith Medical Group is also included. Neither returned phone messages last week asking for comment.

"We're getting a lot of calls and emails from people who just don't know who to go to," said Storm Nolan, the cannabis association's president. "We still have an education problem in that a lot of doctors still think they are recommending cannabis to treat these conditions."

The original amendment approved by voters required physicians to weigh the potential benefits and risks of marijuana use in their certifications, but the Legislature struck that requirement this year.

Melissa Fults with the Drug Policy Education Group, an Arkansas group that supported the amendment, called it a "tragedy" if family doctors won't sign certifications for longtime patients.

"These are very ill patients, and they are finally having the opportunity to get this medicine that we fought so hard to get," she said.

House isn't taking new patients, so his certifications don't represent a new market for his clinic. Others are focusing specifically on marijuana. A retiring colleague of House's, Dr. Dan Bell, hopes to open a dispensary in town, for example.

Josh Winningham, a pharmacist in Cabot, recently set up a company that will provide the required pharmacist consultation services to several dispensaries so that they won't each have to hire a pharmacist. PhytoPharm.D will compile patients' medical histories, watch out for their medications that marijuana might amplify or otherwise affect, and work with the patient to see if the marijuana is helping, he said.

He's had some reservations about marijuana and said the nascent industry needs experts involved. Last week he held information sessions about the law and medical professionals' roles in Fayetteville and Little Rock for other pharmacists, physicians and marijuana entrepreneurs.

"I really felt like somebody needed to step up," Winningham said in an interview. "It's happening in Arkansas; it's been passed, it's going forward."

Dr. Dane Flippin in Jonesboro took an even more enthusiastic tack. He quit the family medicine he'd practiced for 20 years and started Arkansas Progressive Medicine in April to certify qualifying patients for marijuana. More than 100 patients have come in so far for visits for which he charges $250, he said, and business is gaining speed. The state charges $50 for a patient's permit.

Doctors who focus mainly on marijuana sometimes draw accusations of being predatory or focused on money, but Flippin said he wants to help Arkansans while following state law. He goes through patients' medical histories and ailments and decides whether to certify them in one visit.

"We're not certifying everyone who comes through the door -- it's none of that crap," he said. About half of his patients haven't used marijuana in any form, relying on traditional pain medications or other treatments.

Everyone is different and might see different results with marijuana use, Flippin said, but he added, "I think a lot of people are suffering with what's currently available."

Jack Cross, a Eureka Springs real estate agent, said he was one of those people. The opioid painkillers he used after a late-stage, metastatic prostate cancer diagnosis last year left him like "a vegetable" in his chair without taking away the pain, he said.

"The cancer was still eating me up, and it hurt," he said.

Cross researched chemotherapy's effectiveness and learned about oil that can be extracted from marijuana plants. He thought medical marijuana could be a ploy, an excuse to smoke the plant. But he tried a drop of the oil in his mouth one night before bed.

In the morning, the pain was gone. Cross credits God and marijuana for the change and said it has allowed him to live normally. He plans to sign up for a patient permit and doesn't expect any reluctance from his doctor.

"I was dancing on New Year's Eve when I should have been dead," Cross said.

Metro on 07/31/2017