MARIJUANA CARD

Medical marijuana card OK’d after 8 minutes, 6 questions

2010-08-21T23:26:00Z 2010-11-19T06:49:16Z Medical marijuana card OK’d after 8 minutes, 6 questionsDIANE COCHRAN Of The Gazette Staff The Billings Gazette
August 21, 2010 11:26 pm  • 

It took me eight minutes to get a doctor’s recommendation for medical marijuana.

Jason Christ thinks I waited too long.

The less time physicians spend with medicinal-pot seekers the better, according to Christ, executive director of Montana Caregivers Network.

The controversial group has helped thousands of Montanans sign up for medical marijuana cards at traveling clinics and via Internet consultations.

My eight-minute conversation with a doctor over Skype, an Internet video-communication program, was unnecessarily long, Christ said.

“It sounds like it was pretty thorough,” he said after I described it to him. “It’s not really necessary to have a doctor who does an in-depth evaluation, like an hour-long evaluation.”

That’s not how the voter-approved Montana Medical Marijuana Act reads or what the Montana Board of Medical Examiners requires. But Christ is confident that his organization is on the right side of history.

“I don’t think we should be making it harder for people” to get medical marijuana, he said. “We should be making it easier.”

It was easy for me.

I did it as The Billings Gazette’s health reporter after MCN invited me to witness and report on interactions between its doctors and patients and then refused to let me into the clinic when I arrived at the agreed-upon time. With no other way to assess the validity of those doctor-patient interactions, I decided to sign myself up for a consultation.

I called MCN in July to schedule a web appointment with a doctor. Two days later, I logged on to Skype from a laptop computer equipped with a web camera and waited for the doctor to “call” me.

Once we were connected, he asked me why I needed medical marijuana.

I told him the truth: I have back pain. It started 15 years ago after I fell onto a concrete floor, and it has gotten progressively worse.

Shortly after my fall, I saw an orthopedic doctor, who recommended stretches, and I occasionally go to a chiropractor.

The doctor I did the recent web interview with has been licensed to practice medicine in Montana since 2001 and was at one time a surgeon in Great Falls.

The doctor asked six questions: Is the pain localized to your back or does it radiate into your legs? Do you have any other medical conditions? Do you take any medications? Do you drink alcohol? Do you smoke tobacco? Have you ever smoked marijuana before?

He did not ask me for my medical records or proof that what I told him was true. He did not ask me what kind of pain it was or to rate it on a pain scale.

He did not ask me if I had any questions about marijuana as a medicine.

I did have questions, but he did not seem to have time to answer them. A caregiver could talk to me about the form of marijuana that I should use and what to expect from the drug, he said.

The doctor did tell me not to smoke marijuana — smoking is, after all, unhealthy — and to select a “stable” caregiver.

What does that mean? I asked.

“They would have a storefront and different products,” he said. “A lot of people have been growing marijuana illegally for years and have a lot of knowledge about it medically. You want one of those people.”

I paid $150 to MCN for the Internet consultation. When I mailed the doctor’s signature to the state Department of Health and Human Services, which issues medical marijuana cards, I parted with another $25.

Now I am one of about 23,500 Montanans who have been authorized to use medical marijuana. Like me, almost 70 percent of cardholders were approved to treat severe or chronic pain.

The Montana Medical Marijuana Act does not define severe or chronic pain, one of eight medical conditions that the law says may be treated with pot. But the act does outline what must take place before a doctor can certify a patient to use marijuana.

A physician must use his or her professional opinion “after having completed a full assessment of the qualifying patient’s medical history and current medical condition made in the course of a bona fide physician-patient relationship.”

In a meeting earlier this year, the Montana Board of Medical Examiners voted to ask lawmakers to replace “bona fide physician-patient relationship” with a phrase about “generally accepted standards of care.” Doctors who recommend medical marijuana should be held to the same standards as other practicing physicians, the board said.

In May, the medical board fined a doctor who failed to meet the expected standards of care by spending an average of six minutes with patients before signing marijuana recommendation forms.

Members of the board declined to comment on my experience. But Pat Bollinger, a registered dietician on the board, said the board has been clear about what is expected from doctors.

“It’s pretty clear from our position paper what standard care is, and it’s pretty evident when the standard of care is being met,” Bollinger said.

At their May meeting, board members defined “generally accepted standards of care” with a list of eight bullet points.

My online visit failed to meet at least three of the requirements: taking a medical history, discussing advantages and disadvantages of a treatment and monitoring a patient’s response to a treatment.

“This is exactly the kind of medical encounter we hope ends,” said Rep. Diane Sands, D-Missoula, a member of a legislative subcommittee looking at ways to revise the state’s medical marijuana law.

“It is total medical incompetence.”

The subcommittee will report to the Children, Families, Health and Human Services interim committee, which will draft a bill for the 2011 Legislature based on the subcommittee’s recommendations.

If legislators approve a bill that tightens medical marijuana regulations, Montanans who got cards under questionable circumstances might not be able to renew them, Sands said.

I’m not the only one who has sought a medical marijuana card without planning to use it.

Law enforcement agencies across the state have sent undercover officers complaining of a variety of medical conditions to traveling clinics. They almost always get approved, and it often takes even less time than it did for me.

“The ones I’ve gone to, it’s been a minute,” said Mark Long, narcotics bureau chief for the state Division of Criminal Investigation. “The guys who try to ask questions or go into detail get hurried up because there’s a line behind them.”

“Yours is one anecdote of what we hear all the time,” Long told me. “I think it’s a joke.”

 

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