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A few Oklahoma doctors take the plunge on marijuana, but many wait

Dr. Amanda River evaluates patients for medical marijuana recommendations at Natural Remedy MD in Edmond. [Photo provided]

Dr. Amanda River evaluates patients for medical marijuana recommendations at Natural Remedy MD in Edmond. [Photo provided]

Oklahoma City — For some Oklahoma physicians, recommending patients use medical marijuana is a confusing and perhaps even frightening process.

State Question 788, which voters passed in late June, doesn't provide in-depth instruction on how to determine if a patient is a good candidate for a medical marijuana license. State licensing boards haven't set up any requirements for doctors who recommend cannabis, and occupational groups have directed much of their public messaging toward fixing what they see as problems with the law, such as allowing the sale of plant matter a patient could smoke.

The evidence on marijuana as a medical option also isn't particularly strong, though anecdotes about ways people have tried to treat themselves abound. Without clear information about potential benefits and side effects, it can be difficult to determine if cannabis is right for a patient.

Dr. Amanda River, who works at Natural Remedy MD in Edmond, understands the hesitation. She said she often gets referrals from doctors who aren't familiar with medical marijuana, or who are waiting for guidance from a health system they work with.

“A lot of our business has come from other physicians,” she said.

River has experience with recommending cannabis from when she worked in Oregon, which legalized medical marijuana in 1998. She remained a member of the Society of Cannabis Clinicians after returning to Oklahoma in 2015.

While it would be ideal to have more studies on medical uses of marijuana, patients often have exhausted their other treatment options before trying cannabis, River said. While no two patients are the same, and there is a risk of addiction, it's a relatively safe option for most patients, she said.

Some studies have found as many as 10 percent of marijuana users develop signs of addiction, though it's not clear if medical users would have the same odds as recreational users, who are studied more often.

Most medications come with specific guidelines for when they should be used, and a doctor prescribes how large a dose patients should take, how often and for how long, River said. Cannabis is different, partly because federal law makes it difficult to study how best to use it in medical settings, she said. A doctor can recommend it, but patients have to determine what strain, method of ingestion and dose work best for them.

“They are in control of which medication they use and how much they use it,” she said. “It's a very empowering medication.”

River said she starts by reviewing patients' symptoms and any medications they are taking. If a patient has a condition that might respond well to marijuana, she then discusses what type of cannabis might work best. Some strains have a sedative effect, while others act more like stimulants.

“There's definitely conditions that respond better to different types of cannabis,” she said.

Doctors don't need an extra certification or license to recommend medical marijuana, so it's difficult to know how many have started recommending cannabis to patients.

The Oklahoma Medical Marijuana Authority reports that 48 doctors joined a registry of physicians interested in recommending medical marijuana. The four dozen physicians are only a small percentage of all doctors practicing statewide, but others who are participating in the medical marijuana market may not have joined the registry.

The state doesn't track who recommendations come from, so it's not clear if a few clinics are dominating the market.

Perry Jones III, co-owner of Tulsa Higher Care Clinic, estimated Dr. Jason Sims had written recommendations for about 400 patients at the clinic before the Oklahoma Medical Marijuana Authority began accepting applications on Aug. 25.

As of Wednesday evening, the authority reported it had received nearly 3,000 applications from patients who want to use cannabis. If all of Tulsa High Care's patients have turned in their paperwork, they would account for more than one out of every 10 applicants.

Patients have ranged from their 20s to their 70s, and some drive from as far as Altus for a recommendation, Jones said. Insomnia, anxiety, post-traumatic stress disorder and irritable bowel syndrome are some of the more common conditions they are looking to treat with marijuana, he said.

“A lot of people have multiple things, because things add on to each other,” he said.

Jones said he doesn't expect the rush of patients seeking recommendations to end any time soon.

“I believe now that we'll be steady (in business) for years to come,” he said. “This is just the beginning of the wave.”

River said she expects interest may even pick up, now that the state has begun issuing licenses. While questions about how the state will regulate parts of the medical marijuana trade remain to be answered, there's enough for doctors to go at this point, she said.

“Everyone's learning this together, but the majority of the framework is there,” she said.

Meg Wingerter

Meg Wingerter has covered health at The Oklahoman since July 2017. Previously, she lived in Topeka, Kansas, and worked at Kansas News Service and The Topeka Capital-Journal, where she earned awards for business coverage. She graduated from... Read more ›