NORTHAMPTON – Western Massachusetts’ top medical marijuana gatekeeper has stopped accepting new patients, narrowing the already small field of physicians ready to provide access to the drug as demand for it is expected to increase.
Northampton’s Dr. Jill Griffin is one of only 13 doctors in western Massachusetts who provide the bulk of annual certifications needed by patients to purchase medical marijuana. Griffin has 3,284 active certifications – over half of the 6,270 provided by doctors in the region, according to state records.
And those in the medical marijuana industry expect that over 16,000 people in western Massachusetts will eventually seek access to medical marijuana, raising questions about whether enough local doctors will be able to meet that need.
Griffin could not be reached for comment. Her attorney, Michael Cutler, confirmed last week that she has stopped taking new patients. He said she is backed up helping existing patients slog through a slow-moving state Department of Public Health patient registration process, which follows physician certification. He said there may be other reasons for Griffin’s decision but would not detail them.
Griffin will remain available for stage-four cancer patients in need to new medical marijuana certifications, Cutler said.
It’s unclear what impact Griffin’s not taking new patients will have on local access to medical marijuana.
Those in the industry say there’s a strong demand for doctors willing to offer the drug to patients, since an overwhelming majority of physicians have declined to get involved. Of Massachusetts’ nearly 36,000 active registered physicians, 155 have completed the certification process needed to provide medical marijuana certificates, according to state data.
Despite the small pool of certification providers, Northampton-based medical marijuana consultant Ezra Parzybok said he hasn’t heard of prospective patients having trouble gaining access to the drug. “I personally haven’t heard about patients facing a long wait list,” he said.
But Hadley psychiatrist Dr. Bruce I. Goderez called the lack of willing physician-certifiers “a big problem.”
“Very few people are doing it. Dr. Griffin does what she can, but she’s maxed out,” Goderez said. “It’s available, but now people can’t get access.”
While many patient certifications are provided by doctors at dedicated medical marijuana practices such as Griffin’s Locust Street office, Goderez is among the small group of local physicians who have embraced cannabis as an option to treat their existing patients’ ailments.
In order to provide marijuana access to patients in Massachusetts, doctors are required to complete a course about the proper use of the drug, including side effects, dosage, substance abuse recognition and treatment related to cannabis. They are then required to register with the state.
“I got the certification just so I have another tool that I can use to deal with my ongoing patients,” Goderez said. “I already know them, I know their situation.”
Goderez has 24 active certifications.
Doctors avoid getting involved in the world of medical marijuana for a variety of reasons.
Sometimes it’s what Goderez calls a “moralistic attitude,” one that centers around historic thought of marijuana as a drug of abuse and the fact that it remains a Schedule I drug – the federal government recognizes no legitimate medical use for it. That category is shared by heroin and LSD.
Another problem is the lack of education for physicians about the legitimate uses of marijuana for treatment of medical conditions, Goderez said.
Parzybok said that Griffin is highly respected in the local medical community and particularly knowledgeable about the intricacies of cannabis-based treatment. That reputation provides comfort to many patients wary about walking into an unfamiliar doctor’s office, he said.
“There are many patients who are terrified about medical marijuana,” he said. “They don’t understand how to use it, or they want to go to a doctor they trust.”
Cutler said nearly all of Griffin’s patients come to her from word-of-mouth referrals.
That includes patient-to-patient ones, especially among older people who are unschooled in marijuana. They feel comfortable going to Griffin given her reputation for thoroughness, he said.
Griffin’s existing patients and reputation provided her with a large base of medical marijuana patients, Cutler said. “A number of practices in the Valley prohibit doctors from certifying patients,” he said. “She has an outstanding reputation with those doctors as a very competent diagnostician and care-provider – she has a huge referral base of existing doctors in the Valley.”
Two of the largest health care providers in the region, Baystate Health and Cooley Dicksinson Hospital, have differing approaches to medical marijuana.
Cooley Dickinson has no specific policy regarding cannabis treatment, according to spokeswoman Julia Sorensen.
“Our approach is that we want physicians to practice in areas they feel comfortable with,” she said. “Some providers have moved ahead and started prescribing it and others have elected not to,” Sorensen said.
Baystate leaders have decided it’s best for that system’s doctors to steer clear of marijuana for now, according to spokesman Brendan Monahan. “They didn’t feel it was appropriate for them to move forward with this as a routine means of treatment,” he said.
Some areas of the Baystate system have stringent policies against offering certification, while others have more inforal rules.
While the vast majority of Baystate physicians do not offer medical marijuana, Monahan said, that doesn’t suggest that none of its doctors have provided certifications.
“Because it has not been federally regulated, there has been no adoption of certifying across our health system,” he said. “We are constantly talking about it and looking at evidence and research.”
Griffin is the top provider of medical marijuana certifications in the state. The doctors with the second and third greatest number of active certifications, Dr. John C. Nadolny and Dr. Tyrone S. Cushing, had their medical licenses suspended by the state earlier this summer for allegedly improperly certifying that thousands of patients were eligible to receive medical marijuana, according to the Boston Globe.
Cushing worked at CannaMed, a medical marijuana practice with an office in Framingham. Nadolny was medical director of Canna Care Docs, which has eight offices in Massachusetts.
According to the state’s medical marijuana law approved by voters in 2008, patients must have a “debilitating condition” to qualify for certification. What exactly counts as debilitating can range from AIDS to insomnia and is at the discretion of the certifying physician.
Department of Public Health data shows that 78 physicians across the state and 13 in western Massachusetts had seven or more active medical marijuana patient certifications as of June 3. Those numbers do not include doctors who have provided fewer than seven certifications in order to protect patient privacy, according to DPH spokesman Scott Zoback.
The number of physicians registered to offer certification totals 155 as of June 30, according to Zoback.
Dr. David Getz, of Springfield’s MariMed Consults, is the second greatest provider in the region with 1,351 active certifications. He’s followed by Dr. Kwesi Ntiforo, who operates DocsConsult Medical offices in Greenfield and Longmeadow.
Other top providers in the region include Dr. Mario Addabbo and Dr. Lydia Kapell, who work in the Canna Care Docs Northampton office in the Potpourri Plaza on King Street.
The office opened in January after the company noticed some of its patients were coming from the Valley to its Worcester office.
“There was a tremendous demand in the Pioneer Valley,” said Marta Downing, Canna Care’s chief operating officer. Canna Care started offering appointments two days per week and recently added another day, Downing said.
“It’s been a very steady increase,” she said. “I expect by the end of the summer we’ll be a five days per week.”
The remaining seven doctors, including Goderez, have a total 307 active certifications. They all work in either private or group practices.
It’s a common benchmark in the medical marijuana industry that 2 percent of a state’s population will seek the drug as medicine, Downing said.
That would mean that over 135,000 of Massachusetts’ 6.79 million residents will become medical marijuana patients. There are now over 31,000 active marijuana certifications.
Like Parzybok, officials at Northampton dispensary New England Treatment Access say educating physicians about medical marijuana will be key in insuring access to certifications.
“As an industry I think our goal in the near-term is to educate providers that this is legal, this is a real option and there’s a safe way to recommend and to use medical cannabis,” said Norton Arbelaez, NETA’s standards and practices consultant.
Part of that includes reaching out to large medical organizations such as Partners HealthCare and other institutions, some of which prohibit their doctors from recommending marijuana, he said.
Goderez said he views marijuana just like any other drug – one that has potential downsides and potential benefits – an attitude he thinks more doctors ought to have.
“I’ve seen many patients who it’s made a huge difference for them. It just seems like a reasonable thing to do,” he said. “I see no solution to the supply-demand problem until more doctors are just willing to do it for their own patients.”
He also said the state Legislature could act to allow advanced practice registered nurses and physicians assistants to provide certifications.
Parzybok is looking to the results of a November ballot referendum that will decide whether to legalize recreational marijuana. Such a decision could drastically change the way that cannabis is provided as medicine, he said.
“I’m interested in opening a very health-focused dispensary. One that can really serve patients as opposed to just churning out as much cannabis (for recreational use) as possible,” he said. “Someone like Jill Griffin, who’s familiar with the science of cannabis and not afraid to back up her knowledge with advocacy, could work a couple hours per week at this dispensary or come to a clinic and give a lecture.”
Chris Lindahl can be reached at clindahl@gazettenet.com