D.C. Council approves medical marijuana, posing challenges for doctors

By Lena H. Sun
Washington Post Staff Writer
Wednesday, May 5, 2010

For doctors such as Pradeep Chopra, long accustomed to prescribing carefully tested medications by the exact milligram, medical marijuana presents a particular conundrum.

On Tuesday, the D.C. Council gave final approval to a bill establishing a legal medical marijuana program. If Congress signs off, District doctors -- like their counterparts in 14 states, including Rhode Island, where Chopra works -- will be allowed to add pot to the therapies they can recommend to certain patients, who will then eat it, smoke it or vaporize it until they decide they are, well, high enough.

The exact dosage and means of delivery -- as well as the sometimes perplexing process of obtaining a drug that remains illegal under federal law -- will be left largely up to the patient. And that, Chopra said, upends the way doctors are used to dispensing medication, giving the strait-laced medical establishment a whiff of the freewheeling world of weed.

Even in states that allow for marijuana's medical use, doctors cannot write prescriptions for it because of the drug's status as an illegal substance. Physicians can only recommend it. And they have no control over the quality of the drug their patients acquire.

"I worry about that," said Chopra, a pain medicine specialist. "That's what's throwing a lot of [doctors] off."

The District's measure, like those elsewhere, specifies certain conditions and illnesses that qualify for medical marijuana. A patient who has HIV, glaucoma, multiple sclerosis, cancer or a chronic debilitating condition will be able to receive a doctor's recommendation to possess up to four ounces in a 30-day period.

Unlike in many states, the District law would not allow patients and caregivers to grow their own marijuana, at least initially; an advisory committee would later decide whether to permit cultivation. Until then, patients could only acquire the drug illegally or from five to eight government-regulated dispensaries.

The bill goes to Mayor Adrian M. Fenty (D), who is expected to sign it and send it to Congress, which has 30 days to review the measure before it becomes law.

In the District, physician reaction was mixed.

Internist Mahmoud Mustafa said a few of his sickest HIV patients already smoke marijuana to ease pain and stimulate appetite. "I think it'd be great," he said. "I don't have to worry about [my patients] being arrested."

Hunter Groninger, medical director for palliative care at Washington Hospital Center, said he would be uncomfortable recommending marijuana because the medical community doesn't know enough about its benefits.

Because there are no uniform standards for medical marijuana, doctors have to rely on the experience of other doctors and their own judgment. That, they say, can lead to abuse.

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