To Improve Patient Enrollment in DC's Medical Marijuana Program, Physicians Must be Empowered

Medical marijuana is legally available today in the District of Columbia, but because its program has the most restrictive set of qualifying medical conditions in the country, the District serves an alarmingly low number of patients. 

The District’s Medical Marijuana Program was signed into law by then-Mayor Adrian Fenty on May 21, 2010, but as of January 31st of this year, the Department of Health (DOH) reported that there were only about 150 patients enrolled in the program. There are several contributing factors that can explain this low number, such as the lack of educational programs on cannabis for physicians (a mandated task for DOH), and a prohibitive administrative procedure for qualifying physicians. But the primary reason why so few patients in D.C. have been able to legally obtain medical marijuana is that the District has the most restrictive set of qualifying conditions in the country.

Fortunately, the District has the ability to fix the problem this Thursday when the DOH Medical Marijuana Advisory Subcommittee meets for the first time to discuss the addition of new qualifying conditions for patients. The DOH subcommittee should amend policy to put physicians in charge of determining whether their patients can or should be treated with cannabis. Thankfully, DOH has the tools at its disposal to reform policy without legislation from the Council, but if the Department fails to act soon, legislation may be needed to ensure that D.C. patients who benefit from the use of cannabis can actually obtain a physician's recommendation.

Twenty states have adopted medical marijuana laws and have approved a total of 51 different diseases and medical conditions that can be treated with cannabis. The District, however, only allows four of these conditions: cancer, glaucoma, HIV/AIDS, and severe muscle spasms such as with multiple sclerosis.  As a result, many District patients who could benefit from the therapeutic use of cannabis are unable to do so legally. The D.C. program also establishes a de facto physician registry, deterring many doctors from getting involved. In New Jersey, the only state with an explicit registration requirement for physicians, patients also report having extreme difficulty finding doctors who will recommend cannabis, causing similarly low enrollment rates as in the District.

A successful medical marijuana program must empower physicians to recommend cannabis to any patient where the potential benefit outweighs the potential risk. Many states accomplish this by allowing their physicians to recommend medical marijuana for common conditions that have numerous causes. For example, 17 states allow physicians to recommend cannabis to treat severe or chronic pain, which can be brought about by conditions ranging from Arthritis and Fibromyalgia to Shingles and nerve damage, just to name a few. According to the Institute of Medicine, 116 million Americans (about 30 percent of the population) were living with chronic pain in 2011. According to the American Academy of Pain Medicine, 51% of people with chronic pain do not have control over there pain.  By extrapolation, approximately 175,000 people are suffering from chronic pain in D.C.  and 89,000 who do not have control over their pain. This is a considerable number of people who might benefit from cannabis compared to the current enrollment of 150 patients. Each one of these patients deserves the best treatment possible which must depend on their physician’s evaluation and professional medical opinion. Cannabis may be their best treatment option.

Some states have taken an even more direct route to protect the physician-patient relationship. For example, the State of Massachusetts authorizes its doctors to recommend marijuana for treating not only the four conditions approved here in the District, but an array of additional ones, including any “other debilitating conditions as determined in writing by a qualifying patient’s certifying physician.” Massachusetts requires the same bona fide physician-patient relationship that the District does, but it puts physicians in charge of treating their patients without the burden of an overly restrictive condition list that keeps an otherwise deserving patient from legally being able to treat their condition with cannabis. Other states that are looking to start new medical marijuana programs, such as Pennsylvania and Florida, have legislative proposals that would similarly put physicians in charge of determining what conditions can and should be treated with cannabis. There's no reason why physicians in the District shouldn't have this discretion as well.

Medical marijuana may be legally available in D.C., but not enough doctors are recommending it, and too few patients are benefiting from it. The Department of Health can address both of these issues by granting physicians the authority to recommend medical marijuana to anyone who, in the professional medical opinion of their doctor, might receive benefit from the treatment.