Many Iowa doctors hesitate to help patients enroll in new medical marijuana program

Tony Leys | The Des Moines Register

Show Caption Hide Caption Medical marijuana could help Des Moines mother Heather Cooper says after watching her daughter suffer side effects from several meds she takes for epilepsy, she wants to see if medical marijuana with low THC would help.

Many Iowa doctors have qualms about helping patients qualify for the state's new medical marijuana program, which is set launch Dec. 1.

The program’s rules ask doctors to certify that patients have specific medical conditions allowing them to participate. Doctors will have no role in prescribing the products, which five dispensaries will sell to Iowans who have obtained special state cards.

So far, only about 325 of Iowa’s 7,000 actively practicing physicians have certified people for the program, confirming that the patients have conditions such as intractable pain, cancer or epilepsy.

Medical marijuana supporters predicted tens of thousands of Iowans could qualify for the program because of their chronic health problems. But fewer than 600 patients have been approved to participate. Others want the now-legal drug but can't find a doctor to certify them.

'We just want to try it'

Heather Cooper of Des Moines said her daughter's neurologist declined to sign a form confirming the 3-year-old girl, Adley, has epilepsy.

Cooper said she wants to give Adley drops of a marijuana-derived oil, which some families say reduces seizures in children with epilepsy. Cooper and her husband, Adam, are unsure if the oil would work.

"At this point, we just want to try it and see if there is a possibility that it could help," she said.

But Adley's Des Moines neurologist said the oil might cause side effects, such as fatigue, Cooper said. Adley's pediatrician deferred to the neurologist on the question.

The Coopers had already given Adley over-the-counter versions of the medication, called CBD oil, which are widely available in Iowa even though federal and state authorities say they're illegal.

The over-the-counter CBD oil had little effect for Adley, but her parents want to try new products that will soon be available at Iowa dispensaries. Those state-licensed stores will be allowed to sell products that have up to 3 percent of THC, the chemical that makes recreational marijuana users high. Heather Cooper has heard a little THC can help CBD oil reduce seizures.

Heather Cooper is frustrated by the neurologist's focus on possible side effects of medical marijuana. She said Adley already takes prescription anti-seizure drugs that can have strong side effects, including sleeplessness, irritability and lack of appetite. They're part of the reason Adley weighs just 24 pounds, even though she's almost 4 years old, her mother said.

Leaders of several large health organizations employing central Iowa physicians, including Mercy Health Network, UnityPointHealth, Broadlawns Medical Center and the Iowa Clinic, said they're leaving it up to doctors to decide whether to certify patients for the new medical marijuana program. They've heard rumors to the contrary, but said those are false.

Department of Veterans Affairs hospitals and clinics do not allow their doctors to participate in state medical marijuana programs. VA employees must follow federal law, because the agency is part of the federal government, leaders say.

The Iowa Medical Society, which is a voluntary professional organization for doctors, opposes the state's new medical marijuana program as “unsustainable and dangerous public policy." The group has warned doctors they could face legal or insurance problems if they participate in the program.

The medical society notes that federal law still bans most marijuana products, even for medical uses. That law isn't being enforced against Americans following state rules, but the situation "is very much in flux," the group told its members.

Randy Mayer, director of the Iowa Office of Medical Cannabidiol, said he wasn’t surprised to see many physicians hesitating to certify patients. “I think this is very common when a state sets up a program,” said Mayer, who is an administrator for the Iowa Department of Public Health.

Iowa’s limited medical marijuana program was modeled partly on Minnesota’s, which opened in 2016. That program was slow to get off the ground, but is gaining momentum, Mayer said. More than 1,300 health care practitioners are participating in Minnesota’s program, a state website says.

A key difference is the Minnesota program allows nurse practitioners and physician assistants, as well as physicians, to certify that patients have qualifying medical conditions.

Iowa allows nurse practitioners and physician assistants to prescribe most standard medications, including addictive opioid painkillers, but they cannot certify patients for the medical marijuana program.

That may change. The Iowa Medical Cannabidiol Board, which is mainly made up of physicians, recommended this month that the Legislature allow such "mid-level providers" to certify patients for the program.

Doctors, even those who have certified, are conflicted

Des Moines physician Steven Adelman said he doesn’t understand why the state doesn’t permit nurse practitioners and physician assistants to certify participants for the medical marijuana program.

“Doctors don’t have any more training in this than they do,” said Adelman, a neurologist at Mercy Medical Center.

Adelman said he has certified one patient who applied for a medical marijuana card. That patient is an adult with a severe case of epilepsy, which causes seizures.

Adelman said he shares many other physicians’ hesitation to recommend marijuana products to patients. “We’d like to have more science,” he said. “It’s not that we’re against medical marijuana, we just want to have more evidence that it will help our patients. … The hype has really preceded the science.”

Doctors who certify patients for the new Iowa program are also instructed to give patients a three-page explanation of medical marijuana.

Des Moines oncologist Richard Deming, who is director of Mercy's cancer center, has signed the certification documents for a few of his patients. But he's uncomfortable with the medical marijuana program.

"This whole law is not the way health care should be provided to patients," he said.

Medicines should not be given to patients until they're proven safe and effective, and until proper dosing levels are scientifically established, Deming said. In the new medical marijuana system, patients will be buying unproven medications and taking advice from cannabis shop staff members about how much they should take and how often, he said.

"This is just not the way we handle any other medication," he said.

Deming said there is some evidence marijuana products can help cancer patients deal with pain, nausea and side effects from chemotherapy. He agrees with medical marijuana supporters that the federal government should ease limits on research, so scientists can determine what works.

Iowa's new medical marijuana law says physicians cannot be charged with state drug crimes or disciplined by the state medical board for participating in the program. The law says physicians must have an "established patient-provider relationship" before signing certifications for patients, but the law doesn't define such relationships.

A leader of the state's first legal medical marijuana producer said he's frustrated that some doctors seem unwilling to look into the issue.

"I think that does patients a great disservice, because if nothing else, patients should be able to come to their doctor have a discussion about this," said Lucas Nelson, general manager of MedPharm.

MedPharm spent more than $10 million to build the state's first legal marijuana growing and processing center, southeast of downtown Des Moines. The company also owns two of the five dispensaries that soon will open around the state.

Nelson said he hopes more doctors will become familiar with Iowa's medical marijuana program as it gets going. If not, he said, the shortage of doctors willing to certify patients could be "a massive problem" for the industry.

Nelson, a lawyer, said he couldn't find any successful lawsuits brought against physicians who followed their states' rules.

"As long as they follow the program, they're safe," he said of physicians.

Mayer, the state administrator, said his agency knows of a few doctors who are willing to talk to patients in their towns interested in being certified for the medical marijuana program. The agency will informally refer such patients to the doctors, but it is declining to post a list, to prevent doctors from being overwhelmed with patients.

Iowa's medical marijuana program is more limited than those in many of the other 42 states that have them. Iowa's program does not allow sales of marijuana products that could be smoked or vaped. The sales may only happen at five licensed dispensaries, and the products may only be made by two licensed manufacturers.

Patients can qualify for the Iowa medical marijuana cards if they have seizures; Crohn's disease; untreatable pain; multiple sclerosis with severe spasms; AIDS or HIV; amyotrophic lateral sclerosis; Parkinson's disease; cancer with severe pain, nausea or wasting; or a terminal illness accompanied by pain, nausea or wasting. The state board overseeing the program has recommended adding ulcerative colitis and severe pediatric autism to the list.

The health department reports 42 percent of current cardholders said they plan to use medical marijuana products for pain. Fourteen percent want to use the products to treat seizures; and 13 percent want to use them to treat amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

Patient Sioux Newberg, 68 of Ankeny, hopes to get a doctor to certify her for the new program so she can legally use marijuana products for persistent pain from fibromyalgia, slipped discs in her back and bone spurs in her neck.

Last winter, a nurse at her UnityPoint clinic said the system wasn't allowing its doctors to sign the certifications. That frustrated Newberg, who previously was prescribed addictive narcotics at the clinic. She stopped taking those pills, because they made her feel sick or sleepy. "They take the pain away, but the side effects are terrible," she said. "I don't want to live like that."

Newberg, who is a retired nurse, has been using cannabis oil, which she buys at local vape shops or has a friend send her from Colorado. She's uncomfortable making such purchases, which aren't legal.

"It makes me feel like a criminal," she said. "It makes me feel like they might take this 68-year-old grandma and put her in jail."

Newberg said she'll ask again whether her UnityPoint internal medicine doctor would certify her for Iowa's new medical marijuana program. If that doesn't work, she'll ask her neurologist, she said. "I'll keep shopping until I find one."