Jill Griffin, Western Mass’ top medical marijuana gatekeeper, is getting out of the game.

On Aug. 1, Griffin posted an open letter to her patients and the Valley saying that she will no longer recommend medical marijuana to new or existing patients after Aug. 31.

Her decision was driven largely by what she called “hostility toward cannabinopathic medicine from government regulators and the medical establishment.”

In June, two Massachusetts doctors had their licenses suspended for over-recommending marijuana to patients the state says did not have an “established” relationship with the physicians.

“Several colleagues now face disciplinary action arising out of their practice in this field,” she wrote. “Although I know, as a matter of my experience and training, that I have done nothing wrong in caring for you, the risk of losing my medical license is a peril I can no longer endure.”

Griffin did not return phone messages left at her office seeking comment.

On the voicemail at her office, Griffin said she may reconsider her decision following the outcome of the ballot measure to legalize recreational marijuana in November.

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.

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.

“There are many, many people with chronic pain, undergoing chemotherapy, those who have seizures, and myriad other debilitating conditions, and medical marijuana helps them,” said Canna Care in a statement to the Advocate. “That was the intent of the law and the early indications are that it is working.”

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, said Dr. James Gessner, president of Massachusetts Medical Society.

The reason why there’s no wide spread and popular use [of recommending medical marijuana] among physicians because the data is not there,” Gessner said. “Physicians would welcome it — if the studies were good and people didn’t have to smoke it, if they could have it in a pill, I can guarantee physicians are interested in taking care of pain and chronic pain, but there’s nothing to guide us. We really need that. Doctors like working with facts.”

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.”

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 Dickinson 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 informal 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 at 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 ensuring 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.”

Kristin Palpini can be reached at editor@valleyadvocate.com.

Chris Lindahl can be reached at clindahl@gazettenet.com.