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Small core of doctors write vast majority of medical marijuana recommendations

PHOENIX — Just 25 doctors are responsible for allowing more than 25,000 Arizonans to legally obtain marijuana, according to a report released Friday.

State health director Will Humble said the evidence shows development of “certification mills” since voters approved a law in 2010 that allows those with a doctor’s recommendation to obtain up to 2½ ounces of marijuana every two weeks.

Those 25 doctors — out of more than 27,000 licensed in Arizona — are responsible for 70 percent of the recommendations issued in a one-year period.

Humble said he is troubled by the findings. But he said there may not be much he can do about it.

He said it may be that all of the 36,346 recommendations issued during that one-year period are justified. But he said it would be better if the patients actually worked with their regular primary-care physicians who are familiar with them and can offer ongoing treatment.

He acknowledged, though, that many family doctors have been reluctant to recommend marijuana, possibly because they lack information about the drug. Others, Humble said, don’t want to deal with what they see as an administrative hassle of certifying patients, a process different from simply writing a prescription.

That “pushes the patients to the certification-mill physicians,” he said.

Overall, the state found just 472 doctors statewide issued the more than 36,000 medical marijuana recommendations. Of that, 27,275 came from naturopaths, who make up fewer than 7 percent of all physicians in Arizona.

“It’s unfair to say this is a problem with naturopaths,” Humble said. “It’s a problem with about 20 to 25 naturopaths.”

And he said the interests of the legitimate patients are not being served.

“Let’s face it: The certification mills are there to take the money, and they never see the patient again until the year comes around and their (annual) card expires,” Humble said. “And that’s not the best way for this program to operate.”

But Mason Tvert, spokesman for the Marijuana Policy Project, which wrote the 2010 Arizona law, said the findings of the report should come as no surprise.

“It is not rare for physicians to specialize in specific treatments,” he said. And Tvert agreed with Humble’s conclusion that some doctors are either unfamiliar with potential benefits of marijuana or choose not to issue recommendations.

“Given the many benefits of medical marijuana and the growing demand for it, it comes as little surprise that doctors are opting to specialize in it,” he said.

Humble tried to craft the program to prevent the pattern found in the report.

The 2010 initiative set out basics for operation of the medical-marijuana program, which include a “full assessment” of the patient’s medical history and condition, and mandates that there be a “bona fide physician-patient relationship.”

But the law did not define exactly what that means.

Further, the 2010 law lists a series of conditions for which a doctor can recommend marijuana, including glaucoma, seizures, cancer and nausea. But the report shows the vast majority of those who get state-issued medical marijuana cards are for “severe and chronic pain.”

Humble said that is not supposed to be a catch-all category, but is supposed to be linked to some “debilitating medical condition.” But he said there’s probably no way to police that.

“I think we’re just going to have to live with that the way it is,” he said, adding that he is not necessarily alarmed by the numbers, pointing out that the alternatives for some patients may be far worse.

“We have a thousand people that die every year from overdoses of opiates,” he said, with the majority due to misuse.

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