Page 20 - Delaware Medical Journal-October

SCIENTIFIC ARTICLE
TABLE 2: Frequency of Categorized Responses
DOMAIN
CATEGORY
FREQ.
PARTICIPANT’S STATEMENTS
Comfort with Authorizing (WOULD NOT)
Lack of knowledge
18
“Not comfortable with prescribing something about which I have virtually no knowledge.” “Would need to know more about law and indications.”
“I would not consider myself knowledgeable enough about the medication to prescribe or educate patients.”
Not “prescriber”/ unlikely to see patients
13
“Not a prescribing care giver.”
“I typically do not treat any patients with those disease.” “Unlikely to see patients in this stage of illness.”
Potential for abuse/ misuse
8
“Liberalizing it’s use will only open the door to more serious drug abuse!”
“Increased odds of being abused and shared with someone else. I have already had an incident where the patient suffered from one of the listed ailments and their caregiver wanted to sign that they indeed had this ailment. It was obvious to me that the caregiver actually wanted it for themselves and the patient was not interest in it.”
I cannot imagine myself giving or facilitating a ‘prescription’ to smoke.”
Comfort with Authorizing (WOULD)
When other Rx fail
18
“As a hospice physician, I am certain to run into patients with the qualifying conditions whose symptoms are not being relieved with more standard therapies. At that point, I am OK with a pt trying medical marijuana.”
“I often care for patients with chronic cancer pain or other chronic pain syndromes for which I feel they may ultimately benefit from medical marijuana, if other treatments have failed or have been maximized.”
“I see patients with diseases that I do not have a treatment for. If there is research sug- gesting that Med Marijuana may be effective for these patients I am likely to offer that as a treatment option.”
Effectiveness / benefits / humane treatment
16
“These are serious, chronic diseases, many that are fatal. These are legitimate reasons for marijuana usage and humane.”
“There is no question in my mind that marijuana is beneficial for patients which chronic/ debilitating illnesses. It should be should be administered via a vaporizer as a supplement to other medication. Indeed, it would probably be more effective, less expensive, and less addicting than the more traditional medications.”
“For the right patient, medical marijuana can provide relief from pain. Patients should be given an alternative to the usual medications presently available.”
Specific Concerns with Authorizing
Potential for abuse/ misuse / diversion
25
“My concern would be that people, other than the intended person, would use the drug. It should not be used for recreational purposes.”
“As with any other controlled substance, diversion is an area to be aware of.”
“Patients coming in requesting medical marijuana for abuse purposes under the guise of vague conditions like intractable nausea that I cannot prove is occurring.”
Legality issues
(for pt and provider)
8
“legal related to state and federal prosecution for supplier and pt.”
“Concern is what can the patient do if questioned by police.”
“Marijuana is still illegal in the United States of America, of which Delaware remains a part. The DEA a federal agency, gives us our licenses to prescribe controlled substances. Marijua- na is still considered a ‘category one’ narcotic, meaning there is no legitimate medical use. Thus, I am concerned that recommending a schedule one narcotic to my patients, could in theory, put my DEA license at risk and possibly subject me to federal criminal sanctions.”
Lack of standardization (quantity & quality)
7
“How to ensure that the marijuana isn’t tainted. How to rate one’s response to it. How to quantify usage.”
“Will not authorize. No standard dosing.”
“It is a mind altering substance, and the quality control varies from batch to batch.”
Helpful to Learn More
Education: Courses (online and CME- sponsored), seminars, lectures, pamphlets, reviews of DE Law
27
“Concise written educational material.”
“Online course sponsored by the State and MSD.”
“A review of the law, as to how the dispensaries will work, how patients will be able to fill and refill, RX limits, and a review of the literature about medical marijuana.”
Clinical / Empirical research
12
“Clinical studies indicating effectiveness, rage of use as a treatment modality.” “Well-designed studies to show safety and efficacy and give dosing and strain information.” “More independent research on the effects of Med marijuana in specific disease states.”
308 Del Med J | October 2015 | Vol. 87 | No. 10