Medical marijuana is finally here, but many Georgia doctors shy away from it

But, as the first of Georgia’s dispensaries were preparing to open in April, Hayes faced a new challenge.

Like many doctors in the state, her primary care physician had no idea how to help a patient get medical marijuana. And the doctor wasn’t inclined to figure it out.

Determined, Hayes educated herself on what the physician needed to do, went back to her and walked her through the process.

Credit: Natrice Miller / Natrice.Miller@

Credit: Natrice Miller / Natrice.Miller@

Getting the card that allows her to purchase cannabis oil required more effort than it should have, said Hayes, an independent insurance agent. But it was worth it.

”Being in pain, it makes you want to cry,” she said. The low dose of medical cannabis, she said, has helped her “tolerate the pain.”

Medical marijuana might be new to Georgia, but it isn’t new. Thirty-seven other states allow the use of the products. Yet some Georgia doctors seem wary of medical cannabis. For many of them, the reason is simple: They were never trained how to use it during medical school or residency, so it’s not on the list of treatment options they consider.

At a recent informational session at one of the new dispensaries, a common theme among attendees was the difficulty finding physicians who can certify that they have one of the qualifying medical conditions.

Before doctors can certify patients, they must register with the Georgia Department of Public Health, but the state doesn’t disclose who they are.

Dr. Kelly Degraffenreid, former chair of the Medical Association of Georgia’s Medical Cannabis Task Force, said some doctors are hesitant to even discuss with their patients medical marijuana as a possibility. “If you don’t know about medical cannabis, you are like, ‘I’m just not going to say anything. I am just going to be cautious.’ So how do you get them in the know?”

Credit: custom

Credit: custom

There’s limited evidence that medical marijuana can help with a host of conditions including chronic pain, chemotherapy-induced nausea, and post-traumatic stress disorder. Some doctors say they are approaching medical marijuana with caution because more research is needed. They express concern about a lack of dosing guidelines and a lack of consistency in medical cannabis products.

More than 27,000 Georgians have been issued medical marijuana cards. It’s a number that’s been building for years as legislators passed piecemeal legislation that left residents in a quandary. While it’s been legal to use cannabis oil for medicinal purposes in Georgia since 2015, there was no way to legally buy the product here until this year.

The number of people with cards is expected to swell now that local retail outlets are up and running.

“People are using it, whether we physicians like it or not,” said Dr. Adam Perlman, director of Integrative Health and Wellbeing at the Mayo Clinic in Florida. He is also the medical editor of the recently published 95-page guide, “Medical Marijuana: The Science and the Benefits.”

“That ship has left the dock. So, you can jump up and down about it, but I think there’s very little chance of that, all of a sudden, the legalization will be reversed. …We need to learn to deal with this.”

Getting the card

In Georgia, where recreational pot use is illegal, qualified patients can get low-THC medical cannabis oil. It’s packaged as liquid tinctures, topical cream, capsules and nasal spray, by law, must have less than 5% THC, the chemical that produces a high.

Street marijuana has a far higher level of THC – usually around 20%.

A person must obtain a card to be eligible to buy the products. Seventeen medical conditions qualify, including intractable pain, seizure disorders, post-traumatic stress disorder, end-stage cancer or severe nausea related to cancer and treatments, Crohn’s disease and amyotrophic lateral sclerosis, which is also referred to as ALS or Lou Gehrig’s disease.

Credit: Natrice Miller / Natrice.Miller@

Credit: Natrice Miller / Natrice.Miller@

But patients have no way to know which doctors could certify them. The state keeps the names of doctors who are registered to certify patients confidential and major hospital systems, including Emory Healthcare and Piedmont Hospital, don’t keep lists of which doctors have certified patients.

That lack of transparency has frustrated some patients.

On a recent rainy evening, cannabis company Trulieve hosted a “Cannabis 101″ session at its Marietta outlet to answer questions from people who either recently obtained certification or believe they could benefit from medical marijuana.

Hayes was among those who filled the lobby lined with white folding chairs, set up near posters with the words “Revive. Relax. Relieve.”

So was Lydia Cook, who lives in Villa Rica. Cook turned to marijuana edibles years ago to ease her chronic knee pain and reduce anxiety. But her supplier was thousands of miles away, in the state of Washington, where marijuana is widely accessible and legal for adults 21 and over.

Now that medical marijuana is available in Georgia, the 57-year-old is hopeful she can soon find relief close to home.

The Georgia Access to Medical Cannabis Commission has licensed six cannabis oil dispensaries to sell to the public. Trulieve has opened dispensaries in Marietta and Macon and is expected to open three more in Newnan, Pooler and Columbus sometime this summer. Another dispensary, operated by physician-owned Botanical Sciences, is scheduled to open in Pooler in July.

Pen and paper in hand, Cook listened carefully as Trulieve employees explained the different products. She patiently waited to raise her hand to ask a seemingly simple question: How do I get medical cannabis here in Georgia?

Last year, she said, she broached the subject with her primary care doctor. “He rolled his eyes at me, so I knew not to take it any further,” she said.

And she probably won’t, at least not with him. But, she said, she is determined to get easier access to a product that she says has alleviated her pain and anxiety.

Educating doctors

Over the years, as medical marijuana legislation stalled under the Gold Dome, Allen Peake, a former state representative from Macon and Shannon Cloud created an informal network to help Georgians who had medical cannabis cards but had no way of legally obtaining the product.

Cloud’s daughter, Alaina, has Dravet syndrome – a rare, serious seizure disorder.

Credit: Contributed

Credit: Contributed

Cloud and other volunteers met patients and families in the parking lots of big box stores to give them medical cannabis shipped in from another state. She estimates they provided medical marijuana, free of charge, to about 800 patients.

Cloud said she realizes some doctors are not necessarily supportive of the use of medical marijuana. She hopes that now that medical cannabis oil can be sold in Georgia, doctors will become familiar with it and will be more open to certifying patients.

If so, some patients might face another challenge — cost. Public and private insurance companies won’t pay for medical marijuana even in states where it’s legal, because it’s still illegal on a federal level.

Dr. Ali J. Zarrabi has seen patients at Emory’s Palliative Care Center who have been taking medical marijuana for several years. The center takes a holistic approach to treating patients with serious, life-threatening illnesses, but did not acquire medical marijuana for their patients.

Zarrabi, a palliative care specialist, acknowledges that research is limited on the potential benefits and harms of cannabis in seriously ill patients. But he and his colleagues believe there is substantial evidence supporting the use of medical cannabis for the treatment of a number of health conditions. And, he said, it can help with managing the emotional aspects of the pain.

Patient demands

Zarrabi said when he first started working at Emory in late 2016, he had “absolutely no experience or interest in medical cannabis.”

“The interest arose from my patients because they truly demanded that I know something about it,” he said.

Patients continually asked him and other physicians in his practice about cannabis products as a potential alternative to opioids and other medications, he said. Between 2015 and 2021, his practice certified 1,711 patients for medical marijuana.

Increasingly, doctors around the country have become more open to it as the opioid crisis has unfolded. Medical marijuana, Zarrabi said, can be a relatively safe alternative to highly addictive opioids. He said many of his patients are looking to medical cannabis as a way to lower their dependency on powerful opioids.

Credit: Natrice Miller / Natrice.Miller@ajc.com

Credit: Natrice Miller / Natrice.Miller@ajc.com

While opioids can be quite effective in dulling the intensity of pain, Zarrabi has found that medical cannabis can lessen the psychological distress that comes with physical suffering.

Cannabis “helps my patients cope better with pain,” he said.

Side effects include dizziness, dry mouth, nausea and drowsiness. He said he’s rarely seen serious adverse effects from his patients taking medical marijuana, but said that’s likely in part because they are taking a low dose.

“I think, given the risks associated with cannabis use, it requires an ongoing relationship that perhaps a minority of physicians are willing to do,” he said.

Zarrabi also has led studies aimed at learning patients’ perceptions of whether medical cannabis helps or not. In a 2020 survey of 101 patients, most of whom had been diagnosed with cancer, 96% said cannabis was important or extremely important in reducing pain and 79% said it decreased their anxiety.

In one of the most comprehensive analyses undertaken, the National Academies of Sciences, Engineering and Medicine formed a committee to review about 10,000 studies done over the past two decades on the use of cannabis to treat nearly two dozen health conditions.

The committee’s report, published in 2017, found “substantial” or “conclusive” evidence that such drugs are an effective treatment for only a small number of conditions: chronic pain, muscle spasticity from multiple sclerosis, and chemotherapy-induced nausea and vomiting.

Degraffenreid, a family physician, said more recent research — done in other countries, including Canada and France — provides evidence of the benefits of medical marijuana for many other conditions.

Degraffenreid would like the state to require doctors to undergo training in medical marijuana.

The Mayo Clinic’s Perlman said eventually patients in Georgia who are eligible and want medical marijuana will not have much trouble obtaining it. New telehealth services with doctors who will certify eligible patients are already sprouting.

“You know, many, many Americans, people across the world, are living with chronic pain,” he said. “Many of the medications we use for chronic pain have side effects that make them less desirable, so people are looking for other options.”