Health Care

Meet a rare breed: Missouri doctors eager to help patients try medical marijuana

For more than 35 years, Lee’s Summit gastroenterologist Marc Taormina has treated patients wracked by inflammatory bowel conditions like Crohn’s disease and ulcerative colitis.

They suffer from chronic bloody diarrhea and abdominal cramps that double them over in pain. For those who get little or no relief from traditional medications, Taormina is welcoming the chance to help them try an alternative: medical marijuana.

“They have to worry about where the bathrooms are located, whether they can make it to work because of chronic abdominal pain, whether they are able to afford their medications, whether they are able to have a normal life with their life partner,” Taormina said.

Depression is a major risk for those patients, he said. “I think medical marijuana may be able to help that as well.”

Taormina, a Kansas City native, is one of a small number of Missouri doctors bucking the state’s medical establishment by openly supporting the medical marijuana amendment voters approved in November.

All of the state’s major physician groups opposed it, saying there hasn’t been enough research to prove cannabis’s effectiveness for many of the eligible conditions, and it’s not sold in standard doses or purities.

Taormina said he shares some of those concerns.

But now that the voters have spoken, Taormina said physician groups should try to help state regulators and patients maximize the usefulness of cannabis and minimize its societal harm.

“The medical society, to me, should be more constructive than obstructive, now that it’s passed,” Taormina said.

John Hagan, the past president of the Kansas City Medical Society, disagrees.

Hagan said the ballot initiative was driven by money from “Big Weed” for commercial reasons, and it’s intended to be a foot in the door for recreational marijuana. Cannabis is addictive and can harm the brain and body, he said.

“I think any ethical physician has no business advocating for medical marijuana,” said Hagan, who is an ophthalmologist.

Joshua Mammen, a University of Kansas Health System surgeon and the medical society’s current president, was less forceful, but still said the new law’s broad access to marijuana products isn’t ideal.

“The medical society continues to be proactive in the education of our members and the public about what is currently known about marijuana use,” Mammen said via email. “Like other substances that have a claimed therapeutic benefit, the medical society is supportive of well-designed studies to evaluate possible benefits for specific indications so that physicians can best care for patients.”

Taormina and other pro-medical marijuana doctors say they recognize the risks.

But they believe it can help some of their patients, and it’s better to have marijuana use out in the open rather than in the shadows.

“People are doing it anyway, so wouldn’t it be a good idea to be able to talk to them about it and kind of explain some of the consequences?” said Sara Bubenik, a primary care doctor with an office just north of downtown Kansas City.

Opioid alternative

Missouri is the 32nd state to legalize medical marijuana.

Before moving to Kansas City two years ago, Bubenik was a nurse and a doctor in Oregon, one of the first states to legalize marijuana for medical use and, later, recreational use. She said physicians in other states have become more comfortable with it.

Bubenik is part of Missouri’s assistant physician program, a first-of-its-kind law that allows medical school graduates who haven’t done residency to practice under the supervision of another physician.

She said that she intends to primarily use medical marijuana as an alternative to opioid painkillers, because the state heavily scrutinizes doctors who prescribe those drugs and because she’s uncomfortable with their high risks of addiction.

Sara Bubenik, a primary care physician in Kansas City, said she will help some of her patients access medical marijuana as an alternative to opioids once Missouri’s program rolls out next year. Andy Marso

“There’s an opioid epidemic because there’s so much pain people don’t know how to manage,” Bubenik said.

She said she already recommends patients try non-traditional pain treatments like acupuncture or yoga, and marijuana will be another option.

Marijuana is only about half as addictive as opioids, Bubenik said, and while thousands of Americans die of opioid overdoses every year, there have been no documented cases of fatal marijuana overdose.

Bubenik said she’s aware of marijuana’s negative effect on developing brains and would not recommend it to any patients under 25 except under extreme circumstances, like treating persistent seizure disorders that can also impair brain function.

She also said that she hopes state regulators will be able to enforce some standards for labeling medical marijuana products and testing them to make sure the labels are accurate and products aren’t tainted.

“Those are all things that are worrisome and need to be addressed,” Bubenik said.

Medical marijuana also won’t be covered by insurance, but Bubenik said that’s less of an issue for her patients than for others. She runs a direct primary care clinic, which means patients pay her a monthly membership fee rather than billing insurance. Clinics like hers often attract patients who either have no coverage or high deductibles.

Research needed

Taormina also said he thinks medical marijuana should be restricted to adults.

But he’s hopeful it will help some of his sickest patients manage the symptoms of Crohn’s and colitis without some of the harsh side effects of traditional medications.

Cannabis has shown some promise for treating the symptoms of those diseases. But large-scale studies have yet to be done because it remains an illegal Drug Enforcement Administration Schedule I controlled substance.

“The federal regulations haven’t kept up with medical advances in this,” Taormina said, “So I think the research will come once the DEA either changes the classification or transfers the jurisdiction of marijuana over to the FDA (Food and Drug Administration).”

The constitutional amendment Missouri voters approved lists several specific conditions that qualify patients for medical marijuana, including cancer, epilepsy, glaucoma and inflammatory bowel diseases. But it also says doctors can add others, at the discretion of the state health department.

By June the department will have to offer an application form that patients can bring to their doctors as the first step toward getting a marijuana card. It’s unclear right now whether the forms will require the doctors to explicitly recommend marijuana or just confirm the patients have a medical condition that qualifies them for it. Then it is up to the state to approve the card applications.

In the meantime, Taormina said, he’s finding out that many of his patients have already been using marijuana or a derivative called cannabidiol, or CBD.

He said he was besieged with messages of thanks and support after he posted comments in favor of medical marijuana on a Kansas City Medical Society social media feed. Once patients knew his stance, they confided to him that they were already using it, and some have been calling to find out when they can get into the state-regulated program.

“We’ve had to come up with a script in the office to tell patients that we’re not able to make a (medical marijuana) recommendation at this point,” Taormina said.

Taormina said he’s planning to host some educational seminars around the first of the year.

Bubenik and her husband and business manager, Jack Anderson, are also organizing educational events for patients and interested physicians. Their first is scheduled for Dec. 5 at Hemp Life Kansas City, a CBD shop on Main Street.

Anderson, who has worked in the medical marijuana industry in the Netherlands, Colorado and Oregon, said other independent physicians around Kansas City are showing interest. But a growing share of physician practices are now tied to major hospital systems, and his experience is that they will be the last group to embrace medical marijuana.

“It’s too complex, as far as their corporate image,” Anderson said.

Bubenik, Anderson and Taormina all said their hope is to make medical marijuana a legitimate treatment tool for patients who have a genuine relationship with a physician.

They agree with Missouri’s major physician groups that the program shouldn’t become a cash cow for “fly-by-night” doctors whose clinics are devoted almost entirely to signing off on medical marijuana applications.

“There’s always a few rogue doctors that are going to open up clinics that are just ‘Come in and get your prescription,’” Taormina said. “But that should not interfere with the ability of other physicians to be able to prescribe that to patients who need it.”

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