{"id":30697,"date":"2018-08-30T11:37:44","date_gmt":"2018-08-30T16:37:44","guid":{"rendered":"http:\/\/stateimpact.npr.org\/oklahoma\/?p=30697"},"modified":"2018-09-07T09:16:20","modified_gmt":"2018-09-07T14:16:20","slug":"the-shadow-of-the-opioid-crisis-looms-over-doctors-considering-medical-marijuana","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/oklahoma\/2018\/08\/30\/the-shadow-of-the-opioid-crisis-looms-over-doctors-considering-medical-marijuana\/","title":{"rendered":"The shadow of the opioid crisis looms over doctors considering medical marijuana"},"content":{"rendered":"<div id=\"attachment_30698\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-30698 size-large\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180821-william-yarborough001_HR-1620x1080.jpg 1620w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact<\/p>\n<p class=\"wp-caption-text\">Dr. William Yarborough, right, speaks with patient Richard Potts at the Oklahoma Pain and Wellness Center in Tulsa.<\/p>\n<\/div><p><span style=\"font-weight: 400;\">William Yarborough walks across the hall from his office to an exam room. His Hawaiian shirt and matching khaki pants aren\u2019t the typical doctor\u2019s garb. <\/span><\/p><p><span style=\"font-weight: 400;\">As he opens the door, the informality is reflected in the <\/span><a href=\"https:\/\/okpainandwellness.com\/\"><span style=\"font-weight: 400;\">Oklahoma Pain and Wellness Center<\/span><\/a><span style=\"font-weight: 400;\">\u2019s,grey-and-white exam room where Richard Potts sits on a black leather chair \u2014 instead of an exam table \u2014 waiting to talk to him. What follows is a conversation that Yarborough estimates he has about 20 times a day at the after State Question 788 passed in June. <\/span><!--more--><\/p><p><span style=\"font-weight: 400;\">\u201cDr. Yarborough, do you think the medical marijuana would help, not the pain, but the muscle spasms and stuff?\u201d Potts asks. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cWell I can\u2019t really say for sure, one way or another since we don\u2019t really have the studies,\u201d Yarborough said.<br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/w.soundcloud.com\/player\/?url=https%3A\/\/api.soundcloud.com\/tracks\/492859299&color=%23ff5500&auto_play=false&hide_related=true&show_comments=false&show_user=true&show_reposts=false&show_teaser=false&visual=false\" width=\"100%\" height=\"150\" frameborder=\"no\" scrolling=\"no\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Why some doctors are wary<\/span><\/h3><p><span style=\"font-weight: 400;\">To get a medical marijuana license in Oklahoma, patients need a recommendation from their doctor \u2014 paperwork attesting that, in their medical opinion, a patient would benefit from the drug. <\/span><\/p><p><span style=\"font-weight: 400;\">So far, 38 physicians have registered with the Oklahoma Medical Marijuana Authority to help streamline the process for their patients who apply for licenses. Doctors aren\u2019t required to register to recommend medical marijuana, and Yarborough, like many Oklahoma doctors, isn\u2019t sure yet if he will. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cPhysicians are really leery about this sort of thing,\u201d he said. \u201cMore so than they were 10 years ago. And more so than maybe they will be 10 years from now when it sort of settles out.\u201d <\/span><\/p><p><span style=\"font-weight: 400;\">Oklahoma is one of the few states that have no specific diagnosis listed in medical marijuana regulations, leaving it up to doctors <\/span><span style=\"font-weight: 400;\">to suss out who are serious medical patients and who are thinly disguised recreational consumers.<\/span><\/p><p><span style=\"font-weight: 400;\">At the <\/span><a href=\"https:\/\/www.stillwater-medical.org\/\"><span style=\"font-weight: 400;\">Stillwater Medical Center,<\/span><\/a><span style=\"font-weight: 400;\"> OBGYN <\/span><a href=\"https:\/\/www.stillwater-medical.org\/patient-resources\/providers-directory\/prasanna-dayan-fernando-md-mha\"><span style=\"font-weight: 400;\">Prasanna Fernando<\/span><\/a><span style=\"font-weight: 400;\"> says the health industry shift toward giving patients what they want, a practice thought to have fueled the opioid crisis, is in the back of many doctor\u2019s minds when they consider medical marijuana. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cHow much are we doing just to satisfy our patients? If a patient came to me and said, \u2018You know what, doc, I want medical marijuana, I think that\u2019s going to help me.\u2019 Once upon a time we would have said, \u2018Absolutely not, we\u2019re going to go through steps A, B, and C before we get to that last recommendation, which is medical marijuana.\u2019 Well, right now we don\u2019t know where that fits,\u201d Fernando said.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Are doctors liable?<\/span><\/h3><p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27332619?dopt=Abstract\"><span style=\"font-weight: 400;\">Aggressive regulations<\/span><\/a><span style=\"font-weight: 400;\"> on physician prescribing, followed by <\/span><a href=\"https:\/\/okcfox.com\/news\/local\/doctor-serving-time-for-opioid-deaths-talks-about-his-case-for-the-first-time\"><span style=\"font-weight: 400;\">high-profile cases<\/span><\/a><span style=\"font-weight: 400;\"> of doctors facing criminal charges for patient deaths related to opioids has made Oklahoma doctors fear a backlash if they recommend the drug. The breakneck speed of rule changes and implementation of the medical marijuana program, coupled with the ambiguity surrounding enforcement has many doctors throwing up their hands. Fernando says clarity from the Oklahoma Medical Board, which oversees medical doctor\u2019s licensing, would help. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cThe last thing you want to be is that renegade physician that\u2019s trying to do something when your board is not behind it,\u201d he said.<\/span><\/p>\n<div id=\"attachment_30699\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-30699\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/08\/20180806-prasanna-fernando001_HR-1620x1080.jpg 1620w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-caption-text\">Dr. Prasanna Fernando, at his office at Stillwater Medical Center.<\/p>\n<\/div><p><span style=\"font-weight: 400;\">Only medical doctors and doctors of <\/span><a href=\"https:\/\/www.ok.gov\/osboe\/\"><span style=\"font-weight: 400;\">osteopathic medicine<\/span><\/a><span style=\"font-weight: 400;\"> can recommend medical marijuana in Oklahoma. Neither of the two professions\u2019 boards has released any guidelines for physicians. And they aren\u2019t planning to, says <\/span><a href=\"http:\/\/www.okmedicalboard.org\/contact\"><span style=\"font-weight: 400;\">Lyle Kelsey<\/span><\/a><span style=\"font-weight: 400;\">, director of the <\/span><a href=\"http:\/\/www.okmedicalboard.org\/\"><span style=\"font-weight: 400;\">Oklahoma Medical Board.<\/span><\/a><\/p><p><span style=\"font-weight: 400;\">\u201cWith all of the controversy and all of the changes and those kinds of things, I think we decided to stand back and see how things flush out, and then see what the role of the board would be, if any, on that topic,\u201d he said. <\/span><\/p><p><span style=\"font-weight: 400;\">The board is restricted by state law, and Kelsey said its priority is protecting the public.<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cThe things that we do, as far as guidelines and policies and those kinds of things, help protect the patient from errant practice, as they would hopefully help the physician not to do something to injure a patient,\u201d Kelsey said. \u201cIn that way, it\u2019s helping them to kind of say, \u2018If you do these things, you should be OK.\u2019\u201d<\/span><\/p><p><span style=\"font-weight: 400;\">Kelsey said the medical board works off complaints, and until it receives one regarding medical marijuana, he\u2019s not sure how it will play out. <\/span><\/p><p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.fsmb.org\/\"><span style=\"font-weight: 400;\">Federation of State Medical Boards<\/span><\/a><span style=\"font-weight: 400;\">, which represents almost all such boards nationwide, including Oklahoma\u2019s, <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2529569\"><span style=\"font-weight: 400;\">published guidelines<\/span><\/a><span style=\"font-weight: 400;\"> in 2016. The 10 recommendations include having an ongoing relationship with patients and drafting a treatment plan and timeline. The federation also recommends looking at a patient&#8217;s mental health and substance dependence histories. <\/span><\/p><p><span style=\"font-weight: 400;\">Many of the recommendations are similar to the Oklahoma State Department of Health\u2019s <\/span><a href=\"http:\/\/omma.ok.gov\/guidance-for-physicians?utm_medium=email&utm_source=govdelivery\"><span style=\"font-weight: 400;\">guidelines.<\/span><\/a><\/p>\n<h3><span style=\"font-weight: 400;\">Is medical marijuana worth it?<\/span><\/h3><p><span style=\"font-weight: 400;\">At his Tulsa practice, William Yarborough says <\/span><span style=\"font-weight: 400;\">physicians are wondering if the state will audit doctors who recommend marijuana the way regulators are <\/span><a href=\"https:\/\/www.pbs.org\/newshour\/health\/justice-department-announces-crackdown-on-fraudulent-opioid-prescriptions\"><span style=\"font-weight: 400;\">investigating opioid providers<\/span><\/a><span style=\"font-weight: 400;\"> suspected of overprescribing. To him, it&#8217;s another reason to avoid a potential regulatory headache. <\/span><\/p><p><span style=\"font-weight: 400;\">\u201cYou\u2019re not going to get paid more for doing this,\u201d he said, \u201cAnd you\u2019re going to be accountable possibly, so why would you want to do it?&#8221;<\/span><\/p><p><span style=\"font-weight: 400;\">\u201cMy schedule\u2019s full,\u201d Yarborough said. \u201cI don\u2019t need to market my practice.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Aggressive regulations on physician prescribing, followed by high-profile cases of doctors facing criminal charges for patient deaths related to opioids has made Oklahoma doctors fear a backlash if they recommend the drug.<\/p>\n","protected":false},"author":199,"featured_media":30698,"comment_status":"open","ping_status":"closed","sticky":false,"template":"page-noFeature.php","format":"standard","meta":[],"categories":[23],"tags":[944,833,834],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30697"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/users\/199"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/comments?post=30697"}],"version-history":[{"count":4,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30697\/revisions"}],"predecessor-version":[{"id":31140,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30697\/revisions\/31140"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media\/30698"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media?parent=30697"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/categories?post=30697"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/tags?post=30697"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}