Dr. P. Travis Harker, a Concord physician, is president of the New Hampshire Medical Society and holds both a medical degree and a master's degree in public health. He responded to these questions from the New Hampshire Union Leader about the state's newly enacted medical marijuana legislation.
How was the medical society involved in the drafting of the law?
We wanted to have a very limited and narrow scope for this legislation because we believe that therapeutic cannabis is an unproven therapy. Studies have not been done to confirm that this would be a useful intervention or to say it would not be a useful intervention. We thought for some people with life-threatening illnesses that were not responding to treatment that this might be something worth considering. We're very concerned about the risk of diversion and the message we send to the children and adolescents of New Hampshire about cannabis. We wanted to make sure we did not send a message that it is a safe product to be used in a recreational way.
Are there any possible uses of cannabis that you specifically opposed?
We played a very active role in getting the scope narrowed; the biggest example is post-traumatic stress disorder, where there is some evidence that cannabis can be disruptive to appropriate treatment.
Are providers writing prescriptions for marijuana under the bill?
They are not. When I write a prescription, I've made a diagnosis, I look at FDA-approved therapies and I prescribe a medication that is approved by the Food and Drug Administration. This allows the doctor to certify that (the patient) has that condition. The patient then takes that certification to a dispensary, which can dispense to a person who has a certifying diagnosis.
Is it troubling to you as a practitioner that you are being asked to diagnose a condition, but the patient decides that medical marijuana is the way to treat it?
It is somewhat concerning; there is lot of question of how it will play out in practice, We in the medical society are going to work with the Board of Medicine and work with the Drug Enforcement Administration to understand what is legally appropriate, but also what is morally and ethically appropriate for our providers within the scope of the law and actually do the right thing for our patients.Can a doctor be a conscientious objector and say, "No, I'm not doing that.'"
I think they could. In the same way that some doctors choose not to prescribe birth control, some doctors could decide not to certify certain diagnoses.Will continuing education be recommended or required for physicians about what to do when someone comes in looking for a diagnosis that will allow use of medical marijuana.There is nothing required in the legislation, but the Medical Society is going to work very aggressively to make sure we have information out to the physicians of the state. It is a critically important issue that physicians do it right, and we want to make sure they have the right information to make the best decisions when they are with their patients.
Do you have concerns over the type, dosage and manner in which cannabis will be administered once someone qualifies to use it?
Smoking marijuana is clearly bad for people's lungs. If I had a patient certified for a diagnosis, I would recommend against smoking it unless they had no other way of getting it into their system.
What is the beneficial part of medical marijuana, is it the THC? Can that be given as a pill instead of self-dosing through marijuana use?
There is a medicine that is a purified form of THC — it is called Marinol — to help stimulate appetite in people with wasting disorders like HIV/Aids. It is something that we've been able to prescribe for a number of years. We have argued that (Marinol) probably would have been a better route than to legalize an unproven therapy, but there was political will in the state that it was going to pass. If (medical marijuana) was going to be a therapeutic option in the state, we wanted to minimize the risk to people.
As this bill was considered, did you have to silence your professional reservations about the concept of medical marijuana?
No. We were very upfront that we didn't think moving forward with therapeutic cannabis was the right thing, but we followed up with, "If you are going forward, these are the things that we think will make your bill better." We did not keep silent on things we cared about.
Are you concerned that the program has potential to be abused by people receiving medical marijuana, since there are no prescribed dosages for someone who qualifies to use it?
I don't think there is any control on that, and that is one of the concerns about it — that some people will use it in a more recreational sense than a therapeutic sense and use it to be intoxicated as opposed to ease their pain or stimulate their appetite.
Is the availability of marijuana as a treatment a distraction from alternatives that might be a better option for the patient? Will its availability mean people don't follow a regimen that their doctor might recommend?
That certainly is a risk, and I think the Legislature decided this is a risk we're going to have. I do hospice and home calls (for terminally ill patients) and we have excellent medications to treat their pain and to keep them comfortable in the last days, weeks or months of their lives when they have a terminal illness. I don't believe we need an additional therapy of marijuana. I'm open to having more research on this, but don't think we should be having research done on patients in New Hampshire in an uncontrolled fashion.