Follow-up visit: $150. DNA requires a follow-up after six months of use to review progress with the type of medical marijuana being dispensed to the patient. If patients refuse the six-month review, DNA will not renew the recommendation for a medical marijuana card.
Initial visit and consultation: $200; includes physical examination and a review of medical records, medications and potential interaction problems with cannabis.
Headquartered in Greensburg, his DNA Pain Advancement Treatment Center practice clinics encounter 3,000 people a month suffering from different forms of chronic pain.
When he and his wife set up their clinics in 2004, which now include locations in Robinson, Mt. Pleasant, Indiana and Pleasant Hills, they never pushed opiates like Percocet or Vicodin.
Now, he estimates his clinics receive 25 to 30 calls a week from patients or people inquiring about Pennsylvania’s medical marijuana program. Many want to wean off prescription opioids they take for pain.
“I feel confident that, if used correctly for correct reasons, this could be a very good and safe drug,” he said. “We know the opioid epidemic is horrendous in Pennsylvania. I wouldn’t classify medical marijuana as a substitute for the use of opiates, but I do feel that there is a place for it in some patients who don’t want to take opiates or haven’t responded well to them.”
Navalgund is one of the 355 doctors in the state approved to certify patients for the medical marijuana program. About 300 more have registered to undergo the four-hour training course required for certification. Approved practitioners can certify patients at the same location where they regularly provide care.
The demand on the patient side is there. So far, more than 16,000 Pennsylvania residents have registered for the program and 3,300 have been certified to receive medical marijuana.
Whether more doctors jump on board remains to be seen. Dr. Rachel Levine, the state’s acting secretary of health and physician general, put out a call for more doctors during the opening of Pennsylvania’s first marijuana dispensary in Bethlehem on Jan. 17. She said it was “critical” for additional doctors to register for the program.
Since then more dispensaries have opened, including several in Western Pennsylvania. More than 50 dispensaries will be open statewide when the program is fully operational by May.
Levine told the Tribune-Review she doesn’t have a magic number of physicians in mind to help the program run smoothly. The state has more than 58,000 licensed doctors.
“What we want is a good variety in the number of physicians spread geographically throughout the state,” she said.
But doctors can be a stubborn bunch. They like science, research and proven results.
Complicating matters even further, Attorney General Jeff Sessions last month said he will allow federal prosecutors to decide how aggressively to enforce federal law prohibiting marijuana transactions, even in states with legalized medical marijuana.
Levine acknowledged that the federal classification of marijuana as a Schedule 1 controlled substance, the same category as heroin, remains a barrier for research. The classification technically means the drug has no medical benefits. She and other medical marijuana proponents believe a reclassification could be a game-changer.
“The fact that marijuana is labeled a Schedule I compound limits the research,” Levine said. “One of the biggest issues we’re dealing with is the way marijuana is scheduled.”
The large Western Pennsylvania health systems, such as UPMC, Excela and Allegheny Health Network, so far are shying away from medical marijuana treatment.
“We’re scientists and have no opinions until there is evidence to guide us one way or another,” said Dr. Terence Dermody, physician-in-chief and scientific director at Children’s Hospital of Pittsburgh of UPMC. “I am a skeptic until I see data that points in one direction. I don’t have a view because I don’t (believe) there is a view to be had.”
“As physicians, we are accustomed to always looking for research, literature and data to support the way we practice,” he said. “In this case, because of how regulated the drug is, that becomes very challenging. A lot of the research and work we do as recommending physicians for medical cannabis really involves research on our own and exploring other states and how things are run there.”
Many of Navalgund’s patients have exhausted all other options for chronic pain treatment.
“They have been dumped by every other physician and feel like they have no other alternatives,” he said.
Dr. Michael Hoffer, an ER physician at ACMH Hospital, initially viewed the concept of medical marijuana with major skepticism.
“I grew up being told that marijuana was illegal and bad, a gateway drug to serious abuse,” he said. “The thought of it being medicinal was outlandish to me.”
When a former colleague, Dr. Bryan Doner, asked him to help him set up a medical marijuana practice, Hoffer was hesitant.
“I started reading up more and more about anecdotal benefits to patients,” he said.
He joined Doner to form Compassionate Certification Centers, a medical marijuana practice that will soon open offices in Natrona Heights, Irwin, North Huntingdon and Kittanning. Its Downtown Pittsburgh office opened last year, along with a clinic in Butler.
“The benefit of my being in emergency medicine is I know a little bit about a lot of things,” he said. “For some of the patients I have seen, suffering from chronic pain or seizures, there is a big hope for them that the quality of life could improve through medical marijuana.”
Under state law, patients can apply for a state-issued medical marijuana card if a doctor certifies they have one of 17 qualified medical conditions, included epilepsy, cancer, Crohn’s disease, multiple sclerosis and seizure disorders.
Qualified patients with a doctor’s recommendation will receive a Pennsylvania medical marijuana identification card, allowing the purchase of medical marijuana from an authorized state-licensed medical marijuana dispensary. Dispensaries are also allowed to sell equipment, such as vaping devices for liquid forms, to administer medical marijuana.
Westmoreland County resident Diana Briggs and her son Ryan, 17, who suffers from epilepsy, were among the first to be evaluated by Compassionate Certification Centers in December. She received a medical marijuana caregiver card to administer medical marijuana oil that helps the reduce the number of daily seizures her son suffers daily.
“It’s imperative that we have more physicians from all specialties register and take the required course to treat patients like Ryan,” said Briggs, who lives in Export. “The current 350 or so is a good start; however, many more will be needed to make our program a success.”
Doner said his Pittsburgh office averages about 30 patients a day. He estimates his staff so far has certified more than 300 patients at its two locations for medical marijuana cards.
“I’m not worried about the physician response,” he said. “To be honest, I think the state is doing well for how early we are in the program.”
Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991, [email protected] or via Twitter at @Bencschmitt.