While state regulators sort out who will get licenses to run medical marijuana dispensaries in Massachusetts, many patients — probably thousands — are already using medical marijuana here.
To find out how they're getting it and which doctors are recommending it, WBUR visited both a clinic and marijuana provider. Here's our report from a newly opened clinic.
BURLINGTON, Mass. — At the front desk of Integr8 Massachusetts in Burlington, office manager Elizabeth Stockbridge answers a steady stream of calls from patients seeking relief — from pain, nausea, seizures and all sorts of other medical conditions.
"How long have you had the migraines and the headaches? Are those documented?" Stockbridge asks a prospective patient.
People coming to Integr8 are asked to provide medical records. But many of them have been self-treating their medical conditions with marijuana for years. And because most hospital groups are steering clear of medical marijuana right now, patients are coming here. And they're not seeking help just for physical ailments.
Twenty-eight-year-old Danielle Page, of Marblehead, says she came to Integr8 for mental health reasons. But she's not new to psychiatric treatment — or marijuana.
"I've been using marijuana since I was 13 years old — that's on and off," Page says.
She realized long ago that marijuana helped ease her anxiety, depression and attention deficit disorder, she says, and she never wanted to have to take pills every day. During her $200, 45-minute initial appointment and after a review of her medical records, she received a doctor's recommendation, or certification, for medical cannabis.
"I feel vindicated that, like, something that I've been doing for a very long time, I finally feel vindicated that I'm right," Page explains.
Dr. Thor Agustsson, medical director of Integr8 Massachusetts, says many patients come to him because they've "failed" a lot of pharmaceutical treatments. Agustsson is an osteopathic physician trained in psychiatry. He opened the clinic in October and has since recommended medical cannabis for hundreds of patients. About half of the facility's clients are treated for psychiatric conditions.
"I think it is better long term to be on cannabis than it is [to be on] a lot of benzodiazepines," Agustsson says. "A lot of antipsychotics, a lot of mood stabilizers are a lot more harmful to the body on a whole."
Psychiatric illnesses are not on the approved list of conditions Massachusetts doctors can treat with medical marijuana. But Agustsson says the law gives doctors discretion in determining what qualifies as a "debilitating condition."
"I ask them everything I would normally ask them in a psychiatric evaluation and then apply the appropriate treatment — if it's cannabis, if it's pharmaceutical medicines, if it's herbs or vitamins," Agustsson explains.
He acknowledges he has to walk a fine line between determining who wants to get high and who really needs marijuana as a medical treatment.
But some mental health patients don't have medical documentation because they may not have been comfortable reaching out for medical treatment before. In that case, Agustsson says he relies on his training in psychiatry. Sometimes he recommends cannabis and prescription psychiatric medicines simultaneously.
Joey Rottman is the other osteopath at Integr8. He specializes in treating chronic pain.
"We do a full history, we do a full physical examination, including an osteopathic examination of their spine and other possible trigger points," Rottman says. "And we have to have medical records that show six months of care."
The Massachusetts Medical Society recently released a statement expressing concern about these clinics, calling them "certification centers" for patients seeking marijuana. The society says the clinics appear to "sidestep" the Department of Public Health regulation requiring an "ongoing physician-patient relationship." But Agustsson says he does establish a relationship with each patient, which includes follow-ups every six months or sooner.
Asked how often Integr8 denies a patient a recommendation for medical marijuana, Agustsson says it has happened, but he can't say how many times.
But once a patient gets a recommendation for medical marijuana, where do they get the drug? Doctors are not responsible for where a patient obtains marijuana.
Susanne Greelish, of Watertown, gets hers from friends or dealers -- instead of growing it herself or getting it from a caregiver, as state regulations require.
"I don't have time to grow it myself right now, and I would like to, because I'd like to be able to get a real nice blend," Greelish says. "But as soon as the dispensaries open, that's what I'm going to do."
Greelish, who is 55 years old, uses pot to treat chronic pain. Before it was legal, she used it to ease severe nausea from chemotherapy. Now, so she doesn't have to take prescription drugs, she says, she smokes a small amount of marijuana three to four times a week.
"I usually do just, like, two puffs, and it really helps me, and I can loosen up and kind of stretch and, you know, breathe a little bit," Greelish explains. "It's really good for connecting my mind and body together, so I can kind of focus where the pain is."
Page says she smokes before -- but not during — her workday, to alleviate her anxiety. She works with kids in a residential mental health program. She insists that it would be debilitating if she took prescription drugs.
"I would be on the floor," Page says. "I mean, I wouldn't even be able to drive or function at work, where I can wake up, smoke in the morning, go to work, and know that I'm safe, the kids I'm working with are safe, and the people around me are safe, and, you know, I'm fine."
Page now gets her marijuana from a caregiver. That's someone who can supply marijuana for a certified patient. Tomorrow we'll have more on why there's a shortage of caregivers in Massachusetts and why some of them are blatantly violating state regulations.
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