The most common problem we hear about from patients concerns the difficulties they face in obtaining a signed recommendation from a physician.  Many patients have clear and long-standing documentation of medical conditions approved by Montana's medical marijuana law ? and yet they can?t obtain a formal recommendation.  Below we list the most common reasons for this difficulty, and our best current suggestions for overcoming these problems.  (Let us know your experiences and ideas ? we want our advice to be as good as possible.  Email us at .)
 
No Personal Physician
Many Montanans, especially those in rural parts of the state, receive their ordinary continuing healthcare services not from physicians but from physician assistants (PAs) and nurse practitioners (NPs).  Unfortunately, neither PAs nor NPs can make medical marijuana recommendations under Montana law.  Patients thus must make an appointment with a physician who may not know them in order to obtain a recommendation ? and this will require extra funding for travel costs and for the appointment itself. 
To maximize success with a physician who doesn?t already know you, we recommend that you take copies of medical records confirming your diagnosis.  This might save you the costs that could be involved in conducting tests needed to make a diagnosis that already has been made.  In addition, a signed statement from your PA and/or NP ? while not sufficient to register with the state health department ? could assist in your communications with a new physician.  Further, we recommend that before your appointment, you acquaint yourself with the other items of advice offered here.
Patients who are members of Patients & Families United can talk with other patients in hopes of learning about physicians in their region of the state who are known to have made medical marijuana recommendations.
Common Problem:  Physicians Mistakenly Feel Legally Vulnerable
Many physicians do not understand basic facts about state and federal law regarding medical marijuana.  A group called Montana Physicians Advocacy has published a brochure for physicians that can help educate your doctor.  If you join Patients & Families United, we will send you a free copy, which also can be downloaded/printed from:  www.mtmedmjscience.org.
The most important facts about Montana's law for physicians to understand are as follows:
·         Any physician's recommendation is completely confidential, fully subject to all the protections of patient-physician privilege.  Making a medical marijuana recommendation to a bona fide patient who has been diagnosed with a condition specified in the law is legally no different than making any other kind of appropriate recommendation to a patient.
 
·         Montana's medical marijuana law makes it a crime for anyone ? including staff at the state health department ? to disclose the identity of a patient, caregiver or physician.  This crime is punishable by a fine of up to $1,000 and/or by up to 6 months in jail.
 
·         While law enforcement agencies can confirm the legal registration of a patient or caregiver whose identity they already know, the state health department WILL NOT confirm the identity of any recommending physician.  The identities of recommending physicians are protected.
 
·         The state's medical marijuana registry and other records are NOT available for review by any state or federal law enforcement agency or agent.
 
·         Montana's medical marijuana law expressly protects recommending physicians from any adverse action by a licensing board or any other entity as a consequence of having made an appropriate medical marijuana recommendation.
 
·         The federal government is similarly enjoined from taking any action against a physician for making a medical marijuana recommendation.  A U.S. Supreme Court decision affirms the ruling established in Conant v. Walters, 309 F.3d 629 (9th Cir. 2002) ? which held that physician recommendations do not violate federal law.  The Conant decision explicitly prevents the federal government from taking any adverse actions against a physician for recommending medical marijuana.
 
·         Neither state nor federal law places a limit on the number of medical marijuana recommendations any physician can make.
 
Common Problem:  Physicians Object to 'smoking? of Medicine
Some physicians mistakenly believe that smoking is the only means of ingesting marijuana ? and they will not recommend medical marijuana, because they understand that smoking can have negative health effects.
We believe it is important for physicians to know and consider the following:
·         Smoking is NOT the only means of using marijuana as effective medicine.  Other means can work just as well, and completely avoid any problems associated with smoking.
 
·         Research documents that smoking marijuana DOES NOT increase the risk of lung cancer ? and that in fact, marijuana may function as an anti-cancer agent.
 
·         The potential negative effects of smoking marijuana should be weighed fairly against the unique relief it can provide to patients in need, particularly in the case of patients suffering from terminal conditions.
 
First, smoking is NOT the only means of ingesting medical marijuana.  In fact, recent scientific study has documented that vaporizers offer all the advantages of smoking ? with NONE of the adverse effects [link to the recent study or a report].  (Advantages include near-immediate relief and the ability to titrate, or control dosage, carefully and accurately.)
In addition, marijuana can be used for medicinal purposes via cooking and eating.  (Patients interested in learning more about this can get a good start by visiting the following: [links?].)
Second, many physicians mistakenly believe that the health effects of smoking marijuana are similar to those of smoking cigarettes.  In fact, scientific research has recently documented a very different finding  ? that marijuana DOES NOT heighten the risk of acquiring lung cancer and that it may, in fact, reduce this risk [link].  Science suggests that the negative health effects of smoking marijuana may be limited to irritation of the throat and lungs and an increased eventual risk of emphysema.  These findings may seem counter-intuitive after generations of anti-smoking and anti-marijuana propaganda ? but they actually conform to the scientific community's steady documentation of the broad medicinal values of marijuana.  Contrary to popular belief, a wealth of recent research suggests that marijuana offers a variety of anti-cancer values [link to a couple summaries or reports].
Finally, it is important also to note that many of the patients for whom medical marijuana provides vital relief already suffer from very serious and severely ?life-reducing? medical conditions.  The patients we tend to work with at Patient & Families United would much rather experience the potential health risks of smoking marijuana than the certain and debilitating suffering they feel when not using marijuana.  These patients report that medical marijuana provides superior relief when compared to ?ordinary? drugs their physicians prescribe ? and that the marijuana's side effects are much milder and preferable as well.
 
Common Problem:  Many Physicians Are Unaware of Cannabis Science
One of the greatest ironies of this problem is that when the U. S. government made marijuana illegal in the 1930s, it was the American Medical Association that protested most vehemently.  At the time, cannabis was the active ingredient in many of the healthcare profession's most common remedies, and the medicinal benefits of marijuana had been understood and accepted for generations.  (Indeed, at one time in American history, it had been illegal for property owners in Virginia to not grow marijuana ? perhaps one reason that leaders such as George Washington and Thomas Jefferson are known to have been marijuana growers!)

But generations of intensive anti-marijuana propaganda and deliberately erroneous claims have now overwhelmed awareness of the facts.  And the present-day physician cannot be blamed when he or she is largely unfamiliar with the now fast-growing body of modern scientific findings on the matter of medical marijuana.

In fact, the body of published, peer-reviewed science affirming marijuana's remarkable ? and unusually broad ? medicinal values is truly daunting in scope.  The Internet abounds with sites offering factual information ? so much information is available that even conducting a search of the facts can be overwhelming.
That's why Patients & Families United was delighted to learn of the existence of Montana Physicians Advocacy, a network of physicians whose goal is to help other physicians find needed information more easily.  This organization's website focuses solely on the most credible, easiest-to-use, fact-based information available on the Internet, in order to provide both physicians and patients a basic starting point for learning more about what researchers have been documenting about medical marijuana:  www.mtmedmjscience.org.
 
Patients Can ? and Should ? Help Educate Physicians and Others
Patients and their families can play an invaluable role in helping physicians and others acquire a better understanding of the facts about medical marijuana.  If your physician won?t make a medical marijuana recommendation, we recommend that you ask why.  Talk with him or her about it in more detail.  If you have been diagnosed with one of the conditions identified in Montana's medical marijuana law, make sure your physician understands the facts we have outlined here, dispelling the common myths behind many physician attitudes.  Refer your physician to the research findings available on the Internet affirming the value of marijuana in treating or relieving your medical suffering.  Do some of the research for your physician ? make it easier by giving him or her copies of an article or two related to your medical condition.  And if you have questions, please do not hesitate to write to us at .  We?d like to hear about your experiences talking with physicians and others, too.