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Local doctor discusses new medical marijuana practice
SHERRY KARABIN
Legal News Reporter
Published: May 2, 2019
For much of his medical career, Cleveland area physician Dr. Richard Silver said he has believed that marijuana should be available for medicinal purposes.
When former Ohio Gov. John Kasich signed H.B. 523 into law in June 2016, allowing the state to create a medical marijuana program Silver said he was excited about the new treatment avenue that had been opened up.
Fast-forward to today and Silver is now one of about 400 Ohio physicians who is qualified to recommend medical marijuana to patients suffering with one or more of the 21 qualifying medical conditions, including Alzheimer’s disease, cancer, epilepsy or another seizure disorder, fibromyalgia, glaucoma, multiple sclerosis, Parkinson’s disease and pain that is either chronic and severe or intractable.
“I have been advocating for the use of medical marijuana for as long as I can remember,” said Silver, owner of the Silver Lake Wellness Center, which has offices in Newbury and Mentor. “Even though the bill was signed in 2016, it was unclear until last December as to exactly how things would work.
“Physicians at a minimum are required to take a two-hour course in order to be certified to provide patients with a marijuana recommendation,” he said. “I have taken more extensive medical marijuana courses prior to being certified in May 2018 and I helped teach the course in early January.”
Silver said obtaining a recommendation for treatment from a physician is an easy process but requires a number of steps.
“Most of the patients seeking a medical marijuana card are elderly or very ill and are tired of taking pills that require increasing dosages to achieve the same effect. Patients are not trying to get high, they are trying to get help,” said Silver.
“They are at their wit’s end and they are desperate to find an alternative.”
Prior to recommending a patient for medical marijuana, Silver said doctors must do an in-person physical exam and commit to continuing to provide ongoing care and monitoring.
If it’s determined that an individual qualifies for medical marijuana, Silver said he registers the patient online with the Ohio Medical Marijuana Control Program, which is accessed through the OARRS (Ohio Automated RX Reporting System) website and overseen by the State of Ohio Board of Pharmacy.
“Once the patient is registered by our office, the Ohio State Pharmacy Board then contacts the patient via email to complete the registration and the patient pays $50 to download or print their card, which they must present to the dispensary.”
There are discounted pharmacy board registration fees for veterans and patients on social security disability, who can present proof of their special status.
Unlike a traditional prescription in which the doctor determines an appropriate dosage, it is up to each patient, with the help of the dispensary staff, to find the best strain of cannabis for the condition being treated.
“We educate the patient in our office about marijuana compounds, but there is no way to know exactly what the dispensary will have at the time the patient visits them,” said Silver. “It is illegal to smoke medical marijuana, but it is legal to vape it.
“Until recently dried flower for vaping was the only way to legally purchase medical cannabis, but processors are just starting to supply medical marijuana in other legal forms such as oils, tinctures, topicals and edibles.”
Since there are no uniform dosing guidelines, Silver said he advises his patients to start off slowly and to report any side effects to the office right away.
“The side effects are usually minimal and never life threatening, so there is no danger of lethal overdose as there is with opioids, sedatives or alcohol,” he said. “Sometimes it can take several tries to get the exact strain and mixture.”
Silver said he keeps track of all his patients and asks them to contact the office every three months.
The registration card is valid for three months, but doctors can opt to extend the recommendation for an additional nine months.
“If at any time I think a patient is abusing or diverting the product, I can go online and terminate the recommendation.”
Silver said he has recommended over 100 patients for medicinal marijuana. The majority of those people suffer from some type of chronic pain and many have multiple qualifying conditions.
A certified addiction specialist, who previously worked at Glenbeigh Hospital in Rock Creek, Ohio, Silver said he would like to see addiction added to the list of qualifying conditions.
“During my clinical career, I had more than one patient self-detox from heroin by using marijuana,” said Silver. “The medical community has traditionally looked at marijuana use as an addiction, but I believe many people have been self-medicating underlying health conditions.
“Even if marijuana didn’t help any condition for which it is currently approved, the potential harm reduction benefit of medical marijuana by decreasing opioid overdose deaths can’t be overstated.”