Dr. Nouman Asif says doctors are reluctant to prescribe medical marijuana because there still are a number of unknowns connected to it. (Submitted photo)

DOVER — The opening of the first medical marijuana dispensary in Delaware, the First State Compassion Center in Wilmington, brings many questions for doctors and patients alike.

Medicinal marijuana is regulated through the Department of Health and Social Services. The regulations reserve the prescription of marijuana to a list of specific conditions, such as HIV/AIDS, cancer-related pain and treatment side effects, Lou Gehrig’s Disease and multiple sclerosis.

Various other chronic or debilitating diseases or medical conditions also are included in cases for which the illness or its treatment produces side effects, such as wasting syndrome, severe, debilitating pain, that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects.

All of these conditions currently have pharmaceutical treatment options available that specialists are familiar with, but medical marijuana is unknown territory for many doctors.

“Medical marijuana is a new type of treatment and not regulated like FDA drugs,” said Dr. Nouman Asif, an oncologist at Beebe Medical Center in Lewes. “But like with any new medication, physicians have a lack of experience which causes a hesitation when it comes to prescribing it.”

Also with new FDA drugs, pharmaceutical representatives meet with doctors to explain details about the drug, all known side effects and properties of the drug. But with marijuana, that kind of information isn’t available to doctors.

Dr. Asif predicts that doctors will begin to gain confidence in marijuana when it is prescribed to those patients who begin to show positive results, but said there are many unknowns at this early stage.

“There are no FDA clinical trials we have to look at, but my colleague has prescribed medical marijuana to two patients, and I will probably prescribe it in the future if a patient has needs marijuana can help,” Dr. Asif said.

Although there are no clinical trials or FDA regulations, people like Joel Allcock, senior vice president of the First State Compassion Center, says he has seen medical marijuana improve the lives of thousands of patients.

Mr. Allcock has been involved professionally in the medical marijuana industry since 2006 when it was legalized in his home state of Rhode Island. He has since run multiple compassion centers and become an expert grower.

If a physician believes marijuana can reduce symptoms of their patient’s illness or improve their quality of life, they can recommend the program.

The requirements are that the physician be Delaware licensed and the patient a Delaware resident 18 years of age or older.

Getting the paperwork in order is up to the patient, who must pay a non-refundable $125 application fee. The physician must fill out two pages while the patient must fill out four, including a release of medical information form. The application is then submitted to the Office of Medical Marijuana (run by the Division of Public Health), which reviews the application and either approves or denies it after conferring with the physician. The process is expected to take about 45 days.

If approved, the card is valid for one year from the month it was issued. If the physician suggests use of medical marijuana for longer than one year, a new application must be completed and approved.

In the oncology field, Dr. Asif and his colleagues typically prescribe narcotics for cancer-related pain and other prescriptions for side effects related to chemotherapy, like nausea and lack of appetite — two problems for which marijuana has seen to be beneficial in other states where the drug is legal for medicinal purposes.

“Marijuana may work in conjunction with the medications we prescribe, because it isn’t strong enough on its own to resolve these problems for patients but may work as a secondary medication,” Dr. Asif said.

Although it may help with side effects from cancer and cancer treatment, Dr. Asif said many doctors are unaware of the side effects that could possibly be caused by the marijuana, while they are fully aware of side effects caused by pharmaceutical drugs.

“This isn’t a drug we would probably prescribe for psychiatric patients, because it can potentially cause anxiety and psychosis or for the elderly, because the euphoria and possible dizziness may cause confusion and increase fall risk,” Dr. Asif said.

He said he would not prescribe marijuana to patients also having cardiac conditions, because not all properties of the drug are known and could aggravate a condition the patient is suffering from.

Only about 330 medical marijuana cards have been issued in Delaware so far, but Mr. Allcock expects that number will soon increase.

“Once we open, I expect an influx of medical marijuana patients because there will finally be a legal means of getting the medicine they need,” he said before the center’s opening.

Before the marijuana dispensary opened, there was no legal way for cardholders to obtain the drug, but they were granted immunity if caught possessing the drug illegally.

But more questions will arise for doctors, such as how the strength of the marijuana effects patients and the right dosage for a patient’s needs.

But Dr. Asif predicted that as patients are selected, physicians will be able to determine the proper doses by tracking their patients’ outcomes. The progress eventually will give other doctors the assurance they need to confidently prescribe the drug.

Some physicians may be more comfortable with prescribing medical marijuana than others, but the Office of Medical Marijuana and the First State Compassion Center are not allowed to provide names of doctors who may be more inclined to prescribe the drug.

To learn more about medical marijuana regulations in Delaware, visit dhss.delaware.gov/dhss/dph/ and click on “sections and programs.” For more information about First State Compassion Center, visit firststatecompassion.com. Admittance to the Center is only granted to those possessing a valid medical marijuana card.