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Finding a doctor
In order to legally use marijuana in Montana, a licensed doctor must verify that a patient has a qualifying medical condition and find that the potential benefits of medical marijuana will likely outweigh the risks. According to the state, a total of 247 doctors have approved the paperwork for the state's more than 7,000 patients. A single doctor estimates he's signed off on nearly a quarter of them.
Chris Christensen, a family practitioner at Big Creek Family Medicine in Victor, has come to specialize in medical marijuana. He says he's registered more than 1,500 patients from a small, cash-only clinic that caters to the uninsured.
"I've just happened to have developed both a willingness and a knowledge base to allow me to feel like I can venture into an area that a lot of doctors won't touch," says Christensen, a primary care physician for 35 years. "It began with people coming to see me who had pain problems, and that started me looking back at what was in the literature about marijuana for pain. I think the first half-dozen patients that I certified were people I already had in the practice and they came to me and said, 'This is how I'm managing my chronic pain.' And as a result of that I got informed about the law and said, 'Okay, I don't have a problem certifying you to do this.'"
Five years after opening Big Creek Family Medicine, Christensen says he now spends about 50 percent of his time working with patients who come from all over the state seeking medical marijuana cards. Many of these patients, he says, are people whose primary doctors rejected their requests for one. He and his staff devote two or three days a week to these patients, seeing about 30 each day. Patients pay, on average, $150 and must watch a 30-minute video of Christensen explaining the legal nuances of the Medical Marijuana Act before visiting with the doctor one-on-one. Patients report that Christensen conducts complete evaluations and fosters a genuine doctor/patient relationship. One patient says Christensen spent three hours evaluating him.
The sheer number of patients Christensen has registered raises the eyebrows of others in his field. But being at the center of controversy is nothing new for him. About a decade ago, while practicing in Idaho, Christensen says authorities charged him with multiple felony counts of prescribing controlled substances outside the scope of a professional practice.
"In other words, dealing drugs," he says.
He was practicing in Idaho's Silver Valley, where he found high instances of chronic pain a function of the timber and mining industries "that leave a lot of damaged bodies behind." His prescribing habits—most of his 400 patients, he says, were on some opioid—raised eyebrows, and the state filed charges. The accusations of abuse also led to a dispute with the state's Board of Medicine, which resulted in Christensen relinquishing his license for two years. He says he also relinquished his ability to prescribe opioids for the rest of his career.
Christensen acknowledges what he calls "the double-edged sword of trying to practice compassionate care." But the key to providing compassionate care, he says, is believing the patient. He explains that many doctors, holding a handful of negative test results, will tell a patient that they must not hurt, instead of figuring out a way to fix it or to make life more tolerable.
"You either believe the patient or you believe the study," he says.
Christensen's point cuts to a major criticism of Montana's Medical Marijuana Act: that individuals can exaggerate, or outright lie about, their symptoms and easily obtain a medical marijuana card.
Christensen addresses the concern directly: "One of the most common things I say to the patient—not that I'm going to be able to observe it—is if the point of you being here today is so that you can go sit in the corner and drool on yourself, I'd rather not be doing this. I'd rather that we talk about some other options. But the vast majority of the people I'm seeing have self-selected by having to get their medical records and wait for an appointment. And they have a one-on-one encounter with me in which they know they have to look into my eyes and be judged. And that, I'm telling you, is a very powerful force."
He says it's impossible, though, to always identify disingenuous patients.
"I wouldn't tell you," Christensen says, "that I haven't had a patient come into my office, give me a song and dance about a past injury and still having pain, go out the door, slap their buddy on the back and say, 'I got what I wanted.' But I think that's, in a percentage, less 5 five percent of the total, and if that's how well I'm doing I think that's probably pretty good."
Christensen's practice stands out, but a number of other clinics specialize in medical marijuana, too. In Missoula, for example, River City Family Health recently expanded its clinic by creating Montana Medical Cannabis Certification Inc., or M2C2. The new branch charges patients $200 for an appointment, offered, typically, twice a month.
"It's quite a remarkable opportunity for health care providers to interface with people who have never had health care, or who have been out of the system for years, sometimes 20 or 30 years," says Deni Llovet, the clinic's owner and a family nurse practitioner.
Llovet estimates her clinic has approved about 300 patients since last April, many of whom have a distrust for western medicine and self-medicate with marijuana. Patients who already have a primary doctor come to M2C2, Llovet says, because their regular doctor refuses to sign the medical marijuana certification, or because the patient is afraid to even mention it.
"One of the things that we ask our patients is, 'Is it okay with you if we notify your primary care physician that we've certified this for you?' And the majority of the patients don't want us to do that, and we're not going to if they don't want us to," Llovet says.
Practitioners like Christensen and Llovet take specific steps to honor the "bona-fide physician/patient relationship" as required by the Medical Marijuana Act, and operate like a traditional doctor's office. But others, most notably the Montana Caregivers Network (MCN), take a different approach.
The group, led by director Jason Christ, drives RVs all over the state and operates "Cannabis Conventions" where, for $150, patients can see a roving doctor, sign up with a caregiver, and even get legal advice. Some critics call this one-stop-shop approach "docs in a box" or an assembly line of medicine. Christ says he's revolutionizing modern health care.
"What we're doing, the community that is arising out of this, is changing the face of medicine," Christ declares. "It's working. We've registered over 7,000 or 8,000 people in six months through our program."
MCN's recent run through Kalispell, Great Falls, Billings, Bozeman and Missoula drew, according to Christ, a total of 4,500 people, 3,850 of whom received recommendations for medical marijuana cards. Christ says the majority of those who didn't left not because the doctor rejected them, but because the wait was too long.
Christ says about 800 people—most appearing to be in their 20s and 30s; some dreadlocked, some in shirt and tie—showed up at the Cannabis Convention at Missoula's Hilton Garden Inn Jan. 26. Attendees registered with MCN staffers, then waited as long as three hours to see one of three doctors in small rooms down the hall. A fourth doctor saw patients through a video feed, part of MCN's trademarked "TeleClinic" program. (Christ declined to provide the names of the doctors because of past attempts to report them to the Montana Board of Medical Examiners.)
In the meantime, prospective patients could meet the few dozen caregivers sitting at booths circling the room, each displaying different strains of medicine in hopes of signing up new patients. Or, prospective patients could go to the next room and listen to Great Falls attorney Carl Jensen lecture on the limits of the medical marijuana law. Occasionally, a woman would read names into a microphone, and patients would head toward their appointment. Five patients said their visits with a doctor lasted between five and 20 minutes.
"Our doctors want to publish what we're doing in the New York State Journal of Medicine and they want to talk to Cambridge about it," says Christ. "These doctors are very well connected. They're going to the state's Medical Board of Examiners and explaining what they do and how they do it, because they believe in it."
Christ is proud of MCN's work, and also not shy about the group's financial status. He says MCN grossed about $1 million in sales its first year.
"God, I'm going to be a millionaire in a year," he says. "But I don't care. It's not about the money at all. Period. My goal is to help end suffering. And if I can do it en masse, great."