December 12, 2010

Central Maine emerges as center of medical marijuana prescribing

Practice offering alternatives thriving

By Leslie Bridgers lbridgers@pressherald.com
Staff Writer

HALLOWELL — Dustin Sulak probably has the fastest growing medical practice in Maine.
The osteopathic doctor, who’s been licensed for just over a year, had 30 patients last fall. Now, he treats 1,300.
On the wall of Sulak’s examination room, next to his diplomas and state license, are framed certificates naming him a Reiki master and a clinical hypnotherapist.
All patients, on their first visit, get a hands-on healing treatment from either Sulak or a nurse practitioner, he said between bites of quinoa, a grain-like seed that he ate from a mason jar.
The 31-year-old doctor is tall and lean, with a long dark ponytail. An advocate for alternative medicine, Sulak gives his patients advice about healthier lifestyle choices, and many of them leave his office with bottles of supplements sold at the reception desk. Before and after appointments, patients get a hug from Sulak.
But that’s not why they come to see him. Since voters approved medical marijuana dispensaries in 2009, his office has become a destination for people from York to Fort Kent in search of a doctor’s certification to legalize their marijuana use. He estimated he’s written 100 recommendations for marijuana every week for the past two months.
Patients have to see Sulak every six months to establish a bona fide relationship — a requirement of the new law. Most, however, are coming back sooner.
“I’m using marijuana as the hook to connect people to a better method of medicine, and it’s working,” he said.
Under the new law, medical marijuana patients have to register with the state by Jan. 1 to be protected from prosecution for possessing the drug. Applicants must submit a doctor’s certification and a $100 fee to get a state-issued identification card, which they need in order to buy marijuana from the soon-to-open dispensaries.
Last week, the Department of Health and Human Services had issued 163 cards and received another 174 applications. Those numbers are increasing every day, said Catherine Cobb, director of licensing and regulatory services for the department.
The applicants so far have received certification from 56 different doctors, which surprised both Cobb and Gordon Smith, executive vice president of the Maine Medical Association. Smith said he hopes the higher-than-expected number is an indication that the association’s effort to educate physicians about the new law is working.
Still, Smith suspects that most of those doctors only certified a couple of patients each. Cobb wouldn’t release the names of the doctors or the number of certifications each wrote because of patient confidentiality laws.
According to Smith, most of the certifications are coming from Sulak and his former teacher, John Woytowicz, a medical doctor and member of the faculty at Maine Dartmouth Family Medicine Residency in Augusta.
“Without Dr. Woytowicz and Dr. Sulak, I would almost go so far as to say the law would be ineffective in the state,” Smith said.
Woytowicz, who’s practiced family medicine in central Maine for 20 years, has been writing recommendations for medical marijuana since a law passed in 1999 allowing people with certain debilitating diseases, like cancer and HIV, to grow their own plants or appoint a caregiver to do it for them. In 10 years, he said, he wrote about 30 recommendations. In the last 12 months, he’s written more than 160.
Woytowicz said medical marijuana patients account for about 10 percent of his practice. For Sulak, they’re just about everyone he sees.
Some of Sulak’s patients won’t register with the state because they’re opposed to having their name on a list and are willing to risk the consequences, he said. Many others haven’t submitted their paperwork yet.
Sulak said most of his patients already use marijuana and, in light of the new law, have decided to get the legal protection the state offers. He does have to turn down patients who he believes benefit from the drug but don’t qualify under the law. Most of them suffer from post-traumatic stress disorder, Sulak said.
Adding that disorder to the list of qualifying conditions is among needed changes to the law identified by the Medical Marijuana Caregivers of Maine, said Jonathan Leavitt, the group’s chairman and a leading advocate for medical marijuana in Maine. The group plans to send a letter to legislators this week, he said.
Sulak said most of his patients use marijuana to treat chronic pain — a condition that wasn’t included in the state’s old medical marijuana law. The single most common problem Sulak said he sees is persistent pain following back surgery, called failed back syndrome.
While the drug doesn’t completely eliminate the pain, Sulak said, patients say it keeps them from thinking about it, making day-to-day living more tolerable.
In order to receive a recommendation for marijuana, those patients must have medical records documenting intractable pain that hasn’t responded to ordinary medical or surgical measures for more than six months.
Those records are what Sulak would have to produce if his practice was challenged by the state’s Board of Licensure in Osteopathy. Any licensed physician may certify medical marijuana use, Cobb said, but doctors have hesitated to recommend it.
“Most of them are too scared to do it because they have some false belief that it will jeopardize their license,” Sulak said.
Sulak said he almost expects to be questioned by the board at some point and keeps that in mind as he documents his patients’ histories. He said all doctors are taught to be meticulous about their record-keeping for that reason.
“I just feel that a little more intensely than others might,” he said.
Smith said doctors do have legitimate concerns about recommending the drug. Some say they don’t know enough about it as medicine, like what the proper doses are, to be responsible for patients who are using it. Others worry about the quality and purity of the marijuana that patients will get, because the sources of the drug — both caregivers and dispensaries — aren’t federally regulated the way pharmacies and pharmacists are. Some physicians are afraid of enabling drug addicts or dealers.
Another set of doctors is hamstrung by their employers. Smith said there are 20 federally-qualified health care centers in the state that prohibit their physicians from certifying medical marijuana patients.
Those include the U.S. Department of Veterans Affairs hospital at Togus and its clinics throughout the state and HealthReach Community Health Centers, which serve rural central and western Maine. Smith said their insurance won’t cover claims against doctors recommending a drug that’s illegal under federal law.
But most doctors have open minds about medical marijuana, Smith said. On behalf of the Maine Medical Association, Smith — sometimes with Woytowicz — has been speaking at hospitals statewide to teach doctors about the new law. He said the talks are well attended. Doctors want to learn; most just aren’t ready to make recommendations yet.
“It takes a little time,” Smith said.
Another fear physicians have is that writing a couple of recommendations could earn them a reputation — and a slew of new patients who just want their signature. That’s a concern Sulak and Woytowicz can understand.
Meanwhile, the two physicians have been bridging the gap between patients’ demands and most doctors’ reluctance to fulfill them. Woytowicz, however, said he’s accepting few new patients. Sulak is near his maximum capacity, as well. He hopes to hire another doctor soon.
New patients have to book their appointments with Sulak at least two months in advance. Last week, his schedule was already full through February. Sulak used to take payments at the time of appointments, but now patients have to pay in full — $300 for a first visit — before their name goes into the schedule  book.
Ten percent of Sulak’s patients are put on a sliding payment scale, with a maximum discount of 50 percent, and he doesn’t accept insurance.
The entrance to Maine Integrative Healthcare, Sulak’s practice, is at the back of an office building on Water Street, just outside of downtown Hallowell. Walking into the waiting room, there’s a bulletin board to the left where caregivers have tacked up Post-It notes with their names and phone numbers. Business cards tout reasonable prices and a variety of marijuana strains, and pamphlets from garden centers advertise hydroponics supplies and grow room installations. A large, white cubby case against the wall holds bottles of dietary supplements, hemp seed bars, and jugs of coconut oil.
The clean, white walls in the waiting room, and in the corridor of exam rooms beyond it, show that Sulak’s practice hasn’t been there long. He first started seeing patients in an acupuncturist’s office down the road, where he rented a room for $100 a month. He moved to the larger office in July and has since hired three receptionists, who answer constant phone calls and file paperwork behind a high, semi-circular desk.
Past the receptionists are two large brown leather couches for waiting patients. There are only a few people in the room at a time and they sit quietly, perhaps heeding a paper sign in the corridor outside the room. “SSSHHHHHHH! HEALING IN PROGRESS,” it says.
Sulak takes his time with appointments and, because of that, he tends to run behind schedule. On the coffee table is a laptop with Internet access, a print out on the benefits of Vitamin D and books about alternative medicine, including “Spontaneous Healing,” by Dr. Andrew Weil. The copy is from Sulak’s freshman year of college.
Sulak, who grew up in the suburbs of Chicago, first became interested in alternative medicine when he was teenager experimenting with marijuana. He said the drug “had some positive effects on my psyche,” and opened his mind to more creative thinking. He declined to say if he uses marijuana now.
After high school, Sulak studied biology and applied health science at Indiana University, where he led an activist group that called for the legalization of marijuana. He then enrolled at Arizona College of Osteopathic Medicine at Midwestern University and did his internship at Maine Dartmouth Family Medicine Residency in Augusta, where he met Woytowicz.
Sulak immediately stood out among his classmates because of his training in Reiki and hypnotherapy, Woytowicz said. Although Sulak left the program after his first year, he made a lasting impression.
“Dustin came with a lot of extraordinary skills ... a larger repertoire than any resident has ever come with,” he said.
Because Sulak never finished his residency in family medicine, he’s technically considered a general practitioner. But, essentially, he’s a specialist.
“He’s good at what he does,” Woytowicz said.

Leslie Bridgers — 861-9252

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