PORTLAND — Some AIDS patients in Portland hoping to have legal access soon to medical marijuana may be disappointed.

A medical team at the city’s India Street Public Health Center, Maine’s largest HIV practice, notified most of its 170 patients last week that it won’t grant medical marijuana certificates to everyone who asks for one. The drug is potentially harmful and often not medically justified, the team said.

“In this current era of effective medications for HIV/AIDS, we are delighted that most of our patients are able to enjoy a very good quality of life and for the majority, medical marijuana will not be necessary,” the center said in a letter to patients. “We can only provide a certificate to those who genuinely need this substance.”

Maine’s medical community – from small family practices to large hospitals – is busy sorting out how to handle medical marijuana and what to tell the growing number of patients asking for a doctor’s blessing to buy the drug.

“Doctors are talking about it a lot right now,” said Gordon Smith, vice president of the Maine Medical Association. “They’ve had a lot of calls from patients ever since the referendum passed back in November.”

That’s because the new law approved by voters says patients must have both a qualifying medical condition and a doctor’s signed recommendation before registering as a legal medical marijuana user. Registered patients are allowed to grow their own marijuana, obtain it from a caregiver or buy it from a dispensary, eight of which are expected to open around the state this winter.

It’s a tricky area for physicians, Smith said. Unlike other medications, marijuana is not FDA-approved as safe and effective and it’s not measured out in prescribed, limited doses by a licensed pharmacist.

“They have to be as careful with prescribing medical marijuana as they are prescribing a new drug that they may know nothing about,” Smith said. “They may shy away from this because of their inability to have any control over the dosage, the quality or the strength.”

Some physicians have said they will write recommendations, while others say they won’t – at least until there is more scientific evidence about effectiveness and side effects, according to Smith.

Most, like Portland’s HIV clinic, are taking a case-by-case approach, he said.

HIV and AIDS rank high on the list of disabling conditions that can qualify a patient to legally use medical marijuana. reducing nausea and increasing appetite, the drug can help control wasting syndrome, a common complication of AIDS marked by weight loss and weakness, according to patients and doctors.

But even AIDS may not be enough on its own to get a doctor’s recommendation.

“I don’t think anybody wants to withhold it. It all comes down to clinical judgment,” said Caroline Teschke, program coordinator at Portland’s India Street clinic, also known as Positive Health Care. “I think it’s really like any other decision – it’s made on an individual basis.”

The program sent the letter last week to the majority of its patients after getting requests for marijuana recommendations, according to Teschke.

“It’s going to be a complex issue for everybody, I think,” she said. For one thing, she said, “it’s hard for a provider to recommend anybody to smoke anything.”

The letter to patients says smoking marijuana long term may contribute to development of cancer, and that smoking is “the least desirable method of using this substance.” Patients also can eat marijuana in food or drinks and can inhale the drug using smokeless vaporizers.

The letter also implies that some patients are asking for the certificates for nonmedical reasons. “Although we recognize that many of you enjoy using marijuana, much as someone would enjoy a glass of wine, this use is not covered by the new law,” the letter says.

Teschke said the health center is not limiting medical marijuana access out of any fear that it could lose federal funding. All marijuana use remains a federal crime. “That has not been an issue,” she said.

Resistance and dismissive attitudes in the medical community are discouraging, said Charles Wynott of Westbrook, a medical marijuana advocate. Wynott was diagnosed with AIDS more than two decades ago, though he is not a patient at the city’s health center.

“I have been a regular marijuana user for 25-plus years and I have no signs of cancer. It is the reason that I’m still alive, without any doubt in my mind,” Wynott said. “It helps with nausea, it helps keep my medicine down and it helps with wasting and eating. Those are the two main things you need to do as an HIV patient in order to survive – keep your medicine down and maintain your weight.”

Wynott said he hopes patients are not denied access to marijuana because it might make them feel good. “That in itself is a good thing for people who are sick,” he said.

Owen Pickus, a Westbrook doctor who specializes in AIDS and cancer treatment, said he also wishes marijuana would be studied and controlled like other medicines. “I see nothing about marijuana that would make it a sacred cow that shouldn’t be in the same group.”

But, in the meantime, he recommends medical marijuana for a number of HIV patients if they have complications and need help managing weight loss and wasting syndrome.

“It’s not just having an HIV diagnosis, it’s wasting and vomiting,” he said. “The drug doesn’t work for everybody, but for a substantial number of people, it does.”

Staff Writer John Richardson can be contacted at 791-6324 or at: jrichardson@pressherald.com