Thursday, November 9, 2017

How To Prescribe Medical Marijuana

Algorithm for prescribing marijuana.
Did you miss your cannabis pharmacology lecture in medical school? Were you too busy following your Facebook friends when your attending described how to prescribe marijuana during morning rounds? If you did and you have no idea how to get in on the lucrative medical marijuana business, the Medical Board of California has good news for you.

The Board, along with coauthor Governor Jerry Brown, has published a short, concise pamphlet on how to prescribe medical marijuana. It is only six pages long, not counting the diagram at the end. Why are they publishing information about a drug that they clearly state in the pamphlet is "an illegal substance under federal law"? Because California voters approved way back in 1996  Proposition 215, which made it legal for people to acquire marijuana for medicinal purposes. It's taken 21 years for the Medical Board to finally establish instructions for physicians "who choose to recommend cannabis for medical purposes to their patients, as part of their regular practice of medicine, that they will not be subject to investigation or disciplinary action by the Board if they arrive at the decision to make this recommendation in accordance with accepted standards of medical responsibility." In other words, it's another way for California to thumb its nose at the feds, like so much else it's been doing since the presidential election last year. If a doctor gets in trouble with the federal Drug Enforcement Agency for prescribing marijuana, he can point to the publication from the Medical Board to prove that he was following strict guidelines made by the state. So there. Nah Nah.

Of course the instructions don't actually tell you how to specifically write for a marijuana prescription. The reason is that marijuana has no proven medical purposes. It's almost all anecdotal as there are no controlled studies for how weed might help patients. As it states, "At this time, there is a lack of evidence for the efficacy of cannabis in treating certain medical conditions" such as patients with cancer, AIDS, anorexia or chronic pain.

The purity of the leaves the patients eventually buy are lacking. It's not like a regular pharmaceutical that has undergone years of clinical trials to arrive at the precise dosage necessary to treat a specific medical condition with minimal side effects. One sample of pot will almost certainly contain a different amount of active ingredient from another sample even if they're both from the same plant. So how can the Medical Board possibly instruct physicians on how to prescribe marijuana?

Instead most of the guideline just goes through the usual patient-physician interaction that you learned when you first started your clinical rotations in medical school. Things like how to document the patient's health, how to make an informed decision on choosing marijuana, discussing alternative therapies. Yada yada yada. When a patient goes to a doctor looking for a marijuana prescription, I don't think they are the least bit interested in discussing alternative therapies.

Regardless of how effective these guidelines are, the sclerotic Medical Board has already missed the boat when the state's voters agreed to allowing recreational marijuana use last year. Starting in January, any adult can purchase pot without a prescription. The state is already anticipating billions of dollars of new taxes. Doctors can then get out of the business of cash for prescriptions that has become a source of shady income for some.

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