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.

Vaping Vs. Toking. The Politically Correct Choice.

The Los Angeles City Council last Wednesday voted to treat the newly trendy electronic cigarettes the same way tobacco cigarettes are treated: no smoking allowed inside restaurants, bars, or workplaces. Their justification is that vaping, the term for using an e-cigarette, has not been studied well enough to understand the long term effects of the second hand water vapor that emanates from these devices on the health of innocent bystanders. Plus they fear that the nicotine in e-cigs might lead the user into using the real tobacco product so they must protect the public for its own good.

Frankly I don't advocate anybody putting any flaming substance to their lips and inhaling. But I can't applaud the City Council's actions when I consider their perverse embrace of marijuana dispensaries dotting the landscape all around LA. While e-cigs are legal devices, medical marijuana, with a couple of exemptions, are illegal in most states and throughout the country under federal law. Yet members of the Council have made impassioned pleas for marijuana shops to be allowed to operate without excessive regulation.

This embrace of the still unauthorized marijuana reaches all the way up to the top of this left wing presidential administration. The country's number one law enforcer, U.S. Attorney General Eric Holder, is even giving advice to banks on how to work with marijuana dispensaries in the hope that these businesses, wink wink, can become more successful.

All this love for marijuana seems misplaced. While tobacco smoking has been linked to lung cancer, smoking marijuana can lead to respiratory illnesses too. Tokers are placing burning plant leaves into their lips and mouths, inhaling the smoke just like cigarettes. Consequently particulate substances reach down into the lungs the same way tobacco particles do. Don't tell me marijuana leaf particles are somehow more benign than tobacco. The City Council's concerns regarding the potential addictive qualities of the nicotine in e-cigs also doesn't jibe when they dismiss the addictive nature of marijuana. The reason pot users need to toke every day is because of their addiction, not because of their glaucomas.

I can understand why the city government is advocating for a banned substance while shutting down the use of a legal one. Most of these members probably have used pot in the past. They're mostly of the baby boomer generation who flauted laws as a matter of pride. Drug culture became their culture. That's why before every concert and ball game there is a public service announcement saying no smoking is allowed but everybody starts lighting up their pot as soon as the event begins. Yet there isn't a bouncer in sight who will throw out a pot user but if somebody lights up a tobacco cigarette there would be mass hysteria to get the user kick out. And no, not all of us enjoy the second hand smoke from marijuana.

So while it's good and well that the LA City Council members are looking after the welfare of e-cigarette users by attempting to keep them off the nicotine dispensing devices, their words would carry more weight and appear less hypocritical if they also embraced the fact the marijuana can be equally harmful. Plus what part of ILLEGAL don't they understand?

Beware Naked Man With Marijuana

A U.S.Airways flight from Philadelphia to Los Angeles was diverted to Pittsburgh when a passenger became unruly after taking too much medical marijuana. Kinman Chan went into the plane's restroom after takeoff and started screaming. If that wasn't concerning enough, he emerged with his pants down and shirt untucked. When told to sit down he became combative and had to be subdued with a choke hold.

Mr. Chan's excuse was that he took double his usual dose of medical marijuana cookies he had with him. The U.S. attorney's office in Pittsburgh examined his medical marijuana prescription and agreed he had a "legitimate" health issue for taking the drug.

This raises some interesting questions. If Mr. Chan took double the normal dose, does that imply there is a standard dose of marijuana? Is a medical marijuana prescription written in a state that allows the stuff (California) legally recognized in other states that don't (most of the U.S.)? Even though the the DEA has never recognized the legitimacy of medical marijuana, which it still considers an illegal substance, can the U.S. attorney claim a person has a legitimate health reason for taking it? If marijuana is legalized in more states, will we have an epidemic of naked men, or women, running amok in society? Where's President Obama's wisdom when we need it the most?

Medical Marijuana, Unlimited

In a victory for stoners in California, the California Supreme Court struck down laws passed by the state legislature that limited the amount of medical marijuana one can legally possess in the state. In 1996 California voters passed a ballot initiative allowing the use of medical marijuana. The state legislature later placed limits on how much drug one can hold. The maximum a person can possess was decreed as 8 oz. of dried mj and grow no more than 6 mature or 12 immature plants.

The Supreme Court ruled that the medical marijuana initiative that became part of the state Constitution never placed a limit on how much drug one can have. So now if somebody has a doctor's excuse, he can have as much marijuana in California as is "reasonably necessary."

Of course it is ridiculously easy to obtain a doctor's prescription for medical marijuana in California. I've written before how a doctor can moonlight as a medical marijuana prescription dispenser and make mucho bucks, all in cash. You don't even need to be certified in marijuana expertise because, well, there is no such thing. I know of no medical school in this country that even teaches a course on medical marijuana. So next time you visit California, don't be surprised if you see a bunch of bleary-eyed people driving around searching for White Castle.

Medical marijuana, a new line of work

If doctors' incomes fall substantially after the passage of ObamaCare, there appears to be a promising new line of work. In the LA Times, a columnist writes about his visit to a doctor to get a prescription for medical marijuana. Now you have to know that in Los Angeles there are close to 800 marijuana dispensaries throughout the county. I see several on my way to and from work; the telltale sign being a green cross over the front door. And thanks to President Obama, the feds will not be raiding any of these places anymore since Californians have legalized medical marijuana.

The writer of the article is initially concerned that he may be turned down, that he isn't sick enough to warrant a prescription for marijuana. When he goes to the "doctor's" office, he talks about his long history of back pain. The doctor "examines" him visually, never laying a hand on him or even getting out of his chair. When asked about the anatomy of the back, the doctor confesses he has no clue, he is a gynecologist by training. And just like that, he is given a recommendation that he can take to any dispensary for legal marijuana.

The great part for doctors is that the writer hands over $150 in cash to the clerk at the end of the ten minute exam. No complaints about copays. No sob stories about how he can't afford his medications. In this office all the patients willingly pay cash for the visit and dutifully fill out their prescriptions ASAP. This could be the greatest line of business for physicians since Botox.