Just down the block from a woman selling $10 palm readings on the Venice Beach boardwalk, past a man hawking giant slices of pizzas, young men wearing green scrub tops encourage passersby to “get legal.”
Obtaining a medical marijuana license in Venice, California, has long been rumored to be remarkably easy (taking no more than 15 to 20 minutes to get approved). I was staying at the beach for a few weeks, so I wanted to see for myself.
In case potential customers are stumped as to how they might benefit from cannabis, the clinic management had conveniently listed a sampling of conditions that marijuana might treat. I selected insomnia, which wasn’t a lie. “Medical records are not necessary,” I was informed by a staffer—who then quickly resumed playing Krazy Taxi on the computer and resisted answering any further questions. None of the shirtless surfers waiting in line had any medical records with them either.
The procedure was remarkably speedy—patients were in-and-out of the exam room in minutes. When my turn came, an elderly, exhausted-looking former surgeon greeted me. We sat in his dimly lit office—no bigger than a broom closet—where we commiserated over the current state of American medicine. But the doctor’s countenance brightened when I confided that I, too, had once worked in a medical marijuana clinic in Los Angeles a few years prior.
As required by California law, the doctor performed a “good faith physical examination,” despite the complete lack of relevance for a condition like insomnia. There were no alcohol swabs or sinks in sight, so he examined me with the same unwashed hands and filthy stethoscope that he’d presumably use on the 100 other “patients” he told me that he would see that day.
Within minutes, I hit the Venice boardwalk with the official letter of recommendation stating that I could benefit from using weed. (You don’t actually need the laminated marijuana wallet card that many pot smokers covet and for which the clinic charged an extra $25.)
Operations like this support the commonly held belief that medical marijuana is a sham—a business dominated by shady entrepreneurs who prop up some exhausted retired physician to churn out scripts for a nominal fee. It’s a scheme that compromises the integrity of the physician and forces many patients to lie about medical conditions just so they can get safe access to marijuana.
But until pot prohibition ends, state laws allowing the use of medical marijuana will continue to pop up across the nation—at this point, almost half the states have put such laws on their books. In fact, New York is poised to become the 23rd state to approve it.
It might be worth considering how we might make medical marijuana a less bogus proposition.
For starters, although the no-medical-records and no-shirt-required Venice beach “get-legal-quick” scenario was clearly not what law-makers originally had in mind, most physicians do have enough experience to exclude the clearly psychotic and staggeringly drunk (which Venice has more than its fair share of). From that perspective alone, keeping a competent physician in the mix is useful.
But for a multitude of reasons, many good doctors are reluctant to get involved. For one, malpractice issues are unclear, since standard policies cover only FDA approved therapies. Physicians are also fed up with being blamed for the prescription drug addiction epidemic, after being scolded for callously ignoring patient pain and then exhorted to stop under-prescribing narcotics.
Many physicians believe these kinds of reversals prove that they will be used as political pawns. No matter what they do, they will be blamed for being on the wrong side, and subjected to increased training, testing, and regulating. The federal government set the inconsistent tone in 1996—the year that California became the first state to approve medical marijuana—when then US drug czar Barry McCaffrey apparently threatened to “prosecute physicians who recommended marijuana.”
Then there are the inexplicable actions of current federal officials. While President Obama reportedly said that the federal government would not persecute those who are abiding by state marijuana laws, we’ve seen a baffling crackdown on marijuana dispensaries and their employees. In fact, the Internet is abuzz with several heart-breaking cases, most recently that of Robert Duncan, a young man who was employed by a marijuana collective after failing to find work in other industries. He is now serving a minimum of a two-year sentence in a federal penitentiary.
In states with medical marijuana laws, more than 335 people have been charged with federal crimes related to medical marijuana, and more than 158 defendants have received federal sentences for marijuana offenses adding to almost 500 years in prison, according to CalNorml, the California branch of the National Organization for the Reform of Marijuana Laws. Nearly as many cases were brought under the first four years of Obama’s term than under Bush’s eight years, and not a single pardon has been granted, according to NORML. Further, pot-prescribing physicians in Michigan and Colorado have faced jail time.
With an atmosphere like this, it’s no wonder that most mainstream physicians will not participate. And it’s too bad, because marijuana can be beneficial for many people, not just those with severe pain. It would be valuable to have more competent physicians with deep clinical expertise be able to work with patients.
Dr. Bonni Goldstein, a former pediatric emergency physician, runs Canna-Centers in the Los Angeles area and has been recommending medical cannabis since 2008. “It’s really sad that the medical community does not want to embrace it,” she told Time Magazine recently. Dr. Goldstein has such a wealth of experience that she’s had remarkable success recommending cannabis for children with refractory seizures. (Full disclosure: Dr. Goldstein was the medical director of the cannabis clinic where I worked several years ago.)
But without people like Dr. Goldstein and others at upscale clinics like hers, many people who could seriously benefit from cannabis are reticent to try; few desperately ill people would ever consider showing up at an outfit like the one I stumbled across at Venice beach. When I was working with Dr. Goldstein, many people told me that they only got legal because the clinic was in a respectable office building and had developed a reputation for professionalism.
Under Dr. Goldstein’s directive, the clinic’s physicians routinely took the time to review the effects of the active components of marijuana, like THC and cannabidiol. We reviewed the difference between marijuana strains like Indica, which tends to be more sedating, and Sativa, which tends to be more stimulating. We gathered as much information as we could about the benefits of specific strains, such as Charlotte’s Web. We reviewed the methods of marijuana use, and educated patients on the differences between using edibles or tinctures and inhaling. Our goal was safety and success for conditions that had inadequately responded to conventional treatment. Furthermore, the director was available to answer any questions after the patients left the office. Not one of these things was provided at the Venice clinic I went to.
For first time users, withholding this kind of information can get them into trouble. Nowhere has a bad pot experience been better described and more talked about than in New York Times columnist Maureen Dowd’s recent article about overdosing on a marijuana edible in Colorado where pot is newly legal. Apparently she wasn’t counseled on how to dose edibles—or she didn’t hear the message—and ended up taking way too much.
Well-known cannabis advocate Bill Maher responded by reminding Colorado that all eyes were upon them and that they needed to get this right. But I’m not sure that we can lay the weight of all this on the shoulders of the “budtenders”—those who “bartend” and serve customers at dispensaries—who are rumored (at least in California) to be hired mostly on the basis of their good looks. It points to the need for qualified physicians with clinical experience.
To be sure, marijuana may not be for everyone. For one obvious example, it seems pretty clear that adolescents should steer clear of it, as they may be at increased risk for psychosis. But for adults, who better to make the call than a sophisticated caring clinician with deep clinical experience? Having savvy, experienced clinicians to help guide patients—especially new patients—may be the key to success and safety.
For the sake of so many needy patients, let’s take a grown up approach to the reality of medical marijuana and reset the tone. Let the growers and dispensers out of prison and make it safe to provide quality marijuana. Heap praise, not scorn, on physicians who are brave and caring enough to recommend cannabis when appropriate. And let us give our desperate patients some much needed hope and change.
And for those who feel that no amount of pot is safe; for those who are advocating against even medical marijuana, let me borrow an often used phrase: You simply do not know what you are talking about.
Related from The Daily Beast