Toke two and call me in the morning

I asked for questions to answer, and I got some responses.  Hoorah!  Ideas for posts!  I’ll answer all three (or however many more may get added over time), but may as well start with a relatively easy question to answer.  Says fellow LOOG blogger  Jaybird:

I’d love to read a post about Medicinal Weed from the perspective of a doctor.

There’s a general answer to this, and a more particular one.

As far as marijuana is concerned, medicinal or otherwise, I am in favor of legalization, full stop.  The “war on drugs” seems like an outright failure to me, obvious even before a high-profile international panel said so.  It is preposterous to outlaw an easily-cultivated plant just because of its mood- and sensation-altering properties.  I’ve had plenty of patients whose lives were destroyed by substance abuse, but the majority of them suffered from addiction to a perfectly legal substance widely enjoyed by most Americans.  The leading preventable cause of death is a similarly-legal plant.  If alcohol and tobacco use are legal (and I believe they should be), then I cannot construct an intellectually compelling argument for marijuana use to be otherwise.  I’ve certainly had patients who used marijuana immoderately, and whose lives would have been improved by moderation or abstinence, but the same could easily be said about junk food or promiscuous sex.  As a medical professional, I strongly support legalization.

On the particular question of medical marijuana when it is otherwise illegal, as a doctor it seems like a royal pain in the ass.  That marijuana has medicinal uses, particularly for nausea or lack of appetite induced by chemotherapy or AIDS, is pretty well established.  I think it should be available for medicinal use.  But then the question arises about which disorders should be open to treatment with marijuana.  If nausea, why not chronic back pain?  If back pain, why not anxiety?  Lawyers who live in California (ahem) should feel free to correct me, but I believe the text of that state’s medical marijuana statute says this:

… seriously ill Californians have the right to obtain and use marijuana for medical purposes where the medical use is deemed appropriate and has been recommended by a physician who has determined that the person’s health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief

Once you’ve got something as subjective as “chronic pain” in there, then you’re pretty much taking all comers, even without that “any other illness” fillip there at the end.  They may as well say “everyone who wants it” and be done with it.

My understanding is that California has providers whose practice is pretty much limited to doling out prescriptions for weed.  I don’t know if that will end up being the case in Maine, or if “caregivers” who register to prescribe marijuana will maintain general practices as well.  The more unrestricted the diagnoses that qualify one to use medicinal marijuana, the more of a pain this would be for a general practitioner outside of a dispensary.  (With regard to pediatrics, it is dubious to what extent medical marijuana has any legitimate use.)  Determining which patients “deserved” medical weed and which didn’t is a problem I’d gladly never face.  Drug-seeking behaviors are a frequently-encountered and often intractable problem as it is.  I can’t even imagine how to deal with patients who come in overtly seeking weed and then trying to determine if this patient wants it because of legitimate medical need vs. a simple desire to get high, and how to document whatever decision is reached and why.  It makes most sense to me that providers who prescribe it be limited either to those who specialize in treating the qualifying disorders (eg. oncology, neurology, infectious disease, etc) or those in dispensaries.  I suspect most other providers would rather avoid this question altogether.

Or we could sidestep this whole question in its entirety, and make marijuana use legal like it should be.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Well, since you asked…

    My understanding is that California has providers whose practice is pretty much limited to doling out prescriptions for weed.

    Yup. There are also doctors who seem to enjoy playing the role of candyman who will write up whatever prescription the patient requests. Perhaps this is for the best — adults should, as a default, decide what they will do with their bodies, and not the state. The doctor as the gatekeeper in that process is supposed to make decisions about what is medically appropriate, and restricting the doctor’s choices in that respect seems offensive from a libertarian perspective. (That last remark count as a faux pas, as we’ve been coached on the front page recently to abandon ideology altogether.)

    With all that said, it’s hard to summon up a lot of respect for the doctors who make their living at weed clinics, much less casting them as libertarian heroes. Clients have described to me the way that they have been coached by their “weed docs” how to answer questions correctly so as to qualify what is obviously recreational weed.

    A lot of marijuana users, though, seem to forget the extra step — after the doc writes you a prescription, you then have to turn in that prescription to the state and actually get the card. Cops seem to enjoy busting kids who spark up with only prescriptions and no registration card — they know as well as anyone that it’s really recreational use, and seem to think it’s b.s. that because they found a doctor willing to prostitute her license to some potheads that the rules get bent. Which is an understandable perspective, but the conduct we’re really punishing in that case isn’t use of an illegal substance, it’s not giving the state ten dollars.

    Seems to me that by setting the bar for use at a) finding a doctor willing to write a scrip, and b) filing a document with a $10 filing fee with the state thereafter, that bar is set so low that we should go all the way and completely decriminalize the stuff. The voters, however, have stopped short of doing that — by a rather narrow margin in the 2010 election, but they did stop short of decriminalization. I understand that there would be a public health impact to decriminalization; in the words of one drug dealer, “…people are fucking irresponsible“, but so what? They’re irresponsible with alcohol, they’re irresponsible with tobacco, they’re irresponsible with cars. Even if use and addiction tripled after decriminalization, we’d still kill more people every year with booze, cigarettes, and bad driving than we would with ill-groomed college kids giggling uncontrollably and eating too many Doritos.

    • I do wonder why any physician would want to be a rubber stamp for a “patient’s” desire to get high. Why not just hand out prescription pads at the door and be done with it? Last I knew, a friend of mine had entered this kind of “practice,” and fond of her as I am, it wasn’t a big shock that she hadn’t chosen a more… academically or professionally rewarding career path.

      I don’t think there’s much credible dispute that there are patients who truly benefit from medical marijuana, particularly cancer and AIDS patients. I don’t for a minute begrudge them treatment for what are unmistakably bad side effects of chemotherapy or illness. For a great many patient in states with dispensaries, however, I strongly suspect that doctors have made themselves little more than sanctioned drug dealers.

      But hey, I don’t really care if people want to get high in the first place. It’s not medicine in most cases, but it doesn’t really grind my gears otherwise.

      • “I do wonder why any physician would want to be a rubber stamp for a “patient’s” desire to get high. ”


        • Well, sure. There’s that. It’s probably a relatively low-stress way to make a decent wad of cash, which is enough for some people. And I suppose they may also feel that they’re either helping to subvert an unjust, oppressive drug policy or helping patients in need.

          It just hardly feels like being an actual doctor to me. One essentially functions as a interchangeable cog in a machine, meant to produce packets of weed at the end. Four years of medical school, plus (presumably) the drudgery of residency for this? Really?

          • Well, it’s stress free until someone decides that it’s not okay anymore. If my wife were to want to go that route, there are many reasons I’d be supportive (she’d have better hours!) and I think the stuff should be legal. But the possibility that some enterprising prosecutor would want to make an example out of her looms. It’s sort of like how I think the dispensaries are simply nuts. I’m sure the money is good, but the government can decide that what you’re doing is wrong and go after you retroactively.

          • Some observations that may give an inkling.

            There’s a local weekly rag here in town that has 9 1/2 pages of medicinal weed ads in it. For a while there, every other one of these ads had a little line at the bottom saying that if you were a doctor, they wanted to work with you.

            There were enough of these mentions that I suspect that doctors got a cut of whomever showed up and made the dispensary in question their “caretaker”.

            “Caretaker” status is important because a “caretaker” is allowed to grow six (or is it ten?) plants per caretakee per year. A plant, of course, can be something freaking *HUGE*… huger than any one person could smoke. So each caretakee who shows up to make the dispensary a caretaker allows the dispensary to sell pounds and pounds more weed per year.

            Here in town, if the ads in the paper are any indication, weed goes for $25/eighth for two-hit schtuff and, if you want to go to the weed equivalent of Sam’s Club/Costco, you can pay $200/ounce for Top Shelf.

            All that to say: a doctor that works with a dispensary is a source of caretakees. A single caretakee is worth thousands. A doctor can demand a piece of that.

  2. When friends from out-of-state visit, we take them for a drive down Platte and point out all of the marijuana dispensaries… between our house and the ice cream place, there are, like, 10 or something. Green Cross after Green Cross after Green Cross.

    Colorado’s doctors allow for maladies such as “anxiety” and “sleeplessness”… so, pretty much, if you want a card you can get a card. The card costs one-hundred bucks or something like that.

      • The mom and pop drug dealers I grew up with gave horrible customer service. The chains are light years ahead.

        Joking aside, I spoke with my friends who have cards (my job does not allow me to have a card, sadly) and they explained to me that medicinal grade is nothing (*NOTHING*) like the two-hit schtuff that we had access to back in 1992.

    • all of the marijuana dispensaries… between our house and the ice cream place

      That must be the busiest ice-cream place in the world.

      • It’s the only one that makes a decent marshmallow fluff shake.

        There are soft serve places until the cows come home and even a handful of parlors where you can get something upon which sparklers are lit before it is brought to the table but only one place that turns the shake upside down for a second before they hand it to you.

  3. I do have to say, that in a state where we can buy whiskey in a grocery store (and beer at a gas station!) we seem to have solved the issue of retail sale of intoxicating substances.

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