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November 24, 2009

The “Pot Doc” as (New) Medical Specialist

Although now nearly forgotten, both California and Arizona passed “Medical Marijuana” initiatives in 1996. Unfortunately, Arizona’s was nullified on a technicality that had been avoided when California’s authors referred to physician approval as a “recommendation,” while Arizona’s Proposition 200 carelessly used “prescription.” Because prescribing a federally illegal drug is a legal no-no, Arizona has been without a medical marijuana law for thirteen years, while its neighbors in Nevada, Colorado, and New Mexico were busy passing more acceptable versions.

On December 30, 1996, two days before California’s new law was to go into effect, Clinton’s drug czar, went on national TV to threaten the license of any California doctor daring to even discuss use of cannabis with a patient, a bureaucratic arrogation of power that was soon blocked by a Ninth Circuit injunction, thus granting Proposition 215 a two year reprieve.

What McCaffrey’s threat did do was guarantee that physicians without their own personal reasons for favoring cannabis as a therapeutic agent would be discouraged from signing pot recommendations; except perhaps for very special patients. It probably also served to discourage all but the most desperate patients from seeking them. Remember that the initiative effectively required all participants to start from scratch in the face of what quickly turned out to be hostile police scrutiny in most parts of the state.

Because I hadn’t been a “head” myself before learning to despise the drug war as policy, I was blissfully unaware of those details when I was recruited by an Oakland club owner seeking a physician to screen his would-be customers in November 2001, after the initiative had been in effect for nearly five years.

The owner who recruited me is now serving five years in a federal prison on a negotiated plea bargain; he is an honorable man who turned out to be as naive as a “club” owner as I had been as a brand new pot doc. Those details, except for the role played by our mutual naivete, are a story for another day. He, like me, hadn't been a “head” in his youth; thus his naivete led him to place too much trust in his compliance with the letter of the new law, while mine was focusing me on curiosity about pot's appeal for my applicants (patients).

When I was led to understand it had been the anxiolytic potency of inhaled cannabinoids, I couldn’t wait to tell my reform colleagues, and was shocked by their summary rejection of that hypothesis in 2004. It would take me a while longer to understand they were/are unwilling to cop to their own emotional reasons for becoming heads; in other words, they see chronic pain as somehow more manly than anxiety in its various forms.

What I have also learned, albeit more gradually over the past five years, is that when one has the relative luxuries of a well-tuned interview and enough time to administer it properly, it becomes more than a useful tool for extracting information, it's also useful in educating patients about their own pot use. Although the principles behind a given solution may be similar, no two scenarios are exactly alike; thus as my own experience in my new specialty has increased, so has my confidence in the advice I’m able to offer. In that respect, the follow-up mandated by the ad-hoc “renewal” requirement that was added after passage of the initiative has also been helpful.

Doctor Tom

Posted by tjeffo at November 24, 2009 05:40 PM