Thursday, September 13, 2012

"Medical" Marijuana Users Need Not Apply

Only recently has "medical" marijuana begun to directly impact my psychiatric practice. When the drug was simply illegal I could deal with patients who admitted to using it just as I would if they admitted to using heroin or ecstasy. I could refer them for addiction treatment or maybe help them recognize how the drug might harm them, maybe even cause their psychiatric symptoms.

With the advent of physicians legally authorizing use of the drug as a treatment, however, I have struggled with how to approach new patients who believe that because a doctor recommended it they must need it. Were it any ordinary prescription drug I might consider whether to take over prescribing myself, or I might telephone the prescribing physician to coordinate treatment plans. But I suspect that physicians who authorize marijuana almost always do so indiscriminately with little regard for adverse effects, essentially circumventing the law in order to give these "patients" access to the drug for getting high, and I am not convinced the drug has any role in treating psychitric illness. In fact I suspect it would interfere with other treatments, or even worsen most psychiatric conditions. (Someday, just for kicks, I must try to call a marijuana doc and discuss the pros and cons of the drug for a particular patient.)

My choices of how to proceed:
  • Pretend that the patient does not use the drug.
  • Demand the patient stop using.
  • Discharge the patient.
  • Continue treating the patient, but regularly encourage them to give up the pot.

Recently another choice occurred to me: I can simply refuse to accept these patients into my practice even for an evaluation. This same approach has worked well for prospective patients who admit to wanting to continue benzodiazepines. Some time ago I made a decision to stop accepting these patients into my practice. Not only did I find the process of weaning them off to find out whether they still needed treatment of an anxiety disorder unsatisfying and troublesome, but it might discourage physicians from prescribing the drugs in the first place. I figure if physicians cannot assume that if something happens to them another physician will just pick up the ball, maybe they will try harder to find a different treatment.

Maybe if more of us refuse to accept "medical" marijuana patients we will discourage its use. Or patients will just lie about it. 

I hope this just represents another stop on the road to legalizing marijuana so doctors can get out of that loop altogether.


  1. Why assume it is negative? It fits well into my life, I do long distance triathlon, work a great job, raise a great family, participate in the community, smoke marijuana every day of my life since I was 15 years old. Who cares?

    1. "Who cares?"

      Is that the MJ talking?

      "Why assume it is negative?"

      I assume you're not seeking the help of a psychiatrist.

    2. There is NO SUCH THING as "Medical Marihuana".

      If they are using it as a recreational intoxicant it is called "marihuana".

      The medicine in Cannabis is "Natural Cannabinoid Medicine".

      Your blog has Zero Credibility because you don't know the difference.

      You are an idiot Doctor.

    3. Maybe I'm an idiot. But what you do with something doesn't change what it is. If you drink a shot of whiskey to get high or down a fifth trying to kill yourself, it's still whiskey.

  2. You choices on how to proceed are strikingly similar to the predicament that physicians face who are prescribing opioids for chronic pain and have a contract in place prohibits the use of any drug prescribed outside of that clinic. A certain percentage of physicians will ignore the THC and others will not.

    I think that refusing to see patients will not solve the problem because they will always be able to see physicians who either ignore the issue or don't care.

    1. If it just solves my problem that's good enuf for me.

    2. Wow.

      It's good you are honest with yourself but I rue the patient who has you for a doctor.

  3. When I was in college, there was a doctor across the street with a giant marijuana leaf painted on his window. On the leaf was a list of several conditions he would prescribe marijuana for. It listed anxiety, depression, PMS, headaches, bipolar disorder, etc...

    I have heard nothing but good things about marijuana for bipolar disorder. A counselor I met told me she knew many people with bipolar disorder who were greatly helped with marijuana, because it calmed their racing thoughts. I personally met someone with bipolar disorder who smoked medical marijuana every morning and night. I thought that was excessive, but she swore it was keeping her calm.

    1. I've heard alcoholics say the similar things about alcohol. Ditto for people taking benzos, but if it's all so good, what makes them need a psychiatrist? You also have to find out how the really feel after they stop for a long time.

    2. I think it is worse than that. There are many people who are misdiagnosed as bipolar or a psychosis because they are marijuana smokers. Several good studies document the risk and on a clinical level, marijuana use is a risk factor for admission to a hospital. An informed consumer needs to keep in mind that marijuana for one purported use or another does not meet safety and efficacy standards of other medications. Anyone skeptical of FDA approved medications should apply that level of skepticism to anything that has not gone through that vetting process.

    3. You can also search for the information regarding marijuana dispensaries san diego to know all about the medical marijuana card for purchasing the medical marijuana products.

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    4. I would suggest they stop Decarboxylating the delta-9-tetrahydracannabinol-ACID and then there is NO PSYCHO-ACTIVE substance present.

      Problem solved. Medicine still effective.

  4. why assume that his legal pain pills are not affecting his mind...contrary to all direct evidence. do you refer them for addiction services too?

    look at the variety of "good for....and ...." claims made by pharmaceutical vendors. what's so different with pot Rx? except the resistance to possible truth in advertising?.

  5. Never assume. Yes, we need a more honest pharma too. But it's a poor comparison. At least pharmaceuticals are consistent, Marinol for example. With MJ you never know what the doc is prescribing, what you're getting -- or what pharma was testing.

  6. Cannabis potency is exactly like liquor proofing. Some people drink Wine at around 10-15%, others tolerate Bourbon Whiskey that is 64.5%. A 6 to 4 times multiple of dosage.

    Either dosage can be LETHAL to an unsuspecting alcohol consumers.

    Some Natural Cannabinoid Medicine users have 10% THCA-A Cannabis, some have 25% THCA-A Cannbis.

    Neither can be lethal to the unsuspecting Natural Cannabinoid Consumers consumers.

    It has been estimated a consumer MUST smoke 1500 lbs. of Cannabis in less than 3 hours for a lethal dosage.

    Let's agree "A lethal dosage of Natural Cannabinoid Medicine is NOT possible."

    Opiates and Barbituates are known to require much lower dosages when administered in combination with Natural Cannabinoid Medicine.

    How about you do your homework and just prescribe the lessor dosages necessary.

    The reason the U.S. has the 38th best healthcare system is due to the fact we have 2012 Technology, 2012 Science, 2012 Equipment, 2012 Medicines and a 1912 Medical University System.

    The Average U.S. Physician knows NOTHING about the Endogenous Cannabinoid System.

    This doctor is obviously one of them.

    Learn how to use Natural Cannabinoid Medicine properly...

    Or we will learn naturally on our own outside of your Main Stream Medical system, and you sir...will be as unnecessary as you are evidencing yourself to be.

    The chinks in the armor are obvious.

    1. The chaos shows in this article in today's Seattle Times:

      Calling something "medicine," natural or not, doesn't change what it is or what it does. Allowing it to be legally "authorized" or prescribed corrupts medicine, just like prescribing opiates has corrupted many physicians. This physician wants no part of the charade.

      I like this quote from the Times article: "It makes it more difficult for law enforcement to separate out who's doing it for medical purposes and who's doing it for profit purposes.

      "And not so shockingly, a lot of times it's a mixture of both."

      Difficult? I say impossible. What someone uses it for, or how they rationalize its use is none of the state's or DEA's business as long as it's used responsibly.

    2. BTW: I'm happy to be unnecessary. You should not need authorization or prescription to get MJ, "medical" or otherwise. It should be regulated like alcohol or tobacco, but any claims of "medicinal" value should have a basis in research.