doc420

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I have a couple questions for the rest of us:

1) How many times have you encountered evidence of seriously substandard (or even dangerous) practice by a physician; in the form of ridiculous med regimen, grossly inaccurate diagnosis, dangerous manipulation of medications (up or down much too fast), or stories from patients of wholly improper behavior, etc.? Reading SDN, it looks like we encounter this a lot.

2) How many times have you personally reported suspicions of dangerous practice to the medical board?

It seems to me that if we are so sure of others' dangerous or seriously substandard practice that we gripe about it here, then we ought to have the courage to report those suspicions to the Medical Board. We are not required to have evidence sufficient to indict in order to report. Even just a patient story, or certainly several patient stories about the same doctor, should be enough to report the suspicion.
I know, nobody wants to the guy who reports everybody else and gets a reputation of being a tattletale. But we complain that the Medical Board does nothing, when we haven't given them anything to investigate.

Perhaps we need to put up or shut up.
And I sincerely include myself in that category.
 
ghost dog said:
Every post of yours I read, I question the fact you being a physician.

Where are your ethics ??

This person is a drug dealer, plain and simple. If you had bothered to watch this cringe inducing video ( I suggest you do so) , it's blatantly obvious she uses leading questions in order for her "patients" to qualify for "medical marijuana".

Her lack of physical exam and informed consent are hardly surpising considering her stunning lack of professionalism.

She's not a smart " businesswoman"; to somehow justify her behavior by way of her family practice training is just idiotic.
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(shrug)

Like I said earlier, take it up with the state of california.
 
diagonal said:
It's just weed. Jesus. This woman is doing God's work. God forbid she's not pretending like she needs to do a goddamn rectal exam to allow you to smoke a joint. The law has given her the authority to sign her name and allow someone to get stoned. She's doing it and making a living at the same time. Win win.

The nice thing about graduating med school is you get to stop worrying about all the Dudley Dooright's in medicine, and you get to do what you see fit, provided it's not illegal. As she's doing. Check and mate.
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agreed
 
notdeadyet said:
I'm curious, now that a few folks have commented on this: where are we getting that she's only done one or two years of residency? A quick search on California's medical board site indicates she completed residency and is BE but not BC?

As to judging her to be hugely successful based on her website? My take is that it's an ego thing (look at the ostentatious nouveau-riche real estate porn shots for crissake). There's no shortage of docs like her. take BART and you see lots of advertisements much more geared towards the MJ crowd. She's one of many....
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I know....but most of the people like her don't look like she does. Or are as business saavy. Hell she has a dating service on her website.

As for the residency thing, if you go to her webpage and blog the years dont add up....like she graduated ross in 2002 but supposedly "finished" her residency in 2004. Also, if you look at the residency "certificate" she has on her webpage, she put up something that signifies she completed one year of family medicine at some clinic/hospital.....if you completed all three, why wouldnt you put that up instead?

My guess would be that she did around 2 years, and for whatever reason just didn't finish....she does say she took what sounds like a lot of urgent care/doc in a box walk in clinic type shifts after leaving residency to make money to open up her own business.
 
michaelrack said:
vistaril said:
well state boards reall only go after the most egregious of cases....

also, and a point nobody has brought up, what exactly is she doing that the state board could go after?

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charging only for the card- and not for the evaluation itself -could be a problem. It would be like a pain clinic stating that there would be no charge if there wasn't a prescription for opioids
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I've actually heard of pain clinics(not outright pill mills) offering to "rip up the ticket" early on in the eval when they make it clear to the pt they wont get pain meds
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vistaril said:
I've actually heard of pain clinics(not outright pill mills) offering to "rip up the ticket" early on in the eval when they make it clear to the pt they wont get pain meds
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I have done something similar a few times myself. There is a difference in occasionally doing that to get an upset patient out the door than advertising it as a policy (to get patients in the door).
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kugel said:
I have a couple questions for the rest of us:

1) How many times have you encountered evidence of seriously substandard (or even dangerous) practice by a physician; in the form of ridiculous med regimen, grossly inaccurate diagnosis, dangerous manipulation of medications (up or down much too fast), or stories from patients of wholly improper behavior, etc.? Reading SDN, it looks like we encounter this a lot.

2) How many times have you personally reported suspicions of dangerous practice to the medical board?

It seems to me that if we are so sure of others' dangerous or seriously substandard practice that we gripe about it here, then we ought to have the courage to report those suspicions to the Medical Board. We are not required to have evidence sufficient to indict in order to report. Even just a patient story, or certainly several patient stories about the same doctor, should be enough to report the suspicion.
I know, nobody wants to the guy who reports everybody else and gets a reputation of being a tattletale. But we complain that the Medical Board does nothing, when we haven't given them anything to investigate.

Perhaps we need to put up or shut up.
And I sincerely include myself in that category.
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I have absolutlely no problem reporting inept clinicians to my regulatory board, and have done so on occasion in the past.

If you like, I also have no problem listing their names here if you so wish ( public record).

Medical boards move as slow as molasses: it took them 2 years to appropriately discipline one joker who was giving out super high dose Oxycodone.
 
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vistaril said:
I know....but most of the people like her don't look like she does. Or are as business saavy. Hell she has a dating service on her website.
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She only seems business savvy if you don't know much about business. What does having a dating service on her website have to do with anything? With all the competition that's the equivalent of starting a small cottage eBay. Doomed.

Yes, I'm sure she makes a lot of money. But she's a scrip doctor for a very popular drug. You don't need to be savvy, just bold. Not much different from all the opiate cowboys down in Florida.

And I find it hard to believe she's very good at what she does. Any good dealer knows to get known without getting public. For every one of her, there's probably 10 more that are smart enough to do big volume word-of-mouth. Her ego ( evidenced by all the goldleaf real estate porn shots of her office, and all the other personal detail on her side not relevant to her practice ) is more important to her than running a smart business. The savvy marijuana Drs. do not have articles written about them.

Selling a product everyone wants and relatively few can provide (scrips for marijuana) is shooting fish in a barrel. I see no evidence she has any business savvy at all.
 
Agree. This is like Frank Lopez telling Tony Montana in Scarface that the ones that survive in that business are the ones that don't get too greedy. You pick out a good lot, keep with it, make good money but don't get too greedy.

She's basically making a target on her back. Yeah, maybe nothing will happen now with the current legal state, but like most people you want to be working this business for a few decades. Seriously, she could be setting herself up for some type of clientele most people will not want. I have enough problems with ticked off Suboxone patients and I'm doing it by the book with that.

And this is besides the point that what she's doing is completely unprofessional, unethical, and someone ought to be taking action against her.
 
whopper said:
Agree. This is like Frank Lopez telling Tony Montana in Scarface that the ones that survive in that business are the ones that don't get too greedy. You pick out a good lot, keep with it, make good money but don't get too greedy.

She's basically making a target on her back. Yeah, maybe nothing will happen now with the current legal state, but like most people you want to be working this business for a few decades. Seriously, she could be setting herself up for some type of clientele most people will not want. I have enough problems with ticked off Suboxone patients and I'm doing it by the book with that.

And this is besides the point that what she's doing is completely unprofessional, unethical, and someone ought to be taking action against her.
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You act as though pot is liquid napalm. I promise you the pot she's prescribing is far more benign than much of what is acceptable via the status quo in medicine. IF you want to get into an argument about the efficacy of SSRIs, and the fact that people can't get boners when they're on them, but you think it's super awesome to prescribe those, but somehow pot is satan, well you have some explaining to do.

Let me guess, you drink alcohol, right? A drug FAR more destructive. If so, I think you're judgmental tone is null and void.
 
Uh---, this is not about marijuana being better or worse than alcohol. By the way, I actually think there is some argument for medical marijuana, just that doctors shouldn't be giving out like it's candy. Truth be told, out of my former 600 private practice patients, I did think that perhaps marijuana could've helped 3 of them because nothing except benzos was causing benefit, they didn't want to be on benzos, and they were not good candidates for ECT.

It's about a lady putting herself in bikini calendar, getting that calendar to her patients, and then offering marijuana for pretty much anything, opening the flood gates for someone not wanting it for real medical treatment.

You'd have a valid argument if I was giving out g-string calendars of myself to patients while recommending alcohol through the roof for anything and that person wouldn't be able to get alcohol otherwise. Depressed? Are you a convicted drunk driver or someone under the age of 21 who is not allowed to purchase alcohol? Here's a prescription for Jack Daniels and since it's on a prescription, it's now tax free and maybe we can get your insurance company to pay for it.

(yeah and my former David Hasslehoff avatar doesn't count because that was not in the presence of my patients!)

But if you want to get onto loose association analogy arguments where there really aren't any valid parallels--

You're wrong because the sky is blue! So there! "If so, I think you're judgmental tone is null and void."

If you don't understand what I mean, check out Doc420's commercials if you haven't already.

And since I'm on a rant, again, I do think marijuana should be considered as a possible therapy, just that the way it's going in California, it's opened the floodgates to MDs that have become in reality de facto drug-dealers. While I was in the NJ APA, I supported that state's APA stance that the medical community should be open to considering that marijuana could have some possible therapeutic benefits. But if it ever became legalized, I'd want more evidence and more regulations than to allow anyone to prescribe it the way this lady-doc420's doing it.
 
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I can't believe we've made it this far onto page 2 and nobody's mentioned how heavily photoshopped her promo images are.
 
whopper said:
And this is besides the point that what she's doing is completely unprofessional, unethical, and someone ought to be taking action against her.
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I don't see how they could......if they did the california board of medical examiners office would have to increase their staff by 700% at least. She isn't doing anything hundreds of other docs there arent doing.

She is practicing legally. And she is doing what tons of other "docs" are doing. Really cant take action against her without opening up a whole can of worms. And she knows it; thats why she does it so out in the open
 
whopper said:
It's about a lady putting herself in bikini calendar, getting that calendar to her patients, and then offering marijuana for pretty much anything, opening the flood gates for someone not wanting it for real medical treatment.
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opening??? They've been open for some time....

99.9% of the insane number of mj cards out there i california are for people "not wanting it for real treatment"

So blame california, or the people in california. Blame the original law for making it legal for pts to have "medical" marijuana for very vague and nonspecified reasons. Even if the cali board of med examiers wanted to go after people like this(and they dont) they would be somewhat hamstrung by the state itself.....
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Wow, I heard about her 5 years ago before starting med school while living in southern California. I remember her website stating that new MJ card referrals were like 125$ dollars and renewals were like 85$. I just checked her website today and new cards are now 40$ and renewals 30$, looks like competition is stiff. I bet everyone there is a medical MJ doc compared to 5 years ago. She made her money though, big time.
 
She is practicing legally. And she is doing what tons of other "docs" are doing. Really cant take action against her without opening up a whole can of worms. And she knows it; thats why she does it so out in the open
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Not disagreeing with your comments, technically speaking. I'll bring up a counter-example. Ever hear of Ginger Lynn? The porn-star? The IRS went after her. Anyone who knows anything about this can basically connect the dots that they went after her, not because of taxes, but because she was a porn-star, and one of the big ones at the time. The belief was that since she was at the top, if they targeted her, it'd send a message to the entire industry to basically keep quiet even if they did nothing illegal.

The way taxes are, anyone in the government can do anything to say you didn't pay them right, then pull out some law saying you may have broke it whether you did or not, then lock you in court for years costing you hundreds of thousands in legal fees, and that's what happened to her.

Point being is that if you're doing something that's going to piss some people off, even if it's legal, don't exactly be the loudest voice out there if you don't want a target on your back.

To pull in another example, Frank Rosenthal, the real-life person that the movie Casino is based on (called "Ace Rothstein" in the movie), had television shows while he was being investigated by the local authorities that was seen by them as a direct challenge. Was it illegal? No, but it was definitely adding fuel to the fire, and if you want a lasting business you don't want that.

As for the state board and your comments about it, I actually agree. This is something that the people of California should've expected with this type of thing being allowed. I still think given the existing laws, they could do something about it, but they likely will not because of the doctor patient relationship being highly protected, and doing so would be very difficult.

Part of me is actually wondering if she was intentionally doing her tricks in an attempt to move from practice of medicine into being a media icon.
 
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vistaril said:
ummm....her house isn't evidence of that? what...did she buy that with coupons?
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A flash house doesn't mean she's running a great practice. Could be from her Bollywood days. Could be an inheritance. Could be a rental property designed to impress folks who ooh and ah over lots of gold leaf and 70's-style opulence. Or it could all come from her practice which is high risk, high volume and declining profit (based on her price slashing). Again, no sign of business savvy as we usually use the term...
 
I went to med school with her. As you can tell by my SDN join date and the number of posts that I have, hopefully you can see that I am not a troll.

I did not know her but was an acquaintance of her male "friend," TP (I don't want to name names). I think there was a love triangle between herself, TP and YP (for the few out there that know what I'm talking about!). Anyways, in her class alone (I think she was part of the original Ross Sept '98 class - may have started in the May '98 class - not sure), there were at least 3 or 4 Indian girls better looking, friendlier, more approachable etc than her - many more if you include all races. It's not that she wasn't good looking - she was - but nothing special. She's short (maybe 5'4", if that) and had no ass. It looks like she's had some work done - definitely her breasts.

When I forwarded her website to a some friends when it first came out a few years ago, it was naturally a good place to catch up! I still can't believe the outright lies that she tells in her bio:

http://sonapatelmd.com/spot/index.php?option=com_content&view=article&id=37&Itemid=44

First of all, who brags about being the top of their class at a Caribbean med school? It's like being the world's tallest midget (just as an aside, believe it or not, it's actually hard to be the top of a Caribbean school!). Secondly, she was an average student - at best. The top of the class, those who graduated with honors etc have their names published during the grad ceremony etc. She was definitely not the valedictorian as she would be no doubt bragging about it somewhere. Also in her bio, she makes it sound like she had this promising Bollywood career and she threw it all away to become a Caribbean FP...riiiiiiiiiiiiight, we believe you...

I don't think I've ever spoken a word to her. She was not particularly loud or obnoxious and did not stand out in any way at all. If I had to stereotype her, she's that above average Indian girl who's really stuck up but nothing great - you all know what I'm talking about.

I'm not a hater - I think it's great that she's doing well, although there is no real barrier to her competition. Can't any doctor become a marijuana screener? Her rates have gone down more than half. She used to charge $100 from what I remember. It's hard to imaging anyone from med school doing something like this, but I would have never guessed that it would have been her. Like I said, I never really knew her.
 
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notdeadyet said:
A flash house doesn't mean she's running a great practice. Could be from her Bollywood days. Could be an inheritance. Could be a rental property designed to impress folks who ooh and ah over lots of gold leaf and 70's-style opulence. Or it could all come from her practice which is high risk, high volume and declining profit (based on her price slashing). Again, no sign of business savvy as we usually use the term...
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well the point is she bought(or rents) that house, and in that area that house costs major $$$$.....if she got that by practicing "medicine", then by definition she has been business saavy because she would have had to acquire a lot of money/have a lot of income to reside in such a house
 
vistaril said:
well the point is she bought(or rents) that house, and in that area that house costs major $$$$.....if she got that by practicing "medicine", then by definition she has been business saavy because she would have had to acquire a lot of money/have a lot of income to reside in such a house
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I know nothing about business (really, I don't), but isn't that kind of like saying Bernie Madoff was obviously savvy about business since he had lots of money at one point? Time will tell.
 
Thank you, kugel. Saved me so much effort...
 
Come on guys she charged ~100$ a pop for referrals for about 5 years before competition caused her to slowly lower prices to where she is now. She worked 7 days a week in a news article I read about her years ago. If she did 20 MJ referrals a day x 7 days a week at 100$, that is around 600K cash per year. Who knows how many patients she saw, 20 probably is a low estimate per day given her popularity. She has 2 clinics right now. I think she had 3 before.
 
Whether or not it's good business short-term vs long I couldn't say. It might get legalized for recreational use and then where would you be as a one-trick medical pony.

I have to say I have a hard time formulating an opinion on this one. I'm rotating with our trauma surgery team now and hardly a patient comes through that isn't ETOH related. It's illegality seems therefore ironic at best. But I still share the opinion that medical doctors who are as grossly imprecise as the MJ docs are unethical.

Everything from cocaine to psyloscibin to MJ to opiates have medical applications. But these cowboys are slinging scripts without any concern for medical criteria. And what we consider a doc who just wrote for one therapy if it wasn't MJ.

It think it needs to be a demedicalized issue and put to society for legalized use in general. I don't see it's our issue beyond it's specific medical applications, which as far as I've seen are limited to refractory depression and bipolar disorder, refractory neuropathic pain, and appetite and weight loss prevention in HIV or Cancer patients, or nausea in general.

I've always been curious how docs handle these legitimate potential uses, particularly the nausea issue. Can oncologists write for MJ use and not suffer any consequence? It seems less than ideal to have to go to an MJ-specific doc for this.
 
sunlioness said:
Yeesh.
I often find myself wishing that pot would just be legal already so as to avoid the farce that "medical marijuana" often turns into. I'm kinda glad we don't have it here. Very glad, actually.
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True.
 
I'd recommend not to touch it if it's not legal in your state. I mentioned I had 3 patients where I do think there was enough argument to justify trying marijuana in a clinical sense but I wasn't going to recommend they do it to their face due to the legal restrictions.

But even if it is legal, there's a lack of evidenced based data for the several applications where it's being used. If it were legal, I'd only recommend it if nothing to hardly anything else worked that you'd typically try if it were not an option for treatment.
 
There's alot of personal experience and documentation regarding marijuana psychosis esp in young men with a propensity to schizophrenia, but this is never mentioned. Why?
 
notdeadyet said:
A flash house doesn't mean she's running a great practice. Could be from her Bollywood days. Could be an inheritance. Could be a rental property designed to impress folks who ooh and ah over lots of gold leaf and 70's-style opulence. Or it could all come from her practice which is high risk, high volume and declining profit (based on her price slashing). Again, no sign of business savvy as we usually use the term...
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It's obvious her family is wealthy. And she mentions in her bio of driving a mercedes convertible when she worked at a free clinic after Ross.

And much like American film, there are different calibers of "Bollywood."
 
GroverPsychMD said:
There's alot of personal experience and documentation regarding marijuana psychosis esp in young men with a propensity to schizophrenia, but this is never mentioned. Why?
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Because marijuana is "natural".
 
Blais said:
My knowledge of heroin's intricacies is limited, but isn't it a derivative of the opium poppy.
In other words, various processes have to be done to it's natural state in order to become the final product: "heroin".

...In opposition to marijuana that can be picked right off the plant and smoked as is for full-effect.

Natural? Guess it's up to personal interpretation.
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Natural is just a buzzword. Surely those concerned about it wouldn't consider lithium natural, but surely unreal dosages of supplements are.
 
kugel said:
I know nothing about business (really, I don't), but isn't that kind of like saying Bernie Madoff was obviously savvy about business since he had lots of money at one point? Time will tell.
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bernie maddoff obtained his money illegally. She isnt. If bernie maddoff had obtained all that stuff legally, sure, he would be business saavy
 
badasshairday said:
Come on guys she charged ~100$ a pop for referrals for about 5 years before competition caused her to slowly lower prices to where she is now. She worked 7 days a week in a news article I read about her years ago. If she did 20 MJ referrals a day x 7 days a week at 100$, that is around 600K cash per year. Who knows how many patients she saw, 20 probably is a low estimate per day given her popularity. She has 2 clinics right now. I think she had 3 before.
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Im sure she does a ton more than 20 per day....more like 120 at least I would guess
 
That zombie guy who ate the guys face in fla only tested positive for mj. If you have other info, please let me know.
 
Yeah I have a small sample size of cases I knew where normal-functioning people had a psychotic episode after MJ intoxication too. And a n = 1 for same with LSD.

What I wonder though is if there is some underlying propensity for psychosis that the psychotropic effect of weed triggers or if these people experienced psychosis purely as a result of the weed. I don't believe the cited research make the distinction...? Given, I haven't the time to make sure.
 
Abider said:
Yeah I have a small sample size of cases I knew where normal-functioning people had a psychotic episode after MJ intoxication too. And a n = 1 for same with LSD.

What I wonder though is if there is some underlying propensity for psychosis that the psychotropic effect of weed triggers or if these people experienced psychosis purely as a result of the weed. I don't believe the cited research make the distinction...? Given, I haven't the time to make sure.
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This seems to be the more commonly accepted theory.
 
Abider said:
Yeah I have a small sample size of cases I knew where normal-functioning people had a psychotic episode after MJ intoxication too. And a n = 1 for same with LSD.

What I wonder though is if there is some underlying propensity for psychosis that the psychotropic effect of weed triggers or if these people experienced psychosis purely as a result of the weed. I don't believe the cited research make the distinction...? Given, I haven't the time to make sure.
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Last I took a look at the literature, there are some components of marijuana that likely cause psychosis(delta-9-thc), and some that may be protective (cannabidiol). The problem is marijuana isn't one or the other, and that these days it is genetically modified to have excessively high THC.
 
Even if there is an underlying predisposition to psychosis, why hasten it with marijuana use? Who knows when and if a person's full blown psychosis would occur? Why precipitate it and then bury the information?
 
This thread reminds me of the time one of my psychotic patient's PCP's called me up and asked me for permission to start the pt on medical marijuana for anxiety. After I said no, the patient stopped coming to treatment.
 
Last I took a look at the literature, there are some components of marijuana that likely cause psychosis(delta-9-thc), and some that may be protective (cannabidiol). The problem is marijuana isn't one or the other, and that these days it is genetically modified to have excessively high THC.
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I've read the same as well, in fact I've also been told at a conference that one of the main reasons why synthetic cannabinoids are of worse concern vs. marijuana is they apparently don't have cannabidiol, and thus in theory are far worse vs. marijuana in terms of causing or exacerbating psychosis.

From anectdotal experience, I'm seeing this in real life. I've had a few patients get very psychotic from synthetic cannabinoids, to a degree I have not seen with marijuana.

There is data, as mentioned above, that marijuana can cause or worsen psychosis. There was a study in the Green Journal about 3 years ago showing patients in a group that took cannabinoids already at high risk develop a psychotic disorder in higher amounts vs. those that did not use cannabinoids.

Back in my high school to college days, my attitude was marijuana was a far less serious substance vs. alcohol, but given the above data, I speculate that several-perhaps on the order of thousands if not hundreds of thousands of people that developed schizophrenia or schizoaffective disorder may have not developed it at all if they did not try marijuana, and/or they may have developed it later in life-that usually leads to an improved disease course and prognosis.

For the above reasons, even if marijuana were made legal, I'd still recommend it be given out in the most controlled manner possible and only for treatment resistant cases or for terminal cases.
 
whopper said:
I've read the same as well, in fact I've also been told at a conference that one of the main reasons why synthetic cannabinoids are of worse concern vs. marijuana is they apparently don't have cannabidiol, and thus in theory are far worse vs. marijuana in terms of causing or exacerbating psychosis.

From anectdotal experience, I'm seeing this in real life. I've had a few patients get very psychotic from synthetic cannabinoids, to a degree I have not seen with marijuana.

There is data, as mentioned above, that marijuana can cause or worsen psychosis. There was a study in the Green Journal about 3 years ago showing patients in a group that took cannabinoids already at high risk develop a psychotic disorder in higher amounts vs. those that did not use cannabinoids.

Back in my high school to college days, my attitude was marijuana was a far less serious substance vs. alcohol, but given the above data, I speculate that several-perhaps on the order of thousands if not hundreds of thousands of people that developed schizophrenia or schizoaffective disorder may have not developed it at all if they did not try marijuana, and/or they may have developed it later in life-that usually leads to an improved disease course and prognosis.

For the above reasons, even if marijuana were made legal, I'd still recommend it be given out in the most controlled manner possible and only for treatment resistant cases or for terminal cases.
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Wow. Interesting. Then that comprises a frameshift in my conception of a hierarchy of harm with recreational drugs as well, given the seriousness of the psychotic complication.

If this is true, then it is a wonder that the research has not surfaced in the public consciousness. Perhaps there's just too many stupid reasons why it remains illegal for recreational use. That boil down to a paternal....because I said so, such that rational objections to it's use get smothered.

Cigarettes are legal. So.....?

But I'm glad I read this deep into the thread because I need to take another look at those citations.
 
Drugs being made legal isn't so much about the exact level of danger vs. benefit. If so alcohol would be illegal. Alcohol use has become so endemic to the degree that if made illegal, it'd cost society more than keeping it legal as history has taught us.

Drugs, IMHO, from a legal perspective is more like a Pandora's Box. Make it legal, it becomes widespread, don't figure on containing it unless you go through draconian measures that a free society will likely not tolerate. For example in China, opioid use was one so common it was endemic. China was able to get rid of the problem using draconian methods, methods you can't do in a free society like in the U.S.

But getting to your point, I do believe that any doctor prescribing cannabinoids to a patient ought to be aware of the risks of making someone psychotic. For this reason-there has to be a medical problem, a real one that is going to be treated, and that's why this Doc420 IMHO is full of it in terms of poor ethics. Then the problem has to be to the degree where marijuana is actually arguably justified, and in most cases that means that the conventional treatments don't work, and/or there's enough evidence to justify it's use. The amount of data out there for it's use in medicinal treatments is limited-and largely due to the legal restrictions on it, but this still IMHO doesn't justify widespread prescriptions of it. Further the doc should take into account if the patient is at risk for psychosis. E.g. do they have a relative with a mental illness? Are they in the age brackets where schizophrenia can occur?

And as I mentioned above, out of 600 private practice patients I had, only about 3 would've fit this bill to the degree where I would've been open giving it (but didn't due to state regulations).
 
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There is nothing medical about marijuana. I drink ginger ale when my stomach is upset, but that doesn't make it a medical intervention. Relevant reviews of literature skewer it as ineffective compared to standard treatments, it has tremendous risks in select populations, and it's smoked. We don't have a single other medical intervention that involves smoking, and we probably never will. (We also don't have medical interventions that are baked into brownies).

That said, decriminalizing in general makes sense for tons of reasons, and I wouldn't grudge anybody with cancer going through chemo or someone with a terminal illness in lots of pain smoking marijuana. Even making it legal for these folks to buy small amounts would be reasonable. The privilege should probably be limited to oncologists or palliative care docs, and the scrutiny and requirements for documentation should be fairly rigorous.
 
Abider said:
Wow. Interesting. Then that comprises a frameshift in my conception of a hierarchy of harm with recreational drugs as well, given the seriousness of the psychotic complication.

If this is true, then it is a wonder that the research has not surfaced in the public consciousness. Perhaps there's just too many stupid reasons why it remains illegal for recreational use. That boil down to a paternal....because I said so, such that rational objections to it's use get smothered.

Cigarettes are legal. So.....?

But I'm glad I read this deep into the thread because I need to take another look at those citations.
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I think the numerous groups that support mj use hide this data or refuse to acknowledge it. There are a large number of websites and groups that defend mj use like crazy. When they do acknowledge the risk, they minimize it by calling it 'reefer madness'.

These pro mj people also think psychiatrists are wrong for not liking mj due to their marginalizaion of the risks involved. Most patients will not develop the psychosis but for those of us in mental health care, we know the resources involved in treating these patients and the threat to others during these substance induced psychotic episodes.

There is also a reason mj is known as a 'gateway' drug to other mind altering illicit drugs.
 
In fairness, the government (and to a lesser extent the medical establishment) did themselves a disservice back in the day by exaggerating the effects of the drug and villianizing its users, which created a lot of lost credibility that is hard to overcome in the community.

Also, I think the understanding of marijuana's effect on those with psychotic disorders (or tendencies for them) is relatively recent knowledge. I've heard psychiatrists mention annecdotal stories for a number of years but have only heard people reference research on the subject in the last couple.
 
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