Obama's Medical Marijuana Policy: Clear as mud

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In my experience, I have found the people who request a trial of medical marijuana typically tend to be:

1. Young patients, with a past history of polysubstance abuse.

2. Have not tried anything else for their chronic pain (or almost nothing else - possibly OTC meds ).

Anyone else find this?

"I've tried nothing doc, and I'm all out of ideas ... But pot works great!"

Apart from using it in MS, the evidence for using THC in managing chronic pain is very unimpressive.
 
I've no problems with pot being legal, as long as it's taxed to cover the costs of the health consequences, increased driving accidents, and diversion to kids. But, I've got a big problem with it being 'medical'.

If we are going to treat it like a medicine then lets prescribe it like a medicine - dosage - and perform random UTS check for DIVERSION. As it is this is a boodogle, the excess supply is being diverted and nothing is being done about it.
 
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I'd like to see phase 1-3 clinical trials and FDA approval after it proves safe and effective for treating a particular disease. I can already see the lawyer commercials: rx for pot? Did you get schizophrenia? Call now.
 
Young ones have polysubstance abuse and concomitant hydrocodone/oxycodone dependence along with unemployment or disability. I'm most amused by those requesting soc security disability, even submitting their "rx" as evidence.

Older pts using it tend to have less dependence problems and usually avoid interventions. they're fairly easy to deal with
 
In other times, when Congress and the Presidency were expected to take their job seriously, Obama would have been tried for sedition due to his selective enforcement and deliberate lack of enforcement of the laws of the land that were passed by Congress and signed into law. One president does not have the power under the Constitution to decide on his own that he does not agree with the law and therefore will not enforce it, but this is exactly what the Obama modus operandi is on several fronts, including ordering federal agents to not enforce the laws pertaining to marijuana. Obama should , but won't be impeached. If he had any backbone at all he would simply propose marijuana be legalized and worked through the Congress to change the law rather than simply ignoring it. I personally believe it should be legalized but not under the guise of "medical" since we as physicians do not prescribe any medication that has a 12 fold variation in content and may have lethal impurities/adulterants intentionally used to lace the drug. The drug should be legalized without restriction, and should not require physician approval. However, we need to provide better detection and enforcement methods for those operating machinery under the influence of the drug. The current standard, urine analysis is useless since the drug is detectable for weeks to months later and levels have not been correlated to impairment. Blood testing should probably be the standard protocol with impairment levels being defined and infractions treated the same as alcohol. But Obama is a spineless liberal who is more concerned with getting re-elected than he is about the laws of the US. So we will see no rational marijuana laws established under this president, and will continue to see erosion in law enforcement under his seditious rule.
 
I'm still waiting to meet the worker's comp patient who tells me, "You know, if it weren't for those two bowls of MJ I spoke every day, I would have never gotten off the couch and back at work." Haven't met him or her yet...
 
"Medical" marijuana is a misnomer. We don't prescribe it. Some states allow physicians to sign a card for a "patient" to buy pot from a legal dealer.

We don't prescribe a dose. They smoke as much or little as they want. No one really knows the potencies of what they are smoking until after they have smoked it.

We don't prescribe a frequency - they smoke it as often as they want.

We don't prescribe a amount to be dispensed - they buy as much as they want, within the law.

The equivalent would be an "Opioid Card" - I sign a card and the patient buys all the pain pills they want.

Part of me actually would have no problem with that, as long as it came with a waiver that neither they, nor their estate could sue me.
 
Requiring doctors to be involved in the process is a de facto blessing by the medical community of the use of a street drug. It is a means for states that disagree with federal policy and law to abrogate those laws by invoking compassionate use arguments. Problem is: 95%+ of those with medical marijuana cards are using the drug recreationally, and in such cases physicians have simply become shills for reefers. It is a misappropriation of the medical community, violates the ethical standards of being a physician, and physicians that permit themselves to be used by the states and recreational users in this manner are either naive or dense. Do we as physicians know the difference between cannibis sativa and cannibis indicus or the many hybrid strains? Do we understand the pharmacokinetics and pharmacodynamics and have studied the interactions between these drugs and other medications? The invoking of a medical exam is in effect legally certifying that the person is medically safe to use an illicit drug that may vary in concentration from 1.4 to 18% active content and may contain poisonous contaminants. If the person ends up hospitalized due to side effects or kills someone due to driving while under the influence, the patient or survivors of the families could well sue the certifying doctor and would actually have a case.
It is a dumb dumb thing for medicine to be involved in any way in the street drug trade, yet the brilliant state legislators have interposed physicians in exactly that manner. IMHO, doctors should be stripped of their medical license if not their DEA for participating in this sham. Legalize the drug for what it is: a recreational drug that is out of control in its usage in the US, and stop attempting to create a pseudolegal mechanism for legitimization.
 
"Medical" marijuana is a misnomer. We don't prescribe it. Some states allow physicians to sign a card for a "patient" to buy pot from a legal dealer.

We don't prescribe a dose. They smoke as much or little as they want. No one really knows the potencies of what they are smoking until after they have smoked it.

We don't prescribe a frequency - they smoke it as often as they want.

We don't prescribe a amount to be dispensed - they buy as much as they want, within the law.

The equivalent would be an "Opioid Card" - I sign a card and the patient buys all the pain pills they want.

Part of me actually would have no problem with that, as long as it came with a waiver that neither they, nor their estate could sue me.

If physicians are authorized by a state to precribe marijuana, which physicians should be prescribing these drugs? Should it be restricted to pain docotrs, rheum, ID, etc? Also should it be subject to REMS programs and so forth?

I posed these questions to a republican state house rep recently. In my state marijuana legalization is inevitable, so my hope is that it is regulated/restricted somehow.
 
requiring doctors to be involved in the process is a de facto blessing by the medical community of the use of a street drug. It is a means for states that disagree with federal policy and law to abrogate those laws by invoking compassionate use arguments. Problem is: 95%+ of those with medical marijuana cards are using the drug recreationally, and in such cases physicians have simply become shills for reefers. It is a misappropriation of the medical community, violates the ethical standards of being a physician, and physicians that permit themselves to be used by the states and recreational users in this manner are either naive or dense. Do we as physicians know the difference between cannibis sativa and cannibis indicus or the many hybrid strains? Do we understand the pharmacokinetics and pharmacodynamics and have studied the interactions between these drugs and other medications? The invoking of a medical exam is in effect legally certifying that the person is medically safe to use an illicit drug that may vary in concentration from 1.4 to 18% active content and may contain poisonous contaminants. If the person ends up hospitalized due to side effects or kills someone due to driving while under the influence, the patient or survivors of the families could well sue the certifying doctor and would actually have a case.
It is a dumb dumb thing for medicine to be involved in any way in the street drug trade, yet the brilliant state legislators have interposed physicians in exactly that manner. Imho, doctors should be stripped of their medical license if not their dea for participating in this sham. Legalize the drug for what it is: A recreational drug that is out of control in its usage in the us, and stop attempting to create a pseudolegal mechanism for legitimization.

1+
 
I agree algosdoc. The notion that we can legitimize a person's desire to get high by calling the act medicinal is insulting to physicians who strive to use science in an effort to help people. I think the burden needs to be shifted to where it rightfully belongs. Let those who want to smoke pot get it through legitimate, controlled avenues where it can be regulated and taxed just like any other legally abusable product. Pot needs to be relegated to the cigarettes and booze status that it is and not dispensed from a physician's prescription.
 
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In other times, when Congress and the Presidency were expected to take their job seriously, Obama would have been tried for sedition due to his selective enforcement and deliberate lack of enforcement of the laws of the land that were passed by Congress and signed into law. One president does not have the power under the Constitution to decide on his own that he does not agree with the law and therefore will not enforce it, but this is exactly what the Obama modus operandi is on several fronts, including ordering federal agents to not enforce the laws pertaining to marijuana. Obama should , but won't be impeached. If he had any backbone at all he would simply propose marijuana be legalized and worked through the Congress to change the law rather than simply ignoring it. I personally believe it should be legalized but not under the guise of "medical" since we as physicians do not prescribe any medication that has a 12 fold variation in content and may have lethal impurities/adulterants intentionally used to lace the drug. The drug should be legalized without restriction, and should not require physician approval. However, we need to provide better detection and enforcement methods for those operating machinery under the influence of the drug. The current standard, urine analysis is useless since the drug is detectable for weeks to months later and levels have not been correlated to impairment. Blood testing should probably be the standard protocol with impairment levels being defined and infractions treated the same as alcohol. But Obama is a spineless liberal who is more concerned with getting re-elected than he is about the laws of the US. So we will see no rational marijuana laws established under this president, and will continue to see erosion in law enforcement under his seditious rule.

In regards to THC and impairment, I remember a dutch study being cited as evidence of the effect of MJ's effect on driving ability.

Specifically, elevated levels of THC were found in some cadavers of fatal car crashes. However, this is merely a correlation, and not really a cause and effect phenom. Can't remember the study.

I find it interesting that low risk pts usually seem to benefit from Cesamet / Nabilone, while high risk pts don't seem to obtain the same benefit: "those pills don't do nothing doc"! or alternatively : "They make me feel weird".
 
All the patients who have requested medical marijuana have one or more of these traits
1) Young (college) 2) mid-50s (w/ long hx of drug abuse - "been doing pot my whole life") 3) have criminial records 4) alcoholics.... and typically decline most other normal modalities for diagnostics/therapeutics

The very FEW patients who i thought were worth trying marijuana - when they tried it, they hated it and didn't want to do it again...
 
An unbiased review of the situation by our 'smart' friends at the Atlantic.

Challenging the DEA's War on Medical Marijuana
JUL 13 2011, 2:17 PM ET33

<B>The federal agency insists it has no legitimate use. So are all the cancer, glaucoma, and multiple sclerosis patients lying?</B>



Can I interest you in a cross-country trip? Its theme is Anti-Empiricism in America. The tour bus leaves from The Bay Area, where a lot of people still think rent control works. It proceeds through Salt Lake City, where the Evergreen Institute claims to cure same sex attraction, passes through Petersburg, Ky., home of the Creationist Museum, and terminates in Springfield, Va., where the DEA, a liberty impinging branch of the federal government, insists against overwhelming evidence that a plant called marijuana "has no accepted medical use in the United States, and lacks an acceptable level of safety for use even under medical supervision."

That dubious determination is what keeps marijuana classified as a Schedule 1 drug, the only kind that cannot be prescribed by physicians. It is more tightly controlled than raw opium, methadone, and anabolic steroids, among many other drugs far more harmful to the human body, and more prone to abuse than cannabis.

Is that something the DEA can defend in court?

Americans For Safe Access (ASA) intends to find out. The advocacy group has spent years petitioning to change marijuana's designation so that doctors can prescribe it to patients. Last month, the DEA officially denied their request. In response, the group intends to sue. "The federal government is making no bones about its aggressive policy to undermine medical marijuana," said ASA Executive Director Steph Sherer. "And we're prepared to take the Obama administration to court over it."

Though most people don't know it, there is precedent for suing the federal government for access to medical marijuana and winning. On the verge of going blind in his early twenties, the late Robert C. Randall turned to marijuana after discovering that it relieved the symptoms of his glaucoma. It worked. In order to maintain a supply, he grew marijuana on his Washington D.C. sun deck. Police arrested him. "I argued that any sane person who knew they were going blind, who knew that marijuana would prevent them from going blind, would break the law to obtain marijuana," he recalled. Surprisingly, the courts agreed, and soon afterward, he began receiving marijuana legally from the federal government, a fact he publicized, resulting in the termination of his supply.


"They were willing to let me go blind to maintain the fiction that marijuana has no medical use," he said in the video above. He sued. Rather than go to court again, the federal government reached a settlement that required it to establish the Compassionate Investigational New Drug Program. At its peak, 30 people were getting their marijuana legally from the federal government, the entity now claiming that the drug "has no accepted medical use in the United States, and lacks an acceptable level of safety for use even under medical supervision." George H.W. Bush ended the program, but as many as 5 patients are currently grandfathered in and still receiving marijuana.

Here is one participant's story:


Would the head of the DEA have the guts to look him square in the eye and assert that marijuana has no legitimate medical use? Unlikely. Would Bill Bennett, the former drug czar and prohibition advocate, be willingly to publicly debate him? I doubt it. Here is what candidate Barack Obama had to say on the subject before he was president:

I have more of a practical view than anything else. My attitude is that if it's an issue of doctors prescribing medical marijuana as a treatment for glaucoma, or as a cancer treatment, I think that should be appropriate, because there really is no difference between that and a doctor prescribing morphine or anything else. I think there is a legitimate concern about not wanting people to grow their own ... but using medical marijuana in the same way with the same controls as other drugs prescribed by doctors, I think that's entirely appropriate.
You'd think a man who understands that the drug has medical uses -- who therefore believes that there are sick people who aren't getting a useful medicine due to the DEA's designation -- would push for change.

Nope.

Despite legal obstacles to conducting medical research with marijuana, there is all sorts of evidence (.pdf), beyond personal testimony, that it has legitimate medicinal uses. But I actually think that hearing the stories of actual medical marijuana users is as powerful as any study.

I dare anyone to tell me this woman is just out to get high:
 
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Legalize it, tax it, then pay me to counsel people not to smoke it.

Just like cigarettes.

Just like alcohol.
 
No other controlled substance presribed by physicians is of unknown content, purity, or content. No physician should be that naive.
 
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