Psychiatrist stabbed for refusing mj prescribing

[PikminOC]

ELGIN, IL -- A Crystal Lake man apparently desperate to get a prescription for medical marijuana is accused of a trying to kill his psychiatrist who refused to write the script for him, the Daily Herald reports. Elliott C. Lockwood, 20, of the 0 to 99 South Oak Street, is being held on a $250,000 bail following the Aug. 8 attack at the psychiatrist's office in the 1700 block of North Randall Road.

During an appointment that morning, Lockwood is accused of demanding the prescription for medical marijuana and, when his psychiatrist refused, stating she did not have the authority to write a prescription for marijuana, he pulled a steak knife out of his backpack, according to the article.

Authorities said the woman was able to block him from stabbing her in the chest, which resulted in a stab wound to her right palm, but Lockwood then proceeded to slash her right hand near her wrist, according to the newspaper. She ran out of her office, and police say Lockwood chased her and then punched her at least four times in the head.
Psychiatrist Stabbed After Denying Pot Prescription: Authorities

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[birchswing]

The listed proximate cause in these cases is always something novel picked up from the police report, in this case marijuana. Then narrative is framed around it being the core issue, holding a symbolic place for a larger societal issue. It could just as easily have been child goes on rampage when a smartphone was taken away. They always assume a rational actor to make the societal issue sound as if it's coming to a boiling point.

And if the person were rational, why would they attack over one of a select class of drugs that's easy to obtain without a script.

If we're going to make assumptions like the article does (based on what the perpetrator said, which should not be assumed to be reliable), I would posit that equally plausible reasons for the attack 1) He was high on some other recreational drug. 2) He had poorly treated mental illness.

Of course, those are just guesses, but so is going with what a perpetrator claimed was his own motive in a police report.

 

[wolfvgang22]

The listed proximate cause in these cases is always something novel picked up from the police report, in this case marijuana. Then narrative is framed around it being the core issue, holding a symbolic place for a larger societal issue. It could just as easily have been child goes on rampage when a smartphone was taken away. They always assume a rational actor to make the societal issue sound as if it's coming to a boiling point.

And if the person were rational, why would they attack over one of a select class of drugs that's easy to obtain without a script.

If we're going to make assumptions like the article does (based on what the perpetrator said, which should not be assumed to be reliable), I would posit that equally plausible reasons for the attack 1) He was high on some other recreational drug. 2) He had poorly treated mental illness.

Of course, those are just guesses, but so is going with what a perpetrator claimed was his own motive in a police report.

I strongly disagree.

Persons with serious mental illness are 7 times more likely to harm you than the general population. Persons abusing drugs are 17 times more likely to harm you than the general population. That is a big difference. I don't have my source right here at hand, but it squares with my experience in practice.

Anecdotally, I'm rarely threatened by someone with Schizophrenia or other serious mental illness. I'm much more often threatened, yelled at, or witness aggression by patients who are angry I won't prescribe a controlled substance. A couple of the most violent toward me have been those with very heavy Cannabis Use Disorder who come to my office and demanded benzodiazepines. When I tactfully advised them I'm not comfortable prescribing a benzodiazepine to them as long as they are abusing substances, and offer alternative options, aggressive behavior followed. One punched my heavy desk repeatedly and broke it, another threatened to ambush and kill me in the parking lot. Most others just throw a minor tantrum and slam the door on the way out. I've seen colleagues experience actual assault in the same situation.

 

[birchswing]

I strongly disagree.

Persons with serious mental illness are 7 times more likely to harm you than the general population. Persons abusing drugs are 17 times more likely to harm you than the general population. That is a big difference. I dont have my source right here at hand, but it squares with my experience in practice.

Anecdotally, I'm rarely, if ever, threatened by someone with Schizophrenia or other serious mental illness. I'm much more often threatened, yelled at, or witness aggression by patients who are angry I won't prescribe a controlled substance. A couple of the most violent toward me have been those with very heavy Cannabis Use Disorder who come to my office and demanded benzodiazepines. When I tactfully advised them I'm not comfortable prescribing a benzodiazepine to them as long as they are abusing substances, and offer alternative options, aggressive behavior followed. One punched my heavy desk repeatedly and broke it, another threatened to ambush and kill me in the parking lot. Most others just throw a minor tantrum and slam the door on the way out.

But that's mostly what I said. I said a just-as-plausible explanation was poorly treated mental illness. Or use of other recreational drugs. I was saying that this happening over marijuana seemed less plausible than your example of benzodiazepines, for example. I'm not saying the patient didn't blow up saying it was over prescribed marijuana--just that other factors were probably more core to it than that, that the marijuana was the proximate thing he *thought* was upset about.

 

[WisNeuro]

Meh, just legalize it, it's going to happen anyway. Remove the prescribing issue entirely.

 

[PikminOC]

I strongly disagree.

Persons with serious mental illness are 7 times more likely to harm you than the general population. Persons abusing drugs are 17 times more likely to harm you than the general population. That is a big difference. I don't have my source right here at hand, but it squares with my experience in practice.
Disagree with what? I just posted an article.
Anecdotally, I'm rarely threatened by someone with Schizophrenia or other serious mental illness. I'm much more often threatened, yelled at, or witness aggression by patients who are angry I won't prescribe a controlled substance. A couple of the most violent toward me have been those with very heavy Cannabis Use Disorder who come to my office and demanded benzodiazepines. When I tactfully advised them I'm not comfortable prescribing a benzodiazepine to them as long as they are abusing substances, and offer alternative options, aggressive behavior followed. One punched my heavy desk repeatedly and broke it, another threatened to ambush and kill me in the parking lot. Most others just throw a minor tantrum and slam the door on the way out. I've seen colleagues experience actual assault in the same situation.

What are you disagreeing with?

 

[futuredo32]

I've never experienced anything that severe. I can say I was never so bloody and bruised as I was during my child psych rotation. Fortunately, the nurses protect the doctor in inpatient settings. I live in a state where it's SO easy to get medical marijuana (Michigan) , I don't recommend it to my patients, but my private practice is in a very liberal city and practice where they have or had a "hash bash" annually U-M.
But any physician in any specialty can be treating a patient with psychiatric illnesses for their comorbid conditions. I am all for it in terminally ill patients, but other than that I think it needs more study. I have been fairly successful with patients using other illicits, , but for marijuana, "It's fine, a Dr. prescribed it" . I suggest the oil minus THC, but rarely make any headway because it's "legal and doctor prescribed so it must be good."

 

[PikminOC]

Meh, just legalize it, it's going to happen anyway. Remove the prescribing issue entirely.

In Illinois, a psychiatrist cannot prescribe it.

 

[WisNeuro]

In Illinois, a psychiatrist cannot prescribe it.

I thought that they could get medicinal marijuana in IL with a phsyician's recommendation. Anyway, besides the point. If it were legal recreationally, there would be far less time wasted in patients trying to get a prescription, allowed or not. Then we could also stop wasting money enforcing MJ laws currently in effect.

 

[PikminOC]

There are specific doctors who do this.
https://ilcbd.com/libertyville-marijuana-doctor-taher-sobhy-md-cbd-mmj-rx/

People think a doctor can write a presc for it and that is untrue.

And this belligerence occurs with many controlled subs

 

[WisNeuro]

And this belligerence occurs with many controlled subs

Meh, there's some preliminary data that still needs further study that rec MJ use has a relationship with decreased opioid scripts. If that turns out to actually be the case, I'd probably rather many of my patients be using MJ than the current opioid/benzo cocktail that many of them are prescribed.

 

[Monocles]

Oh my god this is one of my biggest nightmares.

In my years of residency I've had several death threats related to controlled substances. During ED settings, I've had patients explicitly say "I will find your office and put a bullet in between your eyes if you don't write me [insert controlled substance here]". We've also had recent shootings in our sister hospitals in the Boston area so this is absolutely terrifying.

 

[AD04]

What is the best way to prevent something like this? A former PD of my program was beaten to within an inch of losing his life by a psychotic patient.

Telepsychiatry is looking more and more appealing.

 

[FlowRate]

I've had patients explicitly say "I will find your office and put a bullet in between your eyes if you don't write me [insert controlled substance here]".

Did you file a police report? That person needs consequences in their life.

 

[MacDonaldTriad]

MJ distribution centers call their customers "patients" because as a profession, some physicians charge money for their "recommendation". The medicalization of what to me is almost entirely recreational use is our fault. MJ doctors are not that different from a lot of stimulant providers I guess, but as a group, I wish we would get out of the business. I don't approve of MJ being described as harmless, but if legalization takes us out of the loop, I vote yes. The problem is in States with quazi-legalization.

As a rule, don't write scripts that make you want to take a shower after you write them. I think our substance use disorder antenna is a good concrete example of using counter transference diagnostically.

 

[WisNeuro]

MJ distribution centers call their customers "patients" because as a profession, some physicians charge money for their "recommendation". The medicalization of what to me is almost entirely recreational use is our fault. MJ doctors are not that different from a lot of stimulant providers I guess, but as a group, I wish we would get out of the business. I don't approve of MJ being described as harmless, but if legalization takes us out of the loop, I vote yes. The problem is in States with quazi-legalization.

I'd actually hazard that benzos are equally if not more harmful than MJ use in the long-term, yet many prescribers still hand out Xandy on regular basis. At least with MJ use, the cognitive side effects wash out with cessation (assuming no heavy childhood or adolescent use).

 

[Stagg737]

But that's mostly what I said. I said a just-as-plausible explanation was poorly treated mental illness. Or use of other recreational drugs. I was saying that this happening over marijuana seemed less plausible than your example of benzodiazepines, for example. I'm not saying the patient didn't blow up saying it was over prescribed marijuana--just that other factors were probably more core to it than that, that the marijuana was the proximate thing he *thought* was upset about.

While I don't disagree with this, I am very familiar with Elgin, IL and given the culture surrounding MJ there I 100% believe that Lockwood stabbed this physician for not giving him a MJ rx.

 

[PikminOC]

Meh, there's some preliminary data that still needs further study that rec MJ use has a relationship with decreased opioid scripts. If that turns out to actually be the case, I'd probably rather many of my patients be using MJ than the current opioid/benzo cocktail that many of them are prescribed.

There are lots of other controlled subs out there.
And many on med mj are still seeking other controlled subs.

 

[PikminOC]

While I don't disagree with this, I am very familiar with Elgin, IL and given the culture surrounding MJ there I 100% believe that Lockwood stabbed this physician for not giving him a MJ rx.

That was never in question. And the assailant was from crystal lake

 

[WisNeuro]

There are lots of other controlled subs out there.
And many on med mj are still seeking other controlled subs.

Holy crap! There are more than two controlled substances out there? I need to update my CEs!
Anyway, it's no panacea, just a way to make a small dent in the problem. Like most of what is done in healthcare.

 

[Stagg737]

That was never in question. And the assailant was from crystal lake

Birchswing implied that the MJ was not the cause of him stabbing the psychiatrist, which I think would be reasonably given the culture of MJ in many parts of Elgin. I didn't realize he was from Crystal Lake, but that makes me believe that this was mostly about the MJ even more.

 

[NontradCA]

 

[PikminOC]

Holy crap! There are more than two controlled substances out there? I need to update my CEs!
Anyway, it's no panacea, just a way to make a small dent in the problem. Like most of what is done in healthcare.

Except now there are more car accidents in Colorado with people under influence of mj. I just updated my cme's.

 

[WisNeuro]

Except now there are more car accidents in Colorado with people under influence of mj. I just updated my cme's.

Could be the case. I'd like to see more long-term data on that one before making a big policy move. Still doesn't change my stance on legalization.

 

[st2205]

I'd actually hazard that benzos are equally if not more harmful than MJ use in the long-term, yet many prescribers still hand out Xandy on regular basis. At least with MJ use, the cognitive side effects wash out with cessation (assuming no heavy childhood or adolescent use).

And I’d follow that logic through by saying opioids are more harmful than benzos, yet many prescribers hand them out like candy, so don’t be ashamed of benzo prescribing.

Makes sense.

 

[st2205]

Except now there are more car accidents in Colorado with people under influence of mj. I just updated my cme's.

It’s interesting. I recently got back from Washington. Have never smelled so much marijuana in public in my life. In any case, I’ve never seen someone with an open container in my life (meaning people aren’t doing it public enough for me to have seen it), three days in Washington and there were at least three people I saw smoking weed in their car out in the open. I think that’s more a reflection of how polarized this has become and the “OMG natural!” pandemonium.

 

[WisNeuro]

And I’d follow that logic through by saying opioids are more harmful than benzos, yet many prescribers hand them out like candy, so don’t be ashamed of benzo prescribing.
Makes sense.

I agree with the first part. But the intent was that we spend a lot of time regulating a substance that is far less harmful than substances that are either freely available (alcohol) or controlled yet still given out freely (benzos and opioids). I'd rather legalize, tax it, and use that money to fund more important things such as education or healthcare.

It’s interesting. I recently got back from Washington. Have never smelled so much marijuana in public in my life. In any case, I’ve never seen someone with an open container in my life (meaning people aren’t doing it public enough for me to have seen it), three days in Washington and there were at least three people I saw smoking weed in their car out in the open. I think that’s more a reflection of how polarized this has become and the “OMG natural!” pandemonium.

I actually lived in Washington state for several years recently, and did not find this to be the case at all. Maybe once in a while did I smell it, but it was fairly rare. This was between Seattle and Tacoma. Maybe it was a different scene where you were. Nothing like the main street in downtown Denver, anyway.

 

[WingedOx]

It’s interesting. I recently got back from Washington. Have never smelled so much marijuana in public in my life. In any case, I’ve never seen someone with an open container in my life (meaning people aren’t doing it public enough for me to have seen it), three days in Washington and there were at least three people I saw smoking weed in their car out in the open. I think that’s more a reflection of how polarized this has become and the “OMG natural!” pandemonium.

Of course to be obnoxious and play devil's advocate with some anecdata, I'd never seen so many people on the streets in obvious withdrawal as I did during my last trip to Seattle... and I live in downtown Chicago, so it's not like I'm living in a sheltered world where I wouldn't otherwise see such a thing.

 

[WingedOx]

There are specific doctors who do this.
https://ilcbd.com/libertyville-marijuana-doctor-taher-sobhy-md-cbd-mmj-rx/

People think a doctor can write a presc for it and that is untrue.

And this belligerence occurs with many controlled subs

And the system for approving patients is a complete joke here in IL. If we really want to tie this thread together, one of worst polysubstance-abusing patients with controlled substance scripts from multiple different providers got his MJ card approved for his "PTSD". He also happens to be someone who said he'd "Send me to the ER" if he ever saw me again because he said I was not sufficiently respectful to his doctor shopping habits.

 

[hamstergang]

Except now there are more car accidents in Colorado with people under influence of mj. I just updated my cme's.

Unless the data's been updated from my last look, the actual stat is that there are more car accidents where the drivers had MJ in their system -- not testing for acute intoxication. And this seems like a useless stat to me because there are more of everything in CO where the people involved have MJ in their system.

Edit: to clarify, for activity X, a higher portion of people involved in X test positive for MJ now than in 2000. X can be MVAs, ordering food from Taco Bell, or showing up to work on time. The real question I'm not sure was answered clearly was, are there now more car accidents occurring than expected?

 

[PsyDr]

@birchswing

By that logic anyone who commits petty theft is mentally ill.

 

[st2205]

Of course to be obnoxious and play devil's advocate with some anecdata, I'd never seen so many people on the streets in obvious withdrawal as I did during my last trip to Seattle... and I live in downtown Chicago, so it's not like I'm living in a sheltered world where I wouldn't otherwise see such a thing.

Yeah, but I’d been to Seattle before. It wasn’t something I was anticipating and I’m not even sure I would have known marijuana was legal in Washington until I saw so much.

 

[MacDonaldTriad]

I was there for two nights last month. Saw it 3 times. Been there before and nothing.

 

[FlowRate]

Honestly, I'm more pro-legalized and regulated everything. Give people clean needles, reliable/tested product, a safe place to get high, and on-site substance abuse resources. Why make people suffer for their soma? The legal complications only beget crime and increased spending. It's all an extension of America's need to obfuscate welfare payments while appearing to punish "undesirable" behaviors.

 

[clausewitz2]

Honestly, I'm more pro-legalized and regulated everything. Give people clean needles, reliable/tested product, a safe place to get high, and on-site substance abuse resources. Why make people suffer for their soma? The legal complications only beget crime and increased spending. It's all an extension of America's need to obfuscate welfare payments while appearing to punish "undesirable" behaviors.

Yeah I don't really see the way in which the opioid problem gets worse if we go back to the good old days when people got their heroin from Bayer. Provided any kind of DTC advertising is entirely banned.

 

[birchswing]

@birchswing


By that logic anyone who commits petty theft is mentally ill.

That gets into the philosophy of what is mental illness, and I obviously don't know as much as the rest of you.

I guess my understanding has been that people can do bad things and not be mentally ill or do bad things that stem from an inherent pattern of behavior that has been defined as mental illness.

But in this particular case, I was saying that there are alternative motives that might be as or more plausible than the stated one of wanting a marijuana script. To me, petty theft could be seen as rational in a number of cases. A person might want a thrill or be poor and they feel the risk is low enough (although I suppose a pattern of wanting a thrill would then be defined as mental illness?).

Also, the likelihood that the person has a mental illness goes way given we know they're a psychiatric patient. The likelihood of the mental illness having not been adequately treated goes up when we know they attacked someone with a knife over a marijuana prescription.

My guesses could be totally wrong, but my point remains that what a person says their motive is might not be the underlying catalysis for their action. I suppose that's a bit paternalistic. That's probably the Swede in me identifying with the perpetrator (they did name Stockholm Syndrome after us after all).

There's also just my overall impression that marijuana is very easy to obtain and relatively inexpensive which made the motive seem odd, but I might be wrong about that as well.

 

[whopper]

I've worked on hundreds of cases that were front-page news. About 99% of them were local news but I did get an occasional national one. In almost all cases what was reported on the news wasn't really a balanced and informative article. While in most cases I believed the journalist was trying to explain the article from a point of intellectual honesty it's not like they were able to get as much in-depth information that I or the police investigators were able to use.

Whatever happened with this doctor I do believe and endorse legalization of cannabis for medicinal purposes but I'd give them to literally 1% or less of my patients and just like anyone prescribing a benzo or opioid should tell their patients of the risks, so too should any physician telling their patient to consider use of cannabis.

It's not legal to prescribe it in the state I'm in, but even if it were I'd still not prescribe it because it's still federally-illegal in all states.

I've prescribed Marinol but only in about 3 cases to memory (I figure there's maybe 1-2 more I might not be remembering). 1-The patient has terminal cancer with only weeks to live. 2-The patient had chronic vomiting literally over 10x a day and her teeth are dissolving off (the Marinol lowered the vomiting to 2x a day, her GI doctor never could figure out what was causing the vomiting, and I recommended to the patient that since she was taking it for vomiting reasons maybe her GI doctor should take over the prescription), and 3-the patient had cancer, was undergoing chemotherapy, but for whatever reason her other physicians didn't prescribe Marinol despite the patient had serious lack of appetite, appetite, and insomnia.

I would consider marijuana if it were legalized (fully that is) and if the patient tried 3 antidepressants, Buspirone, Gabapentin, and a Beta blocker without benefit. So in short that would be very very few of my patients and not 1st, 2nd, 3rd, or even 4th-line.

 

[st2205]

I would consider marijuana if it were legalized (fully that is) and if the patient tried 3 antidepressants, Buspirone, Gabapentin, and a Beta blocker without benefit. So in short that would be very very few of my patients and not 1st, 2nd, 3rd, or even 4th-line.

For treatment of what?

 

[PikminOC]

You can fill out a form saying they have a qualified condition. The only psych condition on that list is PTSD though.

Goverment forms are never easy. And i posted a doc who specializes in mj paperwork. Most physicians in IL are not doing this

 

[PikminOC]

And obviously the doctor in this case was right to not support this patient in this endeavor

 

[PikminOC]

Unless the data's been updated from my last look, the actual stat is that there are more car accidents where the drivers had MJ in their system -- not testing for acute intoxication. And this seems like a useless stat to me because there are more of everything in CO where the people involved have MJ in their system.

Edit: to clarify, for activity X, a higher portion of people involved in X test positive for MJ now than in 2000. X can be MVAs, ordering food from Taco Bell, or showing up to work on time. The real question I'm not sure was answered clearly was, are there now more car accidents occurring than expected?

Its not about acute intox. There is a cut off level. With alcohol, it is also a cut off number.

 

[PikminOC]

And now a doctor was almost killed bc of mj

 

[hamstergang]

Except now there are more car accidents in Colorado with people under influence of mj.

Its not about acute intox. There is a cut off level.

Are you correcting yourself or are you saying there's a difference between "under the influence" and "acutely intoxicated" that's meaningful to this discussion?

 

[PikminOC]

What matters is what the rules are in each state. The most important thing is a doctor is put in the middle of this and almost died.

 

[birchswing]

What matters is what the rules are in each state. The most important thing is a doctor is put in the middle of this and almost died.

Do you think good comes of doctors being gatekeepers of drugs?

When it comes to drugs of possible abuse, I'm not so sure. I don't know how you run the counterfactual; although, you can look at the availability of alcohol and the past availability of heroin. Heroin was at epidemic levels both when it was legal in the early 1900s and then again when it was illegal in the 1970s, though the latter influenced by availability in the Vietnam War.

When it comes to antibiotics, it absolutely seems like someone needs to be a gatekeeper. I feel like you can make a much clearer argument with antibiotics that another person's use directly affects the health and wellbeing of society at large and make a utilitarian argument that they must be prescribed appropriately. With drugs of possible abuse, the effects on others are more indirect, and the criminalization of them also has negative effects on society. Plus you're making a judgment about what a person might do with any particular drug versus what they will do. Some people can't drink alcohol responsibly, but we don't criminalize alcohol consumption. We haven't even criminalized tobacco consumption.

 

[whopper]

For treatment of what?

Treatment resistant anxiety, insomnia, lack of appetite. If they had chronic pain it could be an option but I'd leave that for other physicians. Also I'd strongly advise anyone against it if under age 25 due to the psychosis-risk.

The psychosis risk can be very important. Cannabis could cause someone to become schizophrenic. Further smoking under the age of 25 will likely cause permanent problems to lung-development (although all the studies are with cigarettes) and will cause problems with brain development.

 

[sunlioness]

In Illinois, a psychiatrist cannot prescribe it.

Not true. They can. Many choose not to. My department included. We felt the data wasn’t there and that the risk of a deluge of requests was real.

When the law came out, the only qualifying dx that a psychiatrist might see was Tourette’s. But since then it’s been modified under political pressure to include PTSD. There’s a billboard that I drive past every day in my way to work in Champaign that reads, “Goodbye PTSD, Hello Cannabis”.

 

[PikminOC]

It is not prescribed in illinois, i am in illinois, i can recommend a card. I think you and i are using the term prescribed differently