Why it might be hard to find a medical marijuana doctor

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Monya De, MD, MPH, who practices internal medicine and integrative medicine in the Los Angeles area. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Dr. DeOnce, I responded to an ad for a medical job. The stated location was highly desirable, and the type of work was “alternative medicine” in a “relaxed environment.”

“Why not?” I thought. Something different for a change.

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Oddly, though, the recruiter wouldn’t tell me much about the position by email. When she got me on the phone, she revealed that the plum job was at a medical marijuana clinic.

Many doctors have a difficult time with marijuana as medication, and consider doctors who prescribe it as second-class citizens. These doctors fear that they will enable recreational drug use, that patients will abuse medical cards to get drugs for friends and that patients will lie to them to get a card.

There are worrisome studies of long-term marijuana use that demonstrate a negative effect on the brain. Then there’s the risk to one’s medical license-document poorly or prescribe marijuana to an addict and there could be serious trouble. The cash-only practice some of these doctors maintain reeks a bit of the opioid mills for which “Dr. Feelgoods” are doing time at the state penitentiary.

Yet 10 years ago, I encountered my first medical marijuana patient. Then, it was just “marijuana”-because the patient was a child. No doctor would give that child a card, so his parents allowed him to use small quantities of the drug.

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This unusual move came after trying a regimen of five epilepsy medications, all with varying degrees of side effects and the requirement for frequent blood draws to make sure his liver was not in failure. His pill box looked like that of a cancer patient. His seizures broke through the cloud of brain-doping medications anyway-and stopped when he tried marijuana.

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So, we all looked the other way in the clinic, writing “patient’s family wishes to continue MJ regimen,” while actually saying “Patient, PLEASE continue MJ regimen.” We were not about to start a drug discovery trial for a sixth anti-epileptic drug class for him to take when something else was working. 

So there is a quandary: How do doctors sort out the truly needy-the ones for whom symptoms are so severe that brain shrinkage is acceptable-from the charlatans and the fakers? The epilepsy kids are easy. And Mrs. Smith is not faking her metastatic breast cancer bone pain.

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But most doctors just don’t want to deal with the stigma of being the one who either mindlessly hands out cards to able-bodied 25-year-olds, or who gets duped by good acting by the same.

Research in this area will help tremendously, and FDA approval for marijuana for certain conditions will help to ease the shame in prescribing.

The agency notes on its web page that “glaucoma, AIDS wasting syndrome, neuropathic pain, cancer, multiple sclerosis, chemotherapy-induced nausea, and certain seizure disorders” patients could benefit from the substance. Indeed, two synthetic compounds are approved for chemotherapy-induced nausea and vomiting.

However, the approval process could take years, and may be dependent on the FDA moving marijuana down from the strictest of controlled substance categories.

There’s evidence against unrestricted marijuana for all as a recreational substance. But in dire medical cases, doctors may be glad to help with the assurance of the FDA. Like many other treatments that were once considered "fringe" before being accepted into mainstream society, marijuana will likely emerge as a common line of therapy for a variety of conditions.