99% of people would look at this guy and say “You see. That is what is wrong with medical marijuana in California.  Any punk that can fog a mirror can walk into a doctors office and get a recommendation.” (that happens to be true by they way)  However, you can’t judge a patient by his age, how he dresses or by the color of his hair.

Here is the problem with pre-judging.   When I asked my patient why he used medical marijuana he went on to explain that at the age of 21 he was “T-Boned” by a car going 65mph.  The crash shattered his pelvis, fractured his femur, collapsed his lung and put him in a coma for 8 months in the hospital.   He has had over 12 surgeries and has lived with daily pain since that time.   He explained that he has too many friends abusing pain pills that he does not want to ever take them.   Because of medical marijuana he does not have to take a motrin, alleve or vicodin and his pain is manageable.     It is truly a remarkable medication for him.

The problem with the medical marijuana industry is for every patient like this there are 50 that are truly using it for recreational purposes and they are all using the same dispensaries.   However, the point of this blog is to make you aware so you take a moment before you assume the guy next to you with the pink hair is just a pothead.

** Photo of Dr Breen with an Iraqi Imam as they turn over their care and trust to the Americans**

Ali lost his Mother, Father, brother and 13 of his relatives when a stray American bomb struck his house.   Ali lost both his arms and had 3rd degree burns over the rest of his body.    60 minutes featured a story about Ali in 2007 and Dr Breen can be seen transporting him from an Iraqi hospital to awaiting  US Marine humvee ambulances at the 3:40-3:47 time mark of the interview.  He is dressed in camouflage with one of his Navy Corpsman trailing behind.

Below is the link to the story on 60 minutes:  it is inspirational and shows the human side of two waring countries.  Dr. Breen recalls as he was transporting Ali out of the hospital that he was being screamed at by hospital workers “you did this to him!” .   “It was a very intense situation” Dr Breen recalls.   “Outside the hospital there were thousands of people chanting God is great in Arabic and they were also parading another deceased Iraqi teenager through the streets.  I was just trying to let the local Iman know that despite the fact that our countries were at war, I am a fellow human being and would take care of Ali as if he were my son.  I do recall wanting to get the heck out of there as the crowds began to get pretty upset.  I remember them putting a camera in front of my face and waiting for me to say something to the world.    Not sure what to say I uttered the following: We agree to take Ali into our care and also into our hearts.”  Those words seemed to melt away any animosity and in the picture the Imam grabs Dr. Breen’s hands and thanks him.

From Dr. Breen: Often I think of that day and about Ali laying in bed scared to death of me.    I could not imagine how much courage it took for him to leave that hospital and get into a US Marine ambulance flanked by M19 grenade launchers.   I often think of how lucky we are as Americans to live in such a stable country with access to the best health care in the world.   It is only when we see how children in other countries that we truly appreciate what we have here.    One day I would like to meet with Ali and see him as an adult thriving in society.   I am honored that I took a small role in helping him back to safety and health.

http://www.cbsnews.com/video/watch/?id=2796107n&tag=mncol;lst;1

Howard asked him if he had a California medical marijuana card and Seth Rogan admitted that he did.   * When further questioned what “his ailment” was he responded “chronic insomnia” and joked about it not getting better any time soon because he needs to renew his recommendation every 12 months.    He was clearly making a joke about how ridiculous the process was for him.   He basically made a mockery of it.

What I find interesting is that he admits to having a medical marijuana recommendation for chronic insomnia yet he freely admits to medicating throughout most of the day.    Clearly, if he were truly medicating with marijuana to combat insomnia he wouldn’t use it right before he goes out on Saturday Night Live (which he also admitted) and throughout the day.   Normal patient with insomnia use it just prior to going to bed.

This is the major problem facing the medical marijuana industry right now.   There are “patients” who freely admit using marijuana recreationally and make up a bunch of bullshit to tell the doctor to get the recommendation.   I have spoken to dispensary owners who feel that 60-75% of the recommendations being written are for recreational use.

The problem with this cavalier attitude towards medical marijuana is that the States overreact and make it that much more difficult for legitimate patients to get approved and access it.    California remains the most liberal state as far as the specific diagnosis that patients can qualify to use marijuana but other states are much more restrictive.   Lawmakers point to California and say “we don’t want the same situation that California has”.  They then create laws that make no sense and are impossible to implement.

* Seth Rogan may have other legitimate medical problems and may have told this story just for comedic value on the Howard Stern show.   I have no idea what his true medical issues are.  This blog is based on the interview and statements he made on the Howard Stern show exclusively.

I respectfully disagree.  Let me give you some very specific examples that proved otherwise.

1. Vioxx: FDA approved and marketed by Merke.   Was deemed “safe” by the FDA to treat pain associated with arthritis.   Turns out that the drug actually increased the risk of fatal heart attack and stroke in patients taking it.   it was eventually pulled off the market.   Merke had to settle millions of dollars in lawsuits.

2. Oral Estrogen Hormone Replacement: for 20 years we were telling patients that it was not only safe, but also lowered a womnes risk for heart disease and osteoporosis.   Well it turned out that the oral estrogens that they were using and FDA approved were derived from the urine of pregnant horses.  In 2002 The Women Health Initiative Study was stopped because of increased risks of heart disease, osteoporosis, certain cancers and blood clots.

3. Opiates:  Drugs like oxycontin and vicodin are FDA approved and deemed safe.   The use of prescription, FDA approved, opiods results in more deaths than from heroin (schedule 1 drug) and cocaine combined each year.    Yet they are most commonly prescribed medications for chronic pain.    

There are  A LOT more examples of drugs that went through the FDA approval process that have been yanked from the shelves because they were not safe at all.

So this brings us to medical marijuana, a NON FDA APPROVED PLANT.    Research has shown that cannabinoids are affective for treating pain, reducing nausea, stimulating the appetite, protect neurons from oxidative stress, reduce intra-ocular pressure and reduce inflammation.

It is also a fact that no one has ever died from an acute overdose of marijuana (directly from the medicine).   Millions of Americans use it recreationally every week yet we do not see any ill effects to the major organ systems in the body (liver, kidney, heart, lungs)

I am not arguing that cannabis is a completely benign drug.  However I am arguing that just because it has not gone through the FDA approval process that it is somehow unsafe and should not be recommended.   Some of the most respected oncologists in the world at HOAG hospital routinely refer patients to me for medical marijuana recommendations because it works.

So to the Kansas doctor that argued against the use of medical marijuana for the cancer patients in your state, I would rethink your public comments that honestly make you look “bought”.

I must admit that sometimes when I look at the patients who come into my office at first glance they appear perfectly healthy. Certainly I can see how the layman would think that dispensaries are just serving up medical marijuana to completely healthy patients who want to use it to get high.

However, I learned very quickly in medicine not to pre-judge any patient who walks in the door.  Just because he may be 22 and have a hat on sideways with a skateboard in his hand doesn’t mean he is not sick or does not qualify.

Let me give you a few examples of times when I pre-judged patients before speaking with them thinking that they were just recreational users that were going to malinger about “having anxiety and back pain”.

1. I had a 23 year old man come into my office literally with a skateboard and a hat on backwards.  He was built like an X-Games athlete and appeared to be very healthy.    However when I went over his medical history with him it turns out he was skateboarding and T-boned by a pick up truck and fractured 10 vertebra in his thoracic and lumbar spine.  Her required 2 operations and had rods placed in his spine permanently.   His pain management doctor wanted to give him more and more percocet but because some of his friends had become opiate addicts he decided to not take them all together.  Instead he medicated with cannabis at night to help him sleep through the night. 

2. Yesterday I had a 22 year old mother (of an 18month old) in my Long Beach office that appeared perfectly healthy.   By looking at her you would think she had nothing wrong and just assume she was using marijuana recreationally.   Turns out she has hodgkin’s lymphoma (a blood cell cancer) and had just started chemotherapy.    She wanted to try medical marijuana to offset the side effects of chemotherapy.

3.  This past week I took care of a 27 year old attorney who looked like a crossfit champion (lean and mean).   He looks perfectly fine and healthier than 99.9% of the population.   It turns out he is HIV+ and takes a drug called Atripla which has severe side effects.   He uses medical marijuana as a means to continue HIV treatment. 

So I guess my answer to the question “What does a medical marijuana patient look like?” is this:  they look exactly like you and me.   Its the kid in the skate park, the attorney arguing for the defense or the 22 year old mom in the playground with her child.

You/me/us have NO IDEA what people are going through medically until you ask them.   I have been fooled many times and have learned NOT to pre-judge.   I would encourage you to do the same.

I hope this helps the medical marijuana patients out there who are being judged incorrectly by the public.

My patient was stumped because he could not comprehend how a medical doctor would recommend a treatment that he knows “nothing about.”   My patient had numerous questions about different strains, how to medicate, how frequently to us it, where to get it etc.   So he left the office and had NO IDEA what to do which led him to pick up the phone to make an appointment to see me.

I ended up spending about 30 minutes with this man (great guy) and educated him about all aspects of cannabis.   How to do it, how often to medicate, how to recognize a quality dispensary and also offered him follow up as often as he needs.  24/7 he can email or call me and I will get back to him.

Why would a doctor recommend a treatment that he knows nothing about?  And why would he admit that to his patients?   These are rhetorical questions of course.  The obvious answer is that he is motivated by the potential revenue that he makes off these patients.   If he actually cared he would take the time to learn about the treatment he is recommending.

This is a MAJOR problem in this industry.  There are doctors out there who are purely doing this to make revenue and don’t have the first clue about the research or how medical marijuana works.

This doctor, who by the way looks to be very educated (McGill and Harvard), would NEVER recommend any other prescription medication without at least knowing its side effects, potential drug-drug interactions and dosage/strength.   But with medical marijuana these doctors treat it like candy.   They do recommendations over the phone, computer  and do not even examine their patients.

I guess we should not expect more from doctors since they are people like everyone else and are just as susceptible to greed and can be corrupted just as easily as anyone else.   But I can’t personally see handing a recommendation to this 72 year old man, who is TRULY SUFFERING, and tell him to go learn about it on his own.   This doctor should apologize and return this guy’s money for being unprepared, not compassionate and clearly negligent (for not giving an informed consent which when I went over with this patient he was enlightened).

I am not writing this blog to toot my own horn but to point out the fact that there are doctors in this industry who care and those that don’t.   There are numerous books, research articles and physiological facts about cannabis that would take a doctor a solid week to get through.  If he were to read it all and take a few trips to dispensaries he would become as knowledgable as any other doctor in the field.

I guess my question is this.   If this the face that we want to put on the medical marijuana industry?  Hot kush girls, smoking patios, and photos of fast food wrappers after a session of the munchies (see their facebook page).

This is exactly why the community does not take medical marijuana seriously.     I am assuming that there were doctors who set up booths and issued recommendations which allowed those patients went outside to get high on the smoke patio.   This is what they have done in the past.

It is because of this image that dispensaries are struggling to survive as cities, one by one, ban or shut them down.    A perfect example is the city of Costa Mesa.   In early April I presented, along with 5 other professionals, information on why medical marijuana is a necessity in our community and why regulating it would be their best approach to a legitimate industry.   Their main concern was the fact that 75% of the graduating high school class has medical marijuana cards and parents are finding their children partying and getting high and NOT using it as medicine.    How can you argue with them?

There are too many legitimate medical marijuana patients too have this blow up because of recreational marketing.    Look how it is presented to the community:  Kush Expo, “High Times”, “West Coast Leaf” , Snoop Dog on the cover of 420 Times.   No wonder no one wants it in their back yard.

The reality in my practice is that I see mostly women in their 50-70′s who are benefiting from cannabis incredibly.   There are so many patients that are legitimately using this as it was intended that I can not believe more is not being done to get THIS demographic out there.

Your thoughts?

An Attitude of Gratitude:  Medical Marijuana is Fulfilling

I realize that marijuana is not a perfect drug.   People DO abuse it recreationally.    Parents don’t hope their kids use it regularly.  I have seen chronic users who definitely are not as productive as they probably could have been had they never used it before.    But as a medicine it has been a blessing for most of my patients.    When I think about it as a treatment for my patients I am comfortable with my decision to recommend it.

Last week one of my patients was an 87 year old women who grew up in Alabama.  As old and frail as she was she found me on the internet, picked up the phone, made an appointment and drove herself to my office for  a 10am appointment.   She was the sweetest women and would remind any of you of the grandmother that you wished you had.    She sat with me and said “a month ago I would have never imagined sitting here in front of you but I am at the point that if I don’t do something I just want to die.” She had never tried marijuana before in her life and was scared to death of it.   I must have spent 40 minutes with her going over everything and answering her questions.   By the time she left my office she had hope, something that wasn’t possible even 1 hour before she saw me.    I was confident that marijuana would improve the quality of her life on some level.  Better sleep?   Less pain? Better appetite?   I can think of her right now and smile knowing that I helped her.

If you are breaking into this industry I can tell you to prepare for rough times ahead.   Set aside money for attorneys, reserve cash to float you business when the banks freeze your accounts, and perseverance when your competitors are undercutting your prices by 65% because they are playing by different rules (circa epione.com that was doing medical marijuana recommendations over a blackberry phone for $50).   Be ready to close down at a moments notice when the city says “we want you out.”.

MEDICAL MARIJUANA IS THE MOST UNCERTAIN BUSINESS YOU CAN GET INTO

Just when you think you are coasting in your business, activists will get 600,000 signatures to legalize marijuana in the state and you are left wondering what that will mean to your business.    You can be killing it and then November 2012 comes along and all of a sudden your business model is gone.    Or more realistically, the Obama administration clarifies their position on respecting states medical marijuana laws and now says “if you are a dispensary we can and will come after you.”  This was just 2 years after they said “if you are following state law we have no intention of meddling in your business.”   Open up, close down, open back up, get fined, get robbed, open back up, now you have to close, start a lawsuit against the city… it goes on and on and on.

Despite all of this I say lets PRESS ON.   Too many good people are benefiting from our determination, compassion and purpose.

The ownership in a medical practice has to be a physician.   Without a medical license you can not just open and office and hire doctors to see patients.  This is illegal but unfortunately what has been happening in the medical marijuana industry.

Dispensaries, in an effort to get customers, have developed a business model where they place a medical office adjacent to their location.   They then advertise $25 recommendations and pay a doctor $100.hour to see patients.    The cost of the recommendation is a mute point as they know they are going to make up for it when the patient purchases marijuana at their dispensary.     This is an illegal set up and the medical board is looking to shut these operations down.

Have you ever noticed that when a medical marijuana dispensary gets shut down that there is usually a nearby doctors office that all of a sudden disappears?   It happened in Venice Beach, Lake Forrest, Santa Ana, Costa Mesa and I am sure a bunch of other cities across the state.     One day the doctor shows up and the doors are locked.  The phone number is disconnected and no one is home.

KUSH EXPO TO SELL BOOTHS TO DOCTORS

The “Kush Expo” being in held in Los Angeles from August 26-28th is advertising to doctors to purchase booths to write medical marijuana recommendations to patrons attending the event.   This has been done in the past and gives a terrible name to the industry.   Patient literally walk up and say that they have an illness and walk away with a recommendation.   It has been my experience that very few, if any, of these doctors require medical documentation of their diagnosis prior to issuing a recommendation.    I recently met with a patient who received a recommendation from a doctor at the Kush Expo in Anaheim by simply saying he had anxiety.   He admitted he never went to a doctor, tried any alternative treatments or presented any medical evidence of his condition.   He simply paid $75 and walked off to sign up with a dispensary.

I inquired with the state medical board if this met their standard of care and the response was that they are “well aware” of what takes place at these events and planned on sending “patients” to them to get evidence of medical negligence.    The medical board told me that at one event they had the patient tell the doctor that they “were extremely hung over and have terrible headaches”, and the doctor gave their decoy a recommendation.   I would not be surprised if they do the same at this event.  They indicated they would.

I guess that leads me to my last point.  If the industry wants any longevity it needs to police itself.  The reason why so many cities are against medical marijuana is because they see the blatant disregard for the law.   Although many business are operating within the letter of the law, they are also not operating within the “spirit of the law”.

How many dispensaries sell an ounce to the same person 3 times per week?   How many dispensaries let a patient buy 8 ounces at a time.   Clearly they have to know that those “patients” are selling it to their friends?   Although they are following the “letter of the law” (a patient can purchase up to 8 ounces at a time and there is nothing to say that patient did not use 3 ounces in one week) they are certainly not following the “spirit of the law”.   It is this violation of the spirit of the law that is causing cities to backlash against them.

How about the doctor who just takes the patients word for it?    ”I’ll give you this temporary recommendation (wink wink) and go see a doctor in the next three months”.   They know that patient is going to purchase medicine for three months and just before the three months expire they buy enough to last the entire year.   This is not following either “the letter” or “spirit” of the law.

I know it is coming!  The time when, because we can not police ourselves, the state medical board decides to police us for us.   They are going to limit the indications for recommending cannabis to HIV and cancer patients.   Doctors will need to be supervised.   Collectives will only be able to grow for 3 patients.   The reason I know this is around the corner is because it is starting to happen in Colorado, Montana and Arizona.   The laws are becoming ridiculous because they look at California and say “we do not want what they have”.

It is very interesting how politicians pander to their constituents.   If asked behind closed doors off the record, my guess is that he is completely fine with this pain patient using medical marijuana to improve the quality of his life.  I would go further to say that if one of his children had this mans condition that Mitt Romney would be getting the marijuana for them.

The facts are clear.  Cannabinoids treat pain very well.  There are multiple studies that have been conducted at the UCSD Cannabis Research Center backing up this mans claims.   Secondly I have spoken to thousands of patients that use medical marijuana to treat their pain.   Across the board, they require less opiates and have an improved quality of life.

Come election time I hope that voters see through some of the BS that politicians spew while on the campaign trail.