The federal government has basically taken a stance that when it comes to medical marijuana the states have no rights.   They are determined to make it difficult for store front dispensaries to operate.   How long this will last is the question.   The California Supreme Court has decided to review the Pack Case to see if the feds can legally interfere with state law and shut down local collectives.  That will take at least 12-24 months. 

Because of the federal governments stance the city of Long Beach is voting on February 14 whether or not to reverse its ordinance that created a safe haven for a few well run dispensaries to operate.    Los Angeles is in the process of figuring out what to do with its few hundred dispensaries as well.   In the next 2-3 months the landscape could change even more.

So what does this mean for patients?    Certainly they may have to drive a little bit further to find a great collective.  Many will simply turn to delivery services. Many will learn how to grow their own.  Industry experts have been telling patients how hard it is to grow quality medicine but that simply is not the case.    For most patients, a small up front investment and a little time is all it would take to get enough medicine to last an entire year.   The state allows you to grow 12 plants (6 mature at any given time) which should yield 4 ounces per plant.   The average patient uses between 1-5 eighths of an ounce per month.   That means an ounce would last them 4 months.   If you do the math one harvest can yield enough medicine to last a few years.  There are plenty of good resources for patients to grow their own medicine.  Many hydroponic shops have instructions on exactly how to do it.

How did this happen?  How did we go from President Obama saying he was not going to use federal resources to go after states medical marijuana laws to regular raids using federal resources?     In my opinion the industry has no one to blame but themselves.  Let me explain.

1. Lets start with the doctors.  It is inexcusable how doctors have distorted the law for $25 have handed out recommendations to anyone who can fog a mirror.  The state medical board set guidelines for recommending medical marijuana and the bottom line is that they are not being followed.   I can not count how many times over the past 6 months I have told patients that they do not qualify who have presented recommendations previously from other doctors.  The majority of these cases is because the patients have not been adequately evaluated by doctors for the condition they are telling me they are using medical marijuana for.   For example, a 23 year old male came in with a previous recommendation to use cannabis for migraine headaches.   He was never evaluated or even diagnosed for his headaches.  In fact he had not been to a doctor in over 7 years.  The last time he did see a doctor for for a sports physical in high school.    Yet, despite having no documentation of having migraine headaches he was given a medical marijuana recommendation. As a result of this blatant disregard for the state guidelines we had half of the senior graduating high school class partying with medical marijuana.

2.  Dispensaries:  The reality is that the many of the dispensaries were not helping the cause.   Many were blatantly providing marijuana to recreational users and drug dealers.    Many would sell ounces at a time on more than one occasion in the same week to the SAME patient. Clearly they know that he/she was selling it and not using all that medicine for personal use.    Secondly, how many raids of dispensaries also turned up cocaine?!!  Clearly these dispensaries were illegally dealing drugs under the guise of medical marijuana.    When dispensaries advertise “happy hour” and put girls in thongs behind the counter they are not giving any city official the impression that they are interested in taking care of patients.

3. HempCon:   all you to do is walk through a hemp con convention to realize that much of medical marijuana is recreational use.   “Hot girl contests”, “Smoke rooms” and the in your face advertising only hurt the genuine medical marijuana community.   It’s pretty hard to stand in front of the city council and argue why we need good dispensaries in the community when there are so many bad apples hurting the cause.

The difficult thing to accept about this recent crack down is that there are genuine patients who need this medicine who are going to suffer.    I wish the legitimate patients could have a voice in all of this.    Last week I took care of a 61 year old man with end stage cancer who really needs safe access to medical marijuana.  He would not know what to do without it other than suffer tremendously.   It breaks my heart to see good dispensaries go down as a result of all the bad apples.

If you are a patient who suffers from insomnia I would like to give you some alternatives to try if you are not a fan of medical marijuana.

1. Melatonin:  before you skip to the next suggestion you must read this.   Many patients try over the counter Melatonin and say that it does not work.   The typical dose is 3mg.   The problem with over the counter melatonin is that it is not sustained release and has a very short half life.    Secondly, ver the counter products have no standardization which means the dosing can vary and you have no idea how many milligrams you are actually getting.   They are typically NOT micronized and have poor absorption.   Lastly, the ingredients can be contaminated because you ahve no idea where they are being sourced from.

Melatonin should only be used if it comes from a compounded pharmacy.  This insures perfect accuracy in the dose and guaranteed to have no contaminants.   It should also be a micronized (broken down to tiny particles for better absorption) and in a sustained release formula (has a longer half life and lasts through the night).  The typical starting dose is 3mg for men and 1mg for women.   You simply go up by 1mg per night until you find the dose that works.   If you wake up feeling groggy than simply take it 2 hours prior to going to sleep.  Typically doses are between 9-12 mg/night and in some cases up to 30mg.  So it is no surprise that the over the counter products do not work well.

It is very safe and actually extremely good for you.   It is normally secreted by the Pineal Gland in the brain.  It was anti-oxidant and anti-inflammatory properties.   There are no adverse effects other than the potential for morning grogginess.   Check with you doctor before you start.

2. Turn it off and shut em down!  How many of you take your iPhone into bed and search the net for a few hours.  How about having the TV on in front of you?   Laptop?      Melatonin is what is secreted and starts you sleep cycle when you go to bed.  However melatonin is inhibited or blocked by any light or stimulus.   Therefore, the room needs to be completely dark (pitch black) for you to enter your normal first stage of sleep.    The constant stimulation of the phone, computer and TV disrupts this natural rhythm and makes it very difficult to maintain a normal sleep cycle.  Only two things should happen in the bed room! Sex and Sleep.

If you can accomplish #2 and try #1 many of you would sleep much better.

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.

Here is what I anticipate in 2012:

1. More uncertainty:   More cities will try and create ordinances to limit where dispensaries can operate.    It also looks like Katherine Harris is going to release a new set of guidelines to qualify how the system needs to work.   Word on the street is that California wants to get away from ALL storefront dispensaries. The question is going to be how do patients get safe access to medicine.

2. Patients will still be able to get recommendations from their doctors and grow 12 plants at home at will.   There WILL be dispensary locations to get their medicine but they may have to drive a little bit further than last year.

3. Delivery services will start thriving.    We are already starting to see many delivery services taking over in areas where dispensaries closed.   This is a good thing as it limits the visibility of medical marijuana and hopefully the cities will forget about it and leave them/us alone.

4. Ballot initiative: it looks like proponents of total legalization for recreational use are going to put another ballot measure for vote in November.  I expect this to NOT pass by about 3-4% points just like proposition 19 failed.    However I expect a second ballot initiative to be placed on the books to tax and regulate MEDICAL marijuana.   This I think WILL pass but ONLY IF they do a great job at promoting it as MEDICAL and not recreational.   So how they campaign will be huge.

5. Doctors: expect a handful of doctors to lose their licenses this year for failing to follow the medical board guidelines.   I expect that we will see a lot of these fly-by-night clinics closing and falling like dominos once the medical board takes action.  This is a good thing.

6. Expect President Obama to LOSE CALIFORNIA in the general election.  This will mean the end to his presidency.   The one vote that he had was the left that thought he was a proponent of medical marijuana.  He HAS LOST that vote 100%   Across the board people are fed up with his lip service on respecting states rights.  Expect the next Republican President to be neutral on this issue.   I believe a republican president will be more inclined to respect states rights.

I expect Governor Brown to create a sensible plan for medical marijuana in California.  He is a thinker and a realist.    He will understand the futility of pushing medical marijuana back to the black market.

Stay tuned!

The study looked at 21 patients who took either long acting Morphine or pong acting oxycodone for chronic pain.   They then had them inhale medical marijuana using a volcano vaporizer for 4 consecutive days.    By the 5th day patients who used medical marijuana had a 33% reduction in their pain versus patients who used morphine or oxycontin alone.    In the pain management world that is a tremendous benefit.  What that means they concluded is that patients can most likely get away with taking less opioids and supplement with marijuana.    When you take into consideration how addictive opioids are and how many unwanted side effects come with their use, the potential savings to the medical community is huge.

As more and more studies like these continue to demonstrate the medical benefits of using medical marijuana are published it will be harder and harder for the federal government to keep it as a schedule 1 drug.     Medical marijuana will be in 50 states at some point in the very near future.  Once a large enough volume of patients start seeing the benefit of using it to treat pain it will be hard for politicians to ignore their voices and votes.

Although the tobacco and alcohol lobbyists are extremely powerful and influential, there will come a time when the voice of American people trumps their dollar bills.    I am not confident that it will happen in the next 10 years but by the time I die (hopefully not for another 50 years!) I think it will happen.

Many patients are not aware that they even qualify to use medical marijuana.  In California, there are over 150 different indications to recommend marijuana but the most common reasons people get recommendations for are:

1. Chronic Pain: for things like arthritis, headaches, back pain, dental pain etc.

2. Sleep disorders: primary insomnia to anxiety related sleep disorders.

3. Nausea, Vomiting or Lack of appetite for any reason.

4. Chronic anxiety in patients that do not want to take xanax or valium.

5. Har reduction for people who are addicted to opioids.

If you are wondering if you would qualify to use medical marijuana feel free to pre-qualify for free on our homepage or call our professional staff at 877-721-0047

These closures are not unexpected.  The medical marijuana industry went from being very profitable, to maybe cover the overhead and take a small salary, to being not profitable at all in a 3 year period.     Why the rapid change?   The simplest explanation is because the playing field was not level and the market priced good clinics out.  Let me elaborate.

Marijuana is considered a controlled narcotic drug by the california medical board and they expect it to be prescribed like any other controlled narcotic.   This means a doctor (MD/DO) has to evaluate the patient, order an necessary tests and prescribe it under the same standard of care as if they were prescribing vicodin.   Clinics like medicann employed professional doctors who followed the rules as set by the medical board.   These doctors were paid $80-$100/hour to issue recommendations.   The overhead to run a clinic was fairly substantial.

ALONG CAME POLLY

What happened fairly quickly is that dispensary owners and entrepreneurs realized that if they put a doctors office next to their dispensary it would serve as an endless source of leads for their dispensary.    These people could care less if the clinic made money as they knew that if they just broke even they would make a fortune in selling marijuana to those patients.    What they did was undercut the going cost of a recommendation ($150 at the time) by 75% and started offering recommendations for $25.00.    Some clinics even had doctors their via skype to limit the cost of having a doctor on location.   Under normal business circumstances, supply and demand dictate where the market is at and the price settles accordingly.

But these weren’t normal business circumstances.   These new clinics that were undercutting the price of legitimate clinics were running illegal operations.   They did not have doctors present (required by the medical board) and more importantly the offices were not owned by doctors.   This is considered an illegal medical practice and is a felony in California.    Only doctors can have ownership in a medical practice.   Secondly, they handed out recommendations to anyone who could fog a mirror.  They didn’t require medical documentation supporting their diagnosis nor examine their patients.    It wasn’t long before these clinics were 30-50 patients deep with lines extending out their doors.

With the economy slumping and unemployment at an all time high, patients that would normally go to medicann and get a legitimate recommendation were lured by the price of a cheap recommendation.   This severely hurt the business of every doctor who ran a legitimate practice.   Ultimately many had to close.

The future:   Just as the mortgage industry went from normal, to insane and now back to being overly cautious to the point of being ridiculous, the same thing is happening in the medical marijuana industry.    The medical board is slowly weeding out doctors who are not following the standard of care and cities are closing dispensaries run by criminals who also operate illegal medical clinics.    Ultimately the situation will return (close) to what it was in 2007.   You will have a handful of good doctors willing to recommend medical marijuana for a legitimate price.

In this patient he was actually on a 27 hour sleep cycle.    This means that there are times where 1 in the afternoon feels like 1 in the morning.   Obviously it was very disruptive to his daily life and makes it very difficult for him to function at work with massive amounts of caffeine during the day and heavily sedating drugs at night.

Unfortunately caffeine has a ton of bad consequense and this patient was becoming addicted to sleeping pills.   Specifically, he was using more and more temazepam which is a benzodiazepine medication (like valium).   He came to me in search of a potential alternative.

His sleep specialist told him that he may benefit from a trial of medical marijuana.  There is more research coming out that says that indica strains that are higher in cannabinol (CBD) and lower in tertahydrocannabinol (THC) are more sedating than traditional sativa based marijuana strains.   They tend to be less psychoactive and more sedating.  Therefore patients do not get the intense head high but instead a “body relaxation” effect.

Although I have yet to see any major studies that have compared different strains of medical marijuana I do not that patients report different effects when they use indica versus sativa strains.    Much more research has to be done in order to get an answer that will undergo the rigors of scientific scrutiny but until the federal governement re-schedules marijuana it will most likely NOT happen in the United States.

Stay tuned and continue to petition your politicians to put pressure on the government to allow the safe and funded research of medical marijuana.

Despite the obvious abuse of prop 215 by the recreational community and the outright bold marketing approach they have taken (see HempCon hot hemp girl contest), I am confident medical marijuana in California is here to stay. The reason I feel this way is sitting in the dark behind all the fed raids, recreational use, money laundering, doctor scams are hundreds of thousand of legitimate patients who are seeing tremendous benefit from marijuana as a medication. These hundreds of thousands of patients are grandparents, mother, fathers, business CEO’s, attorneys, doctors, lawyers, teachers, plumbers, stage hands, web developers and veterans who ALL vote and have a voice.

Every day I am reminded by my patients why those of us in the community do what we do. We break free from the “herd called modern medicine” and give patients another option. They are grateful for us and we are honored to fight on their behalf.

Today I had a 61 year old father of twin daughters (22 years old), a professional musician who came to me one year ago on 5 medications to treat anxiety and intermittent claudication. Today he showed me his list of medications from last year and he was OFF ALL OF THEM! He went to say how his surgeon was “blown away” by how much better he is doing and can’t explain it (the reason being my patient has not disclosed his cannabis use out of fear!). I have thousands of stories just like these and each one is more powerful than the next.

I believe at this point there are enough patients that experience the benefit of medical marijuana that their voices WILL be heard. There is no way for politicians to turn back the clocks in California without taking a beating at the polls.

What is the next step in California? I believe that the community as a whole will come together and collectively fight the federal governments all out assault on states rights. A dangerous precedent could be set if the feds continue to interfere with the medical marijuana community.

Regardless, medical marijuana is not going to go down without a significant and formidable fight. Ultimately I believe the will of californians will prevail. So lets dig in and get ready for a fight!

Medical Marijuana benefits HIV+ and Aids patients in many ways:
1. It reduces the pain associated with peripheral neuropathy that often accompanies the disease.
2. It stimulates the appetite and combats Aids wasting syndrome.
3. it reduces nausea and other gastrointestinal side effects associated with the medications used to treat HIV.
4. It helps HIV patients sleep.
5. It reduces HIV/Aids patients need for anti-anxiety medications. Many HIV+ patients have significant anxiety associated with their disease and are prescribed benzodiazepine drugs like xanax (alprazolam) and valium (diazepam).

Treating HIV+ patients with medical marijuana has been extremely rewarding as my patients get excellent results and are very grateful.

I encourage all HIV+ patients to consider using medical marijuana to treat the above symptoms and have an open conversation with their doctor.

If you have questions or would like to come in for an appointment feel free to give my office a call at 877-721-0047.

Be blessed,