Why I always put “medical marijuana” in scare quotes

A dozen doctors in Colorado account for more than half of the state’s 108,000 holders of medical marijuana cards. That isn’t medicine; that’s dope dealing.

Yes, cannabis has medical value for some people. And yes, the sustained effort of the federal government to make medical cannabis research as difficult as possible is a national disgrace.

And then, on the other hand, there’s this, from a report of the Colorado State Auditor:

As of October 2012, a total of 903 physicians had recommended medical marijuana for the 108,000 patients holding valid red cards. Twelve physicians recommended medical marijuana for 50 percent of those patients, including one physician with more than 8,400 patients on the Registry.

Some physicians have recommended what appear to be higher-than-reasonable amounts of medical marijuana. In one case, a physician recommended 501 plants for a patient. In another case, a physician recommended 75 ounces of useable marijuana for the patient.

Do the arithmetic on 8400 patients for one physician. Assume a 50 40-hour workweeks and zero time spent on administrative tasks. That’s a little bit less than 15 minutes per customer. Medical practice? No. Just dope dealing.

Three percent of all the adults in Colorado have “red cards.” And the folks cultivating 500 plants or buying 75 ounces aren’t just supplying themselves.

There are places where “medical marijuana” is not a joke in rather poor taste: pretty much any state east of the Rockies. But in California and Colorado the odor of fraud is as strong as the odor of skunkweed.

The strategy of using quasi-medical legalization as a means of normalizing consumption and moving the political acceptability of full commercial legalization has been a great success; apparently most voters either have short memories (of when they were being assured that “medical marijuana” was all about the patients and had nothing to do with full-on legalization) or don’t mind being bullshat in a good cause. And I’m not unhappy with the outcome. Nor am I naive about political tactics: Bismarck was right about laws and sausages.

Still, the whole deal – and especially the role of the “kush docs” – makes me a little sick to my stomach.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

153 thoughts on “Why I always put “medical marijuana” in scare quotes”

  1. You are starting from a false premise, that none of the illegal consumption of marijuana is motivated by medical necessity. If you leave this assumption out, it is not remarkable at all that the consumption patterns of medicinal marijuana are very similar to the consumption patterns of illegal marijuana.

    1. A brilliant reply to an argument I didn’t make. Do you store it as a macro and spam it to all posts criticizing the medical-marijuana racket?

      1. Prescription drug abuse accounts for 75 percent of all drug overdose deaths
        in the nation.

        The death toll from prescription pill overdoses has more than tripled in the
        last decade. The Centers for Disease Control and Prevention has found that
        more than 40 people die every day in the U.S. from overdoses of narcotic
        painkillers like hydrocodone, methadone and oxycodone. The prescription
        painkillers are responsible for more deaths than heroin (a Schedule I drug)
        and cocaine (Schedule II ) combined.

        Deaths caused by cannabis…NOT ONE in recorded history.

        Please, tell me again why this plant is illegal?

        1. You are 100% correct Hugh! I’m not sure what point Mark Kleiman is desperately trying to make here?

        2. Do the arithmetic on 8400 patients for one physician. Assume a 50 40-hour workweeks and zero time spent on administrative tasks. That’s a little bit less than 15 minutes per customer. Medical practice? No. Just dope dealing.

          Here’s a good question: Who cares? And why? What harm is all of it REALLY causing? The answer is none. And if you have a problem with it, its strictly an ill-founded moral one based upon no real empirical evidence. But when (thru Government forces) about 94% of the research done on it in the U.S. is aimed at shooting it down its no surprise that everyone looks to do just that. Mark Kleiman is obviously no exception.

          Perhaps some people are alarmed at how many people are becoming patients and that its dangerous to make it so “widely available.” But the truth is the overwhelming majority of patients were already users, and there has been no indication of increased consumption since reform has begun that I’ve been able to find.

          I would like all the naysayers who get “sick to their stomach” to ask themselves; why? Looking at the issue from a purely economical standpoint the benefits of reforming marijuana laws overwhelm the costs of marijuana’s part in the catastrophic failure that has been the Government’s war on drugs. Everyone has heard about how many people are put thru the court system and housed in jail at taxpayers expense over a harmless substance. The reasons for reform go on and on. Yet people still get their panties in a wad when they hear about “kush docs” dishing out cards. Just get over it. We’ll all be better off.

          The difference maker with all the drugs and marijuana is obviously monetary. If the drug companies figure out a way to make money off of it (which they may eventually do) they’ll throw enough money at congress to make it happen. Because that’s how they get away with it. How hard could it be with something that WILL NOT actually kill anybody???



  2. Yeah, let’s just be honest. Marijuana is an objectively less harmful intoxicant used by many people for other than medical reasons. Even as a very qualified patient myself, the logical disconnect involved in the premise of many of the things that occur under the guise of medical marijuana is obvious. This would be a national embarrassment of sloppy politics and public policy — except for the fact that prohibition itself is far more embarrassing, far less justified, and ultimately a far more dishonest policy.

    1. Thanks Mike,
      The ‘dodgy’ market around mm is an entirely rational response and tactic in the struggle.

      Mark’s current current consulting contract – and the ensuing notoriety (and any financial gain short and long term) with the evergreen state would not have happened but for the mm warriors pushing the limits.

      Actually it is a fun-house-mirror image of Mark’s strategy: sound authoritative and a little rational to mask the latent anti-drug warrior insider.

      Methinks the folks behind Washington’s initiative are going to rue the day Mark was hired.

      1. Ron,
        There’s a market in ideas and it’s called policy wonkism. I actually don’t begrudge Mark his position. It sells his services to nervous politicians facing a revolt they hope to head off with something short of outright repeal of prohibition. And that’s reasonable — to a certain point. In the spirit of the free exchange here, I think policy needs to be supported by facts — more than a little of what’s wrong currently with the war on marijuana informing every decision made by the feds and most state governments. Some people actually believe they can step in and displace the highly organized and brutally effective people who currently cash in on the blackmarket the government has so carefully pieced together with this criminal class to ensure its high profits and the gov’t’s endless demand for “security” from the public from the very thing its policy has made possible.

        My point? It’s delusional for government at any level to believe they can “regulate” the behavior of people who have shown themselves to be largely immune to the official and sometimes as more methods used against millions of Americans for something that is so harmless.

        But there are entire industries to support in the eyes of politicians — law enforcement, prisons, a vast overseas network of bases and equipment that rivals the armies, navies, and air forces of some small countries, drug testing companies, all their suppliers and contractors, etc, etc. Those folks deserve something to do, right?

        Actually no, in most cases. Why should they be immune to the cuts the rest of the government has suffered, especially so in the case of having been so notably ineffective in milking this war for 40 years or so at the expense of billions.

        There was the recent discussion on how to enforce “regulation” that I avoiding stepping into, but which I do have a comment that was relevant here as there…
        A recent report (none too scientific, but since I’m from the humanities, it works for me) indicates marijuana accounts for 70% of all major drug busts reported in the media across the country. Interesting details:

        So let’s presume that marijuana were made legal tomorrow — and enforcement of its regulation was left to the same green eye-shade sorts that somehow mostly keep liquor and ciggies out of the hands of kids and those taxes paid. I can see hiring more CPAs and inspectors, good jobs for a few of those fat old retired drug warriors.

        What do you do with those folks currently serving, with often violent and usually ineffective means, if YOU REALLY BELIEVE LAW ENFORCEMENT METHODS AS CURRENTLY USED (or even portions thereof) are somehow effective and should be preserved? Why you take the 70% no longer needed to deal with reefer and transfer them to work against all those other “bad drugs.” Give them 5 or 6 years and then remeasure. I doubt there’ll be a lot of difference, but surprise me. All I’m saying is that we have a giant welfare problem with certain forms of policing in this country, despite the current need to address issues more important than whether the neighbor smokes weed or has a few plants in a secure garden…

        My point here is that regulation, for it to make any sense, needs to comport itself to how reasonable people behave and not violate the rights of other when using marijuana. Mark and his posse need to take to heart in some of the more libertarian things said here, which I say as definitely not a libertarian. That’s how people already act, so consider that factor. We’re not trying to presrve a certain number of drug busts in order to keep the cops busy, so we should be coming up with ways to keep people out of trouble as get them into it when it comes to regulations. It’d be good to concentrate those efforts on keeping everyone reasonably safe. That’s not hard, considering marijuana is NOT alcohol or tobacco. People will respond to reasonable accommodations for public safety. People want to pay their taxes. People want to keep kids from wasting time when they should be studying — that’s what college is for 😉 !

        But an effort to put Uncle Sam or one of the state governors in place of the gang boss and rake in the dough? Get real. Make it a reasonable tax that people don’t mind paying. There is no reason for marijuana to cost more than $100/ounce, taxes paid. And there’s no reason to continue to support a vast, bloated bureaucracy that regularly violates the rights of millions of our fellow citizens by giving them makework in something that should be streamlined, efficient, and profitable to the public treasury, with a mostly new cast of smart people on board.

        The best regulation is light, simple, and leaves marijuana a product that is available at an affordably reasonable cost to the consumer. Anything more than that slides progressively back into the same failed system we currently operate under. The regulation of legal marijuana should not be a band-aid on a broken system. It should start from a clean sheet of paper, with a very light touch on what is both desirable and achievable.

    2. Can a substance be an intoxicant without being toxic??? Part of the problem I have with some forms of reform is its being treated as if its in the same category as alcohol and tobacco when it clearly isn’t.

  3. The report admits that the state is not overseeing well and are vowing to improve it, but you’re treating it like this is the natural state of cannabis as medicine. If the state fails to regulate, why are Colorado’s ballot initiative writers to blame? (I do understand the hand-tying problem with CA Prop 215).

    1. Who said anything about “natural state”? It’s not the case in most medical-marijuana states. What is true is that the medical-marijuana proponents haven’t uttered a peep of protest in public, while in private they openly chuckle about how thoroughly they bamboozled the voters. Note the other comments on this page.

      1. as someone who has voted for medical cannabis I resent the statement that I was “bamboozled” most if not all voters know this a step to full legalization……and you might want to research your statement about “medical-marijuana proponents haven’t uttered a peep of protest in public”

        all you have to do is yahoo search it heres one……But the drafters of the bill found just the opposite: Businesses that sell medical marijuana are leading the charge against I-502, and have already mobilized against it.http://www.inc.com/eric-markowitz/420-marijuana-activists-are-fighting-a-bill-to-legalize-cannabis.html

        “The groups that traditionally oppose legalization—conservatives and cops—are not the ones leading the campaign to kill I-502,” Dominic Holden, a news editor for The Stranger, a Seattle alt-weekly, wrote recently. “The people leading the campaign to kill I-502 are, paradoxically, other pot activists—specifically, pot activists with ties to the medical marijuana community: dispensary owners, medical marijuana lawyers, medical marijuana patients, medical pot trade magazines, doctors who give medical marijuana authorizations, etc.”
        and another quote from another story A ballot measure to legalize recreational marijuana is generating debate among suppliers of medical marijuana, who worry the new law could disrupt their thriving businesses.

        the medical marijuana business owners tried to kill competition that’s 2 examples I found in less than 3 secs…….there are many more examples but it was the medical cannabis community that was the loudest voice against legalization

        1. “there are many more examples but it was the medical cannabis community that was the loudest voice against legalization”

          Which is a problem right there. I got mine, so screw everyone else on theirs.

          The interesting point of all this is that large parts of the medical cannabis community insist that medical marijuana should be restricted to those with “serious illnesses”. Never mind that there is no clear definition of “serious” or “illness.” The standard used by large parts of the medical cannabis community is “I am sick enough to need medical marijuana, but I am not so sure about you.” You can be sure that whoever is drawing the line, it certainly includes them, and anyone with a lesser complaint can go hang. There is nothing like enthusiastically throwing other people under the bus to save yourself.

          It is a version of the Stockholm Syndrome – hostages agreeing with their captors to save themselves. Little do these people realize that the DEA, et. al., make no distinction at all between “real” patients and “fake” ones.

      2. “What is true is that the medical-marijuana proponents haven’t uttered a peep of protest in public, while in private they openly chuckle about how thoroughly they bamboozled the voters.”

        If anyone got “bamboozled” then they didn’t read Prop. 215 and/or didn’t give it a moment’s thought. It was obvious to one who thought about it what it was. Prop. 215 allowed medical marijuana for any illness for which it gives relief. There is no clear definition for “illness,” so where does that leave us? (Actually, it leaves us in the only proper moral position — it is up to the doctor to decide, in consultation with the patient. You know, pretty much like lots of other drugs, including all the anxiolytics.)

        I also recall that there was quite a bit of discussion in public, with arguments from the opposition that this was, in fact, a general legalization bill. If someone claims they didn’t get the basic idea then they are a little bit slow and disingenuous. If they can’t read less than one page of text and figure out what it means then maybe they shouldn’t be allowed to vote in the first place.

        But let’s compare this with the standards for other drugs. You can get a prescription for NSAIDs, which kill thousands of people per year, just by calling the doctor and telling him you have pain. He doesn’t even have to see you. You get a prescription for Valium or Xanax just by telling him that you are anxious. So, if this is the minimum standard for drugs that can kill you outright, then what should be the minimum standard for a drug that doesn’t kill anyone? At least with marijuana, the doctor knows there is no chance the patient is going to be dead from a drug overdose tomorrow morning.

  4. If crime and abuse haven’t escalated, you may have to accept that one doesn’t have to be in a acute state to benefit from marijuana.
    Moreover, there is still a stigma around the Rx so many to most primary care physicians don’t have their employers blessing to prescribe it and patients are forced to go to “drug-dealing marijuana doctors that render the statistics you cite.
    If one wishes to juice or cook with their medicine, the standard ration of X plants won’t cut it.

  5. “the role of the ‘kush docs’ – makes me a little sick to my stomach.”

    You know, a little weed might help settle your stomach–works like magic! 🙂

    1. You’re failing to understand (as I see it) Kleiman’s moral taxonomy.

      To make it as clear as possible:

      + several hundreds of thousands of people exploiting liberal medical marijuana laws: tragic and disgusting
      + hundreds of thousands of people East of the Rockies unable to get pain relief for genuine suffering: No Big Deal…as long as The Law is followed!

      My take: Given its low harm profile, Why shouldn’t medical cannabis be Over The Counter and, with age restrictions, ad libitum?

      1. The fact that cigarettes and whiskey are legal and pot isn’t is a grotesque and unacceptable insult. Do the math.

  6. Using a term like “dope dealing” to describe people who prefer marijuana to alcohol attempting to purchase their drug of choice without being subject to crushing legal penalties is a wonderfully effective way of keeping 80’s era stigmas surrounding marijuana alive and well.

    It’s pernicious, and you should know better.

    1. At 15 minutes per patient per year, I find it remarkable that cannabis is medically indicated for every one of the 8400 patients that doctor sees, and can only admire his/her diagnostic efficiency. (If there are substantially many patients being turned away without a prescription, then the time-per-patient drops even more.) After all, the current regulatory regime is supposed to filter out those who simply prefer marijuana to alcohol. One can argue, convincingly, that the regulatory regime should be changed, but that doesn’t alter the inherent silliness of pretending that use is restricted to those with medical need, which was the stated purpose and extent of the law when it was being debated. Making things more convenient or less legally risky for those who simply prefer marijuana to alcohol was specifically denied as being a goal or effect.

      1. @Brian H: Who are you to say that even one of the people you casually dismiss as “those who simply prefer marijuana to alcohol” is not using marijuana medicinally? You have no evidence other than stats on one (very efficient) doctor – who may be the only doctor in his county who will risk making a medicinal marijuana recommendation in the face of DEA persecution. And who exactly is harmed by the medicinal marijuana cottage industry? Your objection (and Mr. Kleimans’s) seem to me to be an outright attack on the medicinal marijuana regime – which Mr. Kleiman has publicly stated is an impediment to implementation of I-502 and its unrealistic tax structure.

        I use marijuana medicinally. I’m better medicated than unmedicated. And I’ll bet you dollars to donuts that every single one of the patients you so casually insult will say the same. I mean, what’s your point? To throw them in jail? Or just insult them and their medical professionals?

      2. “At 15 minutes per patient per year,”

        That is well within normal limits for lots of kinds of doctors, even doctors who do far more serious work than talking to people about weed.

        ” I find it remarkable that cannabis is medically indicated for every one of the 8400 patients that doctor sees, and can only admire his/her diagnostic efficiency.”

        You seem confused about what actually happens. See below.

        ” (If there are substantially many patients being turned away without a prescription, then the time-per-patient drops even more.)”

        Which might put in within the range of doctors who do far more serious medical treatment, such as bariatrics.

        ” After all, the current regulatory regime is supposed to filter out those who simply prefer marijuana to alcohol.”

        Where did you get that idea? Where is anything like that stated in any of the law? I am sorry, but it appears to me that the major problem here is that a lot of people came in with their own fond notions about what they thought should be and really didn’t think it through.

        “One can argue, convincingly, that the regulatory regime should be changed,”

        The current regulatory regime says quite clearly that the definition of “medical” use is defined solely by the doctor. You know, the only person who actually knows anything about the patient, has access to whatever medical records they may have, and has the expertise to actually make that judgment. This is the same basic rule used for every other drug in the medicine cabinet. How do you propose that we change that?

        ” but that doesn’t alter the inherent silliness of pretending that use is restricted to those with medical need, which was the stated purpose and extent of the law when it was being debated.”

        Define “medical need.” Do it in clear objective terms that could be used in any court of law. Let’s suppose we have two people sitting on the couch, hitting a bong. One is medical by your standards, and the other is not. Tell us the clear standards that you would use to determine which one is a real medical patient and the other is just a stoner.

        (That is, assuming you had any access at all to their medical records, and you had anything close to the medical expertise required to make a decision.)

        Just FYI, I have asked this simple question of everyone with your complaint and, so far, not one of them has been able to give an answer. They simply don’t have a clue. Mark Kleiman can’t do it, either. There is only one person who ever came up with a clear answer (besides the courts, who ruled that it is up to the doctor to decide) and nobody likes that answer.

        “Making things more convenient or less legally risky for those who simply prefer marijuana to alcohol was specifically denied as being a goal or effect.”

        Prop. 215 was less than one page, printed out, in a fairly large font. So your complaint is that you got fooled by less than one page of text. You either didn’t read it, or you couldn’t figure out what it meant when you did. I am sorry, I am having trouble working up any sympathy for your complaint. If you get fooled that easily, what does it say about your other votes?

      3. “without a prescription”

        It is not a “prescription.” A “prescription” is a specific order for a specific amount of a drug, as defined by Federal law. The doctor gives a “recommendation.”

        It is the difference between “go pick up this specific number of pills” and “you might want to try this because it might help.”

        Big difference, legally, medically, etc.

    2. Is Kleiman opposed to marijuana as a recreational intoxicant? I’m certainly not aware of such a position on his part. He is against the dishonesty, hypocrisy, and abuse that is involved in huge numbers of peoples obtaining an intoxicant they can responsibly use by engaging the services of fraudulent doctors.

      1. He’s opposed to EVERYTHING as a recreational intoxicant. If you got high on sunshine, he’d try to lock you up in a basement.

        1. Brett, either you’re a liar, or you haven’t read anything I’ve written on drug policy. Please go away.

      2. Is dishonesty, hypocrisy, and widespread scofflaw behavior bad enough to justify the additional harms of (legal) opiate addiction/abuse and pointless, excess chronic suffering?

        1. + It’s supposed to be a reply to Warren Terra’s comment.
          + I can’t tell if the fault is with me or with the blogging software.
          + Either way, please accept my apology.

          1. Your reply was done correctly. I was referring to Warren Terra’s comment itself, which doesn’t seem to have much to do with my point.

  7. I am a healthy looking young white male….with severe epilepsy & a traumatic brain injury (had a seizure while biking). I live in Cali -should I be upset that my stoner coworkers buy their recreational marijuana without fear of arrest, jail, prison, fines, etc? If so why should I wish harm upon them?

    1. I fail to see how their use of marijuana for recreational purposes makes my use any less medicinal.

      1. There is a definite presumption that a healthy looking young male with a medical marijuana permit is engaging in fraud and supporting the income of a fradulent doctor, because that is so often the case. The lies and hypocrisy of these people imperil your access to the medical marijuana you need. I happen to believe they should have recreational access to the stuff – heck, I suspect I’d enjoy it myself – but I refuse to partake in this crooked scheme because I have too much respect for the medical profession, and for people like you who need access untainted by others’ lies.

        1. The lies and hypocrisy of these people imperil your access to the medical marijuana you need.

          How so? Are you anticipating California getting rid of medical marijuana anytime soon?

          1. Are you anticipating California getting rid of medical marijuana anytime soon?

            No, probably not. But all the fraud makes the chances of repeal larger than they otherwise would be, and more importantly all the fraud makes it harder to get medical marijuana legislation enacted in other parts of the country. “A Critic” isn’t the only person in their situation, and he might like to pursue educational, career, or personal opportunities outside of California. Right now, about half the country isn’t hospitable to his medical needs – and even among those that are hospitable, he can’t easily travel there with his supply, and his California state medical use permit is probably invalid there.

          2. Warren said:

            “No, probably not. But all the fraud makes the chances of repeal larger than they otherwise would be”

            Polls show more people in favor of medical marijuana now than when the law was passed. Even the major national prohibitionist organizations are now admitting that national marijuana legalization is now a question of when, not if.

            “, and more importantly all the fraud makes it harder to get medical marijuana legislation enacted in other parts of the country.”

            Define “fraud.” Also tell us how you determined that there was a lot of it when you don’t have any access to medical records, you don’t know any significant number of these people, and you couldn’t understand what you read if you did have their medical records. I think what you meant to say is that you read some sensationalist newspaper articles and never really thought about it.

        2. “There is a definite presumption that a healthy looking young male with a medical marijuana permit is engaging in fraud and supporting the income of a fradulent doctor,”

          Assume that your allegation is entirely true. So what? How did this change your, or anyone else’s day?

          “because that is so often the case.”

          How exactly would you know? You don’t even know any significant percentage of these people. You have no access to their medical records. You have no idea about their complaints. You wouldn’t be able to understand their complaints even if you could read their medical records. You can’t even define any clear standard for the difference between “medical” and “non-medical”. So how would you know?

          “The lies and hypocrisy of these people imperil your access to the medical marijuana you need.”

          Well, we have already established that you wouldn’t have any idea at all about how much “fraud” there might be simply because you would be legally barred from accessing any records that could actually tell you. So it seems that it is not a problem of what these people are doing. Instead, it is a problem of hysterical anti-drug zealots claiming all kinds of crap for which they have no real evidence. The major allegation of fraud always starts with people who believe that marijuana has no possible medical use at all.

          “I happen to believe they should have recreational access to the stuff”

          Then what difference could it possibly make whether someone uses it “fraudulently?”

          ” – heck, I suspect I’d enjoy it myself – but I refuse to partake in this crooked scheme because I have too much respect for the medical profession, and for people like you who need access untainted by others’ lies.”

          Uuuuuuh, yeah. High morals, indeed. Now tell us how we would clearly define the difference between “medical” and “recreational” so that any jury of twelve people could all agree.

        3. “There is a definite presumption that a healthy looking young male”

          So you can diagnose people just by looking at them? How is that done, exactly? Or should “definite presumption” be changed to something more like “uneducated, probably erroneous, bigoted assumption?”

    2. Are ‘kush’ doctors providing a safe service for their customers who actually have legitimate health problems?
      The possibility of actual harm due to symptom masking, allowing a curable problem to fester and grow worse, for example.

      It’s not the stoners looking to get high I worry about, as the folks who actually need a doctor and get a quack instead.

      1. Yes, this. Anyone getting a weed permit from these crooks for fun is merely perpetuating a mass hypocrisy – but anyone seeing them out of genuine need is almost certain to get no useful input from their supposed medical exam. Effectively, they’re prescribing for themselves. It may work out, but that’s not what the doctor is for.

        1. How would you know what it is? I have heard lots of people make these kinds of claims. Turns out that none of them have any medical knowledge, no access to medical records, and not even any really idea of who is getting medical mj.

          Just FYI, there is research on why people are taking the stuff as “medicine”. It doesn’t support your conclusions.

      2. The Board of Medical Examiners does frequently take action against doctors who neglect minimal standards of practice. Often this will take the form of a Letter of Admonition, a period of probation, prescribing restrictions, requiring prescription logs, having to take a prescribing course, external reviews of medical records, and, occasionally, medical marijuana restrictions. The clown who is prescribing marijuana for 8400 patients can expect to come to the Board’s attention if he has not already.

        1. There is no productive purpose in punishing anyone who has done nothing more than to try to relieve their own suffering — even if you disagree with their choice of medicine. In fact, there is no productive purpose in punishing anyone for using cannabis even if you don’t agree they are sick. (Not that you had any way to tell who they are, or whether they are sick.)

          So how is that doctor a “clown”?

          1. Let me give you all a bit of insight into this process….

            I have had severe back pain for 30 years, spent 5-6 years dosing higher and higher on oxycontin…..very bad stuff! I’ve had 2 back & 1 neck surgery & am off all narcotics now.

            My surgeon and my primary care Doc would not & cannot “recommend” MM, for fear of reprisal. Their recommendation would not help me much anyway due to the fact the dispensaries have to call and check on a recommendation to make sure it is valid. My “quack” Doc as some call it has a system in place to handle the validation process and he just doesn’t hand it out to me – he has my medical record history and knows what has been done to me and what I have taken or are taking and I keep my regular Doctors in the know also.

            Some may take advantage of the program, but they should not have to as I see prohibition as a “gateway” not the cannabis itself. When you have to buy black market….you get introduced to many shady characters and other substances that WILL kill you.

            Cannabis has been used for 1000’s of years and will continue to be used no matter what the federal government says! It’s time to remove the Schedule 1 stigma and allow states to proceed as the people see fit….period!! More people are hurt by prohibition than cannabis itself!

      3. I’ve not had the chance to legally make this choice, but my circumstances and the medical issues that many others seek relief from are due to the failure of conventional medicine to deal with our pain and symptoms. I seriously doubt that anyone in a medical emergency would tell the ambulance to get them down to the weed shop, stat. In other words, there’s a lot of excess handwringing about a marginal problem, at best.

        If someone is going for the MMJ first, they are also likely doing that as an alternative to the high cost of conventional medicine. Folks are holding their breaths on healthcare reform, certainly, so that may help. But many folks find that’s what they can afford. That’s tragic. The solution is national health care, where everyone has access to the healthcare they need. It’s not a scare campaign over the very old news of abuse of MMJ being an issue in a few states. All this does is cause states contemplating MMJ to come hup with systems that are “the toughest” because politicians are wary about diversion. Guess what? Legal MMJ is too expensive to be diverted — at least by the customer. But it’s the customer that pays the excess “costs” built into the system in the name of being “tough” on patients who can easily head down to the street corner and avoid a lot of unnecessary paperwork…

        What this country needs is outright legalization and a reasonable, unintrusive regulatory scheme that the public accepts just like they do for beer, liquor, and ciggies. Quit beating up on patients with overwrought concern for our welfare. We’re not stupid, so cut the Cheech and Chong assumptions about “How dumb do you have to be to visit the pot doc?” If people are abusing that, it’s because weed is still illegal, not because I need it for my medical problems.

  8. The only thing that is remotely “alarming” is this idea that someone else’s chocie of medicine is somehow any of your business. I always laugh at loons who pretend to have this new magical power, they are somehow able to diagnose any illness or disease simply by looking at a patient. Breathtaking really. If only we had a few of these magical wizards in every hospital on earth. Who needs an MRI when doctor Doolittle can just look at you and figure out what you are suffering from? Luckily most adults understand reality. All drugs get abused, from caffeine and Prozac to Xanax and Tylanol PM, and medical marijuana is no different. If the author actually believed marijuana would be any different from every other drug on earth, perhaps he should put the bong down and sober up. At the end of the day, no one cares. I never waste a second of my life wondering about the people in front of me at my local pharmacy, i don’t care if they are faking pain just to get pills, i don’t care what kind medicine they choose to use, and i really don’t care who their doctor is. You see, I’m a normal person, i understand when things are none of my business. Keep beating the “duhhhhhh i saw a young “healthy looking” guy buy pot” line of stupidity, if you’re lucky you’ll find someone who thinks that’s an issue worth worrying about. The rest of us have real problems.

    1. It is none of “my” business but it is the business of boards of medical examiners to protect the public from certain practitioners who endanger the health of patients who come to see them. I do not wonder about the people standing in line at the pharmacy either, nor do I care who their doctor is. That is none of my concern. But I do want someone in charge of keeping quacks away from vulnerable sick people who have no way of telling a competent from an incompetent physician.

      There is a new building under construction a few blocks away from me. I do not wonder who is buying the place nor do I care who the contractor is. That is none of my business. But I do want there to be such things as building codes and I want there to be regulatory agencies to see to it that contractors who use substandard materials in these buildings are forbidden to build anything other than a tool shed in their own back yard.

      Of course, if you see no need for building codes, there are opportunities for enterprising garment manufacturers in Bangladesh.

      1. @Ed – Your compassion is overwhelming. You might want to consider that you are “protecting” (with your prim dudgeon) people from a medication with NO toxic dose, less habit-forming than coffee, and with such dreadful side effects as smiling and playing music and eating.

        Indian hemp is such a benign and harmless medicine it’s a wonder to me it was prohibited rather than aspirin, which is actually toxic.

        I have a hard time taking your objections seriously, since they appear to me to be based firmly in the prohibitionist fantasies of the “war on drugs”. I mean, with so many actual serious problems in our society, why do you see fit to pick on people who use marijuana medicinally? Don;t you have something better to do?

      2. Those boards are already in place for the practice of medicine. Also, there is an active legal industry in medical malpractice lawsuits to keep the doctors on their toes. So far, no significant problems for the marijuana docs, and certainly nothing in comparison with lots of other medical specialties.

        So is this a real complaint or are you just worried about sensational newspaper articles?

      3. You are absolutely correct Ed and that is why cannabis should be legally available to any adult that wishes to consume it. It would be regulated and sold to adults only and it would be safer than buying it off the black market….think back to the days when people went blind from drinking moonshine.

  9. My doctor says he recommends a hot bean soup (coffee) to all his patients, why worry about someone recommending cannabis to all their patients?

    I’d imagine quite a few people are consuming cannabis as a dietary supplement and would therefore require a great deal more raw botanical plant matter than someone who is vaping it or using a concentrated extract.

    At the end of the day cannabis is simply a leafy green vegetable. I couldn’t give a damn if a single physician is making all the recommendations in the state, in-fact good on ’em.

    1. Your doctor is (supposedly) recommending coffee to all his patients as a lifestyle choice. He could do the same with minestrone, or with Jane Austen novels. He is not prescribing coffee as the best cure he can find for your condition.

      Also, marijuana is an intoxicant, and regulation of its use is not a wild or crazy notion; it’s only the “reefer madness” madness that must stop. Your assertion that it’s green so it’s harmless is amusing, but I rather doubt you’d feel the same about poison ivy, or foxglove.

      1. Warren, if my doctor is (supposedly) recommending coffee to all his patients as a lifestyle choice, why can’t he recommend cannabis? It has healthful properties just like coffee.

        Cannabis is a plant (of which there are many chemovars) that, when heated/treated, may have psychoactive properties. In the same way grapes aren’t always psychoactive, neither is cannabis.

        1. With respect to your first, it’s not that your doctor is suggesting coffee, minestrone, or marijuana to all their patients; it’s what they’re not doing. Theure not actually examining their patients and deciding what course of action is best for each individual patient. They’re not being a responsible doctor.

          With respect to your second, if anyone is consuming marijuana other than for its psychoactive properties, they’re dong it wrong. You don’t really mean this line of argument to be taken seriously, do you?

          1. What kind of examination must a doctor perform before they should be allowed to recommend coffee?

            Psychoactive effects that may be sought-after with non-medical use are generally eschewed with medical use.

          2. The doctor isn’t being paid to recommend coffee. They’re being paid to diagnose maladies and prescribe treatment. Do you really fail to understand this, or are you just being ornery?

            Maybe I’m not up on the correct definition of “psychoactive”. I’d have assumed that the various qualities that recommend marijuana for both medical and recreational use (most obviously, relaxation, a sense of wellbeing, analgesia, appetite stimulation) were considered psychoactive. If your point is that some pharmaceutical applications of marijuana aren’t technically “psychoactive”, you may be correct, but your line of argument becomes nonsensical. Unlike grapes, no-one is consuming marijuana for its flavor or nutritive value.

          3. Unlike grapes, no-one is consuming marijuana for its flavor or nutritive value.

            Au contraire, Warren. Consuming marijuana for it’s nutritional value in it’s raw form, known as juicing, is the latest trend in medically beneficial marijuana consumption.

          4. If you’ll read your own link, Freeman, you’ll see that the “juiced” marijuana is still being discussed as a pharmaceutical (or isn’t there some portmanteau word about pharmaceutically active foods?). It’s not being discussed as a refreshing beverage nor as a multivitamin, a source of fiber, the latest innovation in non-sugar sweeteners, etcetera.

          5. If you’ll read your own comment, Warren, you’ll see that you said “if anyone is consuming marijuana other than for its psychoactive properties, they’re dong it wrong”. And if you’ll read the rest of the conversation you were having with Strayan, you’ll see that his point you were countering with your statement “Unlike grapes, no-one is consuming marijuana for its flavor or nutritive value” was that “Psychoactive effects that may be sought-after with non-medical use are generally eschewed with medical use.” I don’t see the relevance of your rebuttal that “It’s not being discussed as a refreshing beverage nor as a multivitamin, a source of fiber, the latest innovation in non-sugar sweeteners, etcetera.” Is there some point you want to make here?

            From my link:

            While Courtney understands that smoked cannabis can in fact be used as a medicinal therapy, he believes that in its best form, raw, it is a preventative. He claims cannabis is the “most important vegetable on the planet” and that it can assist the function of your immune system, provide anti-inflammatory benefits, and improve bone metabolism and neural function.

            Reads to me like it IS being discussed as a source of nutritional value in it’s raw, non-psychoactive form.

          6. Freeman,
            I don’t know why I bother, really, when I’m so clearly confronted with bad faith. I’ve already explained in this subthread that I was being cavalier when I referred to marijuana’s psychactive properties, when it would be more accurate to refer to its pharmaceutical properties. You clearly understand this, but feel it necessary first to repeatedly quote the first, terminologically overly narrow statement – apparently because it conveniently clashes with a quote you can pull from your linked article – and then to read your linked article with a blithering incoherence of its meaning. I repeat myself: not a single goddam word of your linked article says any sane person would consume marijuana for the flavor, and every bloody argument made for consuming marijuana is assertions of its remarkable pharmaceutical effect. You know that bit you quote about how they assert raw marijuana can “assist the function of your immune system, provide anti-inflammatory benefits, and improve bone metabolism and neural function”? They are referring to pharmaceutical effects there. Those claims aren’t about nutrition, unless they propose essentially everyone on the planet is receiving poor nutrition.

          7. Sheesh, here comes Warren with the “bad faith” accusation again. All you did here was hyperventilate a bit and repeat your straw-man argument about people not eating raw mj for the taste, which nobody has argued. You seem to have some issue with differences between the terms “nutritive value”, “psychoactive”, and “pharmaceutical”, but if there’s a point in there somewhere you still failed to explain what the heck it is.

            Many nutrients “can assist the function of your immune system, provide anti-inflammatory benefits, and[/or] improve bone metabolism and neural function”. When formulated into specifically defined medicines, we call them pharmaceuticals, but in their raw forms? Not so much. Perhaps your apparent misunderstanding of this factor is why you assume my quotes demonstrate “a blithering incoherence of its meaning”. Or perhaps you believe marijuana contains no nutrients that people would be interested in ingesting in ways that don’t get you high. I can only guess because you didn’t say what it was you think I misunderstand.

            In any event, I agree that it’s tiresome arguing over semantics, especially when there doesn’t seem to be any underlying point to it all. Cheers.

          8. Warren Terra says:

            “The doctor isn’t being paid to recommend coffee.”

            He is being paid to keep you healthy, which includes diet. If your doctor doesn’t do this, get a new doctor.

  10. Dr. Kleiman, this complaint of yours echoes many I’ve heard in Oregon – “10 doctors write most of the recommendations!”

    I can’t speak to Colorado’s laws and I’m in agreement on California. But in Oregon, these doctors are writing the majority of recommendations because other doctors cannot. It is akin to complaining one doctor does most of the abortions in Wichita.

    The facts are that many doctors would like to write recommendations for their patients, but their insurance, their clinic, their partners, their hospital, the VA, or some other legal condition prevents them from doing it. So sick people are forced to gather their records from their doctor’s visits (plural – three in Oregon are required) and take them to a specialty clinic where staff has to review them to ensure the records document the qualifying condition, where then a doctor reviews them and signs off on the recommendation (for only 24 plants & 24 ounces, since OMMA doesn’t allow writing recs above that) and then they patient pays $200 to the state for protection money. By the end of the process, the patient may have spent $800 – $1000.

    Believe me, doc, it’s not as simple as walking in to a pot doc in a tent here, or I would have done it by now. I don’t dispute there may be some abusing the system (and contributing $200 a pop to the Oregon treasury) but it’s certainly not the case that 55,000 people are faking it to get high.

    1. The Colorado numbers Mark cites are 12 suspiciously overprescribing doctors out of 903. Looks to me as if 891 probably honest Colorado doctors don’t find the red tape there too onerous. It’s not hard to investigate 12 practitioners if you really want to. And for the one with 8,400 consuming patients, a sting with chemically tagged product to prove later resale would not be too difficult.

      1. a sting with chemically tagged product to prove later resale would not be too difficult

        Yeah, great idea James. Let’s adulterate products people are using to improve their health just so that we can catch a few DFH’s getting high. Disgusting suggestion.

        1. Do the taggants have to be dangerous? You can use something completely inert like gold.
          Do you really believe that any significant proportion of the 8,400 “patients” are taking marijuana for their health?
          I’m quite unsure whether enforcing the law here would be worthwhile. But it should be feasible, if you think that there’s a problem of medical malpractice.

          1. Gold, eh? All I can say is that’s only slightly better than Scrooge’s suggestion the other day to use aluminum. Could be worse — my government tried to poison me with paraquat a few decades ago, and my aversion to adulterated pot remains strong to this day.

            Do you really believe that any significant proportion of the 8,400 “patients” are taking marijuana for their health?

            I did acknowledge the likelihood that a few DFH’s are getting high. But before we soil our collective panties over the ohh-so scary-sounding 8400 number and jump to conclusions based on a bare statistic, I think we should consider Russ’s point about why some doctors would specialize in mmj recommendations while most others would find it in their own best interests to refer patients to those doctors instead of being the ones to sign the recommendations themselves.

            The thing that really gets me here is the complete mootness of this issue. The law has been passed, the implementation is underway, and any day now marijuana will be legally and openly available for sale to any adult who wants it in Colorado. Do you really believe that mmj fraud in Colorado is something to be so concerned about under these circumstances that we should consider adulterating it with chemical tags? Personally, if I were inclined to get all worked up over an abusable drug commonly over-recommended by physicians for acknowledged non-medically-indicated recreational purposes, I’d target Viagra, given it’s list of dangerous side-effects and health risks.

          2. “Do the taggants have to be dangerous?”

            And how would you propose this completely non-toxic inhaled product would be inserted into an illegal black market?

            “You can use something completely inert like gold.”

            Sooooooo, the plan is that we hand out a lot of gold to people who are growing marijuana and . . . .

            You know, I am liking this idea already. Let me go get some seeds.

            ” Do you really believe that any significant proportion of the 8,400 “patients” are taking marijuana for their health?”

            I believe that you wouldn’t have any way of telling whether they were or not. I believe that you couldn’t even objectively define the difference between medical and non-medical. I believe that you couldn’t tell me any productive purpose for jailing someone for marijuana, whether you agreed with their illness or their medicine, or not. I believe that you couldn’t tell me how this could possibly change your day, even if all your wildest assumptions were true.

            ” I’m quite unsure whether enforcing the law here would be worthwhile. But it should be feasible, if you think that there’s a problem of medical malpractice.”

            Medical malpractice is a civil issue, not a law enforcement issue. That is, the patients who are hurt sue, and there are lots and lots of lawyers eager to help them with their medical malpractice cases on purely a commission basis. Medical malpractice is a huge problem for nearly the entire medical profession. Medical malpractice can put doctors out of business even when the medical board doesn’t. This problem basically doesn’t exist as a problem for the medical marijuana docs. What does that tell you?

    2. So if the goal of the regulation is to make it reasonably medically available, you have to compensate for this legal and cultural stigma that keeps most docs from prescribing.

      It sounds like Oregon’s law is placing an unreasonable barrier in front of patients with a legitimate need.

    3. There may be only one doctor doing abortions in Wichita, but I will bet heavily that he examines women to make certain that they have an intrauterine pregnancy before beginning the procedure.

      1. We are talking about a doctor recommending someone try or use cannabis (y’know, “one of the safest therapeutically active substances known to man”). You don’t have to be ultra cautious.

        Mothers give aspirin to babies for Pete’s sake.

        1. I should attribute my final sentence to the original author Samuel Shem. In the context in which it originally appears (a frightened new medical student [Roy] suddenly has doubts about charting some aspirin):

          “When the Fat Man went to lunch and we did not, the terror returned. Maxine asked me to write an order for aspirin for Sophie’s headache, and as I started to sign my name, I realized I was responsible for any complications, and I stopped. Had I asked Sophie if she was allergic to aspirin? Nope. I did. She was not. I started to sign the order, and stopped. Aspirin causes ulcers. Did I want to have this poor LOL in NAD bleed out and die from an ulcer? I would wait for the Fat Man and ask him if it was all right. He returned.
          “I’ve got a question for you, Fats.”
          “I’ve got an answer. I’ve always got an answer.”
          “Is it all right to give Sophie two aspirin for her headache?”
          Looking at me as if I were from another planet, Fats said, “Did you hear what you just asked me?” “Yes.”
          “Roy, listen. Mothers give aspirin to babies. You give aspirin to yourself. What is this, anyway?” “I guess I’m just afraid to sign my name to the order.”
          “She’s indestructible. Relax. I’m sitting right here, OK?”

        2. Most persistent back pain is mechanical in nature, but sometimes it is a sign of serious underlying pathology. A careful history and physical exam is owed to every patient who comes to a doctor with that chief complaint. This is not brain surgery, or even abortion practice, but it does take some time and at least minimal clinical competence. Perhaps the providers of the marijuana recommendations are doing passable examinations and taking adequate histories from their patients, arriving at thoughtful diagnoses, in which case they are doing what doctors are supposed to do. The State Auditor’s report produces evidence that this is often not the case when red cards are issued. If the doctor and patient were never in the same room together, for example, or if the medical consultation took place after issuance of the red card, there is reason to believe that substandard medicine is being practiced.

          1. I have (thankfully not had) a friend who had back pain, which was later diagnosed as a cancer. Good thing she had a real doctor to find and diagnose it.

          2. As a health care worker I recommend nicotine replacement therapy to people over the phone (without seeing them) everyday. Am I practicing substandard medical care?

            You seem to be confusing cannabis with drugs that have a poor safety profile.

          3. “You seem to be confusing cannabis with drugs that have a poor safety profile.”

            I would have the same problem with a doctor who recommended Tylenol to everyone with persistent back pain if there were no history and physical on the chart. Making a diagnosis and considering serious pathology define the practice of medicine. If the marijuana outliers are all doing what doctors are supposed to do, then the Auditor can just chill with whatever substance helps him relax. But the Board of Medical Examiners have a duty to look at the medical records to make sure that the minimum standards of practice are being adhered to.

          4. “I would have the same problem with a doctor who recommended Tylenol to everyone with persistent back pain if there were no history and physical on the chart.”

            They do it routinely. I have seen them do it without even looking at the patient. The major difference is that Tylenol can kill the patient and marijuana can not. So why aren’t you making this complaint in the Tylenol thread?

      2. Let me help you feel a bit safer Ed, my pot doc has my medical record and knows of my surgeries and my health condition in general! No problem, just costs me more to now have a surgeon, primary care physician and the doc that can recommend a non-toxic plant to help keep me off deadly narcotics!! That brings me to who the real people are against legalization….pharma companies, alcohol companies, MM doctors, MM dispensaries, etc.

        I agree that the medical aspect here is a sham….it should be available legally to any adult that wishes to consume it!

  11. Kind of a moot point in CO about now, isn’t it? I don’t see why you’re making yourself sick over it.

  12. For some context, Dr. Kleiman:

    “Specifically, longitudinal data using the National Ambulatory Medical Care Survey (NAMCS) for the decade 1988–1998 indicate that physician-reported face-to-face interaction time has increased 2.0 minutes to an average of 16.3 minutes per encounter.7 NAMCS data from 2003 indicate that among general and family physicians, the average visit duration is 18.7 minutes.”


    1. Any information on how many contacts per year, on average? The point as I understood it wasn’t that an office visit was 15 minutes, but rather that the number of prescriptions implied a contact of about 15 minutes per patient (1 office visit) per year. That would be useful context, as well.

      1. “estimated 2,237 visits per primary care physician yearly”

        “The average US panel size is about 2,300.”

        By the way, there is no reason at all to think that the doc with 8,400 patients saw them all in one year. Going at the average primary care doctor rate, it would take 3-4 years.

        “Yet, the auditors cited a study that reported the average doctor in United States cares for 2,300 patients.”

        It’s cannabis prohibition ultimately that breeds corruption.

    2. This is consistent with what I saw when I was working in the medical malpractice insurance industry. Note that these are averages and some types of doctors would see twice that number of patients, or more.

  13. Thanks to Warren Terra for saying what I would have said. It’s essential that the legal system continue to respect the recommendations of physicians about what is medically indicated for their patients. Anything that weakens the basis of that respect – as kush-doctoring so grossly does – is not just an affront and a disgrace to the practice of medicine, it’s actually a threat to the powers given to physicians by the laws.

    One slightly technical point: Not all of the medical uses of cannabis involve its intoxicating powers, which are concentrated in THC. Cannabidiol, which is psychoactive (with anti-anxiety and anti-psychotic effects) but not intoxicating, may turn out to be the more important chemical therapeutically. There’s also some evidence that THC-acid, before it is decarboxylated by heat into THC, may have local analgesic effects. At least, topical cannabis creams are being used to treat arthritis pain.

    Again, in a sane world the federal government would be aggressively studying the therapeutic potential of cannabis and the cannabinoids, rather than aggressively making those studies harder to conduct.

    1. The ship has already sailed on this worry, and it was the other side of the drug war that did it. Try being a pain management specialist under the current DEA regime. The ‘respect’ of the legal system for the recommendations about what is medically indicated for patients is gone. It has been replaced with putting doctors in jail for trying to treat pain in ways that scares the DEA. Google Radley Balko’s numerous articles on the topic, and the amptoons blog on how to avoid looking like a drug seeker when you’re in pain.

      1. amen Sebastian… anyone not familiar with the Richard Paey case and the war to keep people in pain, needs to become so. Lawyers and cops (I think they mated and that’s where the DEA came from) are the new overseers of medicine.

        And… as to our resident legalization “expert” Mr Kleiman (I always put expert in quotes) I must say while he claims to spank the Prohibitionists he also still has a bit of their twang left in his voice.

        Mark continues the “sustained effort[s] of the federal government to make medical cannabis research as difficult as possible is a national disgrace” meme falls far short of the mark.

        This system left Peter McWilliams gagging on his own vomit until he died. Some folks might call that cruel and unusual and others might call it torture. Yes, it is. All of that. Imprisoning his friend Tod McCormick in Terminal Island FCI (not a pretty facility inside at all) was cruel, capricious and again, an act of terror committed upon a US citizen far more in medical need of cannabis than imprisonment. Or was Tod’s imprisonment “medical?”

        And what kind of sick excremental-brained bureaucrat decided that the discovery of cannabis’ cancer fighting effects in Virginia in 1974 needed to be buried. That’s not a “disgrace” Mark, that’s a crime against humanity.

        Something like 1/3 of all U.S. adults suffer some form of chronic pain. I’m 61 and I worked in the yard end of the lumber business for over 2 decades, tweaked my back terribly at the ripe old age of 36 and have fought recurrent back pain since. Why would I not choose “one of the safest therapeutic substances known to man” for self treatment? I don’t need a doctor to tell me my back hurts. I don’t need a doctor to tell me to continue doing my exercises until I die. And I remain active, I now work on rooftops and tall ladders. So someone looking at me in work or play would assume I’m a very healthy and active senior male. But at the end of my day? Pass me my pipe please.

        Personally I think Mark always puts quotation marks around “medical marijuana” just to poke those he know it bugs.

        The war on pot/drugs (the WO(s)D, Prohibition II) is not a disgrace Mark. It is an act of aggression by an increasingly hostile government against it’s own citizenry.

        1. urp…

          “Mark’s continued use of the phrase “the sustained effort[s] of the federal government to make medical cannabis research as difficult as possible is a national disgrace” meme falls far short of the mark.”

        2. Is it normal for me to be standing and cheering at the end of a blog comment? No? I’ll just go over here and take a seat then.

  14. “Oh what a tangled web we weave
    When first we practice to deceive”
    -Sir Walter Scott

    1. The flaw in Dr. Kleiman’s arguments stem from his assumption that our current egregiously excessive regulation and attendant criminalization of both marijuana and many other substances are good faith policies enacted to protect the public. However, the real history of these laws and regulations reveals a system that is morally corrupt, racist, and, if nothing else, not based on good faith. Yet, because he seems to believe this system serves the public interest he enjoys a sort of imprimatur of legitimacy — something neither he nor any “partial drug warrior” deserve.

  15. Some use it as getting high other for pain relief. The difference is the amount taken; Or a big spliff, or careful divided over the day to create a low level in the blood. Cannabis users always have been prey for dealers. and now patients are the same by doctors and it is legal too. Money money money. It does not matter if we name it tabac, booze, cannabis, pharmaceuticals or healthcare. Money, greed, profits or trade in stocks should be forbidden. With another drug the fda/fbi arrested doctors with 50 to 70.000 dollar day profit. According to WHO global there are 166 to 225 million daily cannabis users. Potential this could mean ( the real ) patients are max. 16,6 to 22,5 million, global. Potential, when medical world would not be a barricade, this could be 5 x higher ( oops ).

    Money. There is being talked about tax. Tax on a product in your backyard ? Or tax on the real production price of 0,05 cent per gram ? Or tax on illegal cannabis priced 10 dollar, or medical cannabis priced up to 20 dollar ?. Who gets the profit of higher prices AND tax.

    You know the dutch coffee shop. The front is legal, the backdoor, for supply is illegal. Now other “governmental approved medical cannabis applications” are also on the stock market. One company stock value went from 10 to 40 dollar just on the phrase; quote ,, treatment and prevention of cancer” while it was developed in 1993 for pain treatment by chemo for mouth and neck area “. end quote. And while (the real )patients using the “spray” or “cannabis flos “( medical name for flowers ) can not even get reimbursement from healthcare, where they would have if it was one of the tenfolds of synthetic pharmaceuticals. This due the rules and agreements our governments made with pharma and finacial groups. So the dutch coffee shop front-back door tactic is used by these money making people, and we be arguing with each other about til we die.. I have a migraine now, i take a glass of wine. Do i have to report it to my doctor as wel ? and pay extra tax ? No ? to ?

  16. I would hope that you would realize that the partner to G&W pharmaceutical is the same pharmaceutical company that sold Hash oil across the counter until 1942 when the FDA was commissioned and removed it from the shelves,Bayer,they were also largely responsible for the creation of the FDA. The prohibition of cannabis is one of the longest,most evil profit protection scams ever run on a people by it’s own government.
    And if a medicine makes a patient happy or lifts their spirits and improves their quality of life then it is good medicine and if you ever have a patient that is in constant pain and as soon as they inhale some marijuana they start smiling and interacting with their friends and family you will realize just how good a medicine marijuana is,,except in Kleiman’s mind because he considers anyone using marijuana for any reason a second class citizen,medicine or not.

  17. That’s a little bit less than 15 minutes per customer. Medical practice? No. Just dope dealing.

    I’m not convinced of this. Thinking of the last many times I or one of my children have seen a doctor, I think that 15 minutes is longer than we usually spend with a doctor. For complex diagnoses, or dangerous drugs–I might spend more, but even then 5-10 minutes seems pretty routine for follow-up. This is true even for “doctors” with no time pressure, like the on-site clinic at work (doctor in quotes because it’s actually a nurse practitioner).

  18. You’re a real cynic, Mark.

    I bet you’ve never tried to obtain a California medical marijuana prescription, otherwise you would know it’s not a rubberstamp process.

    A medical patient needs a real ailment, one confirmed by a non-marijuana physician, who will examine any other prescriptions a patient may be taking for medical conditions, and any other recorded health data relevant to the case. Much of the medical record information is completed and reviewed before the interview takes place. With all the required information in place and confirmed, the interview may seem short to the uninformed. If it’s all done properly, things usually happen quickly, because we are often an efficient society, unlike much of academia.

    And regardless of what you may believe, people seeking medical marijuana cards do get rejected. It happens all the time. And it usually takes less than 15-minutes. Rejection happens because there are legal sanctions in place for physicians who improperly dole out prescriptions to fraudsters. If you, Mark, were to fake your way into getting an MMJ card, and were caught doing so, you would be prosecuted under California law, and you would probably be forced to pay a hefty fine. So don’t blame the doctors.

    Also, your teleological assumptions about how medical marijuana was a strategy to legalize recreational marijuana are amusing, if not cynical. Francis Bacon noted that teleological explanations in science are typically avoided because their validity is beyond the ability of human perception and understanding to judge. In this case, like some conspiracy freak, you and other prohibitionists automatically presume that decades ago a marijuana expert like Ed Rosenthal invented the whole medical marijuana scheme. Actually, Ed was just making a prescient observation early on. He was noting that the medical attention being paid to marijuana would increase understanding of the drug in ways that would probably exonerate its recreational use. That’s not the fault of marijuana conspirators, but science. Blame the scientists.

    BTW, as a point of experimentation, try carrying out a real conspiracy sometime, Mark; see how far you get.

    1. My single anecdote regarding mm in CA: A friend of mine who lives in SF went to a doc (not his regular doc!) and said he was having trouble sleeping. The weed he acquired as a result of that doc-patient was excellent, I must say. Is my friend ill? No. Do I think this scenario is unique? No. Does it bother me? No.

      Fortunately the substance in question can be procured from a weed whose seeds are readily available.
      I say, skip the middleman/medical establishment/government regulation.

      1. Sleep disorders can be a serious problem, sometimes leading to other illnesses. People do seek real treatment for it. Michael Jackson is a good example, whereby his doctor helped kill him with an OD of propafol.

        By contrast, a friend of mine told her Kaiser Permentente psychiatrist of her sleep problem, and the ability of marijuana to help her doze off. Her doctor’s advice: “Buy a kilo.”

        1. My Kaiser Permanente ophthalmologist wrote my rec 12 years ago after observing the 25% reduction in my IOP. I got yer “scare quotes” right here, Kleiman!

  19. Every front line Internal Medicine physician out there is on a 10/20 schedule (10m for sick visits, 20m for physicals) and that doesn’t include double bookings. 15m per patient is generous. And it’s not for an opioid. Thank you.

    1. The calculation wasn’t <15 min per visit; it was <15 min per patient per year. Surely you're not going to argue that a physician could do a history & physical, investigate the presenting complaint, make a diagnosis, determine a recommendation for cannabis (strain, preparation, means of administration, dosage, frequency), and communicate that to the patient, all in less than 15 minutes? And that doesn't even take into account follow-up visits, or any patients who aren't being given cannabis cards. I'm puzzled that anyone should want to pretend that this doc isn't way over the line.

      1. As I noted above–physicians routinely (have a nurse do) a history and physical, investigate a complaint, make a diagnosis, determine a recommendation for drugs with significant side effects, write a prescription, and communicate it to the patient in 15 minutes of actual physician time with the patient. That was the case when I got my first prescription for an SSRI–re-prescriptions haven’t taken even that much; it’s certainly been the case for children’ pediatrician visits that get an antibiotic.

        I think that this doctor is probably over-prescribing; however, if marijuana is being prescribed with the idea that it has about the same risk/benefit trade-off as an SSRI (which I would dispute, but many medical marijuana advocates would claim), this seems to me about in line with the way SSRI’s (the anti-depressant family with Zoloft, Prozac, Celexa, etc) are prescribed.

      2. Keep in mind, of course, that this is the same routine for pretty much every prescribed or recommended drug in common use.

        For example, I have a script for methylphenidate 5mg. My recommended daily dosage is 45mg in all. Methylphenidate is a powerful stimulant which, I have heard, is popular among some groups for recreational or off label uses. The street value is likely far higher than my meager co-pay for literally hundreds of pills.

        My prescriber and I had -maybe- a ten minute conversation about it, history in hand. And I am left to modulate my dose as needed based on my experience with it.

        Seeing as I am still here and functioning well, I am led to believe that that’s plenty of time to give instructions on something that can’t kill you.

      3. “Surely you’re not going to argue that a physician could do a history & physical”

        I honestly can’t recall the last time I had an actual physician do a history and physical on me. I think it was some time back in the 1970s. Nurse practitioners do that these days, then the actual doctor swoops in for a few minutes of face time so they can bill you. I’ve literally had doctor’s visits where I saw the physician for under 60 seconds on the clock.

        So that’s somewhat of an unrealistic demand.

        1. My wife is on six medications prescribed by her “primary care physician” (it’s “scare-quote” day), who she has seen only once in the last seven years. Medical malpractice? Maybe, but it’s more common that the Kleimans of the world seem to think.

      4. Those times are perfectly consistent with what I saw doctors self-report on medical malpractice insurance applications. Let’s note, of course, that higher patient loads often mean higher medical malpractice insurance premiums so there was at least some incentive to under-report. For lots of specialties the numbers were even higher.

        What should the standards be? As near as I can tell, the state medical boards set that, and the vast majority of the mmj docs seem to be sailing without any problems.

        So what’s your complaint? The state medical boards are ignoring the biggest problem on their plate, or what? If that’s your complaint, then write them an angry letter.

        But I don’t even think that you can clearly and objectively define what standards you would use for determining who deserves not to be prosecuted for using medical marijuana and who doesn’t. You said that the legal system should respect the doctor-patient relationship. That’s fine. I am good with that. But that automatically means that it is none of your business and you wouldn’t have a legitimate complaint in any case.

  20. You know, there may be another reason that so few doctors are recommending cannabis for so many patients. Having had CONSIDERABLE experience with HMO’s, and having done my own my insurance and medicare billing I can tell you one of those reasons. If you are a doctor at an HMO and you recommend medical cannabis, you do so at the direct peril of your job. The HMO’s review their doctor’s practices regularly, and the insurance companies don’t like medical cannabis. They risk being removed from “approved providers” lists, and can find themselves unable to get reimbursed without warning. The only doctors who are safe are those that do not belong to a healthcare maintenance network, and accept no insurance. Not many of those to go around. Another reason springs immediately to mind. You also need to consider the scrutiny that people with prescriptive powers receive from the DEA. These doctors can risk losing their ability to prescribe opiates for pain if the DEA deems their practice “irregular”.
    In this case, I’d argue what those statistics represent is circumstantial, and wholly due to marijuana’s illegal status and the taboos still attendant to it.

  21. I’m sorry, but I just don’t seem able to care about this. If one could point to a rise in addicts, crime, car accidents or lung cancer cases, then I might be able to summon some outrage. If not, we have a lot of bigger problems. (Now, insurers pressuring doctors to deny patients access to drugs that help them??? *That* I can get mad about in a jiffy. That should be illegal.)

    And while cynicism and dishonesty are bad things, they really *don’t* compare to our massively bleeped-up justice system. And who was cynical first, the politicians or the voters? Who is more to blame? From whom should we expect most?

    Bottom line is, most voters no longer give a hooey about pot. They might care if a new pot shop down the street is badly managed and leads to crime, but that’s hardly inevitable or the same thing.

  22. Still, the whole deal – and especially the role of the “kush docs” – makes me a little sick to my stomach.

    I think you need to be careful about distorting your own views based on your distate for certain types of people. Drug warriors do this with hippies, and you seem to do this with people who make money selling or providing intoxication to people. There’s nothing dishonorable about selling recreational drugs. It’s a valid service just like any other.

    The reason I say this is I think your same distaste for doctors who see nothing wrong with their patients getting high and want to facilitate it seeps into your desire for a noncommercial legal marijuana market. You don’t like people who make money off intoxicating the public. But that isn’t the same as saying it is bad policy for people to make money intoxicating the public.

    1. A physician who writes a “medical recommendation” without any attempt to diagnose or treat an actual malady isn’t practicing medicine, but committing fraud. I disapprove of fraud. How about you?

      1. But even this “problem” Mark, is caused more by Prohibition than anything else. Here in Oregon we have a fine man, s very senior gentleman, a former pharmacist and WWII veteran named Phil Leveque. Many accused Dr leveque of this same thing. But from the patients’ perspective, the man was a hero. Dr Leveque was not committing fraud. As a pharmacist his knowledge of cannabis is what convinced him that more people need safe access to the plant. He continues to be a vocal proponent of using cannabis in treating PTSD. (just added as a qualifying condition in Oregon’s OMMP)(both houses of the Oregon legislature have also passed HB 3460, a bill authorizing and regulating the establishment of medical cannabis dispensaries.

        And because these alleged acts of fraud are caused by Prohibition, it leads to an interesting question – is such a fraud truly a fraud if it is perpetrated against that which is itself a true and acknowledged fraud?

        Fortunately that which passes between a physician and patient is supposed to be private and protected under HIPAA.

        1. I just have to add, if the recommending physician WERE to re-order all the diagnostic tests and ancillary office visits for a full diagnosis, he would be an “Out of network” provider, and the patient would be fully responsible for all costs associated with that testing. So you just raised the cost of accessing needed medicine into potentially hundreds of thousands of dollars. Hardly fair to ask that of patients already strapped to the gills with medical expenses, don’t you think “Doctor” ?

      2. The diagnostics are left to the attending physician. The records are reviewed by the recommending physician, and the letter is issued on the basis of the attending physician’s judgment. You would have the recommending physician re-order all the testing, labs, second opinions, and specialist visits?? Are you just ignorant of the way medicine works or are you SO married to your opinion that the facts don’t matter at all?

      3. I disapprove of a system that requires an adult to get a permission slip to buy a plant.

        As a brilliant man once said, “The ultimate result of shielding men from the effects of folly, is to fill the world with fools.”

      4. It’s only “fraud” in the same sense that a cop who witnesses you committing a minor offense and decides not to write a ticket and jack up your insurance rates is committing fraud. It’s basically a harmless subterfuge of an overly harsh law.

        I doubt you condemn all lying equally severely. Nobody does. (We had this public discussion during the Clinton/Lewinsky scandal.) Have a nice legal marijuana market with buyers and sellers, and doctors wouldn’t have to do this.

        It’s just not a big deal. Recreational marijuana users get their intoxicant, serious medical users also get their medication, doctors make some money, and nobody gets hurt. Whereas if everyone obeyed the law to the letter, the first two things would not happen and to the extent they did, drug dealers and organized crime, rather than doctors, would get the profit. A little bit of “fraud” is certainly worth the trade-off (until we have a legal marijuana market).

      5. Fraud must be proved by showing that the defendant’s actions involved five separate elements: (1) a false statement of a material fact,(2) knowledge on the part of the defendant that the statement is untrue, (3) intent on the part of the defendant to deceive the alleged victim, (4) justifiable reliance by the alleged victim on the statement, and (5) injury to the alleged victim as a result.

        Now, for the sake of argument, Mark, let’s assume that everything you said was correct. Let’s assume that:
        1) you actually know some significant statistical percentage of these patients
        2) you have access to their medical records
        3) you have the expertise to understand those medical records
        4) you have the ability to tell what pain these people are really feeling, as opposed to what they are just telling you.
        5) your medical judgment is better than all of those doctors.
        6) You could even objectively and accurately define the difference between “medical” and “non-medical” so clearly that any random jury of twelve peers would decide every case the same way.

        Now, giving you the benefit of the doubt on all of that, let’s start with Item 5 in the list of requirements for “fraud”. Who is the victim and what is the injury?

  23. Man, Kleiman’s got a point! It’s a travesty when people take advantage of the semi legal medical marijuana system so they can have semi legal access to the highly non physically addictive overdose free plant known as the cannabis. If only there was some way to reduce the misuse of the medical system while simultaneously reducing the illegal market and the plant’s availability to children. Some sort of way to regulate who can get what and why. If only someone could figure out this missing puzzle piece that would detour those evil scammers who are exploiting the medical system by offering them some sort of alternative means of obtaining it in a non illegal way that would also increase revenues to prevention and treatment programs. That’d be something wouldn’t it? If only.

    Well, guess we’ll all just have to sit around writing silly articles that whine about inferred problems from statistics but offer no solutions till some genius discovers this elusive needle in the proverbial hay stack.

    1. oh, you… silly Jules.

      I mean it’s not like the plant was ever legal or has ever played an important role in history.

      Where, oh WHERE is that needle!

  24. Huh. I don’t feel too bad about putting “expert” in scare quotes – along with “Justice” (as in The Department of “Justice”), now.

    Note: nary a mention of jail or prison (never mind that silly jail and arrest stuff folks) – but a big “expert” play-up of scary “medical” marijuana.

    And nary a mention of US Patent 6630507 “Cannabinoids as antioxidants and neuroprotectants”(held by, “The United States of America, as represented by the Department of Health and Human Services.”)

    So, cannabis is “medicine” no matter what court-groomed “experts” say to please their government pay-check signers. The hypocrisy of US Government functionaries and mouthpieces is considerable.

    Jail. Prison. Arrests. When you hear some government-paid policy “expert” begin to get weaselly on you when you ask straightforward questions about jailing people for pot: watch out.

    Jailing people for pot is the whole point (when you follow the money) and so prohibitionists are loathe to admit it.

  25. Mr. Kleiman. You have to admit that medical marijuana is the best thing in the world for veterans suffering from various health issues, be it pain, infections, PTSD, TBI and or keeping them away from dangerous narcotics like alcohol and pain pills. Had it not been for marijuana, I assume I’d still have sand in my lungs or at least kept it in there longer than just a half year (which could have done God knows what further damage). When inhaling the medicine, I noticed that my coughing became very deep and when I observed my sputum after it dried up, low and behold, tinny grains of sand from all those storms. It was also good at reintroducing me back into the folds of American society and civilians.

    Wouldn’t the doctors having so many patients in places like Colorado not be a good thing for veterans in physical and emotional pain . . . for the sake of at least finding a doctor who was willing? Wouldn’t this also be good for the spouses of Veterans who likewise need medical marijuana to cope with their spouse’s difficult transitions back into normal life? And using medical marijuana as a gateway to legalization is a good thing because it’s the U.S. saying we no longer approve the rights of terrorists to use drug money . . . and legal pot will be the gateway to total drug legalization in a few decades, which again is a victory for mankind and a society that no longer wants to waste so much money, troops and years fighting foreign enemies or local gangs and cartels who have drug money -enough drug money to keep America at war for over 12yrs. Remember Mr. K, our nation was spending $2 billion dollars a week fighting the War on Drug Money when Iraq was open for business. You should be proud of all this, regardless of how it comes about and if all these prescriptions are normalizing what was once illegally illegal.

  26. The fact that Cannabis is more restricted than tobacco is atrocious. If it makes you feel better, that is medical efficacy– period. Why should Cannabis be required to pass ANY FDA approval hurdles to escape its absurd “Schedule I” status that TOBACCO is not required to pass? Hmmm-m-m-m?

  27. Mark needs either a math lesson or one in ethics. The CO MMJ law was passed in 2000. The 8400 number was “as of October 2012”, but Mark’s math assumes all 8400 recommendations were made in a single year. Over the 12 year history of Colorado MMJ the per-patient time comes to almost 3 hours according to Mark’s formula.

    1. … Or I need to read up on CO MMJ policy. I didn’t find it in the report Mark linked to, but upon further investigation at the state’s website, I learned that the MMJ card must be renewed annually which requires recertification by the doctor, which apparently involves a physical exam. Mark’s math is fine and I need to re-examine the ethics of snarking away before gathering all the facts.

  28. 15 minutes per patient???! What, no one here has Kaiser? I wonder how the patients got more than 10 minutes with a doctor.

    I don’t know much about Colorado’s law, but in California it’s important to note that the law that authorizes medical use of marijuana said it can be for any illness which marijuana provides relief. That’s pretty much anything. In fact, a direct quote from the ballot initiative is, “This could include stress, headaches, upset stomach, insomnia, a stiff neck . . . or just about anything.” And if I am reading the author of that argument correctly, it was JAMES P. FOX, President, California District Attorneys Association. Seems he should know the law, and if so, the law is being followed as written.

  29. Anyone who thinks that brain-washing doesn’t work should read the facts about how cannabis became prohibited. This also, will illuminate how religion gets handed down from generation to generation and is usually never resisted by the brain-washed individual. If a person had to be 21 before he/she ever heard of religion, the fairy tales would be reduced by 90 percent within 1 or 2 additional generations.

  30. “Do the arithmetic on 8400 patients for one physician. Assume a 50 40-hour workweeks and zero time spent on administrative tasks. That’s a little bit less than 15 minutes per customer. Medical practice? No. Just dope dealing.”

    Well, Mark, I worked for a medical malpractice insurance company once, and even wrote a version of the medical malpractice insurance policy that became the industry standard for a while. During the course of that project, I had to research what kind of patient loads doctors usually handle. Too many patients was one of the risk factors for medical malpractice claims.

    I have news for you, Mark. That kind of patient load is pretty typical for lots of doctors. If you are basing your medical judgments on these kinds of statistics then your argument went south before it even started.

    Oddly enough, despite their supposed large patient loads, these medical marijuana doctors don’t seem to suffer any of the medical malpractice lawsuit problems that occur with other types of doctors with similar patient loads. Imagine that.

  31. “Three percent of all the adults in Colorado have “red cards.””

    So, tell us Mark. What should the proper percentage be? Please give us your full medical and scientific formula for how you determined that.

  32. Hey Mark, let’s see if we can agree on the major points here.

    1) You have no way of determining what the proper numbers of mmj patients should be.
    2) You have no actual knowledge of the conditions of any of these people.
    3) You wouldn’t be able to determine who needed mmj and who didn’t, even if you did have access to their medical records.
    4) You don’t live any of these people’s lives and, in fact, it is really none of your business what they do privately.
    5) Even if Johnny Pothead scams the system and smokes a joint that he claims is “medical” but really isn’t, it isn’t going to change your day.
    6) Your own recommendation that the law must respect the doctor means this is none of your business, anyway.
    7) These articles really sound good and scary, but would be more convincing if we had a few tales of kids turned into bats.
    8) There is no productive purpose in punishing someone who has done nothing more than use some cannabis, even if you don’t agree with their choice of medicine, and even if you don’t agree they are sick.

    So remind me again. What exactly is your complaint? The sky is falling again?

  33. I am having a hard time understanding why you would be upset about “Kush Docs” when the US Government through the Department of Health and Human Services was granted a patent on cannabinoids for oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases (US Patent 6,630,507 Cannabinoids as Antioxidants and Neuroprotectants).

    And as I am sure you are aware, the Federal Government shut down new applications for the Compassionate Drug program through the University of Mississippi, so only 4 patients in the USA get it through legal channels.

    How many people in this country have AIDS, cancer, epilespy and all the other conditions that are currently listed under state laws are not getting this medicine?

    Now how many more could benefit from the oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases?

    If this plant can be used for anti-aging, why are we dickering around with forcing doctors to limit it’s use based on nothing more than politics? In fact, why are we inserting politics in this to begin with?

    “Still, the whole deal – and especially the role of the “kush docs” – makes me a little sick to my stomach.”

    Well guess what…cannabis works wonders for that, too! Give me some time and I’ll find you a patent on that as well!

    1. That’s all well and good, but according to Kleiman, they should be sick enough to suit his standards, whatever the medicine may be. He hasn’t been able to explain what “sick enough” means to him, or why anyone should be liable for punishment even if they don’t meet his arbitrary, undefined standard, or a lot of other stuff, but never mind that. This is a “moral” issue, so we don’t need to explain anything. We are outraged! IT’S FRAUD, I TELL YOU!

  34. typo…

    “Now how many more could benefit from the oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases?”

    Should read

    “Now how many more could benefit from cannabis use for the oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases?”

  35. Mark needs to spend some time pondering the work of Dr. Tom O’Connell. It should have been obvious to everyone, circa 1996, that there is a real problem with the definition of “medical use” of anything.

    What exactly does “medical use” mean? How bad does the pain and suffering have to be? How do you even measure pain and suffering except to ask the patient? There is no good objective way to tell how much pain and suffering anyone is feeling. Each person reacts to pain differently. Injuries which may really bother one person may be laughed off by another person. There is no pain and suffering meter that you can hook up to a person and get a definitive numerical reading.

    So how do you tell how much pain and suffering a person has? You have to ask them. Likewise, what works to relieve that pain? You have to ask the patient. If that is the case, then it is, in fact, the patient who determines what is a “medical use” of anything. Take headaches for example. If you feel a headache, nobody can tell how bad that headache is but you. At some point you decide that it is bad enough to make a trip to the doctor and ask for something to relieve it. You put on a suitably sad story in front of the doctor, he thumps you on the chest a couple of times, and you go home with your medicine. The patient is the one who decided to make the trip to the doctor. Presumably, if someone is going to the time, trouble, and expense of going to a doctor, there must be some kind of real reason.

    Mark Kleiman contends that the real reason is that a lot of these people are just having fun, and it is not “medical” at all. The first problem with his assumption is that whether something is “medical” is not his call at all. The law is pretty clear on this, from HIPAA to court rulings and back again. Neither is there any real effect on his life if Johnny Pothead smokes a “medical” joint. But outrage is fun, so let’s get outraged about something.

    But his thesis is possible. We have to grant that. That is, until you get into what Dr. Tom O’Connell found. Dr. Tom issued thousands of medical marijuana recommendations and he became curious about what he was seeing. Being scientifically trained, he began to wonder what really did drive all these people to seek medical marijuana recommendations. What was really going on?

    So he collected detailed histories on more than 4,000 people who had come in for medical marijuana recommendations. He found some interesting patterns. Demographically, they were pretty typical of the cross-section of society. Occupation, education, income, etc. were all pretty close to what you would expect to see in national averages. Patients ranged from the lowest economic categories to Silicon Valley executives. Gender was about two-thirds male, one-third female, and they were about equally divided between under 30 and over 30. They all had medical problems for which marijuana might be appropriate, but many of them had been smoking marijuana for a long time before they came down with the condition.

    As far as the medical conditions they reported, there was an interesting difference between men and women. Women were far more likely to report anxiety-related issues as the reason for their marijuana use. Marijuana is an excellent anxiolytic, and quite safe.

    Examining the life histories of the males, Dr. Tom found that they often had absent natural fathers, or bad relationships with the natural father in childhood. They had high rates of early diagnoses with anxiety-related disorders such as ADD, ADHD, PTSD, etc. They had high rates of early drug use, usually starting with alcohol and tobacco. They had high rates of poly-drug use and were more likely to have used offbeat illegal drugs such as LSD, etc. Many of them reported early binging and blackouts, as well as high rates of hard drug use in general, including real addiction.

    The lesson here seems fairly simple — hard drug abuse is driven by anxiety-related disorders. Give people a hard childhood and they might want to take something to deal with the long-term stress. Duh. Same reason some people go to the doctor and get a prescription for Valium or Xanax. They may not have a visible broken leg, but something hurts.

    The interesting part is that when these people took up the regular use of “medical” marijuana, 90 percent of them greatly reduced their use of hard drugs and ten percent quit completely. Marijuana gave them the anxiety relief they were seeking without screwing them up so badly that they couldn’t function. Dr. Tom found a number of former alcoholics, who directly credited their recovery to the anxiety relief provided by marijuana. If marijuana can stop alcoholism, that would seem to me to qualify as “medical”.

    So when does anxiety become “medical” in the general sense – apart from “medical” marijuana? It becomes “medical” when the patient goes to the doctor and asks for something to deal with it. Mark Kleiman may think that they are just getting the Xanax because Xanax is fun, but the decision is made by the patient, not Mark Kleiman. As Dr. Tom reasons (based on research), if the patient went to all that time, trouble, and expense to actually go to the doctor, then the reason is probably bigger than “fun.” After all, it isn’t like marijuana isn’t available without the recommendation. If they get the recommendation then that means that they want to get marijuana on a very regular basis. That’s a different level of motivation than “let’s have some fun Saturday night.”

    So when does marijuana use become “medical”? Dr. Tom’s conclusion is that marijuana use becomes “medical” the first time someone buys it for themselves. If someone has reached the level where they have spent their own money for it — as opposed to just sharing what their friends pass around — then they have satisfied the criteria of “medical”.

    But, of course, nobody likes that conclusion. Mark Kleiman would object to it because it offends his moral code. Nobody is quite sure about why Mark is so morally offended by the actions of people he doesn’t even know, but no matter. He knows what offends him whether he could really explain it or not.

    Pot smokers don’t like it, either, because that implies that they are somehow sick in the head a little bit. That’s not a very manly thing to admit. Better to make up a story about how you put one over on the pot doc by claiming that your hangnail was killing you.

    It also brings up another real problem. Does the same principle apply to alcohol and other drugs?

    In any event, you can stop any of these arguments dead in their tracks if you just ask the wailing party to explain exactly what they mean by “medical” versus “recreational.” Give us the clear, objective, unquestionable criteria that you would use to separate the “real” sick people from the mere stoners. Invariably, you will find that they can’t do it, because they never really thought it through.

    Not that it was any of their business, anyway. Why should they care if the only reason the doctor issued the rec was to save a stoner from the bad health effects of the criminal justice system? Mark should be praising these doctors for saving tax dollars.

  36. BTW, Mark, Dr. Tom found that his results were so clear on the fact that marijuana could reduce alcohol and other hard drug abuse that he suggested trials with homeless alcoholics to see if marijuana would help with some of them. He was quite sure that some charitable marijuana provider could be found, assuming there was some way to get it through the governmental process.

  37. I believe Professor Kleiman is right, maybe 99% of “medical marijuana” is a fraud. What do we do with the 1% that is not. Creating a fraudulent industry off of those with AIDS, CANCER, serious Neurological diseases goes down a path to a moral wasteland.

    I enjoy the fact that Professor Kleiman refers to the medical ” marijuana industry” as and “illegal market” when everyone else seems to refer to it as a Black Market.

    The sophistication of the Professor argument were best summarized in a piece he wrote about, THC testing and Purple Erkle.

    The professor volatility truly makes him a vetted marijuana warrior.

    1. “I believe Professor Kleiman is right, maybe 99% of “medical marijuana” is a fraud.”

      And, just like Kleiman:

      1) You don’t know any significant statistical portion of these people.
      2) you have no actual stats on which to base your bigotry.
      3) You have no access to their medical records
      4) You don’t have the medical knowledge to understand their records, even if you did have access to them.
      5) It is really none of your business, both my law and by basic standards of morality
      6) Kleiman’s own recommendation that the law must respect the doctor’s opinion automatically means that your opinion is absolutely worthless by comparison. In short, if the doctor said it, and that is the law, then your opinion is nothing but hot air.
      7) You couldn’t even accurately describe the difference between “medical” and “recreational”. You can’t tell who is a faker and who isn’t.
      etc., etc., etc.

      But thanks for demonstrating the bigotry that really drives this issue. Kleiman didn’t make it as clear as you did.

      As for “fraud” — Fraud requires five specific elements (see above where they are already posted). Let’s start with the simplest one. “Fraud” requires a “victim” and an “injury” to that victim. Who is the victim and what is the injury?

      Kleiman can’t answer that question. I am guessing you can’t, either.

      ” What do we do with the 1% that is not.”

      Professor Kleiman should be jumping in right now to ask where you got that 1% figure. Which study was that?

      ” Creating a fraudulent industry off of those with AIDS, CANCER, serious Neurological diseases goes down a path to a moral wasteland.”

      Oooooh Goooody!!!!!! We have a mindless crusade. Never mind that it was none of your business and you had no dog in the fight, anyway. Rational thinking would only be stupid at this point.

      But I will have to ask you how this is in any way connected to “morality.” The idea is that, if someone is sick enough to suit you, and they smoke a joint, then they ought to be dragged through the criminal justice system, with all of its ill effects on health. How is that “moral” in your world?

      “I enjoy the fact that Professor Kleiman refers to the medical ” marijuana industry” as and “illegal market” when everyone else seems to refer to it as a Black Market.”

      Holy 2007, Batman! You are late to the party!

      “The sophistication of the Professor argument were best summarized in a piece he wrote about, THC testing and Purple Erkle.”

      Professor Kleiman could show his sophistication by simply explaining how he separates the “frauds” from the “real” medical marijuana people. That’s the crux of his article — that there are “frauds” and, therefore, he has some method of telling who they are. When exactly is someone sick enough to satisfy his requirements, and how does he determine that?

      If he can’t do that, then it seems his argument isn’t based on any better statistics than your claims. But thanks for demonstrating what it is really about — preconceived notions based on nothing because it feels good to be morally outraged about something, even if you are not sure what the outrage actually is.

    2. “The idea is that, if someone is sick enough to suit you, and they smoke a joint, then they ought to be dragged through the criminal justice system, with all of its ill effects on health.”

      Sorry, left out a word. That should read “if someone is NOT sick enough to suit you.”

      You know, as if you had the deciding hand in this world about who was sick enough to deserve one kind of medicine versus another, and that you are the ultimate moral authority on which chemicals are moral and which ones aren’t. The idea being that, if they are not sick enough to suit you then they should be dragged into a jail which may be full of tuberculosis because that is the proper public health response to this problem.

  38. There is yet another reason why ANY medical marijuana recommendation for any adult should be considered 100% bona fide “medical”. It operates as a vaccine.

    The doctor may be faced with a patient who, to the doctor, is obviously just a stoner who wants to get easily blitzed on Saturday night. The doctor has two choices — issue the recommendation, or don’t issue it.

    If Doc issues the recommendation, the only real effect is that the stoner has now become exempt from arrest for weed. The stoner may now smoke his joint without fear (theoretically) that the SWAT team will be crashing down his door to haul him off to the pokey.

    On the other hand, Doc may refuse to issue the recommendation because it offends him, because the Doc agrees with Mark Kleiman — getting a recommendation just to get “high” is WRONG. In that case, the stoner is still subject to arrest, possible imprisonment, loss of employment, big legal expenses, etc. — none of which are particularly healthy for anyone. In fact, if you want to catch tuberculosis or hepatitis in the modern US, jail is the best place to go. That’s not to mention all the other good diseases you could catch and things that could happen to you with even some short adventures in Punishment Land.

    Any rational doctor should be able to figure out that the negative health effects of the criminal justice system are potentially far worse than the effects of marijuana. The doctor may disagree with the patient’s “morality” but still decide that the better course of care is to keep this person out of the criminal justice system until they can improve their habits in a far less destructive manner than the legal system provides.

    The recommendation then becomes a kind of vaccine against worse effects. If the Doc doesn’t issue it, then the patient potentially winds up in a TB pit. I can understand the “moral” argument somewhat, but is that the result the Doc wanted to achieve?

    It seems to me that there is an equally valid argument that refusing to issue any mmj recommendation to an adult would be immoral, for the same reason that refusing to give vaccines to a patient would be immoral.

    Not that anyone making the “fraud” complaint can even accurately define what they are complaining about, anyway . . . . . .

  39. I don't disagree with you that the medical marijuana system as practiced in some western states is far from perfect and in fact contains a component just as you say it does: a means of normalizing consumption of a substance unjustly demonized for a century and paving the way for full national legalization for those who chose cannabis as their intoxicant or their medicine.

    I am a 215 recommendation holder who has seen the same two doctors for 15 years, usually for an appointment that takes about 30 minutes, a good part of which is spent in chitchat about how to use or recent advances in cannabis medicine. It's not such a bad deal for the $150 bucks I pay out of pocket when I compare it to the doctor who did my cochlear implant surgery. When I look at my insurance statement I am shocked to see that she (UCSF actually) charged my insurance nearly $900 for a 6 month followup visit which took less than 10 minutes and that I had to drive 440 miles round trip to San Francisco to attend—everything that happened in that room could have been handled with an email. I have California Covered Care which means the taxpayers subsidized that bill. I'm not at all ungrateful for the medical procedures I received because they gave me my life back after late life deafness, but the healthcare system in this country is definitely broken and some people are getting very rich off of it.

    So with that perspective, the dishonesty of the medical marijuana recommendation system in California and elsewhere seems relatively harmless. If some recreational grower wants to shield his operation with a 215 recommendation I understand and forgive him for his deception. If it keeps him out of the criminal justice system that's a big win for the taxpayers.

    I think voters' memories are overridden by an expectation that both sides of an issue are going to overstate their positions, or just plain lie to us. Or maybe it's that most voters vote their wallets over abstract ideologies because an important part of every voter guide that hits our mailboxes is devoted to analysis of what the proposition is going to cost us in dollars. If voters have any long term memory at all they will remember if something winds up costing us more than what it was billed as such as the 1994 Three Strikes Initiative which lead to costly prison overcrowding, a SCOTUS judgment against the state, which led to Prison Realignment and another voter initiative in 2012 to attempt to remedy our costly mistakes.

    As for "kush docs" making someone feel ill at ease, try considering the docs who over prescribe opiate painkillers. We now have over 2 million Americans with serious substance abuse health issues caused by the 207 million legal prescriptions issued by doctors (2013 NIH report ) or the 44 people who die every day from overdosing on legal opiates.(CDC website) Now that is truly something to be upset over.

  40. When I first went in for my card, the Dominican doctor was delighted that I actually suffered from gout. He chuckled, "oh, a REAL patient with a REAL problem." He signed my scrip immediately, but then wouldn't let me leave. "By law we must consult for a minimum of 10 – 15 minutes". So we chatted about Haiti and the DR for 11 minutes, and then I left. He told me that he signs up about 90 percent of the kids who want to get high with a diagnosis of "chronic pain — they fell on the slopes three days ago, they say their wrist still hurts a little, so that's pain for more than 3 days, which I can legally call chronic (no pun intended)".

    I also know a large grower and owner of several dispensaries who put ads in the paper looking for patients with gout or rheumatism, for whom the doctors visiting every other Saturday would prescribe ointments, which require way more plants to produce, so one gout patient could generate a green light for 75 plants rather than 4, and his grow would produce accordingly.

    It's a game, that has nothing to do with medicine, and is just an end-around run past the 21st Amendment. I blame neither the growers, dispensers, nor doctors. Colorado could and did finally make it legal, and the gamesmanship was among politicians and law enforcement. Everybody else was behaving as rational economic agents.

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