Medical Marijuana: Health Risks Medical Marijuana: Health Risks and Benefits in California and Benefits in California

San Francisco San Francisco NORML Conference NORML Conference

April 19, 2002April 19, 2002

Tod H. Mikuriya, M.D., President

Marijuana and Health Marijuana and Health Risks and BenefitsRisks and Benefits

for California Physiciansfor California Physicians• Federal Threats & Actions

• State Harassment– Medical Board

• County DA’s

• Sheriffs & Police

• Organized, corporate, and individual medicine

• Marginalization and stigmatization

– Exclusion from conferences• “Advocacy = undesired bias

– “Abortion doctor”• “Mill doctor”

– Censorship from publications

• Intellectual challenge, clinical experience with patients, expanding upon medical intelligence prior to removal from clinical availability.

• Continuing experiences of confidence and trust of patients.

• Freedom from managed care• Opportunities to optimize

management of chronic conditions and advocate for the patient.

1996 Federal Threats & Actions 1996 Federal Threats & Actions Against California PhysiciansAgainst California Physicians

• Removal of DEA Controlled Substances – Moving to take Mollie Fry, M.D.s DEA #

• Drop from Medicare – None Yet

• Federal law suits- Injunctions prevent

• IRS audits- None yet

• Termination of grants- None yet

• Actions without threat: Evolving & Covert

Benefits of medical marijuana for Benefits of medical marijuana for California PhysiciansCalifornia Physicians

• Continuing experiences of confidence and trust of patients.

• Opportunities to optimize management of chronic conditions and advocate for the patient.

• Intellectual challenge, clinical experience with patients, expanding medical intelligence prior to removal from clinical availability.

• Freedom from managed care

Patients’ Medical Marijuana Patients’ Medical Marijuana BenefitsBenefits

• Safe and effective medicine to manage chronic serious medical conditions.– Immunomodulator Analgesic– Mood and affect modulator; easement– Anti-Spasmodic anticonvulsant– Harm Reduction Substitute

• Multiple and concurrent therapeutic effects

143

16871584

1629

1310

277

39 2 1

0200

400

600800

1000

12001400

1600

1800

0 to10

11 to20

21 to30

31 to40

41 to50

51 to60

61 to70

71 to80

81 to90

91 to100

Age Distribution of PatientsN= 6573

Therapeutic Categories of Cannabis UseN = 6573

41%

27%1%

4%

0%

27%

Analgesic Immunomodulator 2709

Antispasmodic Anticonvulsant 1758

Appetite Stimulant 75

Harm Reduction Substitute 260

Hypothermogenic & Other 2

Psychotherapeutic: Antidepressant / Anxiolytic 1770

Cannabis Pharmacological SafetyCannabis Pharmacological Safety

• Free from unwanted side effects compared with “mainstream” polypharmacy and non-medical drugs- alcohol and nicotine..– Compared with opioids, steroids, NSAIDS,

sedatives, tricyclics, and benzodiazepines– Improved quality of life

• Mobility, emotional well being and control of pain

• Less money spent on drugs to control side effects

Medical Marijuana BenefitsMedical Marijuana BenefitsPsychosocialPsychosocial

• Relief from criminal status– Improved self esteem– De alienation

• Increased participation in community

– Decreased fear and paranoia

• Improved critical thinking

• Optimal coping with chronic illness

Medical Marijuana Medical RisksMedical Marijuana Medical Risks

• No pharmaceutical potency standards

• No guarantees of purity or freedom from contamination– Pesticide residues, biologic agents, or heavy

metals

• No dose consistency of oral products

Medical Marijuana RisksMedical Marijuana Risks

• Endemic Negligent Governance– Criminal Justice System

Attorney General’s Office consensus without tutelary mandate policy: Counties do their own thing

County and local absence of Training and Information Bulletins or General Orders.

Problematic prosecutorial, court, and probationExcessive discretionary powers

Subpoena abuse

Medical Marijuana RisksMedical Marijuana RisksPhysicians and Health CarePhysicians and Health Care

• Gross and pervasive non-compliance because of federal threats.

• He who pays the piper calls the tune– Medicare, MediCal federally funded– Federal academic medicine funded grants– Federal Veterans Administration Hospitals

• General fear and ignorance of physicians

A Statewide Audit is CriticalA Statewide Audit is Critical

• I propose a statewide effort to Implement the Compassionate Use Act of 1996.  

• Beyond the current federal assaults on California patients, physicians, taxpayers, and voters, unless a systematic effort is organized and motivated with adequate funding, efforts conceiving and passing propositon 215 will have gone for naught.

• Only a comprehensive audit with remedial civil remedy will ensure the will of the voters five years ago.