Medical Marijuana: Health Risks and Benefits in California San Francisco NORML Conference April 19, 2002 Tod H. Mikuriya, M.D., President

Marijuana and Health Risks and Benefits for 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.

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 Against 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

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 California 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

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 Benefits 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

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

Cannabis 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

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 Benefits Psychosocial 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

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 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

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 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 probation Excessive discretionary powers Subpoena abuse

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 probation

Excessive discretionary powers

Subpoena abuse

Medical Marijuana Risks Physicians 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

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 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.

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.