Dr Frank Lucido's Blog: PotShots from the Bully Pulpit
or: Everyone’s Entitled to My Opinion
The quarterly meeting of the Society of Cannabis Clinicians was held in L.A. on August 1, 2008.
It was the intention of our founder, Dr. Tod Mikuriya, to attract more physicians from Southern California by holding at least one yearly quarterly meeting in Southern California.
I saw a couple of new faces among the physicians, but nowhere near the eight new physicians who showed up in March, 2007 for our first LA meeting.
We had a good educational session with attorney Bruce Margolin discussing two recent state appellate decisions:
People v. Kelly, which overturned the cannabis and plant limits of SB 420
“up to 6 mature or 12 immature plants and up to one-half pound of dried, processed marijuana.”
People v. Windus
in which a judge opined that recommendations do not expire.
(However, the Medical Board still tells physicians they must re-evaluate the patient at least yearly, and that makes medical sense to me, especially if someone wants my medical opinion in a court of law, or better yet, wants to avoid legal issues in the first place. More on these in a future blog.)
Two recurrent problems were noted by me, which I was compelled to comment upon:
1. Dispensary representation for 2nd year in a row at our physicians meeting:
This is inappropriate even for conventional pharmacies,
(See 7/15/08 SF Chronicle op-ed piece:
"Toward purer medicine" by Robert Pearl
The op-ed is about pharmaceutical companies giving physicians gifts, but is even more inappropriate for cannabis dispensaries, since recommending one dispensary over another loses for the physician the full protection of Conant v McCaffrey and Conant v. Walters. I have good friends who runs great dispensaries. And I can’t and won’t refer patients to them for ethical and legal reasons.
As I said in my email newsletter of
July, 2007: "Blessed Are the Caregivers"
An Open Letter to Patients Groups, Dispensaries, Collectives
“I have BAD news, and I have GOOD news:
First, the bad news: I can never refer patients to you.
But the good news is: I can never refer patients to anyone else.
And this will be true of any ethical and legally responsible physician.
As tempting as it is for doctors and dispensaries to cross-refer to increase one’s business, this is illegal, and unethical, and I believe that the vast majority of dispensaries and physicians agree with this.”
I further suggest: Avoid those that DO refer: they are "DEA magnets."
What’s worse, a couple physicians were priding themselves on their association!
Illegal and unethical!
2. Also, one of the new practices was represented by a lay associate whom I had met at the NORML convention is LA last October, 2007. (And the physicians themselves were not present!)
She is a lay person who started a medical clinic. Illegal, as I told her last October.
Now she says she no longer does this, and yet, her "successful" multi-doctor clinic was founded illegally.
In California, lay people CANNOT hire physicians.
As I told the 2 non-physicians: I personally like them both, but their presence was inappropriate.
As I have said: my intention is to make MORE physicians feel comfortable making medical cannabis recommendations, safely and appropriately, not more “corporate medicine.” We have enough newbies fighting for the under 25 y/o patients who have never consulted a physician for their illness. Good luck!
I want to attract that VAST MAJORITY of legitimate patients who fear to make use of the medical cannabis laws of their own state because of the bad press and the bad business ethics of the minority of practitioners.
We have a plethora of new cannabis physician clinics being listed on CaNORML in the past three years since my physician practice standards survey of 2005.
and this year I will continue to expand my survey of physicians. Although I will keep the individual responses confidential (as I have promised the physicians who participate), I will post the qualities I would support and those I will not and will be creating a code of ethics based on my knowledge of the way medicine and medical ethics have traditionally been practiced.
To that end, I have been working with the newly formed AACM (American Academy of Cannabinoid Medicine) to create ethical national standards.
(More about AACM once we have our website up and running: soon…)
Implementation of the Compassionate Use Act in a Family Medical Practice: Seven Years Clinical Experience written with my colleague Mariavittoria Mangini, PhD, FNP
(published in the Spring, 2007 issue of O’Shaughness’s
was designed to make MORE physicians feel comfortable making safe and appropriate recommendations.
Unfortunately, some of the chains have stripped it down to a shell of its protective intention, and pretend they are practicing defensible medicine.
I will be publishing my own code of ethics which I will publish soon, and will use the “bully pulpit” to encourage the ethical cannabis community to support when recommending their own friends and relatives to a physician.
In brief: what I have found out for California at least:
-Lay partner in medical clinics
-“Steering” patients for money or other consideration
-Physicians paying for referrals
More on this soon.
The most complete listing of cannabis recommending physicians that I am aware of is California NORML's excellent website:
Unfortunately, this lists ALL the doctors who wish to be listed, even what I call the "low standard" clinics, some of whom I would recommend avoiding if you have a documented serious illness and/or care about your medical-legal health, especially anyone growing their own medicine or acting as a caregiver for a patient.
If after checking for who may be near you, feel free to email me back regarding my opinion on whether that particular doctor or clinic has good standards.
My responses could include:
"I like their practice,"
"I don't know their practice," or
I will be continuing my Survey on Medical Cannabis Practice Standards
Dr. Lucido’s Physician Survey on Medical Cannabis Practice Standards
Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
2300 Durant Avenue
Berkeley Ca 94704
510.848.0958 (by appointment only)
Dr. Frank Lucido’s blog:
“Pot Shots from the Bully Pulpit”
Bookmark it now, or subscribe to this blog for updates, otherwise you’ll only get my MedBoardWatch.com email newsletter once every few months.
Dr Frank Lucido's Blog: PotShots from the Bully Pulpit: Everyone’s Entitled to My Opinion
Medical Cannabis has been legal under state law in California since passage of the California Compassionate Use Act of 1996 ("Prop 215" or California Health & Safety Code 11362.5) under a certain conditions.
Unfortunately, it is still illegal even for legitimate patients, under Federal law (Gonzales v Raich Supreme Court case).
Physicians making appropriate recommendations, are also protected under State law, when acting appropriately.
Furthermore, physicians are also protected Federally by Conant v McCaffrey (Federal District Court) and Conant v Walters (Federal Appellate Court) as long as they do not aid and abet a patient in breaking Federal Law. On further appeal by the Federal government, the Supreme Court declined to take the case. Therefore, physicians are the ONLY ones protected all the way to the Supreme Court, as long as they do not "aid and abet" a patient in breaking Federal law.
The purpose of this blog is to discuss for patients, physicians, caregivers and other patients advocates, who, in my experience, is most protected, and under what circumstances, and to discuss to what extent the inability of the State of California to regulate cannabis (due to Federal threats and interference) has led to the "wild west" atmosphere that the newspapers love to write about (you know: "Man bites dog" will always sell more papers than "Dog bites man".)
This is my effort to "clean up Dodge". I know I am not alone in this. There are good physicians, good caregivers, and lots of sick patients. I aim to let people know how to spot the good, and avoid the others.