Sunday, July 27, 2008

Why Are Credible Practice Standards Important?

Dr Frank Lucido's Blog: PotShots from the Bully Pulpit
or: Everyone’s Entitled to My Opinion

Why Are Credible Practice Standards Important?
Turf issue? Or are credible standards really important?

As I have struggled with the realization in the past 4 years of an influx of low standards clinics trying to cash in on what they see as “easy money” writing recommendations, and advertising their “compassion” and “green-ness” with expensive advertising, I have attempted to articulate what the benefits of good standards are in the age of the “drug war.” Most of the ethical medical cannabis community do support those with good safe standards. Some just roll their eyes and wish I’d be silent, knowing that cannabis is one of the safest substances known.

Others agree with me: friends don't let friends drive drunk, or clothe themselves with a fig leaf when they may need a suit of armor.

My good friend, Michelle Aldrich, who has been active in cannabis law reform since the 60’s sent me an article called the “Four minute Pitch” which outlined 4 questions to ask when making your case.
1. What is my goal?
2. What needs do I meet?
3. How am I different?
4. Why should people care?

Below are the answers for my practice.
I wrote a similar version for possible use in the preamble to the newly formed AACM’s (American Academy of Cannabinoid Medicine) statement on practice standards. It was well received, and we should be announcing the group soon.

Here is the original version for my practice.
I hope this gives you an idea of what the difference is between an appropriate evaluation and a “signature.”

MEDICAL CANNABIS, A Problem with a Solution:
Safe and Appropriate Recommendations for a Safe and Effective Medicine

What is my goal?

My commitment is to encourage the highest and most defensible practice standards, giving the patient not only competent MEDICAL advice, but also competent MEDICAL-LEGAL advice to avoid legal problems and expenses due to overzealous or misguided law enforcement and/or Medical Board.

What needs does my practice meet?

Patients need honest, competent, and credible advice not only on whether their use of medical cannabis is appropriate, but also on how defensible their use is legally in the event that the patient or their doctor is targeted by overzealous law enforcement.

How is my practice different?

I take the time to give patients an honest evaluation of their medical history and medical records, along with my overall impression of how well the combination of their medical records and my own evaluation (including my experience) will serve to defend them should the need arise. I know patients need an honest appraisal of whether their medical records and/or their history are likely to be sufficient documentation to support them in any legal proceeding.

I have been performing medical-cannabis evaluations since the passage of the California Compassionate Use Act (CCUA) in 1996 and I have successfully defended patients in court. More often, I have been able to help patients avoid legal expenses by speaking with law enforcement, attorneys, employee health officers, and even judges by phone or by writing authoritative letters.

Why should patients, caregivers, and patient advocates care?

Even for patients with entirely legitimate reasons for using medical cannabis, there are still elements of law enforcement who haven’t gotten the message, and who will act inappropriately either out of ignorance or less often, intentionally.

In Summary:

Any patient with good documentation of the ongoing care of a serious illness or symptom which they medicate with cannabis should be advised to obtain a recommendation for their use of marijuana from an experienced physician with a reputation for giving the best medical-legal consultation available.

Caveat Emptor: Let the Buyer Beware:

I would strongly advise patients to avoid the quick-in, quick-out, low standard clinics. Particularly for those who grow their own medicine, using a clinic that does not do a credible and thorough evaluation of the patient’s serious illness gives the impression that:
1. You don’t have a serious illness, or
2. You don’t want to be bothered having a good defense.

My standards are designed to give patients protection while some quick-in, quick-out, low standard clinics are giving patients a fig leaf!

Don’t waste good money on a poor pseudo-defense.

Doctors are free to choose lower standards -- but at what cost to the patient’s protection?
Doctors may choose to be the next “canary in the coal mine” but shouldn’t take their patients with them.

Sincerely, in peace and health,

Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
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 email newsletter once every few months.

The “Victory” of Raich: what patients have won

Dr Frank Lucido's Blog: PotShots from the Bully Pulpit
or: Everyone’s Entitled to My Opinion

The “Victory” of Raich
Medical Cannabis Demystified:

What individual patients have won; and why some are still getting hurt
What patients need in a Recommendation

Declare Victory,
Consolidate Our Gains,
Act Cautiously and Responsibly: Best Practice Standards Likely to Be the Safest

The Victory of Raich
In spite of the unfortunate Supreme Court decision in Gonzales v. Raich, most individual medical cannabis patients have already won the larger war, at least in California. And Angel Raich and Diane Monson, two courageous patients, and patients everywhere, had everything to win, and nothing to lose in the Supreme Court. An adverse decision brings us back to the original co-existing conflict: Medical cannabis is legal under state law, and illegal under federal law.

To his credit, former California Attorney General, Bill Lockyer, stated immediately after the 6/6/05 Supreme Court ruling:
"Today's ruling does not overturn California law permitting the use of medical marijuana…Although I am disappointed in the outcome of today's decision, legitimate medical marijuana patients in California must know that state and federal laws are no different today than they were yesterday.”

And after Angel lost again on appeal in March 2007, current California Attorney General Jerry Brown concluded that state law hasn’t changed.

And in another victory, in November, 2004, even a red state, Montana, voted overwhelmingly for medical cannabis (winning by a greater margin than George Bush!). And in January, 2006, the Rhode Island legislature passed a medical cannabis law overwhelmingly despite the cruel veto of its governor. The House override vote was 59-13!

Patient Advocacy and Voter Power: Eventually, We Are All Patients
The people will also win the rest of the war, piece by piece. Politicians will catch up with the vast majority of the voters in this country who want sick patients to have access to this safe and effective medicine. Remember, we are all getting older. Even the dying Supreme Court Justice Renquist voted with the minority in our favor in Raich (along with Justices Sandra Day O’Connor and Clarence Thomas).

Even in the majority opinion against Raich and Monson, the Supreme Court said:
"The case is made difficult by respondents' strong arguments that
they will suffer irreparable harm because, despite a congressional
finding to the contrary, marijuana does have valid therapeutic

And the federal government’s own Solicitor General (when one of the Supreme Court Justices asked about what would happen to sick patients if the Court were to rule against them) downplayed “the unlikely step of bringing the prosecution in the first place.”

With the public, and even the Supreme Court, watching, the feds know their actions are being scrutinized. Already, they are forced to explain their continued raids on medical cannabis dispensaries as “not going after patients”. It is clear that the DEA cannot afford another embarrassing fiasco, such as occurred when they restrained a paraplegic woman to her bed in their outrageous raid on Wo/Men's Alliance for Medical Marijuana in Santa Cruz. (The San Jose Chief of Police was so disgusted that he stopped city cooperation with the DEA.)

DEA’s Indirect Attack on Patients: Confiscate Their Medicine, Attack Their Sources of Medicine

But while individual legitimate patients will have relative safety, the source of medicine for the majority of these sick patients is still being attacked. Almost 12 years after the passage of Prop 215, dispensaries are still being shut down, medicinal plants are uprooted, medicine is confiscated, people are put in jail, and some are serving prison sentences for growing and distributing the needed medicine.

This renewed attack comes with a shadowy collaboration between the DEA and rogue elements of local law enforcement working against the clear mandate of the people. It’s bad enough that they are working for the feds against state law while accepting state or county money, but in addition they show embarrassingly little knowledge of the law. They also have NO knowledge of medicine, and make sweepingly inaccurate or misleading statements to the press.

Battle-lines Being Drawn
DEA and Local Police Collusion: San Francisco, San Diego, Los Angeles, etc.

The “cannabis dispensary” is one place where the battle-lines are being drawn by the DEA.

The DEA has been using the Raich decision to resume their intellectually and morally bankrupt war against medical cannabis patients by proxy, by attacking dispensaries and growers of the needed medicine, especially those they can stigmatize as “profiteers” (as if that was illegal in the age of Halliburton, Big Oil and Big Pharma!)

On June 22, 2005, 16 days after the Raich decision, the DEA, with apparent collusion by SFPD, raided 3 dispensaries in San Francisco, arresting 19 people, and shutting off access for many sick patients. They justified these raids by claiming dispensaries were involved in "money laundering and international bulk cash smuggling."

And in July 2006, the District Attorney of San Diego County, also in collusion with the DEA, effectively shut down all dispensaries in San Diego. And, as could be predicted, has succeeded in hurting the sickest patients the most, forcing them to go to the black market, where safety and quality may be questionable, or do without and suffer unnecessarily.

More recently, Los Angeles Police have colluded with the DEA in attacks on dispensaries, even confiscating assets of the Berkeley Patients Group, one of the most ethical of all patient groups.

Dispensaries are being accused of “money laundering” for paying their bills from their business checking accounts (what in other businesses would be called good business practice!).

In addition, federal and/or local officials appear to have initiated investigations of doctors, in apparent violation of Federal Judges orders in Conant v. Walters.
See: DEA loses round in Denney lawsuit

The Sickest Are Hurt the Most
When safe access to medical cannabis is denied, it's the sickest who suffer the most.
The non-medical user has always known where to obtain marijuana.

Dispensaries will always serve an important function.
(See my newsletter “Blessed Are the Caregivers” at: )

It is clear that growers and dispensaries are necessary links to safe access for most patients, who are too sick to grow their own medicine. Most patients cannot grow their own medicine. It is not easy, and most don’t have a green thumb. Of course, it would be best if patients could grow their own:
They would know the source of the medicine and know their medicine is additive-free.
But patients who are sick should not have to grow their own cannabis.

I will be monitoring the situation closely for
I cannot, and do not, aid and abet patients in obtaining medical cannabis. It is already common knowledge where dispensaries are found- thanks to the publicity generated by the actions of the DEA, local law enforcement, the press, and patient advocacy groups, such as California NORML ( or the Patient ID Center (formerly known as the Oakland Cannabis Buyer’s Cooperative).

With this in mind, I believe there will different spheres of “relative safety” for those adhering to state laws.

For instance, individual legitimate patients who grow their own medicine may likely have the most “relative protection.” If they act responsibly, have good documentation, and grow reasonable quantities for themselves they will likely have the most safety from the federal government. Caregivers who grow for a few patients may also be somewhat protected, although less so the more medicine that is grown.


I am not an attorney.
Most of the following is my opinion based on my 38 years in medicine, and over 12 years of medical-legal consulting as an expert witness- both in malpractice cases, and as a medical cannabis consultant.
When I make my comments regarding “safety” or “protection," this will necessarily mean “relative safety” or “relative protection.”

What follows is my vision of the hierarchy of “relative protection” possible for the various participants in the California Compassionate Use Act of 1996 (Prop 215) or California Health and Safety Code 11362.5, based on risks from a combination of federal law and state law.

Doctors are uniquely protected from federal threat when making appropriate recommendations, all the way to the Supreme Court, by Conant V. Walters,
as long as they do not aid and abet a patient in obtaining cannabis.
Legitimate patients should avoid doctors who cross this line. (More on this in future postings).
( for text of Conant v. Walters, and:
for commentary on what physicians CAN and CANNOT do.)

My 2005 survey on physicians practice standards can be found at:

Individual patients who grow a few plants are unlikely to be bothered by the Federal government, if one can believe the Solicitor General’s statement to the Supreme Court on November 29, 2004.

Smaller scale grower/caregiver collectives who have a limited number of patients and who make little or no money are less likely to be federal targets.
These will be, by definition, the most altruistic, and will, like WAMM (Wo/Men’s Alliance for Medical Marijuana, ), be another embarrassing target for the DEA to bust.

LEAST PROTECTED: Dispensaries and Growers
As I mentioned above, collectives, growers, and dispensaries are necessary links to safe access for most patients, who are either too sick to grow their own medicine, or who don’t have the “green thumb” skills necessary.

The source of patients medicine, growers and dispensaries, is one area where the battle-lines are being drawn. Least protected will be the larger dispensaries/growers, those most visible, and those with the loosest standards or business ethics. Those who can be easily accused of “profiteering,” whether true or not, are perhaps the most vulnerable.

Expect more DEA collusion with local law enforcement
I am closely following the situation of local law enforcement’s shameful collusion with the DEA when dispensaries are raided. It is clear that these are “rogue” actors who are abrogating their responsibility to follow state and local law.
As former California Attorney General Bill Lockyer stated: "both generally and in the specific context of interpreting the Compassionate Use Act -- it is not the province of state courts to enforce federal laws."

Solidify Our Gains
While this battle plays out between the DEA and the dispensaries, my advice is to solidify our gains. We must support the most protective standards for patients and their caregivers, and doctors, to feel safe under state law.

Since the free market in a capitalistic system, whether legal or illegal, will attract a wide spectrum of ethics and business standards, we will occasionally see some pretty low standards. And almost ALL of reported “problems” are not a problem of cannabis as a medicine, but are invariably related to the drug laws and the unwillingness of the federal government to allow the state to regulate cannabis as an agricultural and medical product.

One thing worse than capitalism: unregulated capitalism, or “unbridaled capitalism."

Act Cautiously and Responsibly:
Best Practice Standards Likely to Be the Safest
I suggest that patients be cautious of who they associate with, whether that be a dispensary or a doctor.

Many Questions, A Few Answers

What is the ethical behavior?
How important is this?
What should one look for in a doctor?
Aren’t all doctors alike?
How important is credibility?
Who reviews standards? Who can we trust?
What standards are most appropriate and defensible?

I am working with the most ethical doctors and patient advocates to try to answer some of these questions. Through MedicalBoardWatch, I have let the Medical Board know that is it being observed and reported on. I have published my standards in the Spring 2004 issue of O’Shaughnessy’s, the Journal of the Society of Cannabis Clinicians:

“Implementation of the Compassionate Use Act In a Family Medical Practice:
Seven Years' Clinical Experience”
By Frank H. Lucido, MD, with Mariavittoria Mangini, PhD, FNP
found at:
and re-posted on my website:

The Medical Board subsequently published their standards, which are comparable, at:

There can be reasonable differences of opinion about what is the best way to practice medicine. But I believe that in this age of the “drug war”, where elements of law enforcement have had an institutional bias against cannabis since the 1930’s, it is better to be more protective of patients, and not less, as some of the “low standards” or “fig-leaf” clinics have been doing.

I encourage patients to think about how a reasonable doctor might assess their serious illness, and what those records might look like, and to make sure to discuss their serious illness or symptoms with their doctor before obtaining a recommendation from the “fig leaf” clinics.

Things to avoid:
-Quick-in, quick-out, minimalist, no medical records required clinics
(the 3-15 minute “fig-leaf” doctor encounter)
-Clinics associated with dispensaries (A major “bozo no-no,” which loses for the doctor, their employees, and perhaps their patients the full protection of the Conant decision)
-Flashy advertising (I suggest to patients: Question all advertising, even mine.)

Two factors make it more difficult for an attorney or medical-legal expert to defend doctors investigated for recommending cannabis:
1. Inadequate documentation of diagnosis.
2. Providing cannabis recommendations in connection with dispensaries or clinics associated with dispensaries, as discussed above.
Although it may be possible to defend patients in the first situation (at considerable legal expense), there is little or no defense for doctors who cross refer with dispensaries, unethically increasing business at the expense of doctors with more protective standards.

Choosing a Consultant
How does one choose a doctor for a medical cannabis consultation?
Here are some qualities that I would suggest patients look for:
1. Experience: Look for physicians with substantial experience. They should have a high level of comfort with medical cannabis- and the medical-legal issues surrounding it.
2. Ability and willingness to testify in court for you should the patient’s medical use of cannabis be questioned.
3. Willingness to confirm the legitimacy of the cannabis recommendation if contacted by law enforcement. This may save the patient considerable legal fees by preventing the need for court testimony.
4. Adequate and accessible medical record keeping, including supporting documentation from other providers. The physician who requires documentation of ongoing care of the patient’s illness by his or her own treating physician can most easily defend that patient to law enforcement.
5. Reputation and Credibility: ask many people in the ethical medical cannabis community who they think are the most credible. Avoid those who make you uncomfortable. Listen to your intuition.

What patients can do to help their doctors (as well as themselves):
1. Have a primary care provider with whom you consult at least once a year regarding the serious illness or symptoms for which you use medical cannabis.
2. Bring records covering the last 12 months to your medical cannabis re-evaluation each year.

Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
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 email newsletter once every few months.

Friday, July 25, 2008

Broken Clock Right Twice a Day: O'Reilly Factor Appearance of Dr. Frank Lucido

Dr Frank Lucido's Blog: PotShots from the Bully Pulpit
or: Everyone’s Entitled to My Opinion

Dr. Frank Lucido On the O’Reilly Factor On March 28, 2005
A Broken Clock is Right Twice a Day

On Friday March 25, 2005, I was called by the producer of the “O’Reilly Factor” to be on the show the next Monday. I had never watched the show, but I knew about it and how O’Reilly worked, cutting guests’ microphones off if he didn’t want the audience to hear something.

I asked the producer why he wanted me on the show. “Well, we saw your website and knew you had good standards.” I knew it was likely to be a hit piece on some aspect of the medical cannabis movement, but I had to make a decision and decided to say yes.

I had three days to make a list of “talking points” or “sound bites” in case I got a word in “edgewise,” and polled a number of patient advocates by email for their favorites. By Monday, I had two pages of talking points to choose from. At the very top of the first page I made a note to myself, “Don’t get mad.” This note came in handy.

On Monday, the producer called me two hours before “live taping.” He informed me that they had sent a reporter to three medical cannabis dispensaries in Los Angeles to buy cannabis. None would sell any cannabis without a physician recommendation (to their credit), but two of them gave him the address of a physician nearby. The reporter went in posing as a patient, paid two hundred and fifty dollars, spent fifteen minutes with the physician, was never examined and was given a medical cannabis recommendation. He then went back to a dispensary and was able to buy cannabis in accordance with California law.

The producer said Bill O’Reilly would want to know my reaction to this. I knew I would be in a position of choosing to seemingly agree with O’Reilly or to appear to support questionable practice.

A slightly edited transcript of the show follows…

Announcer: “In a moment, “Getting High in LA”. It’s never been easier! Now that Medical Marijuana is the law of the land. A Factor Investigation!”

Bill O’Reilly: When I was out in LA a few weeks ago, I was reading one of the weekly newspapers, which was full of medical marijuana ads. Many say you just walk in, see a doctor close by, and walk out with pot. Now California’s medical marijuana law allows people with legitimate pain to purchase pot, but I think the whole thing is a dodge, and I’ve said that…So we sent Fox news producer Chris Spinder to check out some of these medical marijuana clinics. Joining us now from Berkeley, California, is Dr. Frank Lucido, who writes medical marijuana recommendations and from Santa Maria, California, Chris Spinder.

Bill O’Reilly begins talking with Chris Spinder…

BO: All right. We sent you into this clinic, and what did they say to you?

Chris Spinder: Well first to start, we went into three different cannabis clubs, and I attempted to actually be able to buy the cannabis without the doctor’s recommendation, and all three of these clubs turned me away and said that without this recommendation in my hand, I couldn’t buy the cannabis. However two of the clubs gave me the business card of a doctor who they said would be able to give me the recommendation and I went to make an appointment. It turned out to be kind of a walk-in clinic and I waited in line for about an hour and a half, at which point, fifteen minutes with a doctor in his office, asked me a few general questions and name and address, and then he printed out a form letter…

BO: Well now, were you sick? I mean, were you like in pain? What was going on?

CS: We just had a general discussion about my medical condition.

BO: All right: did you have cancer, glaucoma, or any of that? Do you have any of that?

CS: I do not.

BO: So basically he didn’t even give you an exam.

CS: He did not examine me at all, no.

BO: Wow! Two hundred and fifty bucks. You walk out, you walk in back to the little pot clinics with this, and they sell you up to eight pounds you can buy in there, right?

CS: Actually up to eight ounces according to California law and most people usually buy between an eighth and a quarter of an ounce.

BO: All right. Now what did that cost you?

CS: Sixty-five dollars for this eighth of an ounce.

BO: So you’re in now for three hundred and fifteen dollars, which, you know, for an eighth of an ounce, is a lot of money, but, you did it legally and you can do it as many times as you want. They didn’t take the recommendation away from you, right?

CS: No, actually there’s no expiration date on this particular recommendation.

BO: All right, thank you, Chris. Doctor, come on. Doctor, come on!! This is legalized drug dealing! Go!

Frank Lucido: Well I don’t like to see poor quality medicine. What this sounds like to me is the worst stories I’ve heard of HMO’s. You wouldn’t believe how many patients come to me, when I require documentation. I say you need to talk to your doctor about your pain. They say,“Why should I talk to them about my pain? They’re just going to give me pills, they’re going to give me as many Vicodin as I want.” So I’m not saying this is good. But I’m just saying…

BO: But I’m saying this is what it is. It’s a ruse. It’s a dodge. It’s legalized marijuana in California.”Now a doctor like you, now if you write somebody one, you examine them, right?

FL: I do. I spend forty-five minutes with patients. I require documentation of diagnosis. I require they have a primary care doctor that they’re discussing their serious illness with every year. So my standards are, actually, onerous for some people, either if they don’t have enough money to have a primary care doctor, or don’t have faith in the medical system.

BO: This is a scam, it’s a con. Every doctor in California should be outraged! Are you?

FL: Yeah, I don’t like this. It’s really bad business practice as well as bad medicine.

BO: What are you going to do about it, doc?

FL: I’m going to talk to the Medical Board as I always have. What I’m going to challenge the Medical Board to do is start looking at the HMO’s with the same vision that they are looking at the medical cannabis doctors. They’ve examined twelve of the twenty most outspoken doctors. And I was one of those doctors, and the doctors that I know have high standards. This doesn’t sound very good, what you’re telling me.
But this is a minority.

BO: This is a huge scam. All right, we’re gonna follow-up on this.

FL: This…

BO: Doc, I gotta run. But, we’re going to follow-up on this. And it is off the chart a scam.

(End of transcripts)

My O’Reilly "shoulda, woulda, coulda’s…"

Well, thank goodness for my “Don’t get mad” reminder! A shouting match with O’Reilly would have been unproductive.

Now I could have responded to, "What are you gonna do about it, doc?” with:
"Bill, I would have to interview your producer or faux patient and find out exactly what he told the doctor. Do you think he lied to the doctor?"


“Bill, What’s your problem? Cannabis has been widely available to any recreational user since the 1960’s.”

But, hindsight is always 20-20, and as the saying goes, even a broken clock is right twice a day. O’Reilly had struck on a partial truth: In any group, there will be a certain minority of people whose standards lie on the low end of the bell-shaped curve. Whether that field be medicine, law enforcement, politics, business, journalism, or television show hosting. So too, there are a few embarrassingly "low-standards" physicians in the field of medical cannabis evaluation. And, I did get out my point that this is the minority of medical cannabis physicians.

Unfortunately, this minority is seeing an increasingly large number of patients. And, in fact, this was the beginning of my awareness of the increasing number of new physicians opening up medical cannabis clinics to make recommendations. This proliferation has also led to further lowering of standards in an attempt to capture greater “market share."

This apparent “ease” of obtaining a recommendation without documentation of diagnosis (or even credible medical evaluation), has led to a backlash where many cities are imposing moratoria on the number of dispensaries available to sick patients. According to my late friend, Jane Weirick, who founded the Medical Cannabis Association in 2005 for the purpose of monitoring medical cannabis dispensary standards:

“Another current issue is the proliferation of “young, healthy looking” men appearing to be the predominant clients of patient centers (dispensaries). This has become a severe problem for all sides. Not only has the media taken great pains to display anyone not looking “sick enough” to meet their criteria, but the truly sick who look “too healthy” have been threatened and endangered… Reputable patient centers are aware of this and take great pains to make sure that they don’t destroy their own credibility by carefully evaluating and monitoring all of their patients. The problematic ones are more concerned with sales and profits, which are not the proper issues of concern in any case. Worse, the tendency of some cities to arbitrarily reduce the number of dispensaries and to consider imposing high fees on the remaining ones is actually contributing to the problem...” June, 2005

We’ve all heard the phrase “man bites dog” to describe how the media will more likely report about an unusual event than an ordinary, everyday event. So it should come as no surprise that the real practice of medicine is boring to everyone except the doctor and the patient involved – and stories of "low-standard" doctors, dispensaries focused on profits and young, healthy appearing clients going to dispensaries will simply get reported more frequently by the media.

Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
2300 Durant Avenue
Berkeley Ca 94704
510.848.0958 (by appointment only)

Upcoming blog postings will include:
The Victory of Raich: What individual patients have won; and why some are still getting hurt
What patient’s need in a Recommendation

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 email newsletter once every few months.

Holding the Center

Dr Frank Lucido's Blog: PotShots from the Bully Pulpit
or: Everyone’s Entitled to My Opinion

Holding the Center

“Drug warriors,” those who promote the misguided “war on drugs,” say, “Medical marijuana is just a ruse for drug legalization.”

Some in the “drug reform” movement (some of my good friends, by the way) might say that my concern about the minority of medical cannabis doctors who perform the shoddy three to fifteen minute “recommendations” is misplaced, since the whole disastrous war on drugs is immoral anyway.

I have never thought of myself as a centrist. I have always considered myself more of a liberal, maybe even a radical. But I want this article to answer criticism from both “drug warriors” and “drug reformers” and my answer comes from what I see as a centrist approach that balances the views of these positions.

My thirty-eight years of training and experience in medicine, medical ethics, and in medical-legal consulting has made it clear to me that when it comes to patient protection whether that be medical protection, or medical-legal protection, shortcuts are more apt to hurt the patient than to help.

For an example of how a cursory fifteen-minute pseudo-consultation could have actually harmed a patient, see my article “A Cautionary Tale (For Doctors and Patients)”
co-authored with Mariavittoria Mangini, PhD, FNP and published in the Winter/Spring 2005 issue of O’Shaughnessy’s.

The following vignette is a case where a patient consulted me after a “referral” from his family physician for evaluation of medical cannabis use.

Attached to a client’s letter, this note on a doctor’s letterhead:

Re: Patient X

Mr. X has Chronic Obstructive Pulmonary Disease on Pulmonary Function Test and Chest X-Ray.
Dr. Y
The client letter:

November 10, 2006

Dear Dr. Lucido,

I have been a patient of Dr. Y for 25 years and while he has expressed no opinion as to appropriateness of medicinal marijuana in my case, he has referred me to you for help with two medical problems he considers serious.

First, while I do not consider myself an alcoholic, Dr. Y thinks I drink too much. However, marijuana smoking helps limit my alcohol use, partly because I get sleepy when I do both and therefore never drink before 9:00 PM.

Also, I have been smoking marijuana for 49 years and nothing but marijuana for the last 30. I would like to continue to use cannabis in some form and would like your recommendations on harm-reduction measures such as vaporizers, use of smaller amounts of more potent pot and legal access to edible marijuana.

Dr. Y says that if you need further info, to call him.


November 11, 2006

Telephone call to patient: Uses medical cannabis for COPD: breathes easier (plus plans to use Volcano vaporizer). Harm reduction: drinks less than he would.

Plan: Advised patient to obtain past 24 months medical records and I will review for documentation, or alternately, his primary care physician’s willingness to affirm benefit of medical cannabis to patient. Patient gives me ok to discuss with his physician.

December 1, 2006
Telephone call to Dr. Y: I noted weak evidence of benefit in medical records, but was willing to accept Dr. Y’s attestation that patient is benefiting medically from cannabis if he thought this was the case. Dr. Y: “Frank thanks for holding the center.”


This is the story of a patient “referred” to me by his primary care physician. Referred is a generous term I use since the “referral” came as I documented it above: in a non-committal note on the primary care physician’s letterhead, “Mr. X has Chronic Obstructive Pulmonary Disease on Pulmonary Function Test and Chest X-Ray.”

The patient’s physician provided no support from his own observation of the patient for the patient’s claims of benefit from the use of medical cannabis. The patient’s own verbal report of his history with this physician suggested that the physician had some reservations about the patient’s cannabis use.

Unlike most specialties, medical cannabis patients are usually self-referred, because most have been self-treating with cannabis, having discovered that the cannabis benefits them without consulting a physician. I am pleased to see more and more referrals that do come from physicians, including psychiatrists, who recognize that patients are benefiting but still don’t feel comfortable making cannabis recommendations themselves.

Usually, when a physician refers to or consults another physician, it’s a good thing. Consultation with another expert is a very cost-effective approach to a complicated problem. Each of us has his or her areas of greatest interest, focus and expertise. Sometimes this is recognized by certification in a particular specialty, sometimes it a more informal process where colleagues know of one another’s areas of experience and/or interest.

If a referring doctor feels cannabis is an appropriate medicine or treatment, but is hesitant to personally write the recommendation, it is usually for one of three common reasons: fear of possible personal or professional consequences, lack of knowledge of the medical cannabis laws, or unfamiliarity with the use of cannabis as a medicine.

In this patient’s case, the referral seemed intentionally non-committal. This impression was confirmed in my discussion with the patient’s physician, in which it became clear that the primary care physician had misgivings about whether this patient’s use could be considered medical, or even beneficial. Yet, he passed the patient on to my practice anyway, perhaps because he had not succeeded in his previous attempts to address his concerns about the patient’s drinking and smoking. The primary care physician was unable to overcome the patient’s denial, and referred him to me without enthusiasm, thinking that the patient would do as he wished no matter what either of us said.

Some cannabis-recommending physicians to whom the primary care physician might have referred this patient would have written the recommendation, and taken their fee.
“Compassion” might be their rationalization.

Following the standards of my practice, and my experience in medical-legal medicine, I concluded there was no credible evidence of positive benefits of cannabis use for this patient, either in my assessment or in that of his own physician. If I distort my ethics or compromise my integrity to allow patients to justify cannabis use that would otherwise be a misdemeanor, I not only undermine myself, I put the legitimacy of the entire medical cannabis movement into question. This would harm not only my own credibility, but also the value of my medical-legal work for my other patients, and play into the hands of the “drug warriors.”

Therefore, when it comes to the practice of good medicine, and making best use of the laws that support a patient’s right to medical cannabis, I hold the center.

Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
2300 Durant Avenue
Berkeley Ca 94704
510.848.0958 (by appointment only)

Upcoming blog postings will include:
A broken clock is right twice a day (Dr. Frank’s appearance on O’Reilly Factor)
The Victory of Raich: What individual patients have won; and why some are still getting hurt
What patient’s need in a Recommendation

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 email newsletter once every few months.

Credibility-Attorney Dennis Roberts' Testimonial

Dr Frank Lucido's Blog: PotShots from the Bully Pulpit
or: Everyone’s Entitled to My Opinion

In the next few blog postings, I’ll be pointing out why credibility is important in a medical-legal consultation.

Oakland attorney Dennis Roberts sent me this letter 4 years ago, when he was defending a patient of mine. Dennis said it was ok to post.
(Patient’s name omitted of course.)

Dennis Roberts, Attorney
370 Grand Ave, Oakland, Ca, 94610

March 5, 2004

Frank Lucido MD

Dear Frank: Re: xxxxx xxxxx

You’re going to love this. Although med mj is allowed in a probation situation, Judge Taber takes the position that it is completely discretionary in a diversion case (she's wrong, but who needs the extra work). Anyhow, she says she's never granted a med mj diversion because "these doctors are crooks" -citing someone in Santa Barbara and another in Oregon. I told her that you are a pre-eminent physician and directed her to your resume. I told her I knew you personally (she has known me for about 35 years) and that I knew several of your regular (non-mj) patients. When I was finished she issued a minute order which reads:

"The Court notes a LEGITIMATE doctor's note for the use of medical marijuana."

So, congratulations. You are the only legitimate doc in the area at least as far as Jackie Taber, Judge, is concerned.


Dennis Roberts

Frank’s Commentary:
Now obviously I am not the only one. (In fact, I know that the doc in Santa Barbara is one the good ones. Bless you, David!)

And the majority of the cannabis physicians that I know have good standards. Unfortunately, many patients get “steered” to the “advertisers”.

Sorry, I can’t afford that.

But I will use the “bully pulpit” to suggest people avoid the low standards physicians, especially patients with good medical records. Ask around the responsible cannabis community about credibility, and who they would recommend.

Friends don’t let friends drive drunk, or see the “fig leaf” clinics, especially patients or caregivers growing medicine.

The boilerplate I send to patients inquiring about cannabis physicians is posted below.

Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
2300 Durant Avenue
Berkeley Ca 94704
510.848.0958 (by appointment only)

Upcoming blog postings will include:
A broken clock is right twice a day (Dr. Frank’s appearance on O’Reilly Factor)
Holding the Center
The Victory of Raich: What individual patients have won; and why some are still getting hurt
What patient’s need in a Recommendation

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 email newsletter once every few months.

Boilerplate to patients inquiring about cannabis physicians:
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, most of which I would recommend avoiding if you have a documented serious illness, and/or care about your medical-legal health.

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
"No comment".

I believe that my practice standards are the best and most protective

and have been acknowledged by the Medical Board.
(See: )
I would avoid any that do not require documentation of diagnosis, or that schedule less that 30 minutes face time with you.

My website:
is intended to help legitimate patients know what qualities may be important in choosing a credible Medical Cannabis Consultant.
I have posted the overall results of a survey I did of 24 responders out of approximately 30 questionnaires I sent out to the medical cannabis recommending physicians I am aware of.

If, after checking out, you have any questions about the website, or physician practice standards and ethics, feel free to ask.

peace and health,
Frank Lucido M.D.

General info about my practice:

We schedule: 45 minutes for initial consultations,
30 minutes for yearly reviews.

This law is quite specific in applying to "seriously ill Californians".
I will need some documentation of your diagnosis.
I will also require that you have ongoing care with your physician for your condition.
You will also have to have a valid California ID or driver's license,
and you must be 21 years of age.
(Any exceptions to these requirements above must be discussed with the doctor before making appointment.)

Call 510-848-0958 for an appointment, and tell my staff it's for a medical
cannabis evaluation.

peace and health,
Frank Lucido M.D.

PS: NOTE: we don't accept insurance for medical cannabis evaluations.
Also NOTE: A medical cannabis evaluation does not constitute primary care.
It is assumed that you already have a primary care practitioner. If not, I am advising you to obtain one.

PPS: No one may give or obtain a "prescription" for marijuana/cannabis.
Under California's Compassionate Use Act, it may be appropriate for a physician to "recommend" or "approve" cannabis use by a patient. This involves giving a medical opinion as to whether cannabis might be helpful in a specific case. We cannot "prescribe" cannabis in the sense of directing you to use it, nor will we help you to obtain cannabis or direct you to sources of cannabis.

peace and health,
Frank Lucido M.D.

Tuesday, July 22, 2008

Dr. Frank Lucido breaks 4 ribs 6/21/08 (old news to some)

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 email newsletter once every few months.

Dr. Frank Lucido breaks 4 ribs 6/21/08 (This is one month-old news now, but news to some of you.)

OUCH! 4 broken ribs. Don’t make me laugh, please.

No better way to get readership up on my new blog
than to have a life-threatening accident and survive to tell about it.

I was hoping to have my first 4 or 5 pieces posted on my new blog by now,
But stay tuned for a few, all at once. Soon.

I have spent so much time filling people in on my injury of June 21, that I thought I’d take the time to write it up, and post it.
Now I can refer people to this post, and I’ll have a lot more time to write new stuff. or to learn to ride better.

Short version of my accident:
Fell of a horse and broke 4 ribs 6/21/08, 1 month ago.
Healing on schedule.

From the beginning, as long as I don’t move, laugh, cough, walk jauntily, etc., the pain has been tolerable, mostly 3 out of 10.
And I have been able to use my legs to go between these 2 positions, and not hurt my back more.

3 ribs broken left antero-lateral chest, (ribs 3-7 area).
But one rib is also broken near spine, so going from lying down to sitting was more like 8-9 pain on a scale of 10, so even thinking about lying down for a nap was scary.

Until day 5: when I borrowed a friend’s Laz-E-Boy recliner. Thanks!
With that chair, I could go to bed or nap without crying, and get up and down by arm power, and spare my back.

And now 1 month later, I have even been able to sleep in my own bed for the past 4 nights. Sweet!

Other than the problem of reclining, my recovery has been pretty uneventful, and after spending the first few days at home, I was able to go to office and see patients on a reduced schedule after the one week.

Now back to almost normal schedule after one month.

Thanks for asking!
I actually liked telling the story, but this posting will be a timesaver!

Odd and ends:
I have had to be careful opening funny email.
I avoided phone or email contact with certain fraternity brothers, and I wouldn’t even go near my friend Ralph’s emails.
Mom even got me with a funny email. We could laugh about it after the first week, a little anyway. Love you Mom!
Also soda water got me coughing once, before I wised up to how painful humor and seltzer water could be. (Clarabelle the Clown would be a double whammy! Ha ha, OUCH!
I kill me!, ha, ha... OUCH!… getting better now.) Ha! My laughter is coming back.

Dr Frank Lucido

Coming up on this blog, soon,
Really this time:

Several, until now, unpublished pieces I have written about safe and appropriate medical cannabis practice standards, and why credibility is important.
These pieces will come in rapid succession this coming week. My new blog will allow people to respond to me on each post.
I plan to review all posts, and according to plan, none should automatically be posted without my review.
But, hey, I am new at blogging, so can’t guarantee that, but that’s my plan.

But: I will read all replies, and may respond privately on request.

Upcoming blog pieces:

The Victory of Raich: What individual patients have won; and why some are still getting hurt

Dr. Frank’s appearance on O’Reilly Factor: A broken clock is right twice a day

What is the range of service, fees, and credibility of cannabis physician? (which attempts to answer the questions: What Is “Medical?” or How Long Does It Take to write a recommendation?)

Holding the Center

Civil disobedience vs. civil obedience: What's the difference? When is each appropriate? And for whom?

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 email newsletter once every few months.

Frank H. Lucido MD
Family Practice since 1979
Medical Cannabis Consultation
Expert Witness
2300 Durant Avenue
Berkeley Ca 94704
(by appointment only)