Doctor of Last Resort
When the Medical Marijuana Patients Union held a symposium in Fort Bragg in August, 2004, Sheriff Tony Craver asked an organizer to please introduce him to Dr. Tod Mikuriya. It turned out that Mikuriya had left after participating in a morning panel. "That’s one man I’ve always wanted to meet," said Craver, looking down in disappointment. The sheriff knew there was something unique about Mikuriya, and so did half the cops and prosecutors in California, who, unlike Tony Craver, fiercely resented him for conferring legitimacy on people previously considered criminals.
Mikuriya died Sunday at his home in the Berkeley Hills. He was 73. The cause was complications of cancer. In the final days he’d been in the care of his sisters, Beverly, an MD from Bucks County, Pennsylvania, and Mary Jane of San Francisco, and his longtime assistant, John Trapp. Cancer had been diagnosed originally in his lungs, and as of last March it had been detected in his liver, too. Dennis Peron and Dale Gieringer threw farewell parties for him. He canceled a trip to Hungary where he was to present a paper at the International Cannabinoid Research Society meeting. His office began steering patients to other doctors.
And then his condition improved. In late May 2006 Mikuriya attended his 50th reunion at Reed College and sang rounds with his old madrigal group. His office geared up again. He wrote the lead section of an article recounting what California doctors had learned in the 10 years since the passage of Prop 215 ("Medical Marijuana in California, 1996-2006," O’Shaughnessy’s, Winter/Spring 2007). He met with a publisher about reissuing "Marijuana Medical Papers," his 1973 anthology of pre-prohibition medical literature -the new edition to include a CD containing eight more articles that had come to his attention over the years. He had many visits from his 12-year-old daughter, Hero, the apple of his eye; they even went cross-country skiing one weekend.
As recently as this March Mikuriya played a key role organizing a symposium at which retired colonel James Ketchum, MD, discussed the Army’s secret search for a cannabinoid-based incapacitating agent. Mikuriya had begun assembling the contents for a new anthology, "Cannabis Clinical Papers," that would include studies by colleagues and three major papers of his own: "Cannabis as a Substitute for Alcohol;" "Cannabis as a First-Line Treatment for Mental Disorders;" and "Cannabis Eases Post-Traumatic Stress." (The titles alone reflect the relevance of Mikuriya’s concerns. Even his historical studies related to our present time and place. For example: "An 1873 survey by British tax officials in India elicited a range of views on cannabis that seems strikingly contemporary… ‘the general opinion seems to be that the evil effects of ganja have been exaggerated.’")
Mikuriya liked to use the slogans "Grandfather it in!" and "Back to the future!" in discussing the legalization of cannabis for medical use. The generations of Americans who discovered cannabis in social settings in the 1960s and the decades that followed had no idea that it had been widely used in this country between the Civil War and the Great Depression, with tinctures manufactured by Eli Lilly, Parke, Davis and other major pharmaceutical companies available by prescription. For decades Mikuriya was the only MD among the small group of activists and scholars who collected the bottles and labels and sought to unearth and publicize the history that our educational system had erased so systematically.
Mikuriya was given to creating polysyllabic phrases that forced one to puzzle over their meaning. For example, America’s cultural preference for the modern he called "temporal chauvinism." Cannabis clubs, he said, showed the efficacy of "proactive structuralism;" by which he meant, "People can create something and, by doing so, set a precedent."
Tod Hiro Mikuriya was born in Eastern Pennsylvania in 1933 to Anna (Schwenk) and Tadafumi Mikuriya. His father was a Japanese Samurai who converted to Christianity, his mother a German immigrant and practicing Baha’i. Tod and his two younger sisters went to Quaker schools. "The Quakers were proprietors of the underground railway," Tod noted. "The cannabis prohibition has the same dynamics as the bigotry and racism my family and I experienced starting on December 7, 1941, when we were transformed from normal-but-different people into war-criminal surrogates."
He graduated from Reed College in 1956, served as a medic in the U.S. Army, and then attended Temple University School of Medicine. It was at Temple that a reference in a pharmacology text to the medical utility of marijuana triggered the interest that would define Mikuriya’s career.
After getting his medical degree, Mikuriya served an internship at Southern Pacific General Hospital in San Francisco, specialized in psychiatry at the Oregon State Hospital in Salem, and completed his training at Mendocino State Hospital. In 1967 he became director of non-classified marijuana research for the National Institute of Mental Health Center for Narcotics and Drug Abuse. He left the position after several months, he said, "When it became clear they only wanted research into damaging effects, not helpful ones."
Mikuriya moved to Berkeley in 1970 and entered private practice. He was active in Amorphia, a West Coast reform group that eventually folded into NORML, and helped organize a 1972 marijuana legalization initiative, working alongside Michael and Michelle Aldrich, Pebbles Trippet, and others who stayed with the struggle through the ensuing decades of cultural and political rollback.
"Western medicine has forgotten almost all it once knew about the therapeutic properties of marijuana," Mikuriya lamented to a UCSF medical student interviewing him in 1996. (I had the privilege of sitting in.) "Hemp-based tinctures and preparations were prescribed for myriad purposes-analgesic and hypnotic; appetite stimulant; anti-epileptic and antispasmodic; for the prevention and treatment of the neuralgias, including migraine and tic doloreux; antidepressant and tranquilizer; oxytocic (to induce uterine contractions); topical anesthetic; withdrawal agent for opiate, chloral and alcohol addiction; intraocular hypotensive; childbirth analgesic; hypothermogenic." Cannabis is also an anti-asthmatic and antitussive (cough suppressant), Mikuriya told the med student. It went out of favor with doctors in the early decades of the 20th century "not because it was deemed toxic or dangerous but because alternatives came on the market -injectable opiates and synthetics such as aspirin and barbiturates- that were quicker-acting and offered more consistency in dosage and patient response."
When Dennis Peron launched the San Francisco Cannabis Buyers Club at the start of the ’90s, Mikuriya saw "a unique research opportunity." He began interviewing club members in an attempt to confirm or add to descriptions in the pre-prohibition literature. When Prop 215 was being drafted, Mikuriya contributed the all-important phrase in the first sentence that allows doctors to approve marijuana use in treating "any…condition for which marijuana provides relief." (Eleven other states have since passed laws allowing marijuana use to treat specific conditions. Mikuriya considered them all intellectually dishonest compromises.)
Mikuriya’s contention that marijuana alleviates an extremely wide range of symptoms was ridiculed by Drug Czar Barry McCaffrey and other federal officials at a press conference in December, 1996. Reform advocates promptly sued the drug czar’s office and obtained a federal injunction confirming the Constitutional right of doctors and patients to discuss marijuana as a treatment option. Nevertheless, for several years following the passage of Prop 215, almost no California MDs were willing to risk the wrath of the government by putting in writing a recommendation for cannabis in the treatment of say, depression, or lower back pain. People all over the state were calling cannabis clubs to report that their doctors -many of whom had expressed their approval of marijuana previously- would not give them a written "letter of diagnosis" entitling them to join a club. These people would very often be given the name and phone number of Tod Mikuriya.
Thus Mikuriya became the doctor of last resort for thousands of California patients. He flew or drove with John Trapp to cities and towns around the state to preside at ad hoc clinics. "It’s one of the most satisfying experiences for me as a psychiatrist to be able to remove the stigma of criminality from an individual," he said after testifying for an alcoholic Vietnam vet in 1998. "Not just the self-perceived stigma, but removing the real danger of civil forfeiture and other kinds of state viciousness."
Mikuriya was investigated by the California medical board on the basis of complaints from law enforcement officers (none from patients, and no allegations of harm to a patient). At a disciplinary hearing in 2003 all the patients named in the accusation praised and thanked Mikuriya. He was placed on probation by the board, but continued to practice until two weeks ago. Then his decline was rapid. He had issued some 9,000 approvals.
Mikuriya was the founder of the Society of Cannabis Clinicians, a specialty group whose members have issued more than 160,000 approvals. "Tod was the mentor of every doctor working in the field," says SCC president Philip A. Denney, MD. "His observation that cannabis alleviates so many seemingly disparate symptoms has been explained by recent research showing that its active ingredients modulate virtually every neurotransmission system in the body." In other words, the finding the drug czar mocked as "a fraud" turned out to be a most significant truth.
A Quaker service honoring our mutual friend will be held at 4:30 p.m. Friday at the Berkeley Friends Church, 1600 Sacramento St., Berkeley.
FRED GARDNER edits O’Shaughnessy’s, the Journal of Cannabis in Clinical Practice. He can be reached at firstname.lastname@example.org