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10 Years of Legalized Medical Marijuana in California

Tod Mikuriya, MD (Berkeley), was the first California doctor to monitor patients’ use of cannabis systematically. In the early 1990s his interviews with members of the San Francisco Cannabis Buyers Club documented Dennis Peron’s observation that people were self-medicating for an extremely wide range of problems.

The broad range of applications confirmed what Mikuriya had learned from his study of the pre-prohibition medical literature on cannabis, and so when Prop 215 was being drafted, he urged that it apply not only to people with a list of named conditions, but to those treating ” … any other illness for which marijuana provides relief.”

No sooner had Prop 215 passed than top California law enforcement agents colluded with Clinton Administration officials and Prohibitionist strategists from the private sector to plan its disimplementation. On Dec. 30, 1996, Drug Czar Barry McCaffrey, Attorney General Janet Reno, Health & Human Services Secretary Donna Shalala, and the director of the National Institute of Drug Abuse, Alan Leshner, held a press conference to threaten California doctors with loss of their licenses, i.e., their livelihoods, if they approved marijuana use by their patients. McCaffrey stood alongside a large chart headed “Dr. Tod Mikuriya’s, (215 Medical Advisor) Medical Uses of Marijuana.” Twenty-six conditions were listed in two columns. (“Migranes” was misspelled.) “This isn’t medicine, this is a Cheech and Chong show,” he said. Reno said prosecutors would focus on doctors who were “egregious” in approving marijuana use by patients.

Dr. Mikuriya watched the press conference on CNN at his home in the Berkeley Hills. “As doctors become more fearful,” he says. “I’ll obviously get more and more patients who are using cannabis or are considering it. Will that make it seem that there’s something ‘egregious’ about my practice? You bet it will!”

>From the Attorney General’s office in Sacramento a memo went out from Senior Deputy AG John Gordnier to district attorneys in all 58 counties asking them to forward any cases involving Mikuriya. In due course, on the basis of complaints from sheriffs, cops, and DAs, Mikuriya was investigated by the medical board and found to have committed “extreme departures from standard practice.” He was placed on probation and ordered to pay $75,000 for his own prosecution.

Over the years the number of cannabis specialists among California doctors has risen slowly but steadily. In 2000 Mikuriya organized a group, now known as the Society of Cannabis Clinicians, to share data for research purposes. More than 20 doctors have become involved with the SCC. Collectively they have approved cannabis use by an estimated 350,000 patients. This summer, with the 10th anniversary of Prop 215’s passage approaching, I surveyed the SCC doctors get their basic findings. Here are Dr. Mikuriya’s responses to the survey he inspired.

Approvals issued to date: 8,684. Previously self-medicating: >99% Category of use: Analgesic/immunomodulator 41% Antispasmodic/anticonvulsant 29% Antidepresssant/Anxiolytic 27% Harm reduction substitute: 4%

Results reported are dependent on the conditions and symptoms being treated. The primary benefit is control without toxicity for chronic pain and a wide array of chronic conditions. Control represents freedom from fear and oppression. Control -or lack thereof- is a major element in self-esteem.

With exertion of control, with freedom from fear of incapacity, quality of life is improved. The ability to abort an incapacitating attack of migraine, asthma, anxiety, or depression empowers.

Relief from the burden of criminality through medical protection enhances a salutary self-perception.

Alteration in the perception of and reaction to pain and muscle spasticity is a unique property of cannabis therapy.

Patient reports are diverse yet contain common elements. 100% report that cannabis is safe and effective. Return for follow-up and renewal of recommendation and approval confirms safety and efficacy.

Cannabis seems to work by promoting homeostasis in various systems of the body. Its salient effects are multiple and concurrent. They include- o Restoration of normal functioning of the gastrointestinal tract with normalization of peristalsis and restoration of appetite. o Normalizing circadian rhythm, which relieves insomnia. Sleep is therapeutic in itself and synergistically helps with pain control. o Easement of pain, depression, and anxiety. Cannabis as an anxiolytic and antidepressant modulates emotional reactivity and is especially useful in treating post-traumatic stress disorders.

Patients treated for ADHD: 92 Patients using cannabis as a substitute for alcohol: 683. The slow poisoning by alcohol with its sickening effects on the body, psyche, and family can be relieved by cannabis.

Medications no longer needed? Opioids, sedatives, NSAIDS (non-steroidal anti-inflammatories), and SSRI anti-depressants are commonly used in smaller amounts or discontinued. These are all drugs with serious adverse effects. Opioids and sedatives produce depression, demotivation, and diminished mobility. Weight gain and diminished functionality are common effects. Cognitive and emotional impairment and depression are comorbid conditions. Opioids adversely effect vegetative functioning with constipation, dyspepsia, and gastric irritation. Pruritus is also an issue for some. Circadian rhythms are disrupted with sleep disorders and chronic sedation caused by these agents. Dependence and withdrawal symptoms are more serious than with sedatives.

Opioids are undoubtedly the analgesic of choice in treating acute pain. For chronic pain, however, I recommend the protocol proposed by a doctor named Fronmueller2 to the Ohio Medical Society in 1859: primary use of cannabis, resorting to opiates for episodic worsening of the condition. Efficacy is maximized, tolerance and adverse effects are minimized. (Neither cannabis nor human physiology has changed since 1859.)

NSAIDs can be particularly insidious for those who do not immediately react with gastric irritation and discontinue the drug. Chronic irritation with bleeding may produce serious morbidity. Most often, the dyspepsia produced is suppressed with antacids or other medications. Many patients tolerate acute intermittent use but not chronic use. SSRIs, if tolerated, coexist without adverse interaction with cannabis. Some SSRI users say cannabis is synergistic in that it treats side effects of jitteriness or gastrointestinal problems.

Many patients report pressure exerted by the Veterans Administration, HMOs such as Kaiser Permanente, and workers’ compensation program contractors to remain on pharmaceutical regimens. A significant number describe their prescribed drugs as ineffectual and having undesirable effects. “Mainstream” doctors frequently respond to reports of adverse effects by prescribing additional drugs. Instead of negating the problem, they often complicate it. Prevailing practice standards encourage polypharmacy -the use of multiple drugs, usually five or more.

Out of the ordinary conditions? While all pain reflects localized immunologic activity secondary to trauma or injury, the following atraumatic autoimmune disorders comprise a group of interest: Crohn’s disease Atrophie blanche, Melorheostosis, Porphyria, Thallasemia, Sickle cell anemia, Amyloidosis Mastocytosis, Lupus, Scleroderma, Eosinophilia myalgia syndrome. These are all clearly of autoimmune etiology, difficult to treat. Specific metabolic errors such as amyloidosis and certain anemias warrant further study and may elucidate the underlying mechanisms of the illnesses and the therapeutic effects of cannabis. Multiple sclerosis with its range of severity varies in therapeutic response to cannabis.

Demographics: male patients, 72; female, 28%. Women are more likely than men to use cannabis for psychotherapeutic purposes (32% to 18%). Men are more likely to use for harm reduction (4% to 1%). A roughly bell-shaped curve describes the age of my patients. 0-18 years, 1%; 19-30, 19%; 31-45, 36%; 45-60, 37%; older than 61, 7%.

Additional Observations:

Proactive structuralism works. Meaning: people can create something and by doing so, set a precedent.

Medical cannabis users are typically treating chronic illnesses -not rapidly debilitating acute illnesses.

The cash economy works better than the bureaucratic alternative. Word of mouth builds a movement.

The private sector is handling marijuana distribution because the government has defaulted.

Cannabis was once on the market and regulated, then it was removed from the market and nearly forgotten.

Not all that we’ve learned in the past 10 years is new.

Once upon a time the California Compassionate Use Act of 1996 became the law of the state. We had the mistaken belief that civil servants, sworn to uphold the law, would set about implementing the new section of the Health & Safety Code. Hardly… Twenty California doctors have been investigated by the Medical Board for approving cannabis use by their patients. Limited immunity from prosecution for physicians was either proclaimed invalid or, more commonly, evaded by the Board and the Attorney General. They dissimulate, pretending that it is not the physician’s approval of marijuana at issue, but his or her standard of practice. They then hold cannabis consultants to a standard that most HMO doctors violate constantly.

The fix is in. The state criminal justice entities share information and operate in concert with the DEA. There has been a total end run around the injunctive protection of the Conant ruling. [In Conant, a federal court enjoined the government from threatening doctors who discuss cannabis as a treatment option with patients.] General media indifference enables this RICO under color of authority and the continuing defiance of the will of Californians who spoke ten years ago.

This is counterbalanced by the rewards of helping patients with serious chronic aliments who have adverse experience utilizing so-called main stream medicines.

FRED GARDNER can be reached at fred@plebesite.com

 

 

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Fred Gardner is the managing editor of O’Shaughnessy’s. He can be reached at fred@plebesite.com

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