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The Medical Board of California is meeting at the LAX Hilton on April 20th and will vote to approve slightly revised “Guidelines for Recommendation of Cannabis for Medical Purposes.” The most significant change is a warning against marijuana use during pregnancy that will have real ramifications for countless thousands of pregnant women.
The Guidelines effectively script what the doctor should tell the patient about cannabis. A physician “should document a written treatment plan that includes
+ Advice about other options for managing the terminal or debilitating medical condition (pursuant to the Act conditions include cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which cannabis provides relief).
+ Determination that the patient with a terminal or debilitating medical condition may benefit from the recommendation of cannabis.
+ Advice about the potential risks of the medical use of cannabis and reminders to safeguard the cannabis, including but not limited to, the following:
+ The variability of quality and concentration of cannabis;
+ Cannabis use disorder (previously “The risk of Cannabis use disorder.”)
+ Potential adverse events, such as exacerbation of psychotic disorder, adverse cognitive effects for children and young adults, falls or fractures, and other risks.
+ Using cannabis during pregnancy or breast feeding (previously “The risk of using cannabis during pregnancy…”) Please be aware that risks of cannabis use on a fetus or breast-feeding infant are unknown. The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion (Number 722 – October 2017) states physicians should be discouraged from recommending cannabis for medicinal purposes during pregnancy and lactation.
+ The need to safeguard all cannabis and cannabis-infused products from children, pets, or domestic animals; and
+ The reminder that the cannabis is for the patient’s use only and the cannabis must not be sold, donated, or otherwise supplied to another individual.”
Why the emphasis on harm?
Note that the doctor is not required to discuss dosing, not required to discuss delivery methods —essential subjects that patients really need to learn about. Thousands of California doctors are just beginning to approve cannabis use will carefully adhere to the medical board Guidelines. They will tailor their interaction with patients to conform to the requirements of the treatment plan.
How much time will be left for useful discussion after the doctor has told the patient about potential risks, variable quality and potency, cannabis use disorder, adverse events, no diversion, and most of all we’ve got to hide it from the kids?
The MBC Guidelines will guide the doctor-patient interaction away from the useful and towards the fearful.
Restoring the “Parental” Role
“Successful doctor-patient relationships are characterized by candor and trust,” Tod Mikuriya, MD, wrote soon after California voters legalized cannabis for medical use in 1996. “Removing the stigma of criminality promotes candor and trust.”
Mikuriya decried what he called the doctor’s “parental role” in the traditional doctor-patient relationship. The treatment plan that the California medical board is pushing on cannabis-approving doctors re-establishes their “parental role.” Mikuriya was writing in reference to patients substituting cannabis for alcohol, but his approach applies to pain patients seeking to reduce opiate use:
“Treating alcoholism by cannabis substitution creates a different doctor-patient relationship. Patients seek out the physician to confer legitimacy on what they are doing or are about to do. My most important service is to end their criminal status —Aeschlapian protection from the criminal justice system— which often brings an expression of relief. An alliance is created that promotes candor and trust. The physician is permitted to act as a coach —an enabler in a positive sense.”
The med board’s fear-inducing treatment plan re-enforces the notion of cannabis as a dangerous drug, easily abused. This inflated dangerousness is what “justifies” the complex, onerous regulations that politicians at the state and local levels have been enacting in California. The bureaucrats and law enforcers would not have been able to turn legal marijuana into a job creator and moneymaker for themselves if the medical establishment characterized its safety profile as relatively benign, akin to that of coffee.
The whole complex structure of marijuana regulation and taxation rests on its characterization as a dangerous drug by the medical establishment.
PS: On March 2 the Journal of Drug and Alcohol Dependence published a study by researchers at the Centers for Disease Control and Prevention showing that marijuana use during pregnancy does not lead to lower birth weight!