By Rod Moser, PA, PhD
With a legal prescription, patients in California and several other states can go to a medical marijuana dispensary and get their prescriptions promptly filled. These medical marijuana dispensaries are popping out all over the community. They advertise in the newspapers and even on television. Pot is hot.
About once a week, I get someone asking me to write them a prescription for medical marijuana. So far, not one person has had a medical reason for it, in my opinion. If I had a patient with chronic pain, like from cancer, or having problems with chemotherapy, I would not hesitate to allow them to use marijuana if it helped. However, not one patient that I have seen falls into this category. One young man tried to convince me that the only thing that helps his self-diagnosed chronic back pain is marijuana. Another fellow got his prescription at a medical marijuana “mill” where a hundred bucks and ANY reason will get you a legitimate prescription from a licensed physician who is making a bundle of cash. The reason he gave the doctor was Attention Deficit Disorder (ADD) and migraines. I had been seeing him for about eight years and never once had I diagnosed or treated him for either of those things.
The problem that arose for this last fellow was that he was sharing his “legal pot” with three of his friends. They passed around a joint while sitting in the high-school parking lot where they were spotted by an alert policeman who gave all four a citation to appear in court. He wanted me to go to court and testify that he had migraines and ADD!
A good friend of mine passed away from a brain tumor last year. He had difficulty sleeping, anxiety, headaches and problems with his appetite, either related to his glioblastoma or his aggressive chemotherapy. As a survivor of the 60s, he was not a stranger to using marijuana, but he did not want medical marijuana. It was important for him to remain alert, so each one of his precious remaining days would not be altered by being high. It seems that many of the people who could benefit from medical marijuana will not take it; many who do not medically need it and just want it for the recreational buzz do. Recently, I was taking some potent prescription pain medications after my rotator cuff surgery, and I do not like the mind-altering effects of those either. I don’t like pain, but I have given up the narcotic pain medications simply because I don’t like those crazy side-effects or bizarre dreams. My mind is bizarre enough without having it pharmaceutically enhanced.
As a medical provider, I really support having cannabis as a medical option for patients with certain medical conditions, but it really ticks me off when a “licensed physician” will do a cursory exam (or no exam at all) and give a healthy 18-year-old a one-year prescription for medical marijuana for a hundred bucks, based solely on the teen’s claim that he has a medical condition. This is just like those prescription mills that are broken up periodically be the DEA or police where any patient can just walk in and walk out with a legal prescription for powerful, addicting narcotics.
People, who end up getting narcotics by deception will often go to several doctors in the same day, use the same story or performance, and end up with HUNDREDS of narcotic medications that they either take themselves or sell on the street. The abuse of prescription medications is incredible. I once had an adult woman patient many years ago who committed suicide, either accidentally or deliberately, from an overdose of narcotic pain medications. The police discovered hundreds of bottles of narcotics from over thirty different physicians in a half-dozen cities. She collected all of these medications in less than a month so that her insurance company did not take notice. The DEA has made some inroads to limit this practice by tracking controlled drugs, no matter what pharmacy fills them. The medical licensing board of every state tends to do similar tracking, once they are alerted by the DEA that this may be happening. However, the practice is so widespread that the perpetrators often do this for years without being investigated or caught.
My pharmacist friend gets bogus prescriptions every day. Most of the time, he simply refuses to fill them. He calls all of the physicians for verification and will not fill any suspicious ones. But the drug abusers are getting slicker all of the time.
In the past, I would write a prescription for “10″ codeine tablets for someone with legitimate but temporary pain, only to get a call from the pharmacist to verify the “100″ tablets that I wrote. Altering prescriptions is much more difficult now with electronic prescriptions. Drug abusers do not realize that pharmacists know the prescribing practices of their medical providers, so they know that I never write a prescription for a hundred pills. If a patient insists on a “written prescription” so they can shop around, I will write out the word “TEN” instead of “10″ for the amount and write “NO REFILLS” instead of “0” on a special prescription that is very difficult to alter. This really ticks off the drug seekers.
People have real pain, but they also need real diagnoses. Pain management is an art, and simply masking it with repeated prescriptions of habitual narcotics is not the way to manage it. Neither is writing a prescription for medical marijuana. Did you know that a person with a legitimate prescription for medical marijuana can freely use it at work?
Marijuana has been considered California’s largest cast crop; more than wine grapes and more than all of the vegetables grown in the Central Valley combined. True potheads grow their own. In addition to medical marijuana dispensaries, there are hundreds of shops selling all of the hydroponic equipment to grow pot in your garage or basement. Nearly every week, the police will raid a rented home set up as a pot-growing operation. This even happened to a friend of mine who owned a rental house. The police raided his rental home and found hundreds of plastic pots with marijuana plants growing under dozens and dozens of grow-lights. The renter was arrested and released after paying his bail in cash. He returned to the house that was surrounded by yellow police tape, ripped out the bathroom medicine cabinet where he had stashed his cash, and was never seen again. Damage to the property exceeded twenty thousand dollars.
Marijuana grown in Mexico is still being successfully smuggled across our porous borders by illegal aliens looking to make some fast cash. They carry it in backpacks, hidden in automobile gas tanks, launch it with catapults over the border fences, or transport it through tunnels. It seems impossible to stop as long as the insatiable demand in the States continues.
There is a place in our pharmacopeia for cannabis. There are legitimate medical reasons why marijuana would be beneficial; however, this would be such a small percentage of the enormous market for recreational use. Should marijuana be fully legalized and taxed, like alcohol and cigarettes? How do we keep marijuana out of the hands of children? What are your thoughts?
Do you have questions for Dr. Moser? Join his discussions in our Ear, Nose and Throat community.