“Thankfully absent” from the guidelines the California board will vote on today, according to Steve Robinson, MD, are provisions that would allow only a patient’s primary physician to approve their use of cannabis; create a registry of cannabis-using patients; require that a patient be seen in person before an initial approval is issued; make cannabis a treatment of last resort (after the pharmaceuticals have failed); and trigger investigations of physicians based on number of approvals issued.
Robinson is concerned that a “Decision Tree” developed by the CMCR as an attachment to the MBC guidelines could yet make cannabis a treatment of last resort. (See graphic below.) Given the CMCR’s prestige, the medical board’s power, and the fact that very few physicians have had any education with respect to cannabis, the handy “Decision Tree” is likely to be widely used.
Dr. Robinson comments,
“The proposed Decision Tree could be interpreted as a retreat from the more ‘progressive’ stance of the draft guidelines, which state, “A patient need not have failed on all standard medications in order for a physician to recommend or approve the use of cannabis for medical purposes.”
The Decision Tree needs to reflect this policy, which could be done by moving the choice point of “willing to consider cannabis” up from the fifth-tier decision level to the third-tier decision level, on par with “Standard RX.”
The session will be webcast — view it here — and members of the public can comment and ask questions.
Perhaps at today’s meeting, the board will decide to reconfigure the “Decision Tree.” The session will be webcast and members of the public can comment and ask questions. Hard to say when they’ll get to agenda item 18 — MBC publicist Jennifer Simoes guesses between 10 a.m. and noon. The number to call is 888-455-9726 and the passcode is 8280664. “Callers will be asked to verbally provide this code to the operator to enter the meeting,” says the agenda.
The MBC guidelines also include a sample “Agreement” that physicians can give pain patients to sign upon granting approval to use cannabis. This one-sided “Agreement,” since its debut as a handout at the August 30 meeting of the MBC’s Cannabis Task Force, has been critiqued by Dale Gieringer of California NORML and the Society of Cannabis Clinicians. Its authors (CMCR psychiatrists Igor Grant, MD, and Brad Wilsey, MD) have made substantial revisions.
Your correspondent thinks the “Agreement” is inherently misleading — cannabis is not a dangerous drug — and demeaning to patients. In the retro spirit of the Cannabis plant itself, O’Shaughnessy’s hereby provides an Agreement for patients to present to their doctors:
O’Shaughnessy’s Agreement for Physicians Issuing Cannabis Approvals
I, ______________ (clinician name) am treating. _______________ (name of patient) for chronic pain.
1. I acknowledge that in medical school I learned nothing about the body’s endocannabinoid system or cannabis as medicine.
2. I began approving cannabis use by patients in _________________ (year)
3.. To educate myself about medicinal cannabis I have
• taken CME courses (please list)
• read relevant books and periodicals (please list)
• attended conferences on medicinal cannabis (please list)
4. I belong to a group of clinicians who share findings and observations re cannabis, and keep abreast of the emerging scientific and clinical evidence.
5. In treating pregnant women, I follow the “Best Practices Guidelines” developed by Wilson-King and Sexton for the Society of Cannabis Clinicians.
6. I am familiar with the findings of Tashkin et al showing that cannabis smoking does not cause lung cancer or exacerbate COPD.
7. In general, I consider whole plant cannabis extracts more efficacious than single-molecule formulations.
8. Facilitating socialization is one of the major benefits of cannabis use. I support on-site consumption at cannabis dispensaries.
9. I strongly urge patients not to get behind the wheel when they’re stoned —an assessment only they can make.
10. Annual re-evaluations are required by medical board guidelines though in many cases they place an unnecessary, costly burden on patients.
11. I consider it unfair and unAmerican that patients who do not use cannabis at work and who have shown no signs of impairment on the job can be fired on the basis of metabolites in their urine.
12. I am familiar with the extensive Clinical Evidence showing that pain patients can reduce or eliminate use of opiates, sedative-hypnotics and/or alcohol by using cannabis instead.
Photo courtesy of Allie Beckett