Medical Pot Prescribed Mostly For Aches, Pains

[Dr. Bob]

I've exchanged emails with the author of the Free Press article. He attempted to talk to some of the certification docs in Lansing and Detroit, but they were 'too busy' to present their views on the the matter, so it went in as it was. I'll tell you guys something, when the Free Press calls and wants to present our view point, we need to put down the sandwich and chat with them. They have the above, and wanted to get some input and background. I'm submitting this and want opinions from the board. I am not representing MMMA, CPU or anyone else, just my opinion, but I wanted to put it out for comment.

 

=====================================================================

 

Just as a bit of clarification, the post I sent you was in response to the question ‘how many doses of pain medication do primary care doctors write and how many physicians are in Michigan’. There are two interesting background pieces for you to review in preparation for the article.

 

Ontario Superior Court Justice Donald Taliano

 

"Governments' peevish, foot-dragging, marginal compliance with court rulings on medical marijuana has been irrational and inhumane, callously adding to the quotient of pain and hardship of seriously ill Canadians, presumably to serve an ideological bias. People struggling with painful, debilitating illnesses shouldn't have to battle the government and pay junkie-dealer prices for access to medicine that provides relief. As Judge Taliano affirmed, ill people should be able to get the drugs they need and not be branded as criminals for so-doing. If research wasn't being suppressed by governments for ideological and political reasons, indications are that medical marijuana could prove effective for a wider range of ailments than ones where it's already being applied (legally and illegally), such as Multiple Sclerosis, Parkinson's Disease, other neurological disorders, nausea associated with chemotherapy, epilepsy, asthma, migraines, peptic ulcer, clinical depression, chronic pain, anorexia, alcoholism, inflammation, hypertension, some cancer tumours, and AIDS."

 

Currently it take over FOUR MONTHS for the state to issue a MMJ card to a qualified patient with the appropriate paperwork. There is little if any funding of studies looking at marijuana as a medical treatment, thus completing the circle of ‘there are no studies showing the medical benefit of marijuana, so we will not fund studies to evaluate the medical effectiveness of marijuana’. 5000 years of documented clinical use has been conveniently overlooked in a four generation long quest to make marijuana illegal. Until 1937, most physicians in the US viewed marijuana as a valid medical substance and used it. Researching the law, initial efforts to control marijuana involved restricting it’s transportation across state lines without a tax stamp, but you had to cross state lines and bring the marijuana to Washington DC to get the stamp. This same sort of indirect suppression by the authorities exists to this day.

 

Justice Taliano also addressed the climate of fear created by the likes of the DEA, our AG and Oakland County Sheriff...

 

 

"Judge Taliano found that the regulatory regime set up under current "Marihuana Medical Access Regulations" has failed to ensure that patients needing therapeutic marijuana get necessary approvals within a reasonable time frame, if at all, forcing many to either go without or resort to illegal means to obtain their medication, also striking down the aforementioned Controlled Drugs and Substances Act sections as unconstitutional because it can be used to charge medical marijuana users who haven't been able to obtain medical marijuana licences."

 

"Rather than promote health - the regulations have the opposite effect. Rather than promote effective drug control - the regulations drive the critically ill to the black market," the judge wrote in his decision.

 

Again, Justice Taliano cites the ‘climate of fear’ created by the authorities not only for patients, but for their doctors, which result in few certifications being issued- effectively gutting the program and making it meaningless. Patients try to follow the rules to ease their suffering, cannot locate a physician willing to give them the necessary paperwork, and are in essence and practice forced underground to become criminals. Just like the tax stamp for marijuana, available but you had to break the law to get it, he ruled the program was a shame and well qualified patients were denied access to the system as a direct result of the way the government administered the system. Are physicians in the US, like their Canadian colleagues, afraid of repercussions from the AG, DEA, Sherriff, and their hospitals if they write certifications? I think the answer is yes. So what is a patient to do? If they go to a ‘hotel doctor’ or ‘certification center’ the doctor patient relationship- though valid at the proper clinics- is questioned.

 

Marijuana is illegal for everyone, everywhere under both federal and state law. Period. If you child falls off her bike and breaks her arm, and you put her in the car to ‘rush’ her to the Emergency Room you may be pulled over for speeding. Did you break the law? Of course you did, you were speeding. Will the officer that pulled you over, after understanding the situation and seeing your daughter, write you a ticket and bust your chops? My thought is that the vast majority would not. The voters of Michigan made it clear they look at medical marijuana in a similar light. It has helped folks that are suffering, and so long as they follow the rules, we won’t write the ticket.

 

What does the law involve?

 

First and foremost, the voters have made it clear that marijuana has helped sick people and they should be allowed to use it without fear of arrest and prosecution.

Second, once properly certified, they should be able to obtain their medicine to meet their needs.

Third, the state should set up and manage the program in such a way that both these goals can be accomplished in a reasonable manner and timeframe- hence when an application is submitted the state has a deadline to act or it is considered approved.

Finally, the law was written in such a way as to assure patient privacy and a ‘neighbor helping neighbor’ mentality. Large commercial enterprises and drug companies were excluded in favor of small (5-6 person) ‘caregiver’ groups and mom and pop type business. The later is a nice thing in a state with 15-20% unemployment.

 

How should this be implemented? Let’s take them in order

 

1. Stop viewing marijuana as a drug of abuse. It is a medical substance, and like any medications can be abused, but it is useful and helps many people (and has throughout human history). Currently saddling a person with a criminal record, legal expense, baring them from employment/education/military service is a disproportionate penalty when viewed in the context of the ‘threat to society’ a pain or cancer patient poses for using a little pot to ease their suffering.

 

2. Remove the environment of fear established by the authorities (from the DEA/DOJ down to the local road officer and hospital administrator) for those that seek and issue medical marijuana certifications. Accept the fact that patients can obtain their medication, in reasonable amounts and by reasonable means, as they need it and stop treating it as drug trafficking on either end.

 

3. Streamline the system to the point that applications for the program are addressed in a timely manner. The form is a simple- just a couple of pages of demographics, some boxes to be checked, a single signature from a licensed doc, and a payment. Moreover, only about 55 doctors are writing the majority of certs (why can’t they be grouped, the medical license checked, and their certs reviewed in bulk?). Tell me that an agency set up to license and regulate every professional, daycare and hairdresser in this state can’t make short work of a simple form- especially in view of the fact those forms come with a $25-100 check apiece (they don’t seem to have a problem cashing those in 2-3 days, why does it take 4 months to get the card?).

 

4. Finally, and this is the tough one and responsible for most of the ‘grey areas’, how do we protect privacy, honor the letter and the spirit of the law, and keep everyone accountable to the same standard?

a/ The registry is private, it is not shared or reported outside the agency that manages it. The data that registry contains is a part of a medical record and very private. Recently the DEA attempted to obtain data from that registry on 7 individuals suspected of criminal activity in Lansing. Did our AG do his job, protecting the rights of the PEOPLE of Michigan, support the integrity of the law, and stand up to the feds? No, he did not, he protected his employees at the expense of justice and the people of the state. He told the court that if the workers guarding the registry released the information, they would be committing a CRIMINAL offense, BUT if they were shielded from prosecution, sure they would release the data. Talk about protecting your tail at the expense of your duty to the people. Some call it taking the easy way out, I call it cowardness. Either way, justice was slighted that dark day.

b/ The caregiver system should be promoted and kept private. Small grow operations (be in indoor tomatoes or marijuana) which result in product that is exchanged between licensed and regulated individuals for expense is not a business. It is neighbors helping neighbors. Local governments have NO BUSINESS zoning them, inspecting them, or even know who and where they are. The law specifically states that no caregiver can be compelled to identify themselves to the authorities or submit to inspections of their gardens. As for the ‘public safety’ aspect of the case, after all it is marijuana, we could make the same arguments for diabetics or chronic pain patients. After all, do we want people with syringes, needles and maybe even narcotics within 1000 feet of a school, church or play yard? And what about pharmacies? Would the same ‘zoning’ apply to them?

c/ Transfer of medication is specifically address two ways in the law. Registered caregiver to designated patient is clearly allowed. A patient is equally clearly allowed to obtain their needed medication from ANY source, not just their registered caregiver, as they need it. These two specified transfers are very important. The authorities and courts would be well served to take a close look, consider the intent, and practical applications of these transfers.

i/ If a caregiver has a legal grow (enclosed/numbers right/documented) and transfers a legal amount to their designated patient, leave them alone.

ii/ If a caregiver has no medication available, the patient is still allowed to obtain medication. This is one case where dispensaries clearly make sense, meet a legal need and follow the intent of the law and voters. The alternative source would be another registered caregiver, and the law does clearly note the term ‘primary caregiver’ implying that there is a ‘secondary caregiver’. This makes perfect sense, is very reasonable, keeps the transfers ‘within the system’ and meets a clear need. The dispensary and alternate legal caregiver should not be harassed or prosecuted. When considering arrest or charge on one, prosecutors should not be asking themselves ‘can I do this and get a conviction?’ they should ask ‘how does this prosecution help a patient obtain meds and what alternative am I offering the patient?’. Too often prosecutors are simply concerned with convicting someone for an infraction of a law as they see it. Like the road officer and the child with the broken arm, they need to realize that their job has two duties- enforce the law and serve justice and the people.

iii/ What of the patient in an apartment or other location where they cannot grow their own medication? Unless they can find a caregiver elsewhere, what option do they have to obtain meds legally? What of the caregiver that had an unexpectedly good crop? Should he/she flush the medicine or should there be a place it can be taken to be transferred to a patient in need? These are two situations where a dispensary can and should be allowed to meet the needs of the patients as outlined in the law. By cutting off this valuable arm of the supply chain, are we actually forcing medication transfer to the black market, encouraging crime and negating the intent of the law? Rather than use valuable law enforcement resources to fight this ‘problem’ should we instead try to work together to come up with a reasonable alternative, such as dispensaries? Granted dispensaries are not specifically named as such in the law, BUT the function they perform and the place they have in the supply chain is a core principle of the law- patients need to have access to their medication without resorting to illegal activity. Patients want to be legal, that is why they go through the trouble of getting a card and entering the system. The system needs to provide for them and address their needs in an organized way.

 

 

Sorry for the long essay, but there is good information that is not commonly put out. Hope it gives you some things to think about and have a Happy Holiday.

 

Dr. Bob

[Dr. Bob]

Just as a side note, I am not so much a 'dispensary' person. I've deliberately avoided the 'patient to patient' issue because it has some controversy and LEO seems fixated on it. Alternate caregiver (and most of my certs list patients as their own caregiver, so in reality it means there are alot of patients that qualify as 'alternative caregivers') shifts the focus away from that issue and gives LEO an 'out', dodging the patient to patient controversy yet allowing essentially the same activity. My view of dispensaries is that they are essentially clearing houses or grain elevators allowing the redistribution of excess medication to patients that need medication. The cool thing about that concept is that it is a variation on the current system, caregivers/patient groups can exist, and it gives the authorities an entity they can zone and tax while leaving the rest of us the heck alone.

 

Dr. Bob

[treehugger]

I think that "pent-up" demand needs to be considered in this analysis. Cancer patients come and go ( i know, macabre...), but chronic pain patients (by definition) linger.

[Dr. Bob]

This is beautiful , we need to have more statistics and numbers on our side . I hope that in time we can really work with the media and get the truth out .

 

I have spoken with the Newspaper here in Petoskey about the filtration of the media and opening a forum to really get perspective and input from the County voters . This is our best defense in my humble opinion . The oposition has to be overcome in this simple manner .

 

Bring on the MMMA TV , everyone needs to work as hard on the media and the truth as much as we are working on the rally next month ... OD

 

 

Send it to them, I am an advertiser with close ties to that community. The Free Press reporter wants to do a piece on this next week. We need to show we are well researched, well spoken and understand the issues. It will be a good contrast to the 'foaming at the mouth' rhetoric of the AG and Sheriff B.

 

Dr. Bob

[Guest finallyfree09]

dr bob.... you may not think so but you make an excellent p.r. person for us patients. i realize you dont represent anybody in particular but that is good. you are the only health professional with enough guts to run out there and tell the truth. THANK YOU!

 

 

DR BOB FOR PRESIDENT!!!!

 

LOL!!!

[David1946]

So whats their weak point they want to make? People hurt !

 

Tens of thousands suffer from chronic pain in Michigan! Its an industrial(was)manufacturing state, we work frigging hard. I'm thrilled cancer isn't the most common complaint or Aids,

 

America is in the midst of a narcotic pain pill addiction epidemic and these people want to make an issue out of the safest pain medication there is. I just read on here more people die from narcotic pain pills than die in car crashes why ain't they made about that.

 

Chronic pain is a qualifying condition and as long as a Dr certified that the patient would find relief in cannabis its a done deal. Now if they're concerned about the people who skirted the law and went to a motel Dr who doesn't require records because they don't have a true qualifying condition but used chronic pain, thats Lansing's fault not the fault of the law.

 

From what I have read here and on other forums this group told Lansing about the card mills but nothing has changed as far as i can tell. I know two people who went to a motel in Romulus paid $250.00 and got the Dr certification saying they had chronic pain no records, no x rays, nothing just paid the guy.

 

Maybe politicians should have to work in a factory for ten years before they can hold office.

 

I have chronic pain from degenerative disc disease and my hips are shot from standing on a concrete floor running a stamping press, or climbing a ladder, from working for a living not telling other people how to live.

 

If these guys think chronic pain is a joke here is the analogy I use to best describe how my back feels; imagine the worst physical pain you have ever felt multiply by two for five years and then on top of that your worst emotional point of your life. You may get close to how me and thousands like me feel.

 

Chronic pain is real and its deadly; http://nationalpainf...nd-suicide-risk

 

Chronic pain is real and its here; http://www.orlandome...pidemic-cms-121

 

Just two articles from thousands

 

 

[Dr. Bob]

dr bob.... you may not think so but you make an excellent p.r. person for us patients. i realize you dont represent anybody in particular but that is good. you are the only health professional with enough guts to run out there and tell the truth. THANK YOU!

 

 

DR BOB FOR PRESIDENT!!!!

 

LOL!!!

 

Thank you but others have been there before and continue to speak for us, I am just the one that writes in here. I've always been an advocate for patients and will continue to do so.

 

Dr. Bob

[Dr. Bob]

So what their weak point they want to make? Tens of thousands suffer from chronic pain in Michigan! Its an industrial(was)manufacturing state, we work frigging hard. I'm thrilled cancer isn't the most common complaint or Aids,

 

America is in the midst of a narcotic pain pill addiction epidemic and these people want to make an issue out of the safest pain medication there is.

 

Chronic pain is a qualifying condition and as long as a Dr certified that the patient would find relief in cannabis its a done deal. Now if they're concerned about the people who skirted the law and went to a motel Dr who doesn't require records because they don't have a true qualifying condition but used chronic pain, thats Lansing's fault not the fault of the law.

 

From what I have read here and on other forums this group told Lansing about the card mills but nothing has changed as far as i can tell. I know two people who went to a motel in Romulus paid $250.00 and got the Dr certification saying they had chronic pain no records, no x rays, nothing just paid the guy.

 

Maybe politicians should have to work in a factory for ten years before they can hold office.

 

I have chronic pain from degenerative disc disease and my hips are shot from standing on a concrete floor running a stamping press, or climbing a ladder, from working for a living not telling other people how to live.

 

If these guys think chronic pain is a joke here is the analogy I use to best describe how my back feels; imagine the worst physical pain you have ever felt multiply by two for five years and then on top of that your worst emotional point of your life. You may get close to how me and thousands like me feel.

 

Chronic pain is real and its deadly; http://nationalpainfoundation.org/articles/290/chronic-pain-and-suicide-risk

 

Chronic pain is real and its here; http://www.orlandomedicalnews.com/chronic-pain-an-under-treated-epidemic-cms-121

 

Just two articles from thousands

 

 

 

I understand your issue, but you point out the problem better than you realize. There are many of us trying to do things right, yet both your friends made a mill $500 richer, gave them reason to continue this type of shoddy clinic, and continue to enjoy the benefits of 'gaming the system' at the expense of the rest of us. Want to make a change and protect yourself, stop going to mills.

 

When the state steps in and gets rid of the certification clinics, saying you have to see a doctor for a year to establish a bona fide dr/patient relationship, then think back to how easy it was to go to a no record clinic and wonder why you didn't do it right. No patients show up, they leave. Just ran one out of Clare, will take them out elsewhere too. But can't do it if you friends keep going to them.

 

Guess the future of the MMMA is up to the patients, where it should be. Matters not to me, I don't have to do certs to make a living and am not a patient myself. I can serve patients in many ways, this is just the way I want to now. It is my hope we can bring some organization and standards to it before the state takes a heavy handed approach. Every patient that goes to a mill with no records sets that goal back.

 

Dr. Bob

[David1946]

I understand your issue, but you point out the problem better than you realize. There are many of us trying to do things right, yet both your friends made a mill $500 richer, gave them reason to continue this type of shoddy clinic, and continue to enjoy the benefits of 'gaming the system' at the expense of the rest of us. Want to make a change and protect yourself, stop going to mills.

 

When the state steps in and gets rid of the certification clinics, saying you have to see a doctor for a year to establish a bona fide dr/patient relationship, then think back to how easy it was to go to a no record clinic and wonder why you didn't do it right. No patients show up, they leave. Just ran one out of Clare, will take them out elsewhere too. But can't do it if you friends keep going to them.

 

Guess the future of the MMMA is up to the patients, where it should be. Matters not to me, I don't have to do certs to make a living and am not a patient myself. I can serve patients in many ways, this is just the way I want to now. It is my hope we can bring some organization and standards to it before the state takes a heavy handed approach. Every patient that goes to a mill with no records sets that goal back.

 

Dr. Bob

 

 

These people are not friends but I do know them and I didn't use a card mill i went to a Dr.

[Dr. Bob]

These people are not friends but I do know them and I didn't use a card mill i went to a Dr.

 

Not accusing you of anything, just making a point. Those mills will be the downfall of the program, and those that go to them and keep them in business will be responsible.

 

Dr. Bob

[+EdwardGlen]

Not accusing you of anything, just making a point. Those mills will be the downfall of the program, and those that go to them and keep them in business will be responsible.

 

Dr. Bob

 

The state is as much to blame if not more so than the ones using the card mills.

 

The state has been aware of card mills all along and still allows them to operate even thou they are not following the law.

 

And not until those motel/strip mall card mills are shuttered unscrupulous people will continue to use them.

[Dr. Bob]

The state is as much to blame if not more so than the ones using the card mills.

 

The state has been aware of card mills all along and still allows them to operate even thou they are not following the law.

 

And not until those motel/strip mall card mills are shuttered unscrupulous people will continue to use them.

 

Unscrupulous is a term I would reserve for operators of the mills. The patients go there for two main reasons. The first is the most common, they don't know any better and are just looking at the price and the decreased 'hassle' factor. After all, there are records at home or the courts will understand they are poor and can't go to the doctor. Wrong on both accounts, it is not what you have at home (and the doc didn't see) that counts. It is what the doctor reviewed and retained in your chart- it is a question of judgement in the eyes of the court. If I make a snap decision that you qualified and have nothing other than a statement from you that you 'have pain' my judgement could be questioned. If I make the same decision after reviewing your surgical reports from you laminectomy, you long standing pain med prescriptions and repeated visits to your primary, I can clearly 'justify' my decision to anyone, even a hostile court.

 

The second group of patients that go to these clinics are the marginal ones- they don't really qualify and want to see if they can 'slide through'. Here is where we need to make some choices. First do we evaluate with an eye to not missing anyone that would qualify? This will result in getting everyone, but enough unqualified folks will slide through to cause some heartache for the entire program when the news cameras focus on the giggling 18 year old with PMS waiving a 'get out of jail free' card she managed to get with a calendar and a sob story. On the other end do we basically look at all the ones the we feel qualify and deny the most marginal 10% and certify the the other 90%? We miss some deserving patients this way but don't get burned in the news.

 

This is something I've struggled with professionally for the last year or more. I personally don't use MMJ medically, or recreate with it, hate the thought of missing any deserving patient, and don't like being manipulated by marginal patients that want the card for recreation and not treatment. I also believe that we need to keep things very tight in light of the fact that MMJ is still illegal, we are fighting a PR battle for legitimacy, and the courts are hostile for the most part. For these and other reasons I would rather deny the least qualified and documented 10% to protect the other 90% and the program. When things are more accepted, and given the fact it is a relatively harmless substance, I will loosen up. When we have over 200,000 and on the way to 500,000 patients we will be to that point.

 

Until then, I look at it as not being heartless, but as triage. In a mass casualty situation, there are people that could be saved that are left aside because devoting the attention to them will cost lives elsewhere. This is merely legal triage to give us time to build the numbers of patients we need to have the luxury of over treating to avoid missing even one qualified patient.

 

Dr. Bob

[Bandit]

When I first went and got my card I went to a "mill" because 1# I didnt know any better and didnt do any research and 2# cause thats what a friend told me to do.I went with all my paper work from the last 10 years with CAT scans,MRI's and x rays of my back.Along With all my workers comp papers from my job.I just hope it doesnt bite me in the a** because I went there and not my family doc.

I use my meds to help with 2 bad discs,bone spurs and degenerative arthritis along with mild ADHD problems.

[Dr. Bob]

Well hopefully after the fiasco with Dr. Buck and the one coming up with another mill folks will learn their lesson and start being a little more selective. We need to shut these types down and only can do that by refusing to go to them. If you see an ad that suggests the mill will do certs without records, avoid it and spread the word to your friends. There are plenty of legit certification centers around.

 

Dr. Bob

[Bandit]

Well hopefully after the fiasco with Dr. Buck and the one coming up with another mill folks will learn their lesson and start being a little more selective. We need to shut these types down and only can do that by refusing to go to them. If you see an ad that suggests the mill will do certs without records, avoid it and spread the word to your friends. There are plenty of legit certification centers around.

 

Dr. Bob

I agree Dr Bob... What about "goodie kits" like you have at conventions or when you cross a state border.Like info on how to pick a caregiver,what Doc to go to,the "rights of Doc and there patients" ect.That should help cut down the traffic when people know they have choices and the right way to do it.

[Dr. Bob]

I agree Dr Bob... What about "goodie kits" like you have at conventions or when you cross a state border.Like info on how to pick a caregiver,what Doc to go to,the "rights of Doc and there patients" ect.That should help cut down the traffic when people know they have choices and the right way to do it.

 

I am thinking about putting together a series of YouTube vids

 

---How the certification process works

---Lawyer talk for the patient

---Lawyer talk for the caregiver

 

The last two will be by a lawyer friend of mine.

 

Picking a good certification clinic is very simple

 

1/ Records are required of everyone, every time. If there is a different price for records or no records, or they want you to fill out some paperwork in lieu of records, leave.

 

2/ Check the doctor out. Is he even there? Does he review the records or just sign (or have you fill out) the forms? Did you check his/her license? Are there problems? Does he have a DEA license (if you are told he doesn't need one to write the cert- get your money back and leave).

 

3/ What kind of follow up do they offer? If they just say call with questions, but don't make it a point to schedule time in a few months to see how you are doing, you will have problems with the dr/pt relationship.

 

4/ If the clinic tries to get you to sign up with them as caregivers (or charges you to use your own), offers to sell you meds (you have a section 8 DEFENSE when you are signed but are not legal), or tries to buy meds from you, they are doing things that are illegal. Get your money back and walk out.

 

Dr. Bob

[Bandit]

I am thinking about putting together a series of YouTube vids

 

---How the certification process works

---Lawyer talk for the patient

---Lawyer talk for the caregiver

 

The last two will be by a lawyer friend of mine.

 

Picking a good certification clinic is very simple

 

1/ Records are required of everyone, every time. If there is a different price for records or no records, or they want you to fill out some paperwork in lieu of records, leave.

 

2/ Check the doctor out. Is he even there? Does he review the records or just sign (or have you fill out) the forms? Did you check his/her license? Are there problems? Does he have a DEA license (if you are told he doesn't need one to write the cert- get your money back and leave).

 

3/ What kind of follow up do they offer? If they just say call with questions, but don't make it a point to schedule time in a few months to see how you are doing, you will have problems with the dr/pt relationship.

 

4/ If the clinic tries to get you to sign up with them as caregivers (or charges you to use your own), offers to sell you meds (you have a section 8 DEFENSE when you are signed but are not legal), or tries to buy meds from you, they are doing things that are illegal. Get your money back and walk out.

 

Dr. Bob

The + and - of the internet are not that well known to most.But look what happened in Jan in Egypt with the revolution.The keyboard and touch pads that were used with the help of My Space,Face Book and You Tube ......Computers will be mightier than the sword and the pen.