Medical Marijuana: Health Risks and Benefits in California
San Francisco
NORML Conference
April 19, 2002
Tod H. Mikuriya, M.D.,  President

Marijuana and Health
Risks and Benefits
for California Physicians
Federal Threats & Actions
State Harassment
Medical Board
County DA’s
Sheriffs & Police
Organized, corporate, and individual medicine
Marginalization and stigmatization
Exclusion from conferences
“Advocacy = undesired bias
“Abortion doctor”
“Mill doctor”
Censorship from publications
Intellectual challenge,  clinical experience with patients, expanding upon medical intelligence prior to removal from clinical availability.
Continuing experiences of confidence and trust of patients.
Freedom from managed care
Opportunities to optimize management of chronic conditions and advocate for the patient.

Slide 3

1996 Federal Threats & Actions
Against California Physicians
Removal of DEA Controlled Substances
Moving to take Mollie Fry, M.D.s DEA  #
Drop from Medicare – None Yet
Federal law suits- Injunctions prevent
IRS audits- None yet
Termination of grants- None yet
Actions without threat: Evolving & Covert

Slide 5

Benefits of medical marijuana for California Physicians
Continuing experiences of confidence and trust of patients.
Opportunities to optimize management of chronic conditions and advocate for the patient.
Intellectual challenge,  clinical experience with patients, expanding medical intelligence prior to removal from clinical availability.
Freedom from managed care

Patients’ Medical Marijuana Benefits
Safe and effective medicine to manage chronic serious medical conditions.
Immunomodulator Analgesic
Mood and affect modulator; easement
Anti-Spasmodic anticonvulsant
Harm Reduction Substitute
Multiple and concurrent therapeutic effects

Slide 8

Slide 9

Cannabis Pharmacological Safety
Free from unwanted side effects compared with “mainstream” polypharmacy and non-medical drugs- alcohol and nicotine..
Compared with opioids, steroids, NSAIDS, sedatives, tricyclics, and benzodiazepines
Improved quality of life
Mobility, emotional well being and control of pain
Less money spent on drugs to control side effects

Medical Marijuana Benefits
Psychosocial
Relief from criminal status
Improved self esteem
De alienation
Increased participation in community
Decreased fear and paranoia
Improved critical thinking
Optimal coping with chronic illness

Medical Marijuana Medical Risks
No pharmaceutical potency standards
No guarantees of purity or freedom from contamination
Pesticide residues, biologic agents, or heavy metals
No dose consistency of oral products

Medical Marijuana Risks
Endemic Negligent Governance
Criminal Justice System
Attorney General’s Office consensus without tutelary mandate policy: Counties do their own thing
County and local absence of Training and Information Bulletins or General Orders.
Problematic prosecutorial, court, and probation
Excessive  discretionary powers
Subpoena abuse

Medical Marijuana Risks
Physicians and Health Care
Gross and pervasive non-compliance because of federal threats.
He who pays the piper calls the tune
Medicare, MediCal federally funded
Federal academic medicine funded grants
Federal Veterans Administration Hospitals
General fear and ignorance of physicians

A Statewide Audit is Critical
I propose a statewide effort to Implement the Compassionate Use Act of 1996.
Beyond the current federal assaults on California patients, physicians, taxpayers, and voters, unless a systematic effort is organized and motivated with adequate funding, efforts conceiving and passing propositon 215 will have gone for naught.
Only a comprehensive audit with remedial civil remedy will ensure the will of the voters five years ago.