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Concerned Physicians working for safe and appropriate use of Medicinal Cannabis

 

Help for doctors, attorneys and patients legal documents, decisions, precedents, opinions etc.
Proposition 215
(read the text -- its short)
Also known as: California Compassionate Use Act of 1996 (CCUA) Health and Safety Code 11362.5 (HSC 11362.5).
Conant v. Walters
(complete text version)
summary | .pdf (35 pages)
Bearman v. Joseph
with commentary by Dr. Bearman, Attorney Weisberg, and Dr. Lucido
Implementation of the Compassionate Use Act in a Family Medical Practice: Seven Years Clinical Experience by
Frank H. Lucido, MD

Selections from above:

Marijuana Myths,
Marijuana Facts
Cannabis resource list

Home | Links
About Frank Lucido, MD

My practice and "Acceptable Standards"

Because medicine is a constantly evolving field, there is a wide range of acceptable standards of care for treating many specific problems. This is more noticeable in dealing with symptom management as opposed to curative therapy; it is particularly relevant in a new field such as Cannabis Therapeutics, in which research has historically  been constrained by legal considerations.

In my practice, cannabis is most frequently employed for symptom management (Larson, 1992) as well as for the reduction of what has been termed "symptom distress" -the physical or mental anguish or suffering that results from the symptoms the patient is experiencing (Rhodes & Watson, 1987).

Sidebar:

USES/INDICATIONS

Diagnoses for which medical cannabis is used, from from 348 unduplicated medical cannabis patients seen from 5/28/02 to 11/4/02. (261 w single diagnosis; 32 with 2 dx; 15 w more than 2 dx)

primary diagnoses:

chronic pain

235

headache

24

gastrointestinal (nausea, anorexia, abd pain, irritable bowel syndrome, crohn's disease, ulcerative colitis, chemotherapy)

23

chronic anxiety

10

depression

7

insomnia

6

ptsd

6

seizure disorder

5

asthma

5

glaucoma

4

bipolar disorder 

3

add

2

OTHERS:

  • Multiple Sclerosis
    (dysesthesia, muscle spasm)

  • severe dysmenorrhea

  • meniere's (vertigo, tinnitus)

  • restless leg syndrome

  • phantom limb pain

  • ocd

  • parkinson's

With appropriate use of medical cannabis, many of these patients have been able to reduce or eliminate the use of opiates and other pain pills, ritalin, tranquilizers, sleeping pills, anti-depressants and other psychiatric medicines, as well as to substitute the use of medical cannabis as a harm reduction measure for specific problematic or abused substances with a much more serious risk profile (including alcohol, heroin/opiates, and cocaine). The diagnoses of my medical cannabis patients (see sidebar "USES/INDICATION") are consistent with the bulk of my medical practice diagnoses.

Symptoms are subjective phenomena by definition, and as such are difficult to evaluate. Symptoms include, but are not limited to: fatigue, insomnia, depression, anxiety, nausea, vomiting, anorexia, elimination problems, and breathing difficulty.

The control of symptoms and the alleviation of symptom distress are some of the most important therapeutic uses of cannabis. Both the alleviation and the control of symptoms remain areas in which further research is needed (Grant, 1992).

The need for additional research on symptom management is compounded by the lack of research and standards for the use of cannabis therapies. Legal disapprobation, restrictions on the opportunities for clinical research intrinsic to cannabis' status as a Federal Schedule I Controlled Substance, and a long historic gap in the accumulation of clinical writing on cannabis therapeutics since criminalization in the 1930s have resulted in there being relatively little clinical literature from which we can seek guidance.

The Medical Board of California (MBC) and the California Medical Association (CMA) have a "working group" drafting guidelines, but seven years after  the therapeutic use of cannabis was legalized, there are no practice standards other than what is usually expected of any clinician in the course of his or her practice. 

"Any physician who recommends the use of marijuana by a patient," according to the Medical Board's July 2003 Action Report,  "should have arrived at that decision in accordance with accepted standards of medical responsibility, i.e., history and physical examination of the patient; development of a treatment plan with objectives; provision of informed consent, including discussion of side effects; periodic review of the treatment's efficacy and, of critical importance, proper record keeping that supports the decision to recommend the use of marijuana.  However, the Board recognizes that these principles may require further elaboration to take into account the factors that may affect the physician-patient relationship in this context."

PRIOR ARTICLE:  Full disclosure   CONTINUE: Safety

Go ahead and search us:

Input to the Medical Board of California by year:
2004
November 5, 2004 -- Statement
  Reiterating the need for monitoring
 
July 30, 2004 -- Reply
  Regarding the MBC statement of 7/03
May 7, 2004 -- Transcript
  Various question raised to the MBC. Comments on MBC positions.
January 30, 2004
  Packet contents summary and statement calling to cease targeting doctors.
  Dr. Lucido reports on 1/30/04 MBC meeting
  Transcripts: 1/30/04 meeting
2003
November 7, 2003
  Will medical practice be determined by doctors or police?
August 1, 2003
  A cannabis resource list
  Associated risks
  Review of therapeutic effects
May 8, 2003
  Defining standards of care, complaint initiation and responsibility

 


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