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US: Calif. Pot Docs Put Selves at Risk

Lisa Leff

Washington Post

Sunday 05 Nov 2006

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COOL, Calif. -- Dr. Mollie Fry never thought telling her patients where
to get the medicine she recommended for pain, depression and nausea
would be a problem.

Federal drug agents who raided her home and office thought otherwise,
and she was indicted last year on felony charges of conspiring to
distribute marijuana.

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"I assumed the fact that I had 'M.D.' at the end of my name gave me the
right to make judgments about people's health," said Fry, who estimates
she has issued thousands of cannabis recommendations since setting up
her thriving practice northeast of Sacramento in 1999.

Since California passed the nation's first medical marijuana law a
decade ago, a provision requiring written doctor approval to grow and
buy pot has created conflict between the state mandate and federal drug
laws, and strained the doctor-patient relationship.

Until the stalemate is resolved, doctors recommending marijuana do it
with trepidation and a good deal of risk.

Medical marijuana advocates estimate that 1,500 doctors, mostly
oncologists and AIDS specialists, have authorized pot for at least one
patient. But most recommendations have come from about 15 self-appointed
specialists, the so-called "pot docs," who charge $150 and up to walk
what the California Medical Association calls "a gray area between the
clearly permissible and clearly impermissible categories of action."

Following complaints by local law enforcement, nearly all have been
investigated by the state board that licenses and disciplines
physicians. Four had devoted their practices to acting as medical
marijuana consultants and ultimately were sanctioned, ranging from the
public rebuke that Fry got to having their licenses suspended.

California's medical marijuana law, also known as Proposition 215, named
a host of ailments for which marijuana might prove helpful in easing
symptoms: cancer, anorexia, AIDS, glaucoma, arthritis, migraine.

Unlike medical marijuana laws enacted in 10 other states, California's
also gave doctors discretion to certify patients with "any other illness
for which marijuana provides relief," leaving open the possibility that
recommendations could be made to people who did not need them.

David Thornton, executive director of the California Medical Board, said
that until the board issued guidelines two years ago outlining what
constituted "accepted medical standards," physicians pretty much had to
figure it out on their own. Most concluded it was not worth the risk.

Although a federal appeals court ruled four years ago that the U.S. Drug
Enforcement Administration cannot go after doctors merely because they
recommend marijuana to patients, the state medical board's guidelines
make it clear the ruling did not amount to immunity either from
prosecution or disciplinary proceedings.

The board advises doctors that relying on a patient's word instead of
prior medical records to determine whether a marijuana recommendation is
appropriate could constitute medical negligence. Failing to conduct an
independent exam or to consider whether another drug would be as
effective could lead to charges of unprofessional conduct.

The California Medical Association is even more explicit, warning
doctors never to tell patients where to get pot and urging them to
remind patients of possible side effects. Discussing dosages with
patients, opining on whether they should smoke or eat marijuana, and
signing a form that enables patients to obtain a state-issued medical
marijuana ID card also are steps the medical association cautions could
lead to them being sanctioned.

Frank Lucido, a Berkeley physician who devotes about 30 percent of his
practice to working with medical marijuana patients, said he abides by
those recommendations, but thinks pot docs are being held to higher
standards than doctors who prescribe lots of Viagra, prescription
painkillers and other abused medications. Doctors who prescribe sleeping
pills for patients who complain of insomnia, Lucido noted, are not at
risk of being called quacks if they don't do a hands-on exam or develop
a long-term treatment plan.

Fry, 50, who is awaiting trial, continues signing recommendation forms
for patients who come to see her from throughout the state. She no
longer sells her patients starter plants, but freely tells them about
what she sees as the spiritual, emotional and economic benefits of
growing their own pot.

"What did I take an oath to do? To do no harm and to alleviate pain and
suffering," Fry said. "I'm going to be true to my oath, and I'm even
willing to go to prison for it."
http://www.washingtonpost.com/

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