Doctors face dearth of data on effects
July 08, 2006
Erin Allday, San Francisco Chronicle
San Francisco's new pot club regulations underscore the broader issues surrounding the medical marijuana industry, including the complications doctors face in recommending a drug they often don't know a lot about.
Medicinal marijuana has been legal in California since voters passed Proposition 215 in 1996. There are only a handful of published studies that analyze the positive effects of marijuana use in controlling symptoms such as pain and nausea, but anecdotal evidence is strong enough that most doctors agree that the drug is at least worth further investigation.
Physicians don't prescribe marijuana, but can recommend that patients use it. In fact, patients must have a letter from their doctor recommending that they use marijuana before they are allowed to buy the drug in California.
Still, a decade after Californians made medicinal marijuana legal, few doctors feel comfortable recommending it to their patients and most don't know enough about the drug.
"You still have a relatively small number of physicians who are in any way active in this," said Steve Heilig, director of public health and education for the San Francisco Medical Society. "Reluctance comes from the lack of real information we have and federal attempts to crack down on the use. And there is a real perception that there is a lot of abuse of good intentions, in terms of the pot clubs."
Physicians who are knowledgeable run up against a variety of barriers, including difficulty securing federal grants for clinical studies and finding avenues for passing that information on to other doctors.
Dr. Donald Abrams, a professor of medicine at UCSF, has been studying medicinal marijuana for decades and is considered a global expert, but he's had trouble getting published his most recent study on the drug's effect on HIV patients.
"That's a little upsetting because it is a promising study showing cannabis is useful," Abrams said. "More and more we're going to find that it (marijuana) has great potential. My fear is, once you get the evidence it's difficult to disseminate it."
With so few doctors who have the expertise to recommend marijuana to their patients, pot club owners become almost lay doctors, "like your old-time educated pharmacist," Heilig said.
Kevin Reed, 32, who is trying to get a permit to open a pot club at Fisherman's Wharf, has previous experience selling medical marijuana in the Mission District. He said his job there wasn't just selling marijuana, but advising patients on how much and what kind they should use, and whether they should inhale it or swallow it.
Reed said most customers in San Francisco are experienced pot smokers who don't need much guidance from him to figure out what they want to buy. But with new smokers, he talks to them about their symptoms and the different strains of marijuana available, and starts them out with a fairly small amount, so they can figure out what works.
"A lot of people don't know what they're doing when they walk in," Reed said. "Doctors don't have enough education. That's what I've seen a huge lack of, is the education. When you're buying from someone like us, you're dealing with people who know those things. We have a regulated environment."
And Reed does know his business. He smokes up to half an ounce of marijuana a day for pain related to an injury he suffered in a car accident about 15 years ago.
Reed said he plans to run his pot club like a consignment shop, with customers who grow their own marijuana selling their extra supply to him to resell to other customers. The most he can sell to each patient is an ounce a day, which would cost $300. "You have people who come in and buy enough medication for a day, and the next day come back and try something new. A lot of people start out that way because they want to know what works," Reed said. "It's like wine in a lot of ways, they all have different tastes and aftertastes and different effects."