Q&A after the jump.
SFR: You treat patients in both California and New Mexico. Can you tell me a litte about the difference between the two state's laws? Your web site lists a lot of conditions that are eligible for cannabis treatment in California, but not here.
EE: The law came about in a very different way in California. It was actally pushed through by physicians and activists in a very aggressive way and there was a psychiatrist, who unfortunately is deceased, named Dr Tod Mikuriya, and he somehow got a line into this law at the end that basically says marijuana could be recommended--and the word is recommended not prescribed--for anything for which it may be helpful. So, it just made it completely open for anything.
Why is recommended instead of prescribed?
Well, because it is federally illegal and you can't prescribe an illegal drug. For a physician, it's not a prescription, it's not prescribed in California, it's not prescribed here. All physicians are really doing is writing a recommendation--"so and so has a condition for which cannabis may be helpful." The difference in the law here in New Mexico is that conditions that are listed eligible have had some scientific research conducted that deems it useful for those things. Of course, this is challenging, because it's been illegal in this country there is very little scientific research about the use of marijuana. It's kind of a Catch-22.
It's not a traditional drug. How does somebody come up with dosage for it, especially considering the different strains?
Most physicians just write the recommendation and, frankly, it's the people who often work in the dispensaries or the patients themselves who have more knowledge as to what will be useful. What makes it such an interesting herb is that it does have so many different properties and there is so many different strains and people may have to try a few until they find something that works for them. The same thing with the dosing: It's different for everybody. It's just like how somebody can take one Vicodin every six hours and it'll take care of their pain and another person has to take two every four horus for it to take care of their pain, while someone else might take Vicodin and it's not going to help at all and they need to take something else.
When evaluating a patient, I imagine you don't just recommend marijuana for everybody. What sort of things determine wheyther you think it would work for a patient?
Frankly, most people who come looking for a recommendation have already tried it and know that it works. i would say that's probably 95 percent of the people. I would say there are a few, 5 percent, who are about to enter into cancer treatment or who have peripheral neuropathy or somebody who hasn't used it in 40 years and has heard from a friend that it was helpful. I had somebody in New Mexico who had post traumatic stress syndrome and made the suggestion that they try it because it's one of the few things I've heard from many veterans that works to treat the flashbacks, the insomjnia, the anxiety, the anger management. I did suggest it to this person and he came back and said 'Thank you so much, it's the first night's sleep I've had in six years.' But you know it's not for everybody and I tell people that. It's not unlike other meds; you have to try it and see what works.
Why do you think some doctors are resistant to medical cannabis?
We are just programmed to believe this is a bad drug. It's classified the same way heroin is and probably even heroin has medicinal value, although I think it probably it does more harm. Cannabis, if you do your research, it has been around for 7000-8000 years and has been used medically for centuries. It was in over 30 over the counter medications in this country until the 1940s and it was a completely political move that cannabis became illegal. If a physician goes back and understands that, I think many would have a different attitude.
I've received many emails from patients who have trouble finding a doctor willing to recommend it.
In terms of people trying to find a phsyician that will do this or how do you ask your own physician, I always say 'Bring it up kind of generally.' So, if you have PTSD and you are talking to your psychiatrist, you know might ask, 'Have you ever heard of anyone using marijuana to treat PTSD or to treat multiple sclerosis?' If the physician says, 'Oh my gosh, that's the most ridiculous thing I've ever heard, I would never even allow my patients to try it,' then you know they're not going to be interested in signing the document. If they say, 'Oh yeah, I've quite a few patients who tell me that they do it,' then you might be able to broach it.
Are you worried at all about the federal government?
I personally am not.
I recently reported that of the the several hundred approved for the program, 26 have been rejected. How is the process working so far?
From my end, I think it works fairly well. I do have patients who call me from all over the state and I screen people that I speak to very carefully and ask whether they've done their homework, gone to the web site, seen what is approved because there are a lot of people who know the California laws. If they call and say they have, for example, anxiety, I tell them they will not be approved, so they shouldn't even bother unless they want to petition the Department of Health to get this on the list.
What conditions would you like to see added to New Mexico's list of eligible conditions?
I would like to see migraine headaches, Parkinson's Disease.
The Department of Health rejected Parkinson's last time someone petitioned for it.
Yeah, that sort of surprised me. But migraines is really a big one. In California, I've got a lot of patients for whom it helped tremendously.
It seems like migraines might be something prone to abuse.
Well, again, there are patients who will, and I can tell you in California, that was one of the ones I was in particular pretty rigorous about. I screened for people who had migraines their whole life, they'd been worked up, had the CT scan, been diagnosed, taken Imitrix and they can document that. If I was a neurologist treating them, obviously I would have lal that documentation. Now, if I had a 20-year-old sitting in front of me saying,'Well I get headaches,' I just say, 'Uh-huh .What kind of headaches?' and I do my thing and if they can't give me the documentation, I won't give it to them because for all I know they could have a brain tumor.
I would think some doctors would be concerned with the method of taking marijuana, because the Hippocratic Oath-
Oh give me a break.
But, regarding smoking it might be an issue that people are concerned about.
OK, so yes, maybe, except that people are doing very minute amounts. There was actually a study done where patients who smoked marijuana had lower rates of lung cancer than people that didn't even smoke cigarettes. There is evidence in Israel that show it may actually be a suppresant of cancer. There are alternate ways of using and we would recommend using a vaporizer to people who are going to use it chronically and heavily. To say we 'do no harm'... we prescribe tons of narcotics, ibuprofren, anti-imflammatories, the list goes on and on and it's a balance. If you're saving someone's life and keeping them from committing suicide and they smoke a hit of marijuana every day, in my heart it's clear. I don't feel like I'm doing any harm.
I meet a lot of people who smoke pot chronically and are successful in their careers and personal lives.
I think in my heart of hearts, after doing this, I realized I really do believe it should just be legalized. I know I didn't feel that when I started, but then I thought, 'How many people do I know in many generations who come home every single night and have a drink, whether it's a beer or two beers or a glass of wine or a glass of scotch?' I would say that a big percentage of our culture does that. And you know what? Having a hit of marijuana is no different and is a lot safer than drinking alcohol and a lot healthier.