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

2. 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.

4. 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

6. 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

7. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.