In Mississippi, where Dr. David Allen worked as a heart surgeon, authorities seized his home and ranch this year after finding $800 worth of marijuana and $1,000 in hashish. A grand jury is to consider a cultivation charge that could net him 30 years in prison under Mississippi's drug laws.
In Sacramento, where he now lives, Allen is a legal, licensed member of a community of physicians that enables hundreds of thousands of Californians to lawfully consume or grow marijuana for personal use.
His recently opened cannabis evaluations clinic on Auburn Boulevard is a newcomer in an increasingly robust medical industry. Born with California's Proposition 215 in 1996, the profession is newly energized by the federal government's recent decision to relax enforcement policies for 14 states that have legalized medicinal use of marijuana.
Voters approved California's Compassionate Use Act amid stories of AIDS patients needing marijuana to boost appetites and cancer patients needing it to counter nausea and other side effects of chemotherapy.
These days pot physicians, touting marijuana as a healthier alternative to pharmaceuticals, are writing medical cannabis recommendations for a far wider range of ills, from restless leg syndrome to psoriasis, from sleep apnea to menopause.
The widely available doctor's "recommendations" they're not formal prescriptions stir intense debate in the medical community, even among cannabis doctors.
Doctors argue over whether the recommendations, costing anywhere from $50 to $250 each, go to patients who truly need medical marijuana or help facilitate recreational drug users and provide hefty profits for the doctors writing the notes.
Doctors are barred by state law from giving out marijuana or instructing patients where to get it. But cannabis recommendations are necessary for patients to make their purchases at the pot dispensaries now sprouting like Starbucks in some communities.
The dispensaries must operate as nonprofits. The doctors are under no such constraints.
170,000 Patients Seen
Already, a lucrative medical industry is taking shape with pot evaluation networks such as MediCann, a "health and wellness service" started with one San Francisco clinic. It now operates 20 offices in California including sites in Sacramento, Elk Grove and North Highlands and has overseen the care of 170,000 cannabis patients since 2004.
"The growth has been steady. We open up a new clinic every few months," said Matthew Desanto, MediCann's marketing director. "Honestly, it's just that patients need to use cannabis as medicine."
In the past year, another group, Marijuana Medicine Evaluation Centers, opened clinics in 10 California cities. It advertises on "WeedMaps," an Internet service for patients seeking doctors, dispensaries and other pot services.
The newfound visibility of the medical marijuana trade is pronounced on the eclectic boardwalk of Venice Beach in Los Angeles.
Along the boardwalk's short span, greeters work the crowd in front of three oceanfront clinics, pitching the benefits of medical pot. One large beachfront house holds the Medical Kush Doctor physician's office and the Kush Clubhouse dispensary. Another doctor's walk-in clinic is next door to a dispensary entrance, where a woman shouts out: "Free hash bar patients welcome!"
In his Sacramento office, where medical diplomas are displayed with a news article on a rare beating heart bypass surgery he performed in Mississippi, Dr. Allen is bullish on his career change to full-time pot doc.
Allen was living in California last February when his Mississippi ranch was raided. He denies participation in any illegal marijuana activities.
Jackson County, Miss., Sheriff's Lt. Curtis Speirs said Allen is being investigated for felony cultivation and distribution.
"In the state of Mississippi," Speirs said, "whether you think it's for medicinal use or not, it's against the law."
In California, Allen charges $150 for medical evaluations and exults over his work with pot patients.
"Cannabis is a miracle drug that works so well for so many reasons, for so many people, that millions are willing to risk jail and property seizures to use the medicine," he said.
He said he is dedicated to serving the people who tell him that cannabis "is better for my migraines, for my asthma, for my menstrual cramps" than traditional treatments. "How can you deny these patients?"
Construction worker Brent Bomia, 36, who said he had back surgery after a work-related fall, showed up with his medical records and got a recommendation from Allen.
"I'm happy he is here," said Bomia. "I believe as a community this is a steppingstone to more people realizing medical marijuana really helps."
Prop. 215 Applied Broadly
Under Proposition 215, physicians can recommend cannabis for cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraines or "any other illness for which marijuana provides relief."
Clinical support for pot's potential health benefits comes from the likes of Dr. Donald Abrams, chief of oncology at San Francisco General Hospital and professor of medicine at the University of California, San Francisco. Abrams conducted state and federally funded research that showed marijuana to be beneficial for patients with HIV and for pain from nerve damage.
"I see cancer patients every day who suffer from loss of appetite, weight loss, pain, anxiety, depression, insomnia and nausea," he said. "With cannabis, I can recommend one medicine instead of writing prescriptions for six or seven."
But Dr. Lee Snook, a Sacramento pain physician who serves on the public policy committee for the California Society of Addiction Medicine, is alarmed over the burgeoning use of medical cannabis.
Snook, who heads Metropolitan Pain Management Consultants Inc., said he encounters many patients with marijuana recommendations who don't need them or are better served by other treatments.
"People go into an outpatient clinic, say, 'I have chronic pain,' pay $100 for a card," Snook said. "That's it. I see it as a business. I don't see it as practicing medicine at all."
The National Organization for the Reform of Marijuana Laws which advocates easing marijuana restrictions lists more than 160 California doctors and clinics as "medical cannabis specialists." Their work, as with all doctors, falls under the scrutiny of the California Medical Board.
Since 1996, the board has investigated 81 complaints against doctors who recommended pot to patients.
Regulators revoked licenses for 10 physicians for violating guidelines published to ensure they conduct in-person "good faith" examinations and review patients' health and medical histories when recommending cannabis. Some were sanctioned for failing to detect overt, drug-seeking behaviors.
Medical Board records indicate some pot doctors attracted attention after other physicians or psychiatrists complained. Other complaints came from undercover police who said they got cannabis recommendations with little or no medical exam.
All 10 license revocations were stayed and the doctors allowed to continue practicing under supervised probation.
In July, the Medical Board sanctioned Dr. Robert Cohen of Santa Monica for recommending cannabis without a physical exam or patient records for a board investigator who said she was a mother of five and needed pot to relax.In August, the board found that El Dorado County doctor Marion Fry improperly recommended marijuana to a patient with chronic paranoid schizophrenia despite warnings from Merced County health officials that pot exacerbated his condition.
The board put Fry's medical license on probationary status for three years. That action came two years after she and her husband were sentenced to federal prison for conspiring to grow and distribute marijuana. A trial revealed that her medical pot recommendations netted between $750,000 and $1 million over a 26-month period.
Even some pot doctors question whether the expanding industry has sufficiently established standards and oversight.
Dr. Frank Lucido, a Berkeley family physician and leader in the medical marijuana movement, worries about a proliferation of "quick-in, quick-out mills that pretty much give out cannabis recommendations to anyone 18 or over that has money."
"It gives the industry a bad name," he said.
Lucido said he pre-screens patients in a telephone interview, conducts 45-minute examinations and requires medical records documenting serious health issues.
Then, there is Venice Beach.
On an oceanfront featuring four new pot clinics, one employee drew in passers-by by handing out fliers adorned with a cannabis leaf and a list of medical conditions.
"Do you have any of these?" he asked. "We can get you a recommendation. It will only take a few minutes."
Gilbert, a 42-year-old Los Angeles man who didn't want his last name used, was in and out of the doctor's office next to the hash bar. He got a cannabis recommendation minutes after a brief exam and blood pressure check.
"He asked me what medications I was on and what do I think marijuana would do," said Gilbert, who said he smokes pot to alleviate pain and high blood pressure.
"Pot smokers are going to be pot smokers. If this is going to make them feel better, then so be it."
November 8, 2009