I've written previously about my decision not to assist patients in obtaining medical marijuana. My decision is based on my interpretation of the data and of medical ethics. This decision is independent of any opinion I may have about legalization.
But other doctors may see things differently. The data are clear to me, but the plausible nature of many of the claims made about marijuana make it anything but a no-brainer.
That's one of the reasons why a story out of New Mexico is disturbing. New Mexico has a medical marijuana program. Doctors who work for the Veterans' Administration are being told the following:
General Counsel has held that: "VA should not authorize completion of forms seeking recommendation or opinions regarding" participation in medical marijuana programs and that "applicable statutes and regulations do not require VA physicians to complete such forms."
Further "A VA physicians' completion of a form that would permit a patient to participate in a state medical marijuana program could result in DEA action to seek actual or threatened revocation of the physician's registration to prescribe controlled substances as well as criminal charges."
The language in the New Mexico form requires physician certification that "the potential health benefits of the medical use of marijuana would likely outweigh health risks for the patient." Informal advice received from the DEA suggests that the Department of Justice may seek civil or criminal penalties for Federal physicians and other practitioners who complete forms that either recommends the use of medical marijuana or forms that describe the patient's physical condition in order to facilitate the patient's entry into a state medical marijuana program.
New Mexico law permits medical marijuana with a doctor's certification. The VA is claiming that a doctor's status as a federal employee supersedes all other considerations. That is disturbing.
I have no doubt that there are doctor's out there running pot certificate mills, but I doubt they make up the majority of those filling out pot certificates. The Feds have created an ethically untenable situation. If state law allows a doctor to certify someone as benefiting from pot (not prescribing it), and the doctor truly feels the data support this certification, who should bend? Many veterans get all of their care from the VA system.
An analogy could be made that since heroin is an excellent analgesic, doctors should be allowed to prescribe it, and while this analogy is tempting, marijuana, for social, legal, and scientific reasons, is not perfectly analogous to other narcotics. Any physician certifying someone for marijuana use should be aware that the data are thin, and that health risks, including addiction, are real. But this comes very close to forbidding a doctor from giving advice as they see fit.