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Cannabis prohibition and the decades of propaganda that have accompanied it have left physicians in a tough place.

Mickey Martin is the author of Medical Marijuana 101 and a vocal activist in the cannabis community. He will be hosting the Massachusetts Cannabis Knowledge Forum September 28th-30th, and he’ll be answering questions in this column.

In an ideal world, every doctor would be open to recommending cannabis as an alternative to other more dangerous treatment options. Unfortunately, due to years of misinformation, and efforts by Federal agencies to stifle research on cannabis medicines, there are a number of doctors who simply will not look to cannabis as a viable option.

Nancy Reagan speaking at a "Just Say No" Rally in Los Angeles, 1987

Cannabis prohibition and the decades of propaganda that have accompanied it have left physicians in a tough place. Many simply do not want to be associated with cannabis due to its stigma in our society.

But times are changing. More and more we see doctors coming to the table and recommending cannabis for patients. We just saw CNN medical correspondent and US Surgeon General nominee, Dr. Sanjay Gupta, do an about face and admit that he was wrong on medical cannabis for many years because he had “failed to look deeper.” Many doctors are coming to this realization.

Yet, for most patients, getting their regular physician to sign off on cannabis will be difficult. Not necessarily because the doctor does not want you to use cannabis, but because he does not want to be part of the bureaucracy established by the state for physicians.

Doctors who prescribe cannabis must jump through special hoops in order to do so, including taking continuing education courses on cannabis. A lot of doctors who have practices that thrive regardless of cannabis will simply not want to deal with the red tape of the program.

This is why you see doctors who specialize in cannabis advertising their services.  Going to a doctor who you know approves of cannabis use for patients with qualifying conditions can save a person the feeling of rejection they might get from going to their regular doctor and seeing if he wants to put his name on the line for medical cannabis.

The Department of Public Health regulations requires that there be a “bona-fide physician patient relationship” from a physician “acting in the usual course of his professional practice.” This means that an eye-doctor cannot prescribe you cannabis for your arthritis. The bona-fide relationship means that a physician, “in his usual course of professional practice,” is willing to certify that “the potential benefits of the medical use of marijuana would likely outweigh the health risks” for your condition.

In order to meet the definition of “bona-fide relationship” the physician must conduct a clinical visit, complete and document a full assessment of the patient’s medical history and current medical condition, explain the potential benefits and risks of marijuana use, and must have a role in the ongoing care and treatment of the patient. This means the physician will have to have the ability to offer follow up care to the patient, including examinations to determine the efficacy of medical cannabis on your condition. This is the same type of relationship required under Colorado law and it seems to be working fine for patients there.

If your normal doctor is not a good option to approach about your need for medical cannabis, finding a doctor that is a good option is the next step.

Dozens of organizations have sprung up around the State of MA that are specializing in cannabis recommendations.

But all organizations are not created equal, so do your homework.

In other states we have seen some fly-by-night organizations take advantage of patients, only to have their license revoked and their recommendations invalidated. The good news is that most places are on the up-and-up and understand the requirements and how to navigate them accordingly.

But if a doctor promises you that they can get you signed up for $200 with no prior medical history, no physical exam, and no requirement of an on-going relationship with you, chances are you might be getting scammed.

While doctors are assumed to be ethical by nature, many are not. If something seems too good to be true, it just might.

We will not really know how stringent the DPH will be on the physician-patient relationship, but nothing is more disappointing than to think you are legal, only to find out that you are not because some quack decided to take shortcuts to separate you from your money.

When contacting doctors do not be afraid to ask them about their interaction with the Department of Public Health, and how their program meets the regulation requirements. They should be prepared to explain how the $200 you are spending to see them insurance free is going to assure that you are a qualified patient in the program. You can ask the doctor what their “professional course of practice” is to make sure that they are even able to make a recommendation for a person with your condition.

Make sure that you are getting what you pay for, and if you think you are not, find someone else.

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