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Autumn 2005
O'Shaughnessy's
Journal of the California Cannabis Research Medical Group

Practitioner's Perspective
Don't Lie to Your Doctor

By Frank Lucido, MD

Many patients seek out cannabis consultants because they don’t feel comfortable disclosing to their regular doctors that they have been self-medicating with cannabis.

Although I require that a patient’s primary provider or other appropriate practitioner be following the serious illness for which cannabis is used, I do not require that the patient disclose his or her medical cannabis use to these providers in all cases.

I explain: “In a perfect world, you should be able to tell your physician everything. But unless, and until the federal government, employers and insurance companies no longer discriminate against medical cannabis users, there is valid reason not to have cannabis mentioned in your medical records.”

I ask the patient to assess whether he or she feels safe in telling their doctor “off the record” that they’re using cannabis medicinally. If the answer is yes, I encourage them to do so. Your own doctor knows you best.

Altough I don’t require that a patient mention their cannabis use to their own physician, I cannot support a patient hiding other significant information, such as whether they have discontinued medicines their doctor has prescribed.

The following correspondence with patient P, a 30-year-old man, illustrates my approach.

April 11, 2005
Greetings Dr. Lucido,

I am writing you because a friend gave me your website address and I have some questions.

I started having seizures about 3 years ago. They became more frequent over the years and I had my first grand mal seizure 2 months ago. I hurt myself pretty bad (my ribs and back) during the seizure and I am still recovering from it.

Since I have a low income, I was only able to be helped through CMSP (which is like Medi-Cal) but this system is a problem because it takes months to get an appointment or see a neurologist.

Since I had to wait several months to talk with a neurologist and was terrified of having another big seizure I researched alternative methods of seizure control on the internet and read about cannabis... I was able to obtain some cannabis from a friend. I didn’t want to smoke it so he helped me make cookies with it. I tried eating these cookies right before I went to bed so I would not be drowsy during the day. I still experienced some drowsiness after waking up but it usually goes away after a couple hours.

I did notice that the little seizures have become a lot less frequent and I often don’t have any for several days in a row now. I used to get them often several times a day and now maybe once a week.

In a few days I have an appointment with a neurologist but I am worried that he will prescribe some seizure medication to me that has a lot of side effects. I also don’t want to tell him that I have used cannabis to control the seizures successfully.

If I would make an appointment with you, what do I need to bring with me?

Sincerely,
P.

Hi P,
Treating seizure disorder can be an appropriate use for medical cannabis, if it is truly helping you. However, I would require that you have regular neurological and primary care and follow-up care before I would consider approving your use of cannabis as an adjunct to your treatment.

There are many good neurologists who understand that cannabis can help in the overall treatment plan. You may have to ask a few before finding one.

If you have concerns about medical cannabis being mentioned in your medical records, you may want to ask the doctor if you can tell him/her something “off the record.” His/her answer to that will suggest whether you can confide in your doctor.

I will need some documentation of your diagnosis. I will also require that you have ongoing care with your physician for your condition. You will also have to have a valid California ID or driver’s license, and you must be 21 years of age.

(Any exceptions to these requirements must be discussed before making appointment.)

peace and health,
Frank Lucido, MD


4/14/05
Dr. Lucido:

Thank you for answering me so soon.

My neurologist diagnosis is epilepsy and he prescribed “Lamictal” to me today and told me that I should gradually increase the dosage from 25mg to 200mg / day within 5 weeks. In 6 weeks I have another appointment with him.

I have a copy of my emergency room paperwork when I had the grand mal seizure but the neurologist just diagnosed me today so I wasn’t able to get the diagnosis on paper yet. I will call his office tomorrow again and will try to get a copy of the diagnosis.

I would like to make an appointment with you as soon as possible because I don’t want to take the “Lamictal” medication. I am also worried because I don’t want to illegally take cannabis for the seizures and get arrested or get my friend in trouble for helping me get it.

Should I call your office to make an appointment after I have received the diagnosis on paper or is the copy of the emergency room paperwork from the hospital enough?

Thank you, Sincerely,

P.

4/14/05
Hi P.,

I repeat: I would require that you have regular, careful neurological and primary care follow-up care, before I would consider approving your use of cannabis as an adjunct to that good medical care.

I will NOT do it if you are telling your neurologist you are taking your seizure prescription medicine when you are not. Also, be clear that I would not be taking on the medical responsibility of your seizures. That will still be the responsibility of your neurologist, so you need to be honest with him/her.

If you wish to call me, I would be happy to talk to you about this.

Frank Lucido, MD


4/14/05
Hi Dr. Lucido,

I understand that I should tell my neurologist that I am not taking the medication and I will tell him at my next appointment. I was just very uncomfortable and unsure if I should tell him at the first appointment that I have already found a way to control the seizures and that I am using cannabis to do so. I was worried that he would judge me and think I was a drug user. I wanted him to help me without any prejudice towards me.

I will be honest with him and I will also go to my primary care appointments. I had no health insurance until I had the seizure and didn’t see a doctor because I wasn’t able to afford it. Now I am insured through CMSP and can see a physician or neurologist on a regular basis and I will do so because I am absolutely terrified of having another grand mal seizure.

If you require any proof (other than my word) that I will go to my appointments then I will try to get something on paper from the neurologist and physician. I absolutely realize that you don’t have any medical responsibility for my seizures and I would gladly sign any documents you want me to sign.

Cannabis really does seem to control my seizures successfully and the only side effects I noticed so far are drowsiness and sometimes I get hungry from it. The list of side effects of the “Lamictal” is very extensive and I don’t want to find out what side effects I would get from it. I will try to call your office again tomorrow.

Sincerely,
P.

7/12/05
Greetings Dr. Lucido,

I was in your office about 2 months ago because of my epilepsy. You wrote me a 3 month recommendation for cannabis and told me that you would extend it if I can send you some paperwork from my neurologist to show that I am going to follow ups and told him about the cannabis I am using for the seizure control. He reacted as I expected (he was somewhat upset and confused). After he calmed down a little he was actually listening and told me I should try it for a while and see if it worked. He also wrote that down in my records.

He also must have been under the impression that I was getting the prescribed cannabis directly from you because he wrote in the records that I was. I will correct him on my next appointment. I explained to him how it worked with the Oakland CBC but I guess he wasn’t listening.

Cannabis seems to be working good for my seizures and also helps some with my back pain but it may not stop all my seizures by itself so “kepra” was also prescribed to me.

Today I sent the copy of my neurologist records to you by mail. Let me know if you need any other of my records or information.

Thank you,
P.

7/14/05
Hi P,

Reviewed the records. Thanks!

Please correct his misunderstanding, since I don’t and won’t dispense cannabis. And although I do perform primary care on my family-practice patients, I keep my medical cannabis consultations as a medical-legal consultation, and would not be the treating physician for your seizure disorder. I would be happy to discuss any of this with him, at your request.

I am glad you are doing well, and have an open-minded neurologist. Make sure to continue your follow-up with him.

peace and health,
Frank Lucido, MD


O'Shaughnessy's
O'Shaughnessy's is the journal of the CCRMG/SCC. Our primary goals are the same as the stated goals of any reputable scientific publication: to bring out findings that are accurate, duplicable, and useful to the community at large. But in order to do this, we have to pursue parallel goals such as removing the impediments to clinical research created by Prohibition, and educating our colleagues, co-workers and patients as we educate ourselves about the medical uses of cannabis.
 
SCC
The Society of Cannabis Clinicians (SCC) was formed in the Autumn of 2004 by the member physicians of CCRMG to aid in the promulgation of voluntary standards for clinicians engaged in the recommendation and approval of cannabis under California law (HSC §11362.5).

As the collaborative effort continues to move closer to issueing guidelines, this site serves as a public venue for airing and discussing these guidelines.

Visit the SCC Site for more information.