Physicians as gatekeepers in the use of medical marijuana.

In recent years, the question to many physicians around the United States has morphed from, “How about some Viagra, doc?” to, “How about some medical marijuana, doc?” California exemplifies the bookends of the medical marijuana/legalization movement. The movement’s major victory was in November of 1996, when Proposition 215, the Compassionate Use Act, was voted into law, creating a process by which physicians could recommend the use of marijuana for various serious conditions. The Compassionate Use Act was championed as an act of mercy for citizens with chronic serious illnesses that did not respond to conventional medical treatments. The legislation received wide support and has been a model for other states to follow, including 16 states and the District of Colombia. The California law gives physicians the discretion to recommend marijuana for certain listed medical conditions. In addition to those, California physicians may also recommend marijuana for any other conditions that, in their clinical judgment, warrant marijuana use. This methodology places doctors in the gatekeeper role of conferring their blessing on the use of a gateway drug for medical purposes. Law enforcement is often confused when asked to differentiate between criminal laws for marijuana cultivation and the exceptions outlined in the Compassionate Use Act. Attempts to clarify legal issues raised by the Compassionate Use Act have led to court battles that were decided in the highest court in the land. However, the holding by the Supreme Court in Gonzales v. Raich did little to resolve the legal uncertainties associated with medical marijuana. There are compelling arguments both for and against the use of medical cannabis. Those who support its medical use argue that marijuana can be an effective medication to reduce suffering for patients who have exhausted all other means of treating a condition. Those who argue against the medical use of marijuana cite the lack of data on its safety and efficacy, an ever-expanding list of conditions that the drug is purported to treat, and fear that recommendations for medical marijuana are a physician’s blessing for drug abuse. Medical organizations have argued for caution due to both the absence of standardization and the lack of research supporting the use of marijuana for various conditions.