As medical director for medical cannabis of southern california I have dedicated my professional life to evaluating patients to use cannabis legally for medicinal purposes. For the past two and a half years I have taken care of thousands of patients who qualify under CA Proposition 215 and helped them find relief from whatever ailment they suffer from. It has been an incredible journey and each day I am inspired by my patients stories of healing and humbled by their suffering. I truly feel honored and blessed to have this opportunity each day.
Because of my unique experience as a physician who sees patients who qualify under California’s Proposition 215 and Senate Bill 420 I wanted to finally come out and express my opinion on the November ballot initiative Proposition 19 (Tax and Regulate 2010) which would legalize marijuana for recreational use for anyone 21 and over. After much thought, personal reflection and numerous discussions with both patients, collective owners, doctors and law enforcement I feel like I know exactly where I stand on this issue. I want to share my opinion with you so you can make an educated decision as well.
I AM NOT SUPPORTING PROPOSITION 19 AND WILL VOTE NO IN NOVEMBER.
Let me first start out by letting you know what this new proposition allows (to read the entire proposition you can copy and paste this link ) http://www.taxcannabis.org/index.php/pages/initiative/
If passed;
1. Anyone 21 years of age and older will be able to possess, cultivate and transport up to 1 ounce of marijuana legally. They can use and share it with anyone 21 and over for recreational purposes.
2. People will be able to legally grow their own plants for personal use in a 25 square foot area.
3. Individual cities will be able to decide whether or not THEY want to tax and regulate the sale of marijuana. If they allow the sale they will create ordinances for businesses to legally sell marijuana. However each city can still say they do not want to legalize the sale of marijuana. For example, even though it will be legal to use cannabis in Irvine for people 21 and over, Irvine can still decide whether or not they approve the sale of marijuana for recreational use in their city.
4. Marijuana use will only be permitted on personal property. It will not be legal to use in public or where smoking is prohibited. i.e. It will not be legal to use recreationally at a concert.
5. Sales and use by minors (less than 21) will be illegal. It will also be illegal for anyone to use marijuana in the PRESENCE of a minor (less than 18). It will still remain illegal to use marijuana and operate a car, bus or boat.
Here are my thoughts about this proposition:
1) Proposition 215 and Senate Bill 420, which allow for the medicinal use of marijuana by patients, will be marginalized and weakened. I feel this proposition will make it more difficult for the medical community to strengthen its stance and convince the federal government to re-schedule marijuana so that it can be further researched and legally prescribed by doctors. Under current state law, any patient that feels they can benefit from using marijuana for medicinal purposes can be evaluated by a licensed physician. That doctor will go over a patients medical history, review their medical records, perform a physical exam and most importantly go over all the benefits and risks of using marijuana. This system, although not perfect, has allowed thousands of patients to get professional advice by licensed doctors to use marijuana to treat their symptoms. There have been a number of physicians, myself included, who feel so passionate about this issue that we have stepped outside the box of traditional medicine to work with patients on this issue. It takes courage and is not a easy path professionally. I would even make the statement that it can actually hinder our careers professionally. Regardless, because of all the medicinal properties of marijuana we continue to work with patients on this issue.
What makes proposition 215 and senate bill work is that patients who want to use marijuana legally can go and get professional advice. They will each receive a physical exam and have a doctor discuss their medical issues in detail. Many of these patients do not have primary care doctors (mostly do to lack of insurance) and do not get routine physicals. I can not tell you how many patients I see that have undiagnosed and untreated high blood pressure. I have found on many exams patients to have undiagnosed heart murmurs, skin cancers or even thyroid disease. I can also direct them to specialists if they truly need further work up for their complaints. Even patients that are lying in the doctors offices about their ailments (to use marijuana recreationally) will still at least receive a physical exam and get some basic primary care. This is a good thing for our community. If we can treat just a few patients per day for their high blood pressure that would have gone undetected and untreated we are not only doing that patient an incredible service but are saving our taxpayers thousands of dollars down the road when these same patients suffer strokes and heart attacks and require extensive care.
If Tax and Regulate passes in November patients who want to use marijuana will no longer have to see a doctor to do so. Recreational users will also not have to see a doctor to use for recreational purposes. Clinics like mine will not be able to economically survive and doctors who have stepped outside the norms of medicine to specifically work with patients will shut their doors. Patients who would normally be examined and have their questions answered will be on their own. Most physicians WILL NOT discuss marijuana use with their patients and if they do often give INCORRECT information. This is not going to be good for doctors or patients.
Let me address the issue that many of you reading this are obviously thinking: that my motives for voting NO are purely economical. What I say to that is that I will be able to make a living as a doctor regardless of whether or not my clinics survive. There is life after marijuana for myself personally from a medical standpoint. I will always be able to take care of patients. However depending on where I work or what hospital I am affiliated with I may or may not be allowed to recommend marijuana to patients (as is the case with Kaiser doctors). That will be unfortunate because I am so passionate about this cause.
Also, because legalization will increase the number of people who use marijuana as a result of it being more accessible and without the fear of arrest and prosecution we will see an increase in the adverse affects of smoking cannabis on patients. People who smoke recreationally will suffer from worsening asthma, increase susceptibility to cough and lung infections and I believe an increase the cancer rates from the carcinogens in the smoke. In my day to day practice I explain and stress the use of digital vaporizers which allow people to use marijuana smoke free. However MOST patients have not heard of them until I sit down and show one to them. I believe that most people who use recreationally will smoke and not vaporize because of a lack of education. For example, in NY (my hometown) very few recreational users have even heard of a vaporizer. I have relatives who have used marijuana recreationally for decades and still think the only way to use it is to smoke or eat it. The increase in chronic bronchitis, worsening of asthma and the unfortunate cases of cancer will only fuel the opposition who state that marijuana is harmful and has no medicinal value.
We still have a long way to go from a medical perspective. We need more research studies to solidify what we already suspect; that cannabis has incredible medicinal value. What the state should focus on is strengthening the existing medical cannabis laws on the books. They should start implementing a system for supervised production, handling and distribution. It should undergo the same scientific scrutiny as any other medications. Ultimately we would need labs to extract the medicine from the plant and put it in a usable form. I envision pharmacists and labs working with growers to ensure the highest standards of quality. Doctors should be able to confidently recommend this medication without the fear of patients getting medicine that contains molds and other bacteria. All of this is possible if we continue to head in the RIGHT DIRECTION. Recreational use is throwing the movement into reverse.
In conclusion of point number 1: It is a good thing that people and patients are required to see a doctor prior to using marijuana legally. Voting NO on Tax and Regulate 2010 will insure that this current system continues and evolves.
2) Proponents of Tax and Regulate 2010 argue the state of California stands to generate millions of dollars in tax revenue if marijuana is legalized. I see it a little differently. In a perfect world, under Prop 19, people would be able to grow and produce their own marijuana and if they decided to sell it they would report that income and pay tax on it. Stores that want to sell it will pay a tax. In reality what I think is going to happen is that people are going to legally grow their own marijuana and they are either going to share it or sell to their friends and family. That is going to be a cash transaction that will NOT be reported to the state. I do not see people getting business licenses and paying income tax on these types of transactions. In theory it sounds great but how in the world is the state of California going to track or enforce any of that? They can barely enforce legitimate businesses to report their income and pay all of their required taxes.
If the state wants to generate revenue what they need to do is allow Collectives/Dispensaries in the current system to operate FOR PROFIT. Currently, collectives/dispensaries are required to operate as NOT FOR PROFIT. So what are they doing?? They are NOT SHOWING PROFIT. Yet they are making money every month and hiding it under their mattress and it is not getting reported. Wouldn’t it make more sense if the state said “let’s allow collectives who take care of patients make as much money as they want. Let them report it on their income taxes and let the state collect the revenue.” This would do two things: It would legitimize the business because more and more legitimate business people would get into the industry and 2) It would allow the state to generate the type of revenue that it is talking about.
Why would any legitimate business person invest hundreds of thousands of dollars to start a collective, spend all of their time operating it, risk being robbed or kidnapped, risk having to be arrested and go to federal court… and do all of that for NO PROFIT?? Whoever created this current system is out of touch with reality and obviously never run a business. We allow drug companies, pharmacies and pharmacists to make money. Why should people who distribute cannabis as medicine make money.
In conclusion of point #2: Tax and Regulate (Proposition 19) is realistically not going to generate more revenue for the state. What they should do is restructure the laws governing collectives and allow the current system to operate as FOR PROFIT businesses.
3) I want to address the argument that people often use for legalization when they say: “Marijuana is so much safer than alcohol. I can go to the liquor store right now and get as much alcohol as I want. Shouldn’t I be allowed to use marijuana legally since it is much safer?” First let me say that alcohol may be the most destructive drug on the planet. We have all seen it destroy families, relationships, promising careers and the hopes and dreams of many friends and family members. Every year tens of thousands of people are killed in alcohol related accidents. People get intoxicated, get into fights, have unprotected sex, beat their children and spouses and lose both their freedom and jobs because of it. In addition the costs to our health care system are staggering. THAT IS ALL A FACT. Personally I have never made one good decision when intoxicated. Because of all those things alcohol probably shouldn’t be legal. However it has become part of our culture and society and will always stay legal.
But to say that because marijuana is safer than alcohol as a reason to legalize it in my mind does not make sense. Then why not legalize any drug that is safer than alcohol. If we use that argument then let’s legalize oxycontin, percocet, vicodin etc. They are all less destructive than alcohol no? Again, alcohol has done more harm to the human race than probably any other drug and that is very unfortunate. But I don’t think that because it happens to be legal that we automatically legalize every drug that is less harmful.
We have to look at each drug specifically and see how it will impact society and peoples lives. Personally I do not use marijuana for medicinal or recreational purposes. As a medicine I see how it works incredibly for patients every day. A day does not go by that I thank God that a specific patient had this as an option because it dramatically changed their life. For many patients it is a God-send.
However recreationally I think we need to really think about if we want marijuana to be more accessible to our community. I personally believe that if it is legalized their will be more people using it recreationally than there would be had it remained illegal. I do not think that is something we should want in our communities. Any drug, even one as safe a marijuana, is not good for recreational use. It is my opinion that people will make worse decisions using marijuana in all aspects of their lives than they would if not using marijuana. For example, a 21 year old individual may decide to drive when “high”. That is not a good thing. I have a son on the way and would be devastated if he and my wife were injured by someone driving under the influence of marijuana. I also think that continued recreational use of marijuana makes people less productive in work and life in general. It is something that I would not encourage my children to use if they wanted to really get ahead in life (academically, socially and spiritually).
In conclusion to point #3: Yes marijuana is safer and a better alternative to alcohol. However you need to look at marijuana individually and determine based on those facts alone whether or not it will be for the better good of society. I personally do not think it is for the better good.
4) Proponents of Tax and Regulate 2010 argue that law enforcement spends way to much money and time prosecuting people who are arrested for possession and distribution of marijuana. That I happen to agree with. There are more important issues that I think law enforcement should focus their efforts on, especially in light of massive budget cut backs. I personally would rather see the local police force spend their time dealing with violent criminals and white collar crime. In light on 911 and the world we know live in where terrorism is a very real threat, I would like to see local law enforcement work more on protecting our homeland from terrorist cells that most likely are living and working among us waiting to strike.
All that said, when you take into consideration what Prop 215 and Senate Bill 420 were trying to accomplish, the benefits of legalizing possession of marijuana from a law enforcement perspective do not outweigh the risks of what is it going to do to the medical community.
I was going to conclude with the paragraph but I think I want to make this point. I want to be very careful in doing so because the credibility of the medical community is at stake. Unfortunately in this industry I have seen morals and ethics thrown out the window. The line in the sand where there once was integrity has been trampled on and is no longer visible. There are doctors and clinics throughout California that COULD CARE LESS if you are an actual patient and want to use marijuana recreationally. One of the major clinics in Southern California were started and owned by ex-mortage brokers who are simply concerned about profit. They hire doctors and fill the clinics with whoever has their fee regardless if they are patients or recreational users. You can simply visit Venice beach and walk in and tell the doctor your back is injured and they will provide you a recommendation to use cannabis legally. No documentation required, no exams, and no follow up. There is a doctor who feels its appropriate to see all his new patients over video skype! He never once puts his hands on you to examine you. This is very unfortunate but it’s the reality. With that said, marijuana is essentially legal in California. There is no excuse to be arrested for possession because there are clinics that will allow you to take advantage of Prop 215 and Senate Bill 420.
In conclusion to point #4: Although Prop 19 will free up law enforcement to focus on terrorism, violent and white collar crime; The benefits do not justify a YES vote in light of what it will do to the medical community. If you want to use recreationally and are worried about arrest make a trip to venice beach or see a doctor over skype and you will be a legal “patient”.
Ultimately as a voter I think you have every right and can justify a YES or NO vote. My goal of writing this editorial was to give you my perspective based on 2 and a half years of working with patients and discussions with recreational users and law enforcement. This is democracy at it’s best.
If you have questions or comments feel free to contact me by visiting my website www.mcsocal.com and click on “Contact us” I have two medical cannabis clinics in Irvine and Long Beach and see patients full time for medical cannabis recommendations.
Be blessed,
Dr. Sean Breen
Medical Director, Medical Cannabis of Southern California
