Save the date:
June 10 2018
Ghost Town Disc Golf Course
Start Time to follow.
Save the date:
Ghost Town Disc Golf Course
Start Time to follow.
I am a Medical Doctor who has transitioned from Denver Health Emergency Department to Doc Morrison seeing patients about Medical Marijuana. I have been doing this since 2013 coming up on 5 years. I would like to explain an experience I had recently which reveals a problem regarding Researching Medical Marijuana.
In academic medicine I enjoyed asking questions and participating in studies that went to find truth regarding those questions. The Idea is to find practices which improve the quality of life for patients.
I was caught surprised when a significant research project from the University of Colorado approached my business Doc Morrison with a chance to house their study. I can not tell you how excited I was.
The study is looking at the idea of MMJ tolerance. It was to have one group of people who had not used MMJ frequently and one group of people who use MMJ frequently and have them drive in a simulator before and after smoking MMJ and then compare the groups. Some believe MMJ tolerance means that driving is not effected adversely by using MMJ after you have been using it for a prolonged time. No one nows the truth.
The reason I was so excited was because this begins to look past preconceived notions in any direction and tries to find truth. This was an opportunity for off duty officers to evaluate people before & after using MMJ ultimately potentially contributing to a Roadside test used in the U.S. to determine if a subject is intoxicated. The study is legitimate. The best funding available in the U.S. Grant Funding from the State of Colorado from MMJ taxes. Quality researchers from the University of Colorado Denver. I don't believe that there is any Federal funding of research for MMJ. This makes this State funded research some of the first in the United States.
So why did Wheat Ridge say No? There was a recent discussion in City Council as this was explained to me. The discussion decided there would be NO CLINICAL STUDIES in the City of Wheat Ridge. As it was explained to me it would now be difficult to get changed because it was such a recent conversation in Council.
The driving CU study has found a home in Aurora. That study has sailed but I would like to discuss what the concerns with clinical studies are & see if there is a way to do address those concerns & be open to studies in the future within the City limits of Wheat Ridge. I can only guess of what those concerns would be having not been involved in those discussions. I own the building & have a strong desire to participate in research. I would love to start a conversation to address any and all concerns.
I grew up here in Colorado and one side of my cousins were Farmers from Wheat Ridge High School. My experience with MMJ here in Colorado has led me to believe that everything happens for a reason. I believe I found this building in Wheat Ridge because of the farming traditions of the Wheat Ridge blending with the plant/crop foundation of the MMJ industry.
The University of Colorado Denver driving study must have been told by Denver they couldn't do the study in Denver. I have never heard those discussions. Wheat Ridge could have taken the torch from Denver and begun what could be real MMJ research. I am going to use this to reach out to all of the City Council members on the Wheat Ridge City Council. I have been told that I can get this brought up for discussion again if I can get 2 council members to agree to a discussion.
Hearing that Wheat Ridge said no to the possibility of any research even from the highest levels available here in Colorado and maybe in the U.S. was the most disappointing news I have heard since starting Doc Morrison.
I believe I have been a great business addition to Wheat Ridge over the past 5 years. I think we have done a great job of navigating uncharted regions working well with the City, taking excellent care of our Patients & being good neighbors.
The world is a complicated place. I want to use my good standing to respectfully ask the City Council of Wheat Ridge to re-open the discussion on research. I would be willing to help moving forward to find out what kind of research would be more or less possible. I believe MMJ is helping the 3,000+ Patients a year I am directly seeing. We need to look now at so many aspects of using MMJ. It seems disingenuous to take significant tax money for people using Marijuana and completely block all avenues to research acute and chronic questions regarding MMJ.
Lets be genuine. Lets start looking at MMJ with real questions & real research. I heard the research went to Aurora. We missed that one. There will be more. Lets re-open the discussion on research.
Peter Pryor MD MPH
Ronny Jackson the person Donald Trump wanted to be in charge of VA seems to have been sponsored by PERCOCET. Handing out prescription pain KILLERS and wrecking cars after drinking at Secret Service parties. Our Veterans deserve better. Our Veterans are struggling and need leadership and medical help. Percocet are not fun and not for sleeping or driving. The rest of the world is realizing what the opioids are doing to our country and the White House seems to be having a big party. How seriously can our President be taking the Opioid Epidemic if the person he wants to lead such an important health care institution may have improper prescribing practices and substance/mental problems.
A question I have as a Doctor to Doctor Jackson: it seems as though you have a substance abuse problem & potential associated mental illness associated with the abuse, are you the right person to tell the world that our President is of sound mind and body. Would it be OK with you if our president drank 12 drinks a night or abused Percocet to sleep? The orange face of our President looks a lot like the orange faces of the chronic alcoholics I had as patients while working in Emergency Departments in Colorado and in the Bronx NYC. I have wondered about our Presidents face every time I see it since you gave him a clean bill of health.
I made a transition of working in the Emergency Department at Denver Health to “Recommending” Medical Marijuana (MMJ) four years ago. I fear that my time might be limited seeing patients regarding MMJ. I wanted to create an information highway learning about the benefits & bad effects of MMJ. As an unexpected consequence of talking to people about MMJ I now believe the pharmaceutical companies are behaving in an evil manner. Narcotic pain meds and their manufacturers are not to be trusted. I believe Pharmaceutical companies have been operating only in the interest of profit since before I became a Doctor in 2000. Since leaving The Emergency Department my role has changed from being a cog in the Federally supported Narcotics dispensing system working in the Emergency Department, to now being an agent in the State tolerated Medical Marijuana dispensing system.
I think it is safe to say we all agree Narcotics are devastating several generations of Americans. 64,000 dead in 2016 because of Narcotics overdose. I am questioning are there ANY target populations for narcotics, outside of end of life uses, where the benefits outweigh the risks.
So how does MMJ play into this? I have seen 3,000 people (about 3% of the Colorado Medical Marijuana Patients) annually for access to Medical Marijuana. I have written Doctors SOAP notes on every single patient visit. I gather data regarding Prescription drug use, allergies to medications, why they use Marijuana and if they find it effective or if there are adverse reactions to MMJ, other medical problems. I do a brief physical exam & make a plan with the patient regarding marijuana use. People come to me with desire to quit prescription meds. I high FIVE them when the are successful. I high FIVE Patients who quit alcohol, opioids & synthetic opioids, sleeping pills & anxiety medications & antidepressants. Using MMJ I was able to quit drinking alcohol. My brother Josh ended his life using alcohol. My clarity on alcohol comes from my own story including my brother’s story which tells me it alcohol is a socially accepted personal & societal killing poison. I meet people every day I work who are excited to leave these anchors in their rear view mirror.
Several critical functions should be provided by a well functioning Medical Marijuana system. Primarily, it should focus on directed education. I don’t think smoking is good for health so I educate people on edibles & tinctures. Edibles can provide doses of THC CBD in distinct quantities. “Understanding” how to dose CBD & THC has been limited to word of mouth education from Bud Tenders. Bud Tenders then became responsible for making suggestions of a wide range of therapies & dosing with no understanding of the patients condition, other medical problems, medications with MMJ interactions, physiology or biology that are at play. I commonly recommend 1/4th the average recommended “recreational” dose of 10mg THC when getting started. In terms of CBD usage there is even less information out there about dosing. I have created a dosing template which is hand tailored for each patient. There are distinctions between using THC by itself and CBD, THC & a potential parade of cannabinoides ie CBN. How will we learn about adverse reactions unless we see patients and ask them questions? How will we learn about continued effectiveness/ tolerance or effective dosing. Drug to drug interactions will not come to public awareness as fast if it becomes only recreational. What about THC use for conscious sedation in hospitals? That can never occurs unless we think of alternative & safe uses & trial them. The dosing template I have come up with is not as meaningful without follow up where people give input as to if it is working or at what dose etc.
Allowing patients to grow their own Medication is another critical function of the Colorado Medical Marijuana system. Why let patients grow their own Marijuana? Regulation of the Marijuana growing for Medical Marijuana is unmonitored for pesticide use. Recreational marijuana is only monitored for use of illegal pesticide use by whistleblowers. Do I trust the growers to do all the right things if they are not being monitored? No. Do I trust a whistleblower system to care about my brain, lungs or my digestive tract? No. Do I as a Marijuana grower/user know what was added to my soil and water and seed? YES.
How many plants is enough plants? This is a moving target and I have always felt that if a person wants to they should be able to grow enough of the plant to satisfy their personal use without visiting dispensaries. People growing outside or for other reasons may only have one harvest per year. This could make sense if you grow outdoors using the sun as your energy source. It may also make sense if you can grow enough for the entire year in one cycle conserving time and potentially energy. Do you need a Sea of Green which are smaller plants transitioned faster between Vegetative & Flowering states where you get less MMJ but faster? Two Medical Marijuana Physicians I know or have worked with have had their Medical licenses suspended regarding their recommending of higher plant counts. While growing my own plants I have learned of the challenges in growing plants & the volume of MMJ obtained from plants. This information has allowed me to adjusted the number of plants I recommend a Patient be able to grow. I require medical records regarding their medical problem for every person who requests a higher plant count. I have decreased the number of plants I will write for a patient to be able to grow as I have learned about how yields can increase in the hands of an expert balanced with most of the patients I see are not expert. My target patient is someone with interest in personal, mental, physical health & the use of MMJ in that process. I feel we need to be able to maintain the freedom to grow our MMJ. I feel growing marijuana should be more protected than making your own beer or wine. Neither beer nor wine have positively contributed to my health over my lifetime while MMJ has helped me become the healthiest I have been in my lifetime now nearing 50 years old. I am trying to balance a desire to allow people to grow their own medication, the potential for abuse of the system & MMJ as a substance by the patient & a desire to be able to keep my Medical License which allows me to continue to practice Medicine.
My perspective is one of a Doctor who is at a crossroads of Opioids & Marijuana. Doctor means Teacher. That is what I do every day. I teach. I teach people about how to safely get started, where to go, how much to try, what might happen if they take to much and how not to take too much. What to do if they do take to much. My office is very busy office. I prefer it that way. I want to be a helpful teacher. I believe in the Medicinal uses of MMJ. We are in process of gathering useful information on if or how well MMJ works for “X”. “X” being all the things people tell me it helps them with. Pain, nausea, muscle spasm, anxiety, phobias, creativity, anxiety relief, focus, concentration, improving quality of life, getting along with others, getting out of the house, out of bed, getting more comfortable in the bed they will die in, getting them out of a wheelchair or not using a cane, back on the slopes, hiking again, riding a horse, a motorcycle, a bicycle, getting along with a loved one, getting along with anyone, seeing something beautiful or writing lyrics, creating, helping with the pain of a paralyzed or broken body or the phantom pain of a body part lost, helping with the knowledge that the end for them is near. It is easy for me to be helpful to people interested in alternatives to Narcotics and Prescribed medications.
I love cutting through outdated propaganda. I am excited for data & studies. In a world where too many of us are dying using federally supported pain KILLERS now is time we celebrate, protect and grow what we have started with the Colorado Medical Marijuana system. We have a system in place to help some of the people who will be stopping narcotics, muscle relaxers, sleeping pills, anxiety medications as Physicians are forced to stop prescribing or face the consequences which for some patients has meant NO MORE MEDS IMMEDIATELY. I challenge us to stop trying to smash THC CBD CBN .... which I feel are helpful tools for some who are currently addicted to a medication they will no longer be able to get legally. People are being cut off from medications they have been taking for 30 years with no education or treatment. Cold Turkey. Now is the time to take off the 1973 blinders and look closely at MMJ as a helpful tool for people at the end of their rope at the end of a dead end street. I fear we have only seen the tip of the Opioid Iceberg. We need to find alternatives for treatment of pain. Previous experience tells us that many current prescribed medication users will move to less controlled, less legal alternatives once they can’t get what their body has become accustomed to having. For those out there who believe that our current opioid epidemic started at the end of a marijuana joint I will tell you this, the opioid epidemic started at the tip of a Physician’s pen generating fortunes for some companies.
Peter Pryor, MD MPH
P (720) 630-8999
I agree with President Trump that we have a pain killer emergency on our hands. My perspective on this is as a Board Certified Emergency Medicine Physician. Working in emergency rooms prescribing meds including narcotics/opioides for over a decade. And now adding the past 4+ year history of Doc Morrison as a MD performing medical evaluations, education & filling out forms regarding Medical Marijuana.
I am living a Medical Marijuana & Opioid/Narcotic crossroad that our country is now in the early stages of figuring out. I had a patient last week tell me he had been cut off from his narcotics which he had been taking for 10 years without fail 3 times daily. This patient received no ween down of narcotics or really any advice or assistance was given to him about quitting narcotics which his body is depending on. I asked him when he took his last dose curious to see how his withdrawal had gone. “I took the last one just before leaving to come see you.” Hmmm.
Medical Marijuana can help people with chronic pain.
Will our country look to make Medical Marijuana appear as part of the cause or as part of the solution of the Opioid Epidemic?
I would like to pre-empt the response to this cause vs solution question with the concept of High-5-ability: If you quit drinking alcohol over the past year using Medical Marijuana? High-5. Quit a Narcotic or more over the past year using MMJ? High-5. Quit sleeping, anxiety, nausea, mood, psych medication using MMJ? High-5. I happily will High-5 anyone who does one of these things and strange as it may sound, these people love giving that High-5. I have been seeing a mind blowing number of people who are coming back yearly telling me the great things they are doing with the help of MMJ.
Will people say that Marijuana leads to narcotics and thus Medical Marijuana be perceived a bad thing to society? That is not what I have found in my experience talking to people who have had issues with (aka addiction to) narcotics. I feel it can help quench the desires & habits that keep people using narcotics often long after they have lost their effectiveness as pain killers but with continued severe side effects including addiction & withdrawal with chronic use while quitting.
Or will people see this how I see it, that Medical Marijuana HELPS people quit narcotics & other meds. Let this be the season of Medical Marijuana & High-5s for everyone that finds MMJ has helped them put the zombifying narcotics in their rear view mirror. “You can never have too many High-5s”
However we proceed as a Nation over the next months I think we have to remember that this is about Patients who’s lives are going to be changed. I believe no one ever starts a medication knowing they will become addicted to it. Their Doctors have been telling them that it is ok, so it seems ok to the patient. Then one day Medical Opinion changes public opinion and it is no longer ok. I agree with President Trump that we have created an Opioid Emergency.
WEDNESDAY, OCTOBER 5, 2016 AT 6:53 A.M.
By Michael Roberts
In July, four doctors were suspended for allegedly recommending cannabis to patients who didn't need it for health-related reasons after being referred to the Colorado Medical Board by the Colorado Department of Public Health and Environment.
Now, however, the CDPHE's referral process has been struck down in Denver District Court. In a ruling on view below, Judge Jay S. Grant found that the policy had been improperly instituted and ordered the state to immediately stop enforcing it.
This action comes in response to a lawsuit filed in 2015 by nine doctors referred to in court documents as John Does. According to attorney Rob Corry, who represents them, they filed anonymously because "they were being targeted politically by the CDPHE and the medical board, which worked in concert to develop a secret policy in total, blatant violation of the Colorado Open Meetings Law."
In June 2013, the order notes, the Office of the State Auditor released a "performance audit" of Colorado's medical marijuana regulatory system. The report found that the CDPHE "does not have sufficient oversight of physicians to ensure they are making appropriate recommendations for marijuana" and advised the department to "determine risk factors to identify potentially inappropriate physician recommendations and to establish guidelines for making physician referrals."
Over the next year or so, the CDPHE began drafting a policy intended to address this issue based on three primary factors: "Patient caseload (a high caseload was calculated as 3,521 or more patient recommendations in one year for a general practitioner); "Plant and ounce recommendations (physicians who recommended a plant count above 24 plants/8 ounces for any one patient without substantiating medical necessity evidence); and "Age demographics (physicians for whom more than one-third of the patient caseload is under the age of 30)."
In creating this policy, department personnel took part in multiple meetings and additional communication between medical marijuana program staffers and personnel from the medical board. But the public was not notified about any of these meetings, and the policy itself — on view below — hadn't been made public when the nine plaintiffs were referred to the board. (John Does 1-8 were referred in June 2014, while John Doe 9's information was passed along in February 2015. The document is dated April 2015.)
Because the policy was initially in the shadows,"the doctors didn't even know the standards they were supposed to follow," Corry says. "Their defense of that was, 'Then the doctors would tailor their activities toward the guidance,' to which our response was, 'Well, isn't that the point?' Don't you post speed limits? Or do you keep speed limits secret and then do gotchas on drivers who go over the speed limit?"
After administrative subpoenas were issued to the plaintiffs, Corry continues, "we decided to pool our resources — to get together and sue proactively to try to stop this process, which we discovered through open-records requests and discovery depositions."
These efforts have resulted in what Corry refers to as "a major victory" — a claim supported by the language of the order.
Judge Grant found that the CDPHE's policy was not "merely a referral." Instead, he wrote, "the referral acts as a complaint and, as a result, confers injury upon those referred." He cites language in the notification received by the doctors, which reads in part: "The Colorado Medical Board has received the attached complaint regarding your conduct as a licensed physician, more specifically, a possible violation of the Medical Practice Act.”
Additionally, the order states that the policy "was not the product of informal meetings among the Department’s staff members regarding an internal administrative policy. Rather, this policy was the product of about a dozen meetings and about a dozen phone calls between staff members with the Department and staff at the Board for the purpose of alerting the Board to investigate physicians. This policy was adopted and implemented without providing public notice and during which no minutes from meetings were taken. Furthermore, the formulation of this policy does not appear to be based on any scientific or medical evidence."
This last line strikes Corry as particularly damning.
"If you look at the court's order, the legal significance is that the policy was not adopted under law; whether it was a good policy or not, it still had to be passed with public comment and notice. But in this case, the court pointed out that there doesn't appear to be any science behind the policy. The numbers in the policy are completely arbitrary, which suggests that this policy wouldn't have been adopted if the CDPHE had bothered to check with the people who do this every day. That's the purpose of common-sense open-meetings laws. When the government is putting together these policies, they ought to check with the people who know what they're talking about — the doctors who do this all day long."
Corry feels certain the CDPHE will quickly begin developing a new policy, complete with public meetings, as required by law — and he says his clients would welcome guidance, not to mention the opportunity to participate in the process. Yet he also argues that the department's prior approach "exposes the highly politicized posture of the Colorado government. It's so clear that the medical board establishment and the CDPHE itself doesn't want medical marijuana and knows it can't amend the constitution — so it's going to attack the soft underbelly of it, the licensed physicians who have chosen to recommend it. There's always been this default medical-establishment position that if it's not a synthetic pill manufactured in a pill factory, it can't be medicine. That's been one of the challenges to medical marijuana for decades, and it just so happens that the powerful, politicized, governor-appointed members of the medical board are in that camp more so than in the more progressive, open-minded camp of doctors who believe marijuana has medical benefits."
He also sees another possible motivation behind the policy.
"This shows an unintended consequence of the high taxes on recreational marijuana that the Department of Revenue and, really, the State of Colorado legislative and executive branches as a whole are trying to channel the industry toward," he maintains. "Legislators have talked about how medical is a tax dodge. But we wouldn't have the vaunted recreational industry without twelve years of medical marijuana laying the groundwork before that. I'm sure they know that — but I think tax revenue is driving a lot of this. And not to be overly paranoid, but I do think Big Pharma has a role, too. They can't control medical marijuana as it's currently constituted, and it holds a lot of influence in the medical community and in politics as well."
The order doesn't directly impact the four doctors suspended in July, but Corry believes the decision "makes the state's job of proving a knowing violation of generally accepted medical practice much harder to prove, because any violation was derived from a now-illegal policy. The court has enjoined the state from future enforcement of it, and that's how these doctors became known to the medical board in the first place. So it's a strong argument in these doctors' favor and a very positive development in the overall picture of protecting physicians and their patients, as well as the ability to access marijuana for medical purposes."
Continue to read the court order, followed by the physician referral policy the judge says the CDPHE can no longer use.
I found myself sitting in my car outside a patient's house. I was just winding the day down and was realizing I was not prepared for this. As an Emergency Medicine doctor I have seen many upsetting situations and it is usually difficult to know which will break through. I was making a house call because the patient could no longer make it out of bed. She was dying of cancer. As this sunk in I took a deep breath trying not to let the tears fall. "You got this" I told myself but my emotions began to argue. Before being able to think about starting my car and getting out of there someone walked out of the house. I felt relieved seeing her because she was not as sick as I had feared. Small talk ensued but I realized this was not the patient. "Well come on in here she is waiting for you." Big dog just outside the room sniffed me a few times and allowed me to pet her. I was stalling. Keep petting the dog. If it gets too intense just keep talking. I entered into her death room. Now this is what I had imagined. Dark room. Everything in reach of the bed. A frail woman who looked cold in a warm room. I had asked that she should be dressed and she told me that getting dressed was the most painful and difficult thing she had done. I wished I hadn't even mentioned it. I sat down in a chair at the foot of the bed and began to get through an explanation of what we had to do. Not much, a couple of signatures and verification of some information and we would be done. Only problem was that the second I tried to start talking I began sobbing. Not good. Say Something I was telling myself.
"I am sorry about this." Warm tears were flowing like a stream down my face. "My brother killed himself last year and I have not been in a hospital or around critically sick patients since leaving Emergency Medicine 2 years ago. I know this is not about me but I…"
"How did he do it"? Her voice was strong and pissed off.
"He jumped from a building. He wanted to jump into a valcano but the building was probably the closest he could come."
"That takes fucking balls. I wish I had a volcano." She wanted to die.
I wasn't crying anymore. I was stunned a bit but it wasn't as painful. I really couldn't figure out what to think. I focused on the paperwork to make sure it was correct. It was a very intense encounter for me. I don't mind talking about my brother but I have not forgiven him. She made me think that what he had done did take balls. But I miss him and I wish we could still go on cool hikes or road trips. Death is a weird one. She has helped me to understand why he may have ended his life. He has made me want to live my life with passion and without fear. Both taught me painful lessons.
I was pretty darned excited when last year I had the chance to see a 90+ year old couple who had never tried marijuana. They both had pain issues and were looking for something that would give them pain relief without the "high". I introduced them to the idea of edibles and CBD's and for the past year I bragged that my oldest patients were 92 and 93. Well guess what, they are a year older and a year wiser and they came back because they had found their life had been improved with medical marijuana. During the course of the meeting I found myself giving the woman who we will call Bonnie advice about healthy living and it dawned on me that I was giving advice to a 94 year old person on how to live healthily. I laughed and told her she should ignore everything I had told her and continue to do exactly what she had been doing for the past 93 years. She took a moment to reflect on that and then said "I guess the secret to my longevity is… movement." I am glad when I get lucky and shut up and listen. Time to get moving.
THE COLORADO STATE MEDICAL BOARD
Medical Marijuana Workgroup
WILL MEET ON
AT THE FOLLOWING LOCATION
THE PURPOSE OF THIS MEETING IS:
Review and discuss Stakeholder feedback and make necessary revisions to the draft Policy.
PURSUANT TO STATUTE, A PORTION OF THIS MEETING COULD BE CLOSED TO THE PUBLIC
This agenda will be subject to change and items may be added or removed prior to, or during, the meeting.
Date Issued: November 19, 2015
Purpose: To provide guidelines for Colorado Physicians who recommend Marijuana for medical use.
The Colorado Medical Board is creating a policy that will greatly impact access to Medical Marijuana. If passed the impact of this could be substantial and detrimental to Medical Marijuana Patients, Medical Marijuana Dispensaries, Infused Product Manufacturers who focus on creating Medical Marijuana products and the Doctors who evaluate patients for Medical Marijuana. I have been evaluating patients for Medical Marijuana for the past year and a half and it has been an amazing experience. Every day I meet with patients who suffer pain, nausea or have developed cancer among the other reasons patients can have Medical Marijuana recommended to them. Patients come to me for evaluation for a Medical Marijuana License. I will tell you that on a daily basis I meet people who inspire me. They come to me to tell me what Medical Marijuana does for them. Patients come to me often as a last resort. They have tried medications prescribed to them by their physician and have found the side effects of the medications make them feel like a “zombie”.
Here are the points of the policy that seem unique to Doctors evaluating patients for Medical Marijuana.
1) Risk Assessment
a) Patient and family history of substance abuse
b) Abuse history including physical, emotional or sexual
c) Health conditions that could aggravate adverse reactions
2) Review PDMP
3) Imaging studies or lab testing
a) Physicians should order imaging studies or laboratory testing as necessary to render a diagnosis. Urine Drug Screens should be considered to ensure compliance with treatment recommendations. Pregnancy testing should be considered for all women of child–bearing age.
4) For patients who in the opinion of the physician require an increased marijuana plant count, the medical record must reflect the rationale for the increased plant count. This rationale should include documentation of a stepwise progression of efficacy.
6) Collaborate with other Healthcare Providers
7) Patient Education, Monitoring and follow up
Here are my thoughts on each of these points.
By the Constitutional Amendment 20 the patients that can get recommendations for Medical Marijuana all have chronic or debilitating medical conditions. These conditions are going to stay the same or worsen over time for the patient.
1) Risk assessment:
a) Some patients come to me addicted to a Narcotic that were prescribed for them by a pain specialist or by serial ED visits. The vast majority of these patients do not want to continue Narcotics and use Medical Marijuana to help relieve the pain as they wean themselves from Narcotics or Benzodiazepines. I have met patients that have been able to rid themselves of nine medications replaced with Medical Marijuana. With nearly ten years of Emergency Department experience I believe that Narcotics and Benzodiazepines have a safer alternative and that is Medical Marijuana. I will always recommend Medical Marijuana over prescribing Narcotics and Benzodiazepines.
b) Sexual Abuse History? Physical and emotional abuse history?
i) I do not understand what this will add. In six years working in Denver General Emergency Department as an attending physician I asked patients sexual abuse questions rarely if ever. I am no stranger to the bad things people do and say to each other. I am unclear as to how this would help me one way or the other deciding whether Medical Marijuana might help their unrelated chronic debilitating medical problem. The overriding assumption made by the Board of Health and those who wrote this policy is that the patients I am seeing are not patients, but drug addicts and are doing something illicit.
2) Review PDMP
a) Online program designed to monitor for people visiting multiple doctors for purpose of obtaining Narcotics illegally. I have used this at Denver General and find it to be rarely useful, sometimes harmful and would not find occasion to use it for people coming to me for Medical Marijuana evaluations. Again, the overriding assumption from the Medical Board is that the people who come to see me are not to be trusted and likely addicted to Narcotics.
3) Imaging or Lab studies:
a) Remember we are dealing with chronic conditions here and I am not associated with a hospital. Shooting a quick X-ray for a chronic problem because of a State Policy, in my mind, would be a violation of the Hippocratic Oath. While swearing in as a physician I swore that I would “First Do No Harm.” Taking an X-ray on a patient with a chronic debilitating disease because the Board of Health told me I had to is harmful because it is un-necessary to the patient and exposes the patient to radiation
b) Lab work: There is not a Lab I can order that would help me evaluate a patient for Medical Marijuana. Ordering a Urine Pregnancy Test for female patients of childbearing age is ridiculous. If we went to a fully paternalistic state we would have to order Urine Pregnancy Tests on every woman before she purchased alcohol or went to a recreational dispensary. It would make no more sense to do this, but at least it would be consistent. Drug screens, except for in the unconscious patient, are not medically helpful. I believe patients are honest with me about their use and addiction to Narcotics. I love it when a patient can cleanse themselves of Narcotics.
c) Cost to the patient is another issue with this. This is not covered by insurance. A typical X-ray at a hospital will be billed at 3-500$ and with X-ray read will come to 1-1,200$. My typical Doctor visit cost 70$. A Urine Pregnancy Test through a hospital can cost 120$ and beyond.
4) Plant Counts:
a) People are trying to find ways to use Medical Marijuana that are better than smoking. I agree with this effort. It is my belief that many of the therapeutic benefits of the cannabinoids found in Medical Marijuana are lost in the burning of the flower. I encourage edibles and juicing whole plants and growing smaller plants in effort to manipulate the CBD content.
a) The Board of Health states that we must diagnose or independently confirm diagnosis and that I must provide a legitimate medical purpose appropriate for marijuana therapy. In looking at Amendment 20 to the Colorado Constitution it is written “A chronic or debilitating disease or medical condition, or treatment for such conditions, which produces, for a specific patient, one or more of the following, and for which, in the professional opinion of the patient's physician, such condition or conditions reasonably may be alleviated by the medical use of marijuana: cachexia; severe pain; severe nausea; seizures, including those that are characteristic of epilepsy; or persistent muscle spasms, including those that are characteristic of multiple sclerosis.” Many of the patients I see have chronic back pain or hand pain and have never been to see a doctor. Many of these patients have developed arthritis. After seeing thousands of patients in the Emergency Department it is clear to me that many people come into the ED for back pain and leave with the diagnosis of back pain. It was considered bad medicine to X-ray, CT or MRI every patient with back pain. I am comfortable recommending the patient establish a relationship with their PMD or under rare circumstances asking the patient to go to the Emergency Department or even rarer calling 911 if I thought the patient was having a heart attack or stroke.
6) Collaborate with other health care providers. I do this at the patient’s request and never without their consent.
7) Patient Education, Monitoring and Follow Up:
a) Patient Education is the most important part of the process. I evaluate the patient’s experience with Medical Marijuana. Many patients come stating they haven’t tried Marijuana since high school ranging in age from 60-93 years old. They come to me in pain or with cancer or nausea because of the chemo after they have tried the drugs the doctors have prescribed. I take the time to answer every question and I give every patient a hand written lesson explaining how to safely begin using Medical Marijuana and give them alternatives. My phone is on all the time if they have questions or concerns. Patients frequently stop by or send me emails when they find something that works for them or doesn’t work for them. The renewal process ensures an annual visit for those who choose to continue using Medical Marijuana.
We should remember that Medical Marijuana has existed for 15 years in Colorado helping hundreds of thousands of patients. Only since the legalization of Recreational Marijuana and the Millions of dollars of tax revenue it has created has Medical Marijuana come under such scrutiny. There seems to be a effort from the Board of Health to restrict Medical Marijuana. What or who is motivating the Board of Health to restrict and change something that has been working so well for so long. Since graduating from Medical School I have never felt more like a Doctor than I do now. I am a teacher. I educate. I am learning. Medical Marijuana should be preserved and protected.
Peter Pryor MD MPH
On April 2 2015 the State came out with a policy that people interested in Medical Marijuana Licensing (aka red card) should understand. It is a 3 pronged policy aimed at restricting access to medical marijuana.
1. Restricting the number of patients a Physician may see to 3,521 patients per year. This number is taken from a paper which discusses the average number of patients a Family Practice Physician sees in a year. As an Emergency Medicine Physician it was mandated that I see a mandatory minimum of 3,744 patients in a year or I was told I had to work extra shifts. How an average number of patients per year for one type of physician becomes a "high case load" is an interesting jump in logic. Physicians running pain clinics where narcotics are prescribed are not limited in the number of patients they can see.
2. "Physicians recommending increased plant counts for more than 30% of their caseload may be recommended for referral."
3. "Physicians for whom more than one-third of the patient caseload is under the age of 30 may be recommended for referral." This taken from an article with age range in question was from 18-44 years old and using some sort of calculation came up with the age of less than 30 years old. The article found that under the age of 30 for the chronic conditions they looked at patients had a chronic debilitating disease about 30% of the time. I discussed the article with the author and he was curious about the age range and that the chronic conditions they looked in the article did not include severe pain or PTSD.
There is an upcoming Colorado Board of Health "public rule-making hearing July 15 at 10am in the Sabin-Cleere Conference Room of the Colorado Department of Public Health and Environment, Bldg. A, First Floor, 4300 Cherry Creek Drive, South, Denver CO 80246." The hearing will include discussions to add Post-Traumatic Stress Disorder as a new debilitating medical condition. I am currently unable to see patients under the age of 30 because of the combination of restrictions put forth in the Medical Marijuana policy #2015-04_001. This policy restricts the total number of patients I can see to 3,521 and restricts the patients under the age of 30 I can see to 30% of my case load. This policy is completely contradictory to an open honest attempt to help young men and women who have faced life and death to protect our way of living. Although Veterans span the entire adult age range, this policy restricts the number of Veterans returning from active duty which can be seen by an MD for PTSD. I plan on testifying in front of the Board and encourage others to do the same. I have met many Veterans and I have listened to how it has helped them.
I will include the comments from a young Veteran who made a testimonial with me regarding his military service and how MMJ has helped him.
"Allright well, basically for me my experiences gave me problems with both eating and sleeping and basically carrying on with my day to day life. I had to pick up body parts and sort them out and stuff like that. You know, so I ate next to them and everything. Uh when I got back they tried giving me a bunch of pills and just everything made me feel like a zombie, like I wasn't even my own person. I felt hollowed out so I started having, uh not getting anywhere so I said screw it and started using any kind of cannabis I could get basically just to try to like, sleep. you know cause it's hard to do anything if you can't sleep at night. It gets harder when you just feel sick to your stomach every time you try to eat. The nightmares… the hallucinations… just all the bad stuff, marijuana for me helps me to be a normal person really, I can eat but uh I am a pretty skinny dude cause its real difficult for me to eat but it helps me… like I have a normal appetite you know I can eat it and feel good about it and I can sleep way better 1,000 fold and just my outlook on my own life and the world in general has basically done a 180 compared to what it has been and I can easily say that most of it has been from the cannabis."
Doc Morrison it turns out was a man in the 1800s in the Denver area. Since creating the business in March my brother has found his name and where he is buried and a little about his life. I plan on finding out more about the real Doc Morrison and adding it to this. For now though it leaves me wondering why I moved to Morrison and chose the name Doc Morrison while living in the town named after Doc Morrison. Spooky, or Plagiarism? You be the judge.
"Your waiting room is a HELL of a lot better than the DMV."
"Depends on what you do during the day as to what hurts during the night."
"I don't think I'm long for this vessel."
Phone call after hours:
"Doc Morrison's this is Dr Pryor"
"Yeah I was wondering if I could still come in tonight to make a donation."
"Uh, no we are closed for tonight."
"Is this the blood bank?"
"No I am a Doctor who does evaluations for people looking for their Medical Marijuana license."
"Oh, I was trying to call the blood bank so I could donate plasma so I could come see you."
Semi dramatic Lady bursts into the waiting room: "I have Strep throat. I think I have Strep."
"I only do evaluations for patients looking for medical marijuana."
"So youuu? You don't do any? This is weird. You don't do any…"
She sat in the waiting room with her husband for awhile and then left.
-We saw our first WWII veteran this past Saturday when we travelled to Sedgwick Colorado to evaluate patients for their medical marijuana license.
-2 weeks ago we saw our first 92 year old. He wants to keep things rolling for at least the next 17 months so he can make it to his 75th class reunion.
Last week I met a man named Fish. He is from Ethiopia and is a small business owner near me and I had stopped by to purchase some wine. He was standing outside his business on West Colfax as I was leaving and we had a conversation that has stuck in my mind. He asked how things were going and I told him "Great" but then I described the many things I was worried about on that day. He told me how he went to University here in the states and that his life had twisted and turned in so many directions. I told him about the struggles I have had finding the right people to work here and the different ways of trying to get more people coming in. For some reason he then told me that he had cancer and if I remember correctly pancreatic cancer. He was optimistic. I get emotional these days when people tell me they are sick. I think about my uncle. And then I realized that this man named Fish was reminding me of the same thing that many of the patients I see remind me of on a daily basis. What ever your worries are there is someone very near you worrying about something more intense or more real than your worries. I find myself very lucky to be in Colorado at this time. I have a chance to hear incredible stories of strength, happiness, near death, injury, pain and triumph every day. So I tell myself to listen to the daily reminders. Pay attention to my own worries but for me to be truly alive I have to overcome the noise of the day to day. Fish and I spoke of this as well. I told him that he had helped me remind myself of this, again. Allowing myself to turn down the day to day allows me to pay attention to the beauty in life. I have never felt so alive as I do right now. Thanks to Fish and the many conversations I have on a daily basis I am alive.
The effect, drop in the number of patients, the cause…
This week has been slow compared to last week. Everything has been working and slowly growing until this past week. 3 months ago I wanted to wait to get into West Word. I thought everything would go crazy once you put your name into the mix and west word seemed like the place to make it go crazy. Once I got the ad rolling in the weekly paper I became addicted. Each week for the past month I have been excited to get the hot off the press West Word when I get home to Morrison Wednesday night. The color is this… or the placement is that… Some sort of interpretation on how this will effect business. What I have learned over the past week is that you can't win it if you aren't in it… West Word that is. This week has been slow because we weren't in West Word. It is amazing this cause and effect thing. I have grown to appreciate how that tiny little ad in so many thousands of magazines gets people heading our way. I look forward to the steady rise once we get back in again next week. I look forward to tomorrow night when I hungrily search the magazine for our placement again and tell my friends as if I know anything about advertising, "The color is this… or the placement is that."
Haven't had time to post anything recently. Still trying to get out every day if I can to throw some discs and consider the day and imagine the future. We saw 12 patients yesterday. It doesn't sound like much but it made me feel like the business is viable. Doc Morrison word of mouth is being spread. We are nice, keep consistent pricing and know that we exist to serve the patient. I evaluated one man yesterday who is dying from pancreatic cancer. He seems like an amazing person and is coping much better than I would expect. My uncle died from pancreatic cancer. For some reason it is much more difficult to control my emotions here in this office compared with working in the Emergency Department. There I was able to bare witness to a hundred horrible things happening a night to a variety of adults and sometimes children. I was numb to it. I watched and knew the implications of the injuries and illness but it was just one of the facts we had to blend into the equation. Here at my new office I find it challenging to get through difficult conversations without a frog getting stuck in my throat. He seems like an amazing person and is coping much better than I would expect. This job seems like something that I am good at doing. Life in the ED was crushing me. Last night I enjoyed the songs played by the students at swallow hill. It made me realize how many beautiful things there are in life. I think what it made me realize, again, is that if the guy that is dying from pancreatic cancer can smile and make plans for the future and not feel sorry for himself, then I have to try to do better, live more. Smile, try to stay healthy, pass on positive thoughts, love your family and friends and be happy.
Two days ago I was in this office when I got a phone call. A caregiver of a guy we will call Fred called to make sure I was in the office. Caregiver can be used several different ways. Something about her questions seemed to imply she was not a MMJ Caregiver but a Nursing type Caregiver. I asked if he was home bound but she said no. He was a quadriplegic from an ATV injury 2 years ago. He has an injury that has allowed him to recover with tons of work and set backs his ability to use his shoulder muscles but not good strength in his forearms or wrists or grip. He has no use of his legs. The unknowns of opening this business weigh on me sometimes a little and sometimes more than a little. For what ever reason I felt wildly emotional about this guy coming in. My first wheelchair patient. One of the first patients I have seen who has bigger problems than most people. I worried about the ramp and the ramp inside. Will there be enough room for him to pass between the coffee table and the chairs in the waiting room? I lost it just a little bit. I was very happy but I was trying not to cry or trying to stop. Fortunately another patient came in and took my mind off the in coming patient. I am so happy that other patient came in because I was unsure how I would be able to keep it together. So sad I am so self adsorbed that I am worried about me when a guy who has been skating a razors edge between life and death is going to come through the doors. He came in near the end of the last patient's visit and he and his caregiver waited in my office while we wrapped things up with the last patient. I quizzed him on the ramp and parking. When I asked him about the coffee table being too wide he told me that it was a nice walnut coffee table. He could tell I had thought about him before today. He could tell that he meant something to me outside of who he is. He told me with a tired but genuine smile that "It sounds like a good thing for both of us we met today." I agree. My hope is that I mean something to him that is bigger than who I am.
Just ending my 3rd week with the doors open. It is exciting but I found myself annoyed yesterday. Backing up a bit I have noticed that many drivers are self absorbed selfish jerks. My two most favorite hated moves I have seen at least a couple of times are firstly the aggressive highway merge coming off a circular entry from another road. I am in the slow lane and there is a car that is going to be entering the highway. With a recklessness of a 6 year old they come flying around the merge curve at highway speeds. It is unclear that they understand the idea of merge. They come at me as if it is me that is merging into their world. I either slow down letting them continue onto their emergency or I hold my line and hope their car has the suspension, and their brain and body have the coordination to finish their turn into warp speed. I have been flipped off for this on more than one occasion. My other most favorite hated move is again dealing with the merge. This again occurs on the merge onto the highway. These booger eaters come whipping from behind me crossing quickly out of the merge lane into the first traffic lane and put the pedal to the metal. This puts me in the position of attempting to drag race for my life against much newer, faster cars. So what the heck am i talking about. I am talking about a day I had a few days ago where everyone seemed to have gathered early in the day and figured out what string of things they could say or do to me to make my day as crappy as it could be. morning noon and night. The question that got me the most that day was "How is your business going?" My sense was that people were hoping that it was not going well. I should have just gone home. So as I thought about all the people on the road and all the people during that day I thought about something my brother had told me. Maybe all these angry people reflect something emanating from myself. Maybe everyone annoyed me because of my eyes and not their actions. Although I think the business is going great there are huge areas for improvement. This is what I find exciting, developing the business. Finding ways to bring people in and make them want to come back. Make them want to tell their friends. I am striving to be the nicest most positive most helpful person I can be. We are going to try an ad in West Word. We will see. That my friends, is how it's going.