This year Oklahoma voters made a clear choice to legalize medical marijuana, joining thirty other states that permit cannabis for medicinal use.
Unsurprisingly, immediately in the vote’s aftermath, patients began asking me to ‘prescribe’ medical marijuana licenses, as the new law stipulates users must have as a precondition for legal purchase. The new law does not, however, specify qualifying diagnoses for which medical marijuana might be clinically indicated.
My answer thus far has been, “Not now. Likely never.”
This has not been a popular response. One patient looked at me as if I’d put a lump of coal in his Halloween bag.
I’m not a fan of medical marijuana for several reasons. The main issue is the lack of proven medical efficacy. I know there are thousands of anecdotes from people whose pain or anorexia has been diminished by marijuana–and I’m genuinely glad for them. But I’d like to see better powered controlled trials of cannabis products head-to-head with accepted therapeutic agents. Having the FDA weigh in on marijuana’s safety and efficacy would also go a long way toward legitimizing pot’s medicinal use.
Another major problem is smoking the stuff. If we had proven, standardized dosing of edibles, I’d be more supportive of medicinal use. But smoking anything–tobacco, marijuana, vapor juice–is not a healthy practice, and one I counsel patients to avoid. I hear the arguments about the purity of pot and how it’s ‘more natural’ than manufactured tobacco products. The bottom line is that inhaling burning plant matter into your lungs is a terrible idea–regardless of the herb.
If voters want to legalize marijuana for recreational use, I have no objection–provided we put in place a legal framework to make sure that people don’t get hurt. Standardized dosing and measures to assure product consistency would be integral. And we’d need adequate enforcement to make sure that people aren’t impaired when at work or in other situations in which their marijuana use could jeopardize others.
Putting doctors in the middle of what amounts to a political, legal, social, and economic debate steers the medical profession in a race to the bottom–and let’s face it–our profession has enough problems already without being the gatekeepers of grass.
Remember that marijuana is still scheduled by the Drug Enforcement Administration as a Class I narcotic, defined as having “no accepted medical use and high potential for abuse.” So even though medical weed is now legal in my state, I have no interest in violating or abetting violations of federal law.
In fact, as it turns out, since I work at a university, our legal counsel is of the opinion that no provider in our system shall recommend marijuana, since our institution has numerous federal grants and funding streams and must therefore comply with all federal rules and regulations.
Some have suggested that given our national opioid epidemic, marijuana can serve as a safer alternative for pain control. Since most cannabis is homegrown, and where legalized a tax revenue source–this does make medical marijuana a more appealing alternative to propping up the seemingly ubiquitous heroin/fentanyl drug cartels.
This argument makes pot part of a harm reduction strategy, which I’d be more supportive of if the evidence were stronger.
Right now I see the pot economy as a Wild West with hundreds of entrepreneurs and medical professionals looking to stake claims in this new quasi-legal economy.
Get back to me when we have more state/federal legal congruence and clarity on the stuff’s true medical benefits.
This essay originally appeared as a Doximity Op-(m)ed.
Twitter is in the news frequently these days, because it’s a primary source of presidential communication. I like Twitter because I follow various health care practitioners and pundits and they often link to interesting articles.
I came across a link to an article (blog post, really) from Martin Samuels, Chair of Neurology at Brigham and Women’s Hospital in Boston and a Professor at Harvard Medical School. The whole post is worth a read if you’re interested in the evolution of American medical education over the 20th and 21st centuries. [The post originally appeared on The Health Care Blog.]
What really stood out to me was a long paragraph of his culled from phrases he’d overheard in various meetings with hospital leaders and business types.
Certain overtones of, well……jargon to say the least.
[I’ve broken the looong paragraph up for you for ease of reading. – ed.]
I’m afraid that if we don’t drill down on our brand equity on the front end, we’ll have to model it out on the back end to align our seemless incentives or pad our ask regarding the co-branding deliverables on the horizon. As an FYI, this empowerment is going to require an elbow to elbow champion getting under the covers for a 360 of the eRoom to facilitate a paradigm shift in order to achieve buy-in among the stakeholders if we’re going to tip our toe into that water and get the low hanging fruit before our clients incentivize the burning platform with new metrics.
After all, you are the process owner who needs to reach out in the proper bandwidth to push back on the KOL’s or we’ll have to sunset your blue ribbon committee for not trimming the fat on the real-time escalation project. We need to do more due diligence before we hitch our wagon to that indexed outcome measure, and let’s be careful how we message it and roll it out to the core constituency. We can model that projected gap, but we don’t want to get out ahead of our audience before sensitizing them to the moving target.
Let’s not drop the meat in the dirt but rather vet a pause point, collapse it up to a high level statement and assess the current state in order to connect the dots to achieve the ideal state and have you weigh in at the portal for service oriented architecture. After all, at the end of the day, we’ll have more skin in the game and be in a better space if you walk the stakeholders though it so that they can leverage their halo to birddog that from 10,000 feet.
If you could create a placeholder to move the needle in the continuous quality improvement initiative, some heavy lifting might give us a report card so that there can be the accountability for a decent ROI, unless the co-branding produces a choke point so severe that the balanced score card causes a culture change, one by each. Just between you and I, you need to parking lot that issue, take the deep dive and put the rubber to the road with a degree of commonality that will re-engineer a sea change in our SWOT analysis so that we bake it into the budget of the high level implementation group. We have to move the ball down the field and prevent leakage. Net-net there is value added for a win-win, rather than a zero-sum game.
You can manage the matrixed organization on the frontline and in the back office. With central discipline and local control we can achieve savings and margin, while penetrating that segment of the market. A lot of what we have to do to reduce our trend is blocking and tackling in different spaces. Bottom line on top, if I don’t report to myself, we could really take a haircut before we can trim the fat out of the box and shift the culture beyond this pilot demonstration program. That having been said, the PEST analysis shows that if you step up to the plate and evangelize the brand, we can be about the business of creating a placeholder of new buckets with more vertical silos so that we can finally tell whether we are on foot or on horseback.
Comparing apples to apples, it is clear that this is not a plug and play culture, so that you’ll have to hold your nose and jump in order to filter the noise and incentivize the process owners in a more granular fashion before it becomes a major mission drag. A bread crumb has been forming so let’s put some stakes in the ground to leverage our insights as enablers of change to circle back on a more granular view, and tee up our clinical levers to mine insights from the benchmarks and beat the waste out of this process. We will cleanse our application platform and get ready for the first wave of ambulatory e-care care go-live across the family and take advantage of the elbow-to-elbow support of the super-users and be back to 100 percent productivity by the second week.
Having said that, we traffic-lighted that report so you can optimize the outcome metrics. If we can get the whole group on board in this arena we can try to boil the ocean with a six sigma culture change. We mean to hit this one out of the park and get some substantive returns in the coin of our realm to avoid any mission creep. It’s a non-starter to analyze the dashboard for crosswalking noise, so we need to slice and dice our organic growth, peel the onion and hardwire the initiative with more boots on the ground. If this could be the pause point for a new value initiative, that’s where the metal meets the road.
Let’s reach out, using our optimized tool kit to go anything north of zero and put a hard stop on this turn-key operation. If you would like to get some trend lines and traction from this piece, I can ping you a copy of my deck.