California’s "pot docs" persevere, despite attempts to weed them out

SANTA BARBARA, California - After nearly four decades in medicine, Dr. David Bearman seems the incarnation of a trusted old-school physician. His résumé is long, his record unblemished. It’s his choice of treatment that makes him conspicuous.
For most patients, Bearman recommends the same remedy: marijuana. There is the young woman with epileptic seizures, the middle-age man with multiple sclerosis, the amputee bedeviled by phantom limb pain.
Bearman’s practice, based on a controversial curative not found on pharmacy shelves, has proved both lonely and professionally perilous.

Cannabis cadre
Although the courts have upheld a doctor’s right to recommend cannabis for the seriously ill, few dare do so. Among the exceptions is a tight-knit cadre of about 15 California physicians. Dubbed "pot docs," even by friends, they claim credit for nearly half the estimated 100,000 marijuana recommendations issued in the eight years since California approved medical use of the drug.
There is Bearman in Santa Barbara and Dr. Frank Lucido, a family doctor in Berkeley. Dr. Tod Mikuriya, a peripatetic medical-marijuana pioneer in the San Francisco Bay Area, has written approvals for 8,000 patients himself. A presidential drug-policy chief once lambasted his brand of medicine as a "Cheech and Chong show."
The criticism has been accompanied by intense scrutiny. At least 11 of the cannabis doctors have weathered investigations by the Medical Board of California. Half the cases closed without formal accusations. But a few drew blood.
Medical-board officials say the problem is not the marijuana but the way the doctors practice medicine. Are patients thoroughly examined? Do the doctors discuss other options?
Joan Jerzak, the medical board’s chief investigator, says some doctors eager to legalize recreational use "don’t mind flouting the law."
To the pot docs, the attacks are about old grudges that will not die. They say they’ve been singled out by a law-enforcement establishment still displeased by passage of California Proposition 215, the 1996 ballot measure that legalized marijuana for the seriously ill in the state. "Their attitude is, ’This isn’t medicine, but rather a way to abet drug abusers,’ " said Dr. Philip Denney. "They have scared the hell out of California doctors, and it’s been left to us so-called mavericks."
The cannabis doctors say they practice serious medicine, focusing on the sick and weeding out habitual pot smokers simply looking for protection from arrest. Marijuana remains a remarkably safe substance, the pot docs say, with tremendous therapeutic potential for AIDS wasting, chemotherapy nausea and other serious conditions.
Aside from the pot docs, oncologists and HIV physicians write the bulk of the cannabis recommendations.

"Cultural war"
Bearman, a 63-year-old family practitioner, figures it may be years before marijuana is accepted by the medical establishment - and by the criminal-justice system.
"There’s no doubt," he said, "this is part of a larger cultural war at play."
Jessica Griffith, 27, waddles into Bearman’s office, a metal cane in hand. She carries a 3-inch stack of medical records detailing her four-year fight against pain. She ruptured two discs in her back trying to lift a box in, of all places, a health-food store. Griffith tells the doctor she soon will have surgery to fuse her spine.
Meeting such a patient, someone bearing up under a painful or debilitating condition that he thinks could be helped by marijuana, Bearman has a standard response. "You," he tells them, "are exactly the kind of patient the voters were thinking of when they approved Proposition 215."
Bearman’s father, a pharmacist, used to tell stories about marijuana’s history as an accepted part of pharmacopeia. The son was dubious. He spent his career mostly paddling in medicine’s mainstream, but over the years he developed an interest in medical marijuana. When he retired three years ago as medical director of the Santa Barbara Regional Health Authority, he opened a one-room office. Word spread, and the ill flowed in.
So did a problem.
One of his patients, a 21-year-old named Nathan with a history of migraines, was busted with a tiny stash of pot in April 2001 while camping in Ventura County. Confronted by park rangers, Nathan pulled out his medical-marijuana recommendation from Bearman.
They let Nathan walk, but a ranger complained to the medical board. The board, which gets about 12,000 complaints a year about physicians and investigates roughly 2,000 of them, decided Bearman was worth a look.
They demanded to see the doctor’s records on Nathan. Bearman refused, citing patient confidentiality. A two-year legal battle ensued. Bearman at one point faced a $1,000-a-day fine. But a state appeals court concluded that the board’s subpoena was based on "nothing more than speculations [and] unsupported suspicions."
Like other cannabis physicians, Bearman does not dispense marijuana. How patients obtain pot is up to them, but he sometimes points them to Web sites listing cooperatives that distribute the drug.
Mikuriya churns out medical-marijuana recommendations like a factory, more than a dozen on a busy day. And he willingly acknowledges, unlike most of his peers in cannabis consulting, that he does indeed smoke pot, mostly in the morning with his coffee.
But the doctor is no tie-dyed hippie.
He looks a good decade younger than his 71 years and dresses nattily. The only giveaway of his specialty: an embroidered logo on his white lab coat showing the snake and staff of Aesculapius, the Greek god of medicine, atop a marijuana leaf.

Years of research
Mikuriya, a psychiatrist, has studied the drug’s therapeutic potential since the 1960s, when he directed marijuana research at the National Institute of Mental Health. He has written books on its medical use. Mikuriya’s list of more than 100 ills eased by cannabis includes insomnia, premenstrual cramps and stuttering.
Marijuana is so effective and benign, Mikuriya said, that the bar for patient approvals should be far lower than for prescription drugs. Likewise, the role of cannabis consultants is not to perform exhaustive diagnostic tests, he said, but to determine whether a patient’s condition is chronic and could be helped by pot.
In 2000, the medical board accused Mikuriya of gross negligence, unprofessional conduct and incompetence in recommending marijuana to 16 patients. The core of the case: that Mikuriya failed to conduct proper physical exams and keep adequate records.

Put on probation
Last March, the board hit Mikuriya with five years of professional probation and a $75,000 fine. He appealed and has continued to practice pot medicine - with a few changed habits and under the supervision of a state-appointed monitor.
He no longer sees patients at his home, instead leasing a small office suite. A staff of three maintains records and prepares patients for exams by taking blood pressure and other vital statistics.
Ultimately, the struggle over the pot docs comes down to one fundamental question: Are they good gatekeepers for an inarguably controversial medication?
If they don’t dig deep to diagnose a patient’s ills, "there isn’t good medicine going on," said the medical board’s Jerzak. "It’s just sales of a particular prescription. It’s Dr. Feelgood."

"Seems like a witch hunt"
The board’s intense scrutiny of the cannabis doctors has drawn fire from the state’s medical establishment. Jack Lewin, California Medical Association chief executive, said the state should concentrate on doctors who truly endanger lives. Pursuing pot docs, Lewin said, "seems like a witch hunt."
After wrangling with the medical association, the medical board in May spelled out a softened approach: If physicians follow "accepted medical standards, they can avoid being investigated."
If the board has a thorn in its side, it is Lucido. The state investigated him a few years ago but dropped the case. Ever since, Lucido has religiously attended board meetings, urging regulators to lay off pot practitioners. "If patients aren’t being harmed," Lucido said, "what is the problem?".