THIS IS NOT WHAT THE VOTERS INTENDED

I feel it is important for the citizens of Montezuma County to
understand what is happening in this community as a result of the
proliferation of the use of "medical marijuana" and the dispensaries
that supply the products.

In the past month, I have had to do emergency evaluations and consult
on a number of patients who were prescribed medical marijuana and were
now experiencing adverse effects due to improper evaluation, treatment
and follow-up by the prescribing physician.

What I am seeing in the medical community is a handful of physicians,
who come into our town or one nearby, set up shop, provide short
evaluations, take your $180 in cash and leave here without proper,
thorough assessment and any plan for careful follow-up. This has led
to patients being harmed in many instances.

The conduct of these physicians is deplorable and subject to sanctions
by the Colorado Board of Medical Examiners.

You, as a patient, are entitled to a proper medical evaluation which
includes a history, a physical exam, collection of records regarding
prior treatment, assessment of any current medical problems you may
have and any medications or supplements you are currently taking.

It also includes an assessment of a history of any prior substance
abuse and legal issues relating to controlled substances. As a result
of these elements of a complete examination, a diagnosis is
determined, treatment is recommended based on all conditions a patient
is currently experiencing, medication may be prescribed and a
follow-up appointment is made. This is the standard of care for all
physicians licensed in Colorado by the Colorado Board of Medical
Examiners and no exceptions are made by the board to this standard of
care. This is the only way we can keep you safe and make sure no undue
harm will come to you.

What I am reading is there are a handful of physicians in Colorado who
are prescribing 90 percent of all medical marijuana for the entire
state.

At last count, five of these physicians have official Colorado Medical
Board or other state board sanctions and limitations on their licenses
due to past failure to adhere to the medical standards of care in
their fields.

Some of these physicians are practicing outside their specialty area.
For instance, I just had a patient get a medical marijuana card for a
diagnosis of "seizures." The physician who gave her the card is an
obstetrician/gynecologist (with Colorado Board sanctions) who is not
qualified to treat her seizure disorder and should have never engaged
in her treatment. Actions such as this are susceptible to Complaints
to the Colorado Board of Medical Examiners (www.dora.state.co.us/registrations)
and malpractice lawsuits.

The second problem we are seeing is that a disproportionate number of
the medical marijuana cards are being written for males between the
ages of 19 and 25, a known group with one of the highest rates of
marijuana addiction. This is also one of the traditionally healthier
populations, so I seriously doubt there is a new epidemic of chronic,
debilitating pain or other illnesses in this population. Since medical
records are not gathered by these fly-by-night marijuana docs, it is
very easy to lie about your condition, which is exactly what I am seeing.

In some cases, addicts are being given their drug of choice, worsening
an underlying problem that had lead to a variety of social problems in
families, the work place and the legal system.

I have been specifically told by several patients that the only reason
they got their marijuana card is so they could be "safe" from legal
conviction, and blatantly lied to the prescribing physician.

One other point about these prescribing and dispensing practices is
the risk that some of these "patients" are also drug dealers in our
community who may use this supply source to support their trade in
drugs.

Due to high quality and selection of marijuana being provided by our
numerous dispensaries, I have heard of dealers who are now able to
sell this higher quality marijuana to willing buyers who want a
"superior" product without the uncertainty of marijuana purchased elsewhere.

So now we have a potential cycle of unscrupulous physicians, who may
be prescribing to addicts and drug dealers, who then turn around and
sell some of their "medicine" to our kids. Was this really the intent
of the 2000 law that was passed?

I do not think this is what the voters meant, and many of us are very
alarmed with what is happening.

Regarding the issue of dispensaries in the city limits, I have to say
that I have concerns.

First, when a physician prescribes medications of any type, they are
dispensed through a licensed pharmacy that has licensed pharmacists on
staff.

These professionals work in concert with the physicians in the
community to alert us to the potential dangers of drug-drug
interactions, let us know if there are concerns that an individual is
misusing or diverting a drug, and notify the Drug Enforcement
Administration if there are suspicious prescribing practices.

There are no safeguards with the current dispensaries, which are run
by any person who wants to set up a shop with no requirements for
licensure, oversight, training or reporting.

How can this be safe for you?

I practice medicine under the guiding principle of the Hippocratic Oath:
First, do no harm. What is happening in Montezuma County is harmful and
needs to be stopped until adequate safeguards and oversight can be
implemented. I am very much in favor of a physician, with an established
relationship with a patient with a chronic, debilitating, agonizing illness,
now being able to legally prescribe medical marijuana.

I have yet to see a single case of this to date, but for the
physicians in our community who operate in a professional manner, I
encourage you to find the best treatment available for your patients
who are suffering.

To those of you who come into our community, fill out a form and check
off a box without full examination of our citizens, take their money
and hightail it out of town, you are at risk of losing your license to
practice medicine in our community.

Lori Raney, M.D., is medical director of Axis Health System (formerly
Southwest Mental Health) in Cortez.