Shrinks Shocked! Primary Care Physicians “Prescribing” Marijuana



By Bob Starrett
In a year where it would be hard to deny that medical marijuana is a big issue in many states, there is bound to be press coverage and there are bound to be legislators who are influenced by it — whatever it says.
This from the The Baltimore Sun on March 7, 2012: 
In Colorado, it is estimated that only 2 percent of registered medical marijuana users suffer from cancer or AIDS. Medicinal marijuana is often prescribed for psychiatric conditions such as insomnia, anxiety and mood disorders — and often by prescribers who have no specialized training in psychiatric disorders.
What’s wrong with this paragraph, other than that fact that Colorado does not accept insomnia, anxiety and mood disorders as listed conditions for medical marijuana? In fact, petitions to add severe anxiety and clinical depression have been denied by the Colorado Department of Public Health and Environment.

One would think that it makes some sense on first read especially if we see that it was written by two doctors, two psychiatrists as a matter of fact. Unless a demented editor (demented editors do exist) got hold of it and edited it into something it wasn’t, we have to assume that these are the words of the doctors, as represented.

Psychology Today
Dr. Annette Hanson

​This paragraph is like one of those tricky pictures where some things are wrong but the average observer would miss it unless asked to look closer and point out the omissions and abberations.
The authors of the above paragraph, Drs. Dinah Miller and Annette Hanson, are psychiatrists in Baltimore. They are coauthors of Shrink Rap: Three Psychiatrists Explain Their Work, Johns Hopkins University Press, 2011.
But let’s look at this paragraph a bit more in case you haven’t already figured out what else is wrong here. It starts with an attempt to cite figures.
“In Colorado, it is estimated that only 2 percent of registered medical marijuana users suffer from cancer or AIDS.” Well, that doesn’t have to be an estimate.
The Colorado Department of Public Health and Environment publishes these figures on their website. The latest figures available are from December 2011. They show the following reported conditions of cardholders: Cachexia 1 percent, Cancer 3 percent, Glaucoma 1 percent, HIV/AIDS 1 percent, Muscle Spasms 17 percent, Seizures 2 percent, Severe Pain 94 percent and Severe Nausea 12 percent.

Psychology Today
Dr. Dinah Miller

​So that shows 4 percent of medical marijuana patients with cancer and HIV/AIDS; it doesn’t have to be estimated. Let’s continue; cachexia is seen in cancer patients and HIV/AIDS patients as it is with other medical conditions, so that percentage is likely higher. Now let’s assume that some cancer and HIV/AIDs patients also suffer from muscle spasms and seizures.
It is pretty obvious that a high number of patients report severe pain, but are we going to immediately report that these are recreational users using severe pain as an excuse to get high? No reason to estimate, but it is important to note that cancer and AIDS patients are many times in severe pain and that those patients receiving chemotherapy as treatment are also likely to suffer from severe nausea.
People love facts and figures and charts and graphs, they are helpful of course, but let’s not estimate 2 percent when the figure is twice that by Colorado’s own count and likely much higher.
If the Legislature wants to restrict conditions, that is their prerogative, but they have not done so.
Back to that paragraph. It is only two sentences long but it says a lot. Unfortunately it says a lot wrong.
“Medicinal marijuana is often prescribed for psychiatric conditions such as insomnia, anxiety and mood disorders…” 


​First, of course, it should always be noted that medical marijuana is not prescribed, but rather recommended; this is to please the Feds, although there seems to be no pleasing them on anything these days.
“…and often by prescribers who have no specialized training in psychiatric disorders.” This is of course a reference to primary care physicians, also known as general practitioners. 
According to a study from — where else — Johns Hopkins, 73 percent of all antidepressants prescribed in 2007 were prescribed by primary care physicians. That is a 60 percent increase from the 10 years previous.
One paragraph, two sentences, 46 words. Understating the state’s own data by one half to come up with a scary number that even the state admits is low because some patients have more than one condition and because many times several conditions go hand in hand, using the inevitable “prescribe” rather that “recommend” and finally, seeming horror at the fact that primary care physicians are prescribing psychiatric drugs, you can’t get much more wrong in one short paragraph. That’s tight writing.
Primary care physicians are free to prescribe any drugs they wish to prescribe, even for off label purposes. There are no limitations on them other than those Schedule I limitations that apply to all physicians.
These psychiatrists are “astounded” that the Legislature would add psychiatric disorders to legislation. This is the kind of thing that a legislator or a prohibitionist will stand up and spout about in a committee hearing. “These two respected psychiatrists said….” and everybody is in danger of lapping it up.
Of course, you have to throw in “Johns Hopkins” no matter what. That always helps.
While there certainly may be some points to be taken from the good doctor’s article, in spite of this flop of a paragraph, the best one is this: “The wide variety of ways in which our legislators believe it is appropriate to use marijuana for medical conditions leaves one to wonder whether doctors, rather than lawmakers, shouldn’t be making decisions about medical treatments.”
I have to agree.
Baltimore Sun Article:
Colorado Department
of Public Health and Environment – Debilitating Conditions for MMJ [PDF]
Johns Hopkins Study:
Article on above study:
Editor’s note: Bob Starrett, with 22 years of experience with Optical Disc and Drive technology, is co-author of six books on CD and CD-ROM technology, and his published magazine work includes more than 250 articles, reviews and columns on CD-ROM, CD Recordable, DVD-ROM and DVD Recordable technology for publications including PC Magazine, EMedia Magazine, CD-ROM Professional, Digital Video Magazine, Digital Content Creator, One To One, Online, Tape-Disc Business and others. He holds a J.D. from the University of Colorado School of Law.