It’s Wednesday at 3:27 p.m.

I was just in the kitchen cutting potatoes for a belated birthday dinner which, ironically, will be happening very early this evening. I noticed a missed text on my phone and decided to call back, as was requested. It was from a member of “a network of licensed physicians” as they are looking for Massachusetts physicians credentialed to certify for medical cannabis. I am one of them.

The woman on the other end of the phone couldn’t have been nicer. Right off the bat, I told her my concern about “card-mills,” and she, a founding member of the company, immediately assured me that this isn’t one. “Great!” I said, “I’d love to learn more.”

According to the contact, her company educates their patients about the endocannabinoid system (the neurology and biology of cannabis and the body), has them fill out the appropriate paperwork, and tells them how cannabis will benefit their conditions. All that’s left for the physician to do, she said, is to meet the patient via telemedicine so they feel they’ve had a personal experience and to certify them for medical cannabis.

This sounded quite similar to the information I’ve heard from prospecting card-mills in the past. I asked one of my tried and true questions: “So, what happens if I don’t think the patient should be treated with medical cannabis?”

“Well, the way the compensation plan works is this: We don’t bill a patient unless they receive a medical cannabis card. And, since we’re not collecting money from them, the doctor doesn’t get paid.”

Again, this sounded just like the card-mills that seem to be proliferating.  “So, let me get this straight. If you come to see me for what you think is a broken ankle and I tell you it’s just sprained, I shouldn’t be compensated?”

“It’s just the way the way the compensation works.”

“And, if you have diabetes and you want me to give you one medication, but I feel you would be better treated with another, I wouldn’t be compensated?”

At this point, I could tell she was becoming very frustrated with me.

“Look,” I said, “this is the very definition of a card-mill, and it’s giving those of us who truly believe that cannabis is an effective medication a really bad name.”

“Well,” she said, “Cannabis is safe, so it’s OK.”

It is true that, when taken under the care of a physician, modest doses of cannabis can be safely used for the treatment of many illnesses and symptoms. Included in this list are pain associated with cancer, nausea, and insomnia, to name a few. Yet, it was at this moment that my mind went to the potential side effects that can occur with any medication. Do card-mills educate patients about the potential risk of subarachnoid hemorrhage in cannabis users? Do their docs mention CBD and its interaction with medications such as Coumadin? Who talks with them about the possibility of increased anxiety that can occur with too much THC? Pseudomonas pneumonia in immunocompromised people? Erectile dysfunction? Benzene inhalation?  Do card-mills instruct patients about dosing? Routes of administration? More often than not, information is learned from the bud-tender at the dispensary trained in sales and not in medicine.

Is cannabis safer than many pharmaceuticals? Yes.

Is it so safe that anyone should dispense it to anyone? No.

Of course, people want medical cannabis cards. In Massachusetts, those with medical cannabis cards receive a 20 percent discount in the form of tax-free pot. Therefore, one would think the state would crack down on card-mills to obtain this revenue if not simply to ensure the safety of patients. Instead, card-mills incentivize physicians to hand out cards as if they were mints – pun definitely intended.

And, isn’t this how the opioid crisis started? Aren’t the card-mills actually contributing to cannabis use disorder? Yes, that’s a thing! And it’s something that those of us who take this medicine seriously educate about while making sure that our patients’ use is appropriate. We are also committed to being available to our patients and seeing them more frequently than the annual 15-minute visit of the card mill. Shouldn’t that be the standard with all psycho-active and potentially addicting medications?

Don’t real patients deserve real patient care?

Jill Becker is a physician and can be reached at her self-titled site, Jill Becker, MD.

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