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Opinion

Pro-Pot Vote Is Bad Medicine

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I'm not particularly interested in marijuana.

This topic caught my interest recently when a good reporter published a story encouraging readers to read the text of the amendment. I read , felt concerned about its implications related to healthcare quality and patient safety, and wondered how the proposed system would work. I tentatively decided to vote against it, and started looking for well-reasoned arguments in favor of the amendment.

After casually observing the campaigns of both sides, the coverage by other reporters, and the opinions of columnists, I became disappointed in the quality of information presented. I noticed that my insights—the problems that I had easily noticed, as a conscientious, trained observer of our healthcare system reading and reflecting on the amendment—were not being articulated to the public, and decided I should speak up. I’m sorry that I got here late.

Discussion of Amendment 2 has been framed as a series of debates between sheriffs and lawyers. It’s easy to lose sight of the fact that the decision is about whether or not to constitutionally mandate a significant, anti-science, lawyer-designed change to the way we care for patients.

It would be easy to overlook the consensus of the most relevant professionals, Florida’s doctors. We have a lot of practice at making medical decisions: Amendment 2 represents making significant, uninformed medical decisions for hundreds of thousands of people, and we oppose it. (I’m not a member of the Florida Medical Association, but we agree on this issue.)

It’s hard to find doctors who practice medicine in Florida who think Amendment 2 is a good idea. You may know one with a laissez-faire position, but actual supportiveness of this amendment specifically is rare among doctors who have read it.

Have you heard of any medical doctors who want to incorporate use of marijuana into their practices, or who want to “specialize”—become a dedicated marijuana use authorizing physician? Who are they? If the amendment passes, how many doctors will claim to be or strive to become "marijuana literate”?

Media coverage of Amendment 2 has mostly involved fact-checking the talking points of a prohibition-oriented opposition campaign. I’ll address one powerful, deceptive marketing message put out by (the pro-Amendment 2 group) United for Care.

Along with an appeal to emotions, this single, brief message contains a dangerous oversimplification and a nonsensical misrepresentation: “Doctors should be able to do what's best for their patients. Trust your doctors. Support medical marijuana. Vote YES on 2.” (If you take the first part of this advice and trust us about the amendment, you'll vote no.) Is the proposed amendment really about enabling doctors “to do what’s best for their patients”? Let’s see.

The system described in Amendment 2 is not a safe system of care delivery. The amendment would create a parallel treatment delivery system ("marijuana literate" physicians alongside science-based physicians) and a parallel regulatory system (a state-based one that doesn't ensure safety or efficacy, alongside the Food and Drug Administration).

The role of the physician in the system described by the amendment is not to decide what's best for the patient. No physician will prescribe, order, or recommend "medical" marijuana as preferable to any other treatment. The physician’s role in the system Amendment 2 creates is to certify a diagnosis with any of nine listed conditions, or debility due to other causes. If the amendment passes, this certification will authorize self-medication with marijuana.

The decision about whether debility and/or the conditions listed in the amendment warrant access to marijuana in the system described for all Floridians will have been relegated to voters, who are underqualified to make even one individual such decision. This is why we have doctors.

Prospective patients and consumers will decide whether to go to a good doctor for real medicine, or to a pot doctor for marijuana. That’s what makes this unlike medicine and fundamentally unsafe. “Your doctor” won’t decide between marijuana and an evidence-based course; extremely few doctors will offer both. The decision will be made in a new healthcare gap (between two kinds of doctors) created by the amendment. You and your neighbor will decide. Will all of your neighbors be safe?

I oppose the medicalization of marijuana at this time. Here is a recent exploration of the topic, not specific to Amendment 2. Until we have the information we would need to integrate marijuana into medical practice, to know how to use its various forms as medicines, we shouldn’t act as though we do. Until we have the information we would need to prescribe it, doctors should not be involved with granting access to marijuana.

It’s irresponsible to offer voters the opportunity to force this kind of unwanted change onto a profession, and it was foolish to have disregarded the perspective of relevant professionals in crafting the proposed changes. Worst, it’s deceptive and dangerous to use a physician in this way.

The token involvement of a doctor is designed to make the amendment seem legitimate, safe, and palatable to you, the voter. The campaign explicitly attempts to exploit the trust nature of the physician-patient relationship it’s trying to hijack. Unfortunately, because people trust us, using a physician in the system of access to marijuana will make its use seem legitimate and health-oriented even when it’s medically inappropriate.

There’s a radical difference between the credat emptor nature of healthcare and the caveat emptor ethos of business. I’ve seen how commercialization degrades healthcare quality and safety. It's unreasonable to expect a state agency to protect the public from harm and exploitation by commercial quasi-medical enterprises. It's unreasonable to trust the existing system of physician monitoring (self-regulation, combined with oversight by Florida’s notoriously lax Board of Medicine) to ensure patient safety in the system described in Amendment 2.

Please don’t invite Florida's doctors to participate; I doubt that we can be trusted to meet your expectations using marijuana. Involving us probably won't make the drug work better.

Medicalization is different from legalization. Some ideas about transferring drug-related issues from our legal system to our health care system are good and worthwhile. This isn't one of them. Amendment 2 simply doesn’t say what you wish it said, but voting yes would mean you agree with everything it says and insist on the changes it spells out -- that you demand to expose Floridians to harm and exploitation and force unwanted changes on my profession.

Please agree with Florida's doctors and vote no.

Tazia K. Stagg, M.D., M.P.H., is a Tampa-area native and a graduate of University of South Florida College of Medicine. She is board-certified in Public Health and General Preventive Medicine, with fellowship training in healthcare quality and patient safety. She is preparing to open a preventive medicine Specialty practice, Preventive Medicine of Tampa Bay, in Tampa.