From Daniel Brubaker, MD, January 27, 2017

 As you may know, I am a strong patient advocate for medicinal cannabis. I am trying to be more proactive, especially since Prop 64 passed.

I get a lot of patients referred to me by other doctors and patients who want to use an alternative method for their medical problem(s). They need a lot of help, and I spend up to 45 minutes with them. This plant is the most medicinal plant I know of and I have seen so much benefit over the past 10 years (Yes, this is my 10th anniversary).

I am not up to speed on what the California Medical Board is up to. And, I don’t stay in the loop as much as a should, but it is only because I’m not a “Pot Doc” and a lot of my time is seeing regular patients. Don’t put all eggs in one basket..

 I had an elderly man come in today with lung cancer (never smoked), retired engineer, married more than 50 years. They went to the Fresno Health Department and got all of this bullshit info and pay them $107. I told them not to pay the money to them and my $75 recommendation is legal. The patient pulled me into a separate room and asked me how long he has to live? I told him that I don’t pretend to be God, and that he should continue to live as long as he wants to live. And, that medicinal cannabis will help keep him comfortable. you

These are the kinds of patients I see, and I don’t anyone to undermine what I’m doing. 

Attached is a recent letter to  Fiona Ma, chairwoman of the Board of Equalization and Lori Ajax, Chief of the Bureau of Medical Cannabis Regulation at the Department of Consumer Affairs.

RE: Tax on Medical Cannabis

I would like to address the Board’s policy and taxation protocol for medical marijuana patients. I have a significant objection to this policy because it penalizes medical cannabis patients to either pay an annual fee of $100 by Health Department or pay a 15% tax on their medication. The ID card program is ‘voluntary’ in California to be tax exempt; however patients with a doctor’s recommendation will not qualify for the tax break.

I have practiced medicine here in the Central Valley for 22+ years and for the past 10 years I have provided patients with cannabis recommendations when their medical condition warranted it. Most of my patients in the Central Valley are existing at either below or just above the poverty line and for that reason many have no health insurance or a plan with a low premium, i.e.,bhigh deductible ($5k). I also have patients with multiple sclerosis and rheumatoid arthritis who are on expensive medications and want to supplement with medicinal cannabis, especially for pain and inflammatio. Their medical expenses are already outrageous and the State of California should rethink their policy that penalizes legitimate medical marijuana patients.

The policy is punitive when demands an either/or ‘either pay the $100 OR you will have to pay 15% on all purchases’ is egregious and wrong! This means that patients would have to purchase $700 of medicinal cannabis to financially break even with the $100 fee (versus the 15% ‘sin’ tax) that the State charges for their ID card. Ergo, $700 X15% = $105. Medical patients should NOT have to pay anything!

At my office, I do a complete history and physical and charge $75. Many patients have to save up for an appointment. Now, the State is planning on charging an additional fee for doing nothing in terms of examining the patients. The State’s MMID program was initiated so that law enforcement could better identify legal cannabis patients. However, there is already a 24/7 verification system that has been in place for years.

What solutions are available?

Universal State of California Recommendation- like the one enclosed.

I have enclosed the recommendation that I provide to patients. Something like this could be instituted throughout the state for legitimate physicians (not Pot Doc’s). A substantial consideration is the fact that I get numerous patients from referring physicians and from patients who have significant diseases such as Parkinson’s disease, epilepsy, Alzheimer’s, multiple sclerosis, cancer, rheumatoid arthritis, complex regional pain syndrome, etc., and most of these patients have no idea as to how to use medicinal cannabis. I walk them through the whole process, educating them as to which product would benefit their health problems. They want to get started immediately, and to go to the Department of Public Health is another step in the process.

Allow doctors to provide State Cards,

This would provide separation between Pot Doc’s and legitimate doctors who provide recommendations. The State could provide equipment to the doctors for producing a card and there could be a more reasonable fee of $ 10 to $20..

Utilize the California Medical Board for better surveillance.

Another solution, would be for doctors who provide medicinal cannabis recommendations to sign up with the California Medical Board. This would provide better surveillance between doctors who are doing cannabis recommendations legitimately/legally versus those doctors who are doing illegitimate recommendations. I would even consider paying the California Medical Board $250-$500 a year to participate as a medicinal cannabis physician.

I would think that the State of California would want to protect their citizens when there is an opportunity to make something safer. Please consider my recommendations, and I look forward to hearing from those associated with the medicinal cannabis’ arm of the Board of Equalization. It is time to clean up the act with physicians who are doing recommendations that do not conform to the California Medical Board.

Question from the editor: 

But how would signing up and paying a fee result in better surveillance? 

Reply from Dr. Brubaker:

Doctors who sign-up with medical board would most likely be legitimate. Those who sign could take an oath that they will provide legitimate care for patients seeking medical cannabis. The Department of Consumer Affairs will most likely investigate doctors. I think that volunteering to let the medical board know that a doctor is doing legitimate cannabis medicine is better than what we have now. I believe it would also eliminate the profiteering doctors. This may happen regardless as 2018 rolls out.

 I have been doing cannabis recommendations for 10 years as a part of my practice. It has been a great learning experience and I have seen more good come out of this plant than opium.

I want the Pot Docs to go away and create legitimacy. I don’t know if I have a solution, but it is a start.