“Cannabis is fantastic at symptom relief, but I wouldn’t want to treat them naturally without a component of conventional care.” Kelly O

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As people enter clinics hoping to gain authorizations for medical marijuana, health-care professionals have been quietly taking on the role of primary-care physicians and even doing emergency triage. Issuing authorizations has exposed them to a section of low-income, uninsured, doctor-weary patients who desperately need treatment but have resolutely avoided it.

Take 31-year-old Nick, who asked that his last name be withheld. His bike wreck wasn't horrific. In fact, he doesn't even describe it as a wreck. "It was more of a slip and slide," he explains.

"Last May, I was biking to work in the rain and I took a corner a little too fast. My bike slid out from under me and I landed on my right side." Nick picked himself up, evaluated his bike (it was fine), picked the gravel out of his right arm (it stung), and continued his commute to work. His arm throbbed, but it never occurred to him to go to the doctor. His surface injuries were minimal, he'd endured worse pain, and, besides, he didn't have insurance. "I figured I could walk it off, like normal," he says.

Weeks later, Nick found himself in a doctor's office. He was undergoing his first physical in more than a decade, which is mandatory for all patients who seek a medical-marijuana authorization in Washington State. Over the course of an hour, Nick was poked, prodded, and asked about the pain he experienced in the normal course of a day, including how it affected his routines and how he managed it. "[The doctor] helped me realize that I hadn't really used my right arm in a few weeks," Nick says.

"And then she said, 'I want to x-ray your arm. I think it's broken.'"

Nick protested—he wanted his authorization to help with pain management related to another medical problem. Eventually, Nick and his provider each got their way: Nick was x-rayed (his arm was indeed broken in two places) and treated. He also received his authorization card.

"We've sent up to three people in a week to the ER through our docs," says Josh Berman, director of 4Evergreen Group, a two-year-old referral organization that connects anywhere from 500 to 2,500 patients a month to eight Seattle- and Tacoma-area doctors providing medical-marijuana authorizations. "What's amazing is how many untreated ailments our doctors are finding during these physicals—sometimes patients will be denied medical cannabis but sent directly to Harborview."

There's no way of knowing how many medical-marijuana users there are in Washington, as there's currently no patient-registry system. It's also tricky to find patients willing to talk about their pot-treated medical conditions given the tightrope legality of medical marijuana. Physicians and activists are currently our best connection to the pulse of this medical gray area.

"I refer patients out all the time," confirms Dr. Candace McNaughton, a naturopathic doctor who authorizes roughly 20 patients a month for medical cannabis through Glow Natural Health Center, her Madison Valley clinic. McNaughton has evaluated patients requesting medical marijuana authorizations to alleviate the effects of hepatitis C, cancer, severe ulcers, and other ailments for which they are currently not receiving treatment. "I have a lot of people coming to me saying, 'I hate regular medicine,' or, worse, they're afraid of it, but they trust me," she says. "So my big job is letting folks know that cannabis is fantastic at symptom relief but that I wouldn't want to treat them naturally without a component of conventional care." That conventional care could come down to simple things, like prescribing glucosamine to build up cartilage in arthritis patients or referring someone to a physical therapist, or it could mean referring hepatitis C patients to receive interferon therapy.

Medical-marijuana authorizations are not the primary focus of McNaughton's practice; nevertheless, she says that half the people who come see her for authorizations end up taking her on as their primary-care physician. "I think it's a common assumption that people looking to take medical cannabis want to be on it forever, but they don't," she explains. "They want to get better. And whether they come to me with diabetes, high blood pressure, cholesterol, or insomnia, I can make them better. That gives them true relief."

Doctor Gil Mobley, a vocal marijuana-legalization advocate and Washington physician (now relocated to Missouri), agrees: "One thing often overlooked with routine care elsewhere is for a doctor to sit down and talk about pain with their patients—the quality of their pain, the nature of their pain, and how it affects their life," he says. recommended