My Turn
By Dr. Gina Mecagni, Fri Nov 22, 2013


As medical students at Georgetown University, we were indoctrinated with the traditions and values of our attending physicians. It was there that I was taught how to care for patients. It was there that I first heard and would hear repeatedly throughout my training: Pain is what the patient says it is.

That value is critical to the practice of medicine. It establishes a foundation of trust between physician and patient. It begins the conversation with, “I believe you,” so that you can move forward to “How can I help you?”

That value is what made reading The Arizona Republic editorial board’s comments about patients who use Arizona’s medical-marijuana law for chronic pain treatment so upsetting (“Cheech and Chong would love Arizona’s medical-pot law,” Nov. 12).

I have been an emergency medicine physician for 12 years. One thing almost every one of my patients has in common is that they are in pain. Pain is the warning signal our bodies use to let us know that something is wrong.

Many patients present to the ER with chronic pain. Old injuries (reflex sympathetic dystrophy, arthritis, malocclusion, poor wound healing), adhesions (any abdominal surgery), migraines, chest pain, joint and extremity pain (rheumatoid arthritis, autoimmune disorders, septic joints, bone spurs), pelvic pain. Chronic pain encompasses all of these things as well as many others.

Does that make it less real? Should I turn them away from the emergency room because chronic pain just couldn’t be a reason someone would turn to a physician for help and relief? Fakers. Con artists. Drug addicts.

Unless you are old. Or have cancer. Right?

The 20-year-old with chronic pain due to spasticity from cerebral palsy. Wait. Sorry. He’s 20. Couldn’t be in that much pain yet. Faker. Con artist. Young, male recreational-drug user working the system.

According to the Institute of Medicine of the National Academies, 100 million Americans suffer from chronic pain. Fakers. “Inherently dishonest” con artists. Or maybe it is that the Institute of Medicine is “chronically gullible,” to use a phrase in The Republic’s editorial.

These same patients are often encouraged by their physicians to seek alternative therapies when it seems that Western medicine has explored all of its options. When Vicodin turns to Oxycontin turns to Fentanyl, and then you are chemically dependent and out of options.

Yet these same doctors won’t write you a “recommendation.” It’s scary as a physician. I wouldn’t do it. Risk my license? Be reported to the Arizona Department of Health Services? Scrutinized? Exposed? Definitely not worth losing my job! So these same doctors print out patient records and hand them to their patients. “Go to a recommendation center. I can’t do it.”

Will Humble, director of the ADHS, is disingenuous when he says he wants the primary-care physicians to write medical-marijuana recommendations. That will not happen as long as the physician receives federal reimbursement for services (e.g. Medicare) and fears this will be taken away. That will not happen until physicians can speak freely without fear of reprisal. Mr. Humble is a smart guy. He knows this.

The patients who jump through the hoops to get their cards are then sent out to the dispensaries. Usually these are located in an industrial area. Surrounded by chain-link fences with cameras following your every move while a security guard looks you up and down. Dispensaries are kept away from the normal daily traffic of people. Away from the God-fearing, upstanding citizens we must protect from this … non-lethal plant.

Why can’t they just go to a pharmacy where all the other drugs are? Simple. Because it’s still federally illegal.

But Arizona voters stood up three years ago and said, “Enough.” The federal government is wrong. The Drug Enforcement Agency is wrong. The propaganda of the “Reefer Madness” hysteria of the 1930s is just that — propaganda.

If you would do a little research, you would know there is no way to meaningful therapeutic research because the National Institute on Drug Abuse won’t release the “study drug” for research that does not specifically address drug abuse. They are the only ones with a federally authorized cannabis farm!

You want a dose-controlled pharmaceutical product? Did you know that cannabis concentrates are currently illegal under the Arizona criminal code? I would guess from The Republic’s uninformed editorial that editorial-board members do not.

Please, Republic editorial board, do readers a favor and use your platform responsibly. The editorial was sloppy journalism even as an opinion piece. If you disagree with how the Arizona Medical Marijuana Program works, you can at least make a respectable argument instead of throwing around judgments, accusations and raunchy references to pop culture. The readers of The Arizona Republic deserve better.

Gina Mecagni has practiced emergency medicine in the Valley for 12 years.


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