Medical Marijuana - Phil Wolfson, MD


Medical Marijuana Psychiatry evaluations, recommendations and treatment in the San Francisco Bay AreaChill

Medical marijuana may be appropriate for adults suffering from anxiety, depression, insomnia, pain, sexual dysfunctions and other medical and psychiatric problems. Dr. Wolfson provides assessment and treatment planning for those 21 and over.

Here's a presentation I gave in August 2010 at a conference in Lima, Peru: Marijuana: a Review with Emphasis on Medical Marijuana and Use Patterns in the USA

Medical evaluations are performed in Marin County and San Francisco.
For more information, visit
or call for an appointment:
(415) 550-1700

Under California Law: since the successful popular vote for the ballot measure of 1996 (The Compassionate Use Act, Proposition 215), a physician may recommend use of marijuana to a patient for a variety of medical reasons, the recommendation being based on a standard of care medical assessment, diagnosis and the appropriateness of marijuana as a treatment-generally adjunctive - for the condition diagnosed - much as would be the case for any medical process and the recommendation of any other medication.  The physician's recommendation may be for up to a maximum of a year's length of time -- as for any medication -- with lesser durations being left to the physician's judgment and the appropriateness of the timing for re-evaluation of treatment. Re-assessment at the conclusion of the time period is required for another recommendation.

It is in both the patient and the physician's interests to proceed in a thorough and medically appropriate manner as this validates the procedure protecting both parties from legal action.  The physician acts within the law and the standard of care. The patient receives a recommendation that is true and viable and protects from penalties for possession. Thus, to receive a medical marijuana recommendation, the patient must have a medical basis and provide medical records, and/or a diagnosis from a treating physician and/or therapist at the time of the examination; or procure one within 30 days-receiving, if appropriate, a 30 day recommendation for medical marijuana; or must enter treatment with the recommending physician on a basis appropriate for the recommendation of medical marijuana, much the same as for any medication.  In practice this means that recommendations will be issued for time periods such as 30 days, 3 months, 6 months, and one year, whichever is appropriate. Re-examination will be necessary to obtain additional recommendations, depending on ongoing medical appropriateness.

While there is much ado about cheap and easy 'medical marijuana certificates' with quick in-and-out service, physicians who provide this run the real risk of having the Medical Board of California take action against them. There are numerous such cases pending and settled with sanctions and loss of license--and patients receiving such 'certs' run the risk of having them considered invalid by the authorities.  Patients must be aware that physicians are not allowed to associate with or make recommendations for specific clubs - the two must be unconnected and patients seek their own means for obtaining marijuana independently of the physician. Federal law prohibits physicians and their staff from assisting patients in procuring medical marijuana.  Most clubs will accept a valid medical marijuana recommendation, may check with the physician to make sure that the recommendation is in fact real and not bogus, and will be bound by the duration of the treatment recommendation made by the physician.  'Marijuana cards' are private clubs' proprietary 'membership cards' and are not part of the California State medical marijuana law.  You are wise to consider if you wish to enter your name in a data base that may not be truly confidential and for which there is no legal requirement in order to buy marijuana from a club.  Optional Non-state-ID cards may be available from localities such as the City of Oakland - are valid in just the issuing locality - but again are not required and may create exposure. Whenever you give a letter of recommendation to use medical marijuana to anyone, be certain to always have your original document returned to you, as it is the only legally valid copy.  It is advisable that you carry a photocopy as needed for ongoing use.

California State Law SB420 specifies as a state-wide minimum floor for cultivation and possession: 6 full sized, or 12 'immature' plants and 8 ounces of marijuana defined as dried flower tops.  Local jurisdictions have the option of developing greater numbers in their guidelines and many have done so.  Do consult with your local DA's office for guidelines being used in your area for possession and cultivation.

Some Suggestions for Attitude, View, and Practice Concerning Use of Medical Marijuana

  1. Around the clock use of any substance, and compulsive, regular use generally lead to dependency in some form or fashion.  With marijuana this may mean loss of connection with friends and family, lack of motivation, stagnation, inertia, a sense of dissociation, depression, economic and social loss and withdrawal.
  2. Dependency on marijuana may lead to a mild withdrawal syndrome on cessation of use. This often consists of a sense of confusion and inertia, irritability, headaches, restlessness, lack of appetite--coupled with cravings.  The latter may persist for long periods of time. The withdrawal syndrome may persist for 10 days time or infrequently longer, with a possibly longer period for recovery of psychosocial functioning depending on length of use of marijuana and dysfunctionality.
  3. There is no known relationship between smoking marijuana and cancer--lung, oropharynx or other.
  4. Combination of marijuana with other substances-alcohol, opiates, muscle relaxants, tranquilizers, etc should be done with caution.  Increased sedation may be one of the consequences.  Fainting episodes--due to a sudden drop in blood pressure--have been reported
  5. Marijuana should not be used if you are pregnant or nursing.
  6. Under no circumstance should you operate any tools and machines or drive motor vehicles while under the influence of marijuana.  It is inadvisable to make major decisions or sign legal documents under the influence.
  7. Marijuana is a mind-altering substance whose effects are related to dosage and length of use.  The greater the dose, the greater the impairment in coordination, cognition, and judgment.
  8. Marijuana is a substance with many benefits and positive aspects for mind and behavior, for medical utility.  Not everyone does well with marijuana.  Not everyone has a consistent history with marijuana.  One's relationship with marijuana may change for the better or worse in different periods of life, and with stress and loss. 

Marijuana is best used thoughtfully, with awareness of the effects on self and others, and non-compulsively.  Compulsive use blunts marijuana's utility and creates a sense of sameness of experience instead of uniqueness and learning.  Marijuana can be a tool for healing, learning, love, sensuality, sexuality, growth, and spacious mind and is best used as part of an overall approach to goals for personal development that include wellness, spiritual, psychological and community practices.









415-555-1700 Lotus