In the never ending debate about marijuana, it's usually activists on one side and law enforcement on the other, with a smattering of politicians weighing in. But marijuana, at least in part, is supposed to be a medical issue. So where are the doctors?
"There are now literally thousands of peer-reviewed papers," Carter says. Nearly 50 reach what is considered the "gold standard" of research: double-blind, placebo-controlled studies in which patients don't know whether they're getting cannabis, a placebo or a different type of medication. These have shown marijuana to be helpful for alleviating chronic pain--specifically nerve pain-- and other symptoms such as nausea. (For a listing of papers, see the exhibits in the governor's petition.)
More than a decade ago, before medical became legal in this and other states, Carter knew next to nothing about the medicinal uses of marijuana. Much of the early scientific literature on pot, based on recreational rather than medical use, was negative. In his practice, though, he sees a lot of patients with Lou Gehrig's disease, and one told Carter he was finding pot helpful.
"I was shocked," the doctor says. "In fact, I didn't really believe him."
But after medical marijuana become legal here in 1998, more patients starting coming in saying the same thing. Carter started keeping track of his patients' experiences with marijuana, and in 2001 published a seminal paper that he says started a body of research looking at cannabis' potential use in neurodegenerative diseases.
Carter, who also holds a position at the University of Washington, has continued researching cannabis as well. (See, for instance, this paper with Carter's graduate student.)But it has not been easy. Because marijuana is illegal, the feds as well as UW require exhaustive paperwork before they will authorize its use in research. To get approval for a recent study using human subjects, Clark says he had to hire a lawyer. The process took six months.
And that's just the barriers for research. Doctors thinking about whether to recommend marijuana for patients have something more serious to think about: punishment from the feds. Carters points out that the DEA can take away a doctor's ability to prescribe drugs like morphine, which can put a physician out of business.
That helps explain why most of the doctors signing off on marijuana authorizations are affiliated, not with mainstream practices, but dispensaries or other pot businesses.
Carter, however, does give such authorizations. He says he protects himself by following the state law. And, he says, "I try to keep a low profile." With his participation in the governor's petition, though, his profile just got a lot higher.