COOL, Calif. – Dr. Mollie Fry never thought telling her patients where to get the medicine she recommended for pain, depression and nausea would be a problem.
Federal drug agents who raided her home and office thought otherwise, and she was indicted last year on felony charges of conspiring to distribute marijuana.
"I assumed the fact that I had 'M.D.' at the end of my name gave me the right to make judgments about people's health," said Fry, who estimates she has issued thousands of cannabis recommendations since setting up her thriving practice northeast of Sacramento in 1999.
Since California passed the nation's first medical marijuana law a decade ago, a provision requiring written doctor approval to grow and buy pot has created conflict between the state mandate and federal drug laws, and strained the doctor-patient relationship.
Until the stalemate is resolved, doctors recommending marijuana do it with trepidation and a good deal of risk.
Medical marijuana advocates estimate that 1,500 doctors, mostly oncologists and AIDS specialists, have authorized pot for at least one patient. But most recommendations have come from about 15 self-appointed specialists, the so-called "pot docs," who charge $150 and up to walk what the California Medical Association calls "a gray area between the clearly permissible and clearly impermissible categories of action."
Following complaints by local law enforcement, nearly all have been investigated by the state board that licenses and disciplines physicians. Four had devoted their practices to acting as medical marijuana consultants and ultimately were sanctioned, ranging from the public rebuke that Fry got to having their licenses suspended.
California's medical marijuana law, also known as Proposition 215, named a host of ailments for which marijuana might prove helpful in easing symptoms: cancer, anorexia, AIDS, glaucoma, arthritis, migraine.
Unlike medical marijuana laws enacted in 10 other states, California's also gave doctors discretion to certify patients with "any other illness for which marijuana provides relief," leaving open the possibility that recommendations could be made to people who did not need them.
David Thornton, executive director of the California Medical Board, said that until the board issued guidelines two years ago outlining what constituted "accepted medical standards," physicians pretty much had to figure it out on their own. Most concluded it was not worth the risk.
Although a federal appeals court ruled four years ago that the U.S. Drug Enforcement Administration cannot go after doctors merely because they recommend marijuana to patients, the state medical board's guidelines make it clear the ruling did not amount to immunity either from prosecution or disciplinary proceedings.
The board advises doctors that relying on a patient's word instead of prior medical records to determine whether a marijuana recommendation is appropriate could constitute medical negligence. Failing to conduct an independent exam or to consider whether another drug would be as effective could lead to charges of unprofessional conduct.
The California Medical Association is even more explicit, warning doctors never to tell patients where to get pot and urging them to remind patients of possible side effects. Discussing dosages with patients, opining on whether they should smoke or eat marijuana, and signing a form that enables patients to obtain a state-issued medical marijuana ID card also are steps the medical association cautions could lead to them being sanctioned.
Frank Lucido, a Berkeley physician who devotes about 30 percent of his practice to working with medical marijuana patients, said he abides by those recommendations, but thinks pot docs are being held to higher standards than doctors who prescribe lots of Viagra, prescription painkillers and other abused medications. Doctors who prescribe sleeping pills for patients who complain of insomnia, Lucido noted, are not at risk of being called quacks if they don't do a hands-on exam or develop a long-term treatment plan.
Fry, 50, who is awaiting trial, continues signing recommendation forms for patients who come to see her from throughout the state. She no longer sells her patients starter plants, but freely tells them about what she sees as the spiritual, emotional and economic benefits of growing their own pot.
"What did I take an oath to do? To do no harm and to alleviate pain and suffering," Fry said. "I'm going to be true to my oath, and I'm even willing to go to prison for it."