WHEN DOCTORS GO TO POT
Family of physicians approaches medical marijuana with caring attitude, professionalism
The Knox family is a clan of four doctors living in Oregon and California who specialize in medical marijuana. They seem to be doing quite well selling something that’s illegal in many states, working with those they know best.
“We’re all fighting the same fight,” said Janice Knox, the founding doctor behind American Cannabinoid Clinics in Portland, Ore. — and the mother of two fellow physicians and the wife of the other. “I think when they do see us they’re surprised at who we are,” she said of her patients.
The family aims for something not always associated with medical marijuana: professionalism.
Knox led the family’s move into medical marijuana in 2012, when she retired from a decades-long career in anesthesiology. One of 15 children, she grew up in the San Francisco Bay area and went north for medical school in the 1970s.
“There were not very many black women or men, at least not at the University of Washington,” she said. “It felt like a cultural shock when I went there.”
Knox stuck it out, choosing a career as an anesthesiologist because she thought — wrongly — it would give her more time to raise children. After 35 years, however, she got tired of working up to seven days a week. And she got tired of being mistaken for a nurse.
“Patients would say, ‘I want a white male doctor,’” Knox said.
After she stepped away from the job, she got a call from a “card mill” — a practice known more for writing prescriptions for medical marijuana quickly than for close attention to patients’ needs. One of the doctors couldn’t be found. Could she fill in?
Knox wasn’t sure. One of her colleagues, a marijuana enthusiast, had been sent to rehab. And despite going to college at the University of California, Berkeley, she was a square — had never seen or smelled marijuana “at a time when drugs were everywhere,” she said.
But having always been interested in natural treatments, she agreed to fill in — and was pleasantly surprised to see the patients weren’t a bunch of reprobates.
“I was shocked to see the people that came into card mill,” she said. “Grandmothers, grandfathers, people with seeing-eye dogs. They weren’t at all who I expected ... These were people who conventional medicine had failed.”
Nor was Knox content to sign prescriptions and send patients on their way.
Some had questions, as anyone would when told to take any drug. What strain was best? What about dosage? And was smoking pot better than a cannabis edible or a cannabis oil or a cannabis hand cream? Knox didn’t know. “I was embarrassed because they expected me, a physician, to tell them how to use this medicine,” she said. “I couldn’t answer them. I did not know anything about cannabis.”
Undaunted, she delved into research of what’s called the “endocannabinoid system” — a network of receptors in the body and brain that respond to cannabis and regulate, among other things, immune response, liver function and the production of insulin.
“It’s very, very real,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
Volkow pointed out that understanding of the endocannabinoid system suffers from what she called a “circular problem.” Even though more states are moving to legalize medical marijuana, there is insufficient evidence about how it works partly because the drug, a federally controlled Schedule 1 substance purportedly of no medical use, is restricted and not easy to study.
The American Medical Association considers cannabis “a dangerous drug and, as such, a serious public health concern,” according to a policy statement.
Knox read all the studies she could, attended conferences and has been certified as a cannabis specialist. She learned, for example, the difference between THC, the cannabis compound, or cannabinoid, that gets people high, and CBD, a cannabinoid that offers therapeutic effects sans altered states of awareness.
Knox’s husband, David Knox, an emergency room physician for 38 years, kept his day job but also started working at the clinic. He knew nothing about the endocannabinoid system but quickly saw the potential of cannabis as a treatment for epilepsy, cancer-therapy side-effects and pain, particularly in the middle of an opioid epidemic.
He also said former president Richard Nixon’s decision to sign the Controlled Substances Act, which slated marijuana as a Schedule 1 drug in 1970, was “one of his biggest crimes.
“I think a majority of establishment medicine still is not on board with (medical marijuana),” he said. “That’s the way we were taught.”
After a year of the Trump administration, the future of patients seeking medical marijuana still isn’t clear. Attorney General Jeff Sessions sought the ability to prosecute medical marijuana providers in states where the practice is legal.
The Knox family, however, isn’t that worried. While Janice Knox acknowledged that physicians are “in a precarious position” working with a federally controlled substance, 29 states and the District of Columbia have legalized medical marijuana; eight have legalized recreational use by adults. With so many benefiting from the once verboten drug, it’s hard to imagine going back.
“We’re going to plow ahead and do what it’s right for us to do,” she said.