A small number of physicians account for a disproportionate share of medical marijuana recommendations across the United States. That claim came from testimony on day seven of an eleven day Drug Enforcement Administration hearing into the rescheduling of cannabis. Dr. Ken Finn gave the testimony. He drew on decades of clinical experience and his own data.

Few Doctors Behind Most Medical Marijuana Recommendations

Dr. Finn is licensed to practice in Utah since 1990, Colorado since 1994 and Arizona since 2025. His credentials include board certification in physical medicine and rehabilitation, pain management and pain medicine. Chronic pain treatment has formed the core of his career.

Three licensed physicians in Colorado made more than a quarter of all medical marijuana recommendations in 2022, Dr. Finn told the hearing. Just 21 percent of qualified physicians in Florida issued 88 percent of medical certifications. Nine doctors in Oregon approved more than half of all patients enrolled in the state medical marijuana programme. Only 3.4 percent of physicians in New York take part in the state programme at all.

Why the Testing Standard Matters

Dr. Finn presented these figures to challenge an assumption made by the Assistant Secretary of Health, a role within the Department of Health and Human Services. Dr. Rachel Levine, appointed under President Biden, decided the Food and Drug Administration should apply a new two part test. The five part test the agency normally uses when considering rescheduling under the Controlled Substances Act was set aside in favour of this approach. On day two of the hearing, the FDA’s Dr. Dominic Chiapperino testified that marijuana would not have passed the standard five part test.

The two part test rests on an assumption, Dr. Finn argued, that doctors across the 43 states which have legalised marijuana for medical use would consistently recommend it to patients who needed it. His own data on marijuana recommendation practices told a different story.

A Doctor’s Own Experience

From Prescriber to Patient

Colorado legalised medical marijuana in 2000. Dr. Finn began recommending it to his own pain patients soon after. Almost every one of them told him, over time, that opioids managed their pain more effectively than marijuana did.

The 2009 Ogden Memo marked a turning point. Issued by President Obama’s Department of Justice, it advised states not to prosecute people using marijuana for medical purposes. Dispensaries opened across Colorado in the months that followed. Curious about what his patients were experiencing, Dr. Finn applied for a medical marijuana card himself. What he learned changed how he practised medicine, and he stopped recommending marijuana to his patients altogether.

A Card Granted Without Basic Screening

Dr. Finn described his own approval process to the hearing. The recommending physician granted his card for severe pain related to his knees. Yet that physician never asked him to rate his pain, which he says sits at around zero to two out of ten on most days. His medical history went unreviewed. Physical therapy and other treatments were never discussed, nor were the medications he was taking or how cannabis might interact with them.

Records That Did Not Exist

A year later, Dr. Finn returned to renew the card. This time, he asked the recommending physician pointed questions of his own: What happens if a patient has an adverse reaction? Could chest pain or heart palpitations follow? Might a patient feel depressed, or have thoughts of suicide? Colorado law requires clinics to retain patients’ medical records and make them available on request, yet when Dr. Finn requested his own, the clinic told him they did not exist.

The physicians involved in his care were not following state guidelines around doctor patient relationships or record keeping, Dr. Finn said. A wider pattern is playing out, he argued, across communities that have embraced legalisation with too little scrutiny of medical marijuana recommendation practices.

Death and Suicide Data Tied to Marijuana Recommendation Practices

Dr. Finn’s testimony pointed to figures he said had gone largely unnoticed. State data show THC as the leading substance found in deaths in Colorado that were neither natural nor the result of homicide. Marijuana also ranks as the leading substance found in completed teen suicides in the state.

The 2020 Youth Risk Behavior Survey offered a further data point. That survey found the single greatest risk factor for an adolescent misusing opioids was having ever used marijuana. Dr. Finn stopped short of claiming marijuana use causes opioid misuse. Even so, he noted the data consistently show a higher likelihood of opioid use disorder among people who have used marijuana.

What the Testimony Suggests

Several conclusions follow from the figures presented on day seven. A small group of physicians approves the vast majority of medical marijuana patients in several states. Dr. Finn’s account also shows the standard of clinical assessment behind those approvals varies widely. These facts, taken together, suggest the two part test relied upon by the Assistant Secretary of Health may rest on shaky assumptions.

The DEA hearing continues. Dr. Finn’s account adds a first hand dimension to scientific testimony delivered over the previous six days. He speaks both as a prescribing physician and as a patient. His experience points to gaps in oversight that extend well beyond whether regulators should reschedule marijuana. A more immediate concern emerges: do medical marijuana recommendations, as currently practised in many states, meet the basic standards expected of any other area of medicine?

Source: suerusche.substack