The pool in the front yard of Dr. Francis D’Ambrosio’s Hollywood Hills house is shady and filled with inflatable loungers that drift in the breeze. An empty energy drink can and full tray of cigarette butts rest on the table near the entrance. Just inside, in a home office to the side of his dining room, D’Ambrosio sits at his wide, full desk. A few other desks are set up, where D’Ambrosio’s support staff is on the phone or intently typing. The pool is visible from this room, but D’Ambrosio does not seem tempted by it. Here he sits, from 8 a.m. to 10 p.m., seven days a week, writing cannabis prescriptions online for a website called 420recs.com.
Until two and a half years ago, D’Ambrosio worked as an orthopedic surgeon — a career that he’d held since entering the medical field in 1986. “Even though [orthopedic surgery] was a very intense and lucrative job, nobody ever got better. You’d do these amazing operations on their backs, and they were still in miserable pain. It was very unsatisfying,” says D’Ambrosio, an affable man who is proud of his Italian heritage, and the fact that he’s a Yankees fan.
In January 2014, when U.S. Attorney General Eric Holder announced that banking restrictions would be loosened for cannabis businesses, D’Ambrosia says he thought: “’This is the moment to do this, because if they’re going to start loosening the banking, that means this is a viable medicine.’" He started becoming an advocate and seeing patients for the recommendation letters. "The most amazing thing happened — people were happy," he says. "Everyone would leave the office happy. I wasn’t used to that.”
Like many cannabis enthusiasts, D’Ambrosio first took a liking to the plant in college, when he discovered that he preferred its effects to those of alcohol, and felt that it was healthier. Once he entered med school, though, D’Ambrosio had to stop using. Cannabis use was then, as it is now, frowned upon within the medical community.
To this day, D’Ambrosio does not himself use cannabis. He’d love to use it to treat his bad hip, which keeps him on a daily regimen of Advil and Aleve, but it is against the law for doctors to prescribe medications like cannabis to themselves. He doesn’t have another doctor write him a prescription because “I’m so vocal. I’m such a big advocate. I’m a target. I want to take away at least that potential bullet.” In his off hours, D’Ambrosio also hosts a cannabis-centered broadcast called “Elevate the Conversation."
According to D’Ambrosio, his passion for cannabis stems from something in the human body called the endocannabinoid system, which is comprised of receptors and enzymes that react to cannabis and bring about its effects. “The fact that there’s a plant that has the same chemicals our body inherently has, and that there’s a system that can capture these chemicals fascinated me," he says. "It actually got me to think philosophically about cannabis and the world we live in. The chef Mario Batali, when he cooks, he uses ingredients from all one region. He says, ‘If it grows together, it goes together.’ How is that any different than humans?”
Physicians like D’Ambrosio have substantial reason to believe that cannabinoids may indeed be effective. Glaucoma patients experience decreased pressure on the optic nerve when they use it — which, according to D’Ambrosio, can perhaps prevent blindness. Cannabis is a bronchodilator, which means that it can relieve lung inflammation in asthmatics. It’s also a vasodilator, which means it can lower blood pressure.
Despite the number of promising treatments the plant offers, however, research on the medical benefits of cannabis is scant within the United States. This is because marijuana continues to be classified as a DEA Schedule I drug, which defines it as a substance that has no medical benefit. In a Catch-22, this makes it ineligible for studies that could prove its medical benefit.
“The medical board has not smiled gently on cannabis,” D’Ambrosio says, “They’re allowing [medical marijuana] to happen, but cannabis is not where they want to be. The advocacy that I’m taking right now — it’s dangerous, what I’m doing. There’s too many people who want to see it the way it is. The system is rigged at this particular point.”
Currently only one university in the United States, the University of Mississippi, is legally allowed to grow marijuana for research purposes. D’Ambrosio notes that researcher Sue Sisley was driven from Arizona to Nevada to Colorado, where she finally found a home for her study on the uses of marijuana for veterans with PTSD. Because research in the United States is limited, studies out of countries like Israel and the Netherlands often are used to give cannabis physicians clues as to its potential benefits. In one study at Hebrew University in Israel, mice were subjected to head trauma. Those that were given cannabinoids recovered remarkably more quickly.
“Cannabis is a neuroprotectant,” D’Ambrosio says, “which is why it’s crazy to me that organizations like the NFL are taking such an enormous stance against cannabis. Head trauma seems to be such a huge issue. If we can show that cannabis may protect the brain from injury, why not give it to people who are in a position where they are constantly getting concussions? They’ve got the shield and their big brand. The last thing they want to do is get behind cannabis.”
The social stigma of cannabis use is what D’Ambrosio believes makes his over-the-phone visits a comfortable option for his “patients, (many of whom) are first-timers — people in their 50s, 60s and 70s, who would never think about going down to Venice to get a recommendation letter.”
D’Ambrosio's iPhone is constantly chiming. He checks his texts and emails frequently. He uses a light-hearted tone when speaking over the phone to patients, “Is the medicine working?” he asks one, “Well, then it’d be criminal of me not to renew your prescription.”
He continues: "Anything to make more patients get access to medicine that they can grow in their yard. That’s a win-win for everyone. Except for the big pharmaceutical companies. They don’t like that. If I can grow something in my backyard that takes care of my headaches, my depression, my insomnia, my arthritis, my blood pressure, my diabetic neuropathy — that’s six different pills I don’t have to take from Big Pharm.”
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Often, says, D’Ambrosio, it’s one Big Pharm pill in particular — their opioid — that patients come to him looking to replace. Opiates like hydrocodone, which are widely prescribed for pain, can be addictive within as few as five days of use, and are currently at the center of a deadly nationwide epidemic. D’Ambrosio believes that he can wean even “the worst addict” off of opiates and onto cannabis within two months of treatment. “Patients don’t want to be addicted to shit," he says. "They’re looking for a way out. They want something different. I think cannabis gives them that option. I tell them, ‘I want you to replace these bad drugs with something that grows next to the parsley in your backyard.'”
Even if recreational marijuana is legalized in California this November, D’Ambrosio does not see his role as an advocate and health care provider diminishing. He explains that patients between the ages of 18 and 21 will not be eligible for recreational use, and will still need a prescription if they want to use cannabis for disorders like depression. Other medical patients may need a doctor’s prescription to justify possession of more than the proposed legally allotted amount of one ounce.
“I’m not going back,” D’Ambrosio says of orthopedic surgery, “I’m going to keep being an advocate. We still don’t have it legalized in this country.”
Comparing California’s cannabis boom to the Gold Rush, D’Ambrosio says, “This is one of those once-in-a-lifetime moments that we’re in the middle of right now. This is something we are giving to future generations — the fact that we were able to work through legislation and get a medicine you can grow in your backyard to treat just about anything. I want to be part of it. I want to be on the right side of it.”