The unintended consequences of medical marijuana

It was 1978 and I was a third year medical student when my friend was slowly dying of metastatic breast cancer.

Her deteriorating cervical spine, riddled with tumor, was stabilized by a metal halo drilled into her skull and attached to a scaffolding-like contraption resting on her shoulders.  Vomiting while immobilized in a halo became a form of medieval torture.  During her third round of chemotherapy, her nausea was so unrelenting that none of the conventional medications available at the time would give her relief.  She was in and out of the hospital multiple times for rehydration with intravenous fluids, but her desire was to be home with her husband and children for the days left to her on this earth.

Her family doctor, at his wit’s end, finally recommended she try marijuana for her nausea.  My friend was willing to try anything at that point, so one of her college age children located a using friend, bought some bud and brought it home.

Smoking, because of its relatively rapid effects,  it didn’t do much other than make her feel “out of it” so that she was less aware of her family,  and she hated that the entire house reeked of weed, especially as she still had two teenage children still at home.  Her nausea prevented her from eating marijuana mixed into brownies or cookies.

Desperate times called for desperate measures.  I simmered the marijuana in a small amount of water to soften it, then combined it with melted butter.  That mixture was chilled until it was solid and I molded multiple bullet size suppositories, which were kept in the freezer until needed for rectal administration.  Although we never could warm up the suppositories to a temperature that was comfortable for her without them melting into unusable marijuana mush, she found that she could get relief from the nausea within twenty minutes of inserting the frozen marijuana butter rectally.  It worked, without her feeling as stoned as the smoked marijuana.

My actions, though compassionate, were also illegal and if my medical school had found out I was acting as an apothecary, preparing an illicit drug for use for a non-FDA approved indication, I could have lost my student standing and future profession.   I don’t regret that I did what I could to help my friend when she needed it. Subsequent studies have confirmed the efficacy of marijuana, in various forms, for nausea from HIV and chemo, muscle spasm from multiple sclerosis and quadra- and paraplegia, some types of chronic pain, and glaucoma, yet it has never been seen by the medical community a first line drug for any of those conditions.  I have prescribed Marinol, the oral form of cannabis, in a few cases where it was warranted because of the refractory nature of the patient’s symptoms, for indications that are supported by controlled clinical studies.    This made sense and like most medications, it worked for some, not for all.

Yet if you believe the extremely vocal marijuana proponents, cannabis can treat almost any condition under the sun, and in a number of states now is being prescribed and encouraged for everything from anxiety to insomnia to sinusitis to asthma to arthritis to headaches to premenstrual syndrome.  If you are simply alive, there is a good chance you have at least one symptom that warrants a medical marijuana card. It is a fine example of not so modern snake oil, as it has been around for thousands of years, except now we have multiple state legislative bodies putting their stamp of approval on it.  I’m concerned our nation’s overwhelming drug abuse statistics will not decline with the legalization of the possession of small amounts of marijuana for medicinal purposes,  in addition to open marketing, sale and distribution.  We are simply bringing the dealers and pushers out of the shadows–not a bad thing if we can all agree that a staggering percentage of the population, including our adolescents, suffer symptoms deemed worthy of being medicated with a mood altering substance well known to cause dependency, not to mention a host of psychiatric problems in vulnerable individuals.

Patients who have antipathy for the pharmaceutical industry or for government agencies responsible for studies of drug safety and effectiveness seem to lose their skepticism when confronting the for-profit motivation of marijuana growers, brokers and storefront sellers.  These patients prefer to trust a physician willing to pocket $150 cash for a ten minute assessment of symptoms in exchange for a signature on a medical marijuana card. Many choose not to be followed by responsible health care providers who might actually take a thorough history, do a complete examination and lab tests including drugs of abuse testing, possibly order confirmatory imaging studies, and might actually recommend treatment that is proven in multiple controlled studies to be effective.

Over the last few weeks in my university health center clinic I’ve been asked by several otherwise healthy teenage college students if I would prescribe medical marijuana for their stress-related daily headaches.  These young people have friends who have gotten their medical marijuana card elsewhere so they can “smoke whenever they need to” without fear of being found in possession by law enforcement.  They want the “get out of jail free” card, or better yet, “never get arrested to begin with” card.  They have symptoms, as all of us do, but none of these are patients with chronic disease found unresponsive to other treatment.   These are patients who have never had more than a cursory headache evaluation, never had a trial of non-pharmaceutical modalities like relaxation techniques or massage, or prophylaxis with non-addictive medication.  Yet they are willing to sign on to a substance that has, at best, a shadowy origin, no quality standards in production, distribution or dosing, is traditionally and most expediently used only by inhaling, and has well-studied adverse effects on memory, focus and reaction time.   All this defies logic, especially in a college student who needs every neuron at the ready to absorb, retain and process complex information, something marijuana has proven ability to impair.  I’m perplexed at how easily these leaves of grass are given a pass by young and old, rich and poor, professional and blue collar, liberal and conservative.

It could be that over twenty years of addiction treatment work with thousands of chemically dependent patients has warped my perspective about this weed forever.   I see marijuana as the “least” of the problem recreational drugs, to be sure, and not nearly as physically devastating as alcohol, benzodiazepines, methamphetamines, or opiates.  None the less,  I’ve seen it ruin lives, not because of dangerous side effects, nor fatal overdoses, nor instigation of violent behavior.   In its twenty first century ultra high concentrated version,  far more powerful than the weed of the sixties and seventies, it just makes people so much less alive and engaged with the world.   They are anesthetized to all the opportunities and challenges of life.  You can see it in their eyes and hear it in their voices.  In a young person who uses regularly, which a significant percentage choose to do in their fervent belief in its safety, it can mean more than temporary anesthesia to the unpleasantness of every day hassles.  They never really experience life in its full emotional range from joy to sadness, learning the sensitivity of becoming vulnerable, the lessons of experiencing discomfort and coping, and the healing balm of a resilient spirit.  Instead, it is all about avoidance.

Benumbed, blunted, and stunted.  I’m sure this is must be yet another indication for the prescription of medical marijuana.

Emily Gibson is a family physician who blogs at Barnstorming.

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  • Kent

    In 1978 you sent your teenager out to score some bud. It’s now 2011- Think about it

  • Tom

    It seems to me that your argument is that a not-insignificant number of people want to be able to use marijuana recreationally (using its “medicinal” properties as a smoke screen), but they shouldn’t be allowed because it’s a form of escapism. This is a puritanical, paternalistic argument. It represents tyranny over another person’s body and soul — “these are the things you should do and feel, because I’ve lived and know things.” That’s moot, though, because your argument at its very core is hyperbolic and reactionary. People smoked pot in the past and tasted success. People will smoke pot in the future and do the same. Furthermore, there’s an argument to be made that — despite what it looks like from the outside — being high increases the feeling of emotion. Happiness is happier, sensation is deeper and more meaningful. It’s something worth thinking about.

    You also mention marijuana’s unknown safety profile. It’s kind of an catch-22 type of argument — “don’t use marijuana because we don’t know if it’s safe,” but also, “we can’t test marijuana’s safety because we aren’t allowed to use it.”

    • J P

      Tom, Dr. Gibson has spent two decades seeing patients destroyed by marijuana. Destroyed, ruined, wrecked, ok? …And students wanting medical marijuana for just HEADACHES! Come on, man, don’t take me for a fool. This is clear taking advantage of medical marijuana. Don’t be blind. Her so-called “puritanical, paternalistic argument” is completely justified. How would you like it if your parents when you were a child willingly knew you were for sure going to get into harm but just let you do it anyway, like run-out-into-the-middle-of-oncoming-traffic hurt? If we as a people can’t even trust those who have our sincerest interests in mind–who also have credibility, mind you–what are we? History just repeats itself. Of course her argument seems reactionary: It’s her reaction toward things she’s been seeing and people she’s BEEN WORKING WITH FOR 20+ YEARS.

      Second, you talk about success and happiness. “People smoked pot in the past and tasted success.” What is success to you? There’s so many definitions of success. And you claim a deeper, more lasting and meaningful happiness associated with marijuana…really? Really? And I quote from Dr. Gibson that her friend smoking marijuana “didn’t do much other than make her feel “out of it” so that she was less aware of her family”. Your happiness is ignorance-is-bliss, escapism, etc. That is not happiness; that is just running away.

      And I’m not against medical marijuana, but we’ll just use it liberally for anything if we get the green-light. It should only be used as a last resort.

  • ninguem

    You always hear these sob stories of the terminally sick people helped by marijuana.

    “Medical” marijuana is allowed in my state. The clinics all advertise with 38D breasted models stuffed into pretend nurse uniforms that they bought from the love shop next to the leather bustiers.

    Get real. Legalize it and tax it. The instant that happens, the “advocates” will cease to have any interest in the medicinal properties of the drug. Too bad in a way, as there is likely some medical use for it. OTOH, maybe that’s what we need to get some adult supervision of the drug.

    • http://www.womeninpainawareness.ning.com carol

      “sob stories” That shows your prejudice and lack of compassion, empathy and understanding of those ill and in terminal/constant chronic pain.
      As an advocate for chronic pain, and not marijuana (I am on the fence still) I have heard too many stories from too many in constant intractable pain who have run out of options, their doctors trying multitudes of procedures, surgeries and drugs to no avail who have found medical marijuana to be of help to them to just get through the rudimentary tasks of living, unable to do so before using it. (Btw, I have been given marinol, it did not help me and often does not have the same beneficial effect on those in pain as does actual marijuana, the removed ingrediant in the necessary one)
      Benadryl is now OTC, has that stopped pharma fro investigating and coming out with other antihistamines. Your argument is specious. The non medical ‘advocates’ may no longer have no need to advocate but that will not stop pharma from working to get a better plant/uses for a prescriptive so they can still make money from it.
      Carol
      Carol Jay Levy, B.A., CH.t
      author A PAINED LIFE, a chronic pain journey
      http://womeninpainawareness.ning.com/
      http://apainedlife.blogspot.com/

  • Fam Med Doc

    “All this defies logic, especially in a college student who needs every neuron at the ready to absorb, retain and process complex information, something marijuana has proven ability to impair. ”

    Dear Dr Gibson,

    Full disclosure: I’m personally against any mind altering substance for myself. Drugs, pot, alcohol, even beer or wine. I dont do anything. I’m not in recovery, I just don’t like any of that stuff for me. Believe me or not.

    But, FYI, as I was graduating from medical school in the not to distant past, much to my surprise, I discovered what seemed like nearly half of my med school classmates smoked pot at one time or another during medical school. Why didn’t I know about it, I asked? My friends knew I wouldn’t partake. Which was a good point.

    My point to you: relax on the cannabis lecture. We primary care physicians seem to have a lot of other bigger issues to work with our patients on that appear so much more urgent. My collegues did quite well in medical school & beyond.

    • http://briarcroft.wordpress.com Emily Gibson

      I’m a little older, having been in practice over 30 years, so I’m aware there are plenty of people who seem to “do quite well” with their intermittent use of marijuana for recreational purposes, including medical colleagues. Would I want my marijuana using physician colleagues consulting on my patients, making rapid decisions or performing surgical procedures with positive THC in their urine? No more than I want the commercial pilot flying the airplane I’m riding in to have a positive urine for THC. Executive decision making adversely affected by THC. For whom do we say their decision making doesn’t impact others?

      Yes, there may be bigger issues for us to deal with for many of our patients but THC, now sanctioned and prescribed as a self-dosed self-regulated medication by many physicians, is now on a par, if not exceeding, excessive alcohol use and tobacco use. We have caved in and abdicated our responsibility to “first do no harm”.

      • Fam Med Doc

        “but THC, now sanctioned and prescribed as a self-dosed self-regulated medication by many physicians, is now on a par, if not exceeding, excessive alcohol use and tobacco use. ”

        Dear Dr Gibson,

        Sorry, but I have NO clinical experience, and I have alota professional years under my belt too, that suggests cannabis is exceeding the problems brought on alcohol & tobacco use/abuse. Quite the opposite. I think you are becoming hysterical. And FYI: I have worker with many addicts over the years: heroin, c meth, & alcoholics. My experience with Addiction Medicine is quite full, & I could pursue that more if I chose.

        “Would I want my marijuana using physician colleagues consulting on my patients, making rapid decisions or performing surgical procedures with positive THC in their urine?”
        Poor argument. Of course no one should be doing anything like piloting a plane, doing surgery, driving etc on pot. But neither would I want them with alcohol in their system. Are you suggesting we PROHIBIT alcohol? I know you are not.

        You already admit some (I say nearly all) “are plenty of people who seem to “do quite well” with their intermittent use of marijuana for recreational purposes, including medical colleagues”. Leave well enough alone. Let’s focus on getting our patients off tobacco, slow down their alcohol abuse, & help our c meth, opiate addicts, & cocaine addicts get into rehab.

        You helped (God bless you for doing this, btw, I’m so sorry for your loss of your friend) your friend with cannabis . Geez, cannabis is the least of of worries, if it should be a worry at all.

        • http://briarcroft.wordpress.com Emily Gibson

          Let’s see–hysterical is a loaded word directed at a clinician with twenty years of addiction medicine background. Of course cocaine, meth, opiates and benzos, in addition to alcohol, are more debilitating and lethal than cannabis. I am not advocating prohibition of cannabis. But it isn’t the benign friendly drug that its advocates make it out to be. It has its place, regulated and managed by knowledgeable clinicians, not self medicated by patients.

          Why are so many physicians willing to give carte blanche via a medical marijuana card/prescription to allow patients to produce, prepare and dose their own cannabis with virtually no monitoring or supervision? THC has a role in our pharmaceutical armamentarium but physicians roll over and allow complete patient control over a “controlled substance”? That makes no sense whatsoever.

          If you’ve been working with users, you will see modern high concentration THC marijuana cause significant paranoia, dissociative experiences, psychosis and panic attacks in otherwise mentally healthy individuals. This is not 60s and 70s weed–this is a much different and more potent plant and giving adolescents (in particular) medical marijuana cards for management of headaches, anxiety, and insomnia is insanity. If I’m being “hysterical”, maybe it is for good reason.

          • Fam Med Doc

            “But it isn’t the benign friendly drug that its advocates make it out to be.”

            No, it’s not a benign drug. But neither is ibuprofen which can also lead to health problems, sometimes serious ones (like a GI bleeder from NSAID abuse). But I’m still going to advocate the legal & OTC availability of ibuprofen, just like I am w cannabis. I do not doubt the serious risk of heavy, daily use of potent cannabis. My point is I’m not going to freak out over a very, very small population of people who get into trouble w it versus the OVERWHELMINGLY large amount of the population which does fine w cannabis. I will save the freaking for the c meth, cocaine, & opiate addicts. Tobacco use too.

  • Paulo Tavares

    “well known to cause dependency” is an overstatment! The truth is “cause as much dependency as chocolate”.
    Modern anti-emetics, even when used in combination and at optimal doses, can at best eliminate 90% of the chemo induced nausea. The remaining 10% are a slight nuissance or a living hell depending on the patient. It leads to poor nutrition, weight loss, slower recovery from chemo pulses and depression. Most notably the late high dose platinium nausea.
    Marijuana/haxixe is the only drug that eliminates 100% of that nausea. The anti-emetic effect is achieved with much lower doses than the laughing side effect.
    Melting first in a teaspoon of water and then on heated butter is what I recomend to patients for many years with enormous success. The proportion is arround 1g of haxixe to 100g of butter. One toast at breakfast and one toast at teatime is enough for most. For those who hate the taste I recomend using the aditivated butter melted in soup instead of olive oil.
    Reserving this prescription for the terminal patients is nothing but a prejudice. Compliance with chemo should start from the very begining. I practice hemato oncology for over 25 years, have a hundreds of patients experience, and never saw one become addicted after treatment.

    • http://briarcroft.wordpress.com Emily Gibson

      Your chemo patients are being prescribed marijuana for a symptom that usually goes away when chemo is finished, so I’m not surprised you have seen no “cannabis dependency” among your patients. They don’t “need” it any more like someone who is self medicating for chronic symptoms or recreational purposes. There is no physical withdrawal from cannabis because it remains in the body fat for weeks. Cannabis dependency is characterized by the symptoms as defined by the American Society of Addiction Medicine (ASAM):

      “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

      Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. “

  • gerridoc

    I see a parallel between medical marijuana arguments and the prescription of OxyContin. What started as a movement that was motivated to relieve patient’s symptoms of chronic pain has morphed into a widespread addiction problem. We have patients obtaining prescriptions for their chronic pain and selling the pills on the black market. The number of drug overdoses from narcotics has risen dramatically in the past 10 years.
    To quote an old saying: “The road to hell is paved with good intentions.”

    • pfroehlich2004

      Why is it that the people who wring their hands over medical marijuana are never able to point to any measurable harms that it has inflicted on society?

      Simple, because there are none. The development of a semi-legal marijuana industry has produced none of the predicted disasters. No increases in crime, traffic accidents, or high school dropout rates.

      The only “problem” that opponents can seem to find is that in some states adults who like to smoke marijuana for fun (the horror!) can now do so without fear of arrest.

      Hey Dr. Gibson, you remember that bit about “first do no harm?” Let me tell you something, prohibition harms. Black markets do harm. SWAT raids on private homes do harm. Prison sentences do harm. These things are violent and destructive and they are what you implicitly support when you oppose legalization.

      Don’t want people to get high? Then provide credible scientific evidence that shows people why they shouldn’t. This approach has led to massive drops in alcohol and tobacco use over the last 30 years and we didn’t even have to break down anybody’s door.

      Data on US teen substance use rates here:
      http://www.monitoringthefuture.org/data/10data.html#2010data-drugs

      • Bobbo

        “Don’t want people to get high? Then provide credible scientific evidence that shows people why they shouldn’t. This approach has led to massive drops in alcohol and tobacco use over the last 30 years and we didn’t even have to break down anybody’s door.”

        Hear hear. Legalize, tax, and regulate. Fixes all the problems the author mentioned, namely mandated research on effects, ensured quality in production, etc. Once there is a clear fund of knowledge of Marijuana’s risks and benefits, allow one to make the decision for themselves, so long as their usage doesn’t harm others.

      • http://briarcroft.wordpress.com Emily Gibson

        This is a medical marijuana discussion and like most medical marijuana discussions, it devolves to “just let people get high because why shouldn’t they if they want to and it doesn’t harm anyone”. No physician is legally allowed to prescribe medical marijuana for anything other than a documented approved indication/diagnosis and not just for the purpose of “getting high”. But yet that is ultimately what marijuana advocates want, isn’t it? Most medical marijuana prescriptions are a complete fallacy and a health care professional who cares about their license to practice medicine won’t participate unless it is prescribed for a well documented diagnosis, in pill form so manufactured and dosed with standardization. We’re highly scrutinized (and justifiably so) on our opiate and amphetamine prescriptions so why should inhaled marijuana be treated differently?

        • Fam Med Doc

          so why should inhaled marijuana be treated differently?

          Because, a vast majority of people do not have problems with cannabis. Just like with alcohol (but a thousand times more of a societal problem than cannabis), most people smoke cannabis in moderation & therefore it should remain legal but supervised by societal laws. And taxed.

          I don’t think too many physicians, at least I’m not, are arguing that with alot of work, someone can get into trouble w cannabis. But until I see you advocating the same measures for alcohol, your argument seems far out of place & overdone.

    • http://www.womeninpainawareness.ning.com carol

      I wish that when doctors, and others, refer to those with chronic pain and issues with opiates they would differentiate between addiction, not only a loaded word but a medical problem very different from physical dependence, that some in chronic pain may develop after taking oxycontin or other narcotic medications.
      Carol
      author A PAINED LIFE, a chronic pain journey
      http://apainedlife.blogspot.com/
      ( http://www.womeninpainawareness.ning.com )

  • http://www.DRJAG.com Simeon Jaggernauth, DO

    I couldn’t agree with you more! In the face of relieving pain and suffering, some people are taking advantage of a tool for those in desperate need for their own selfish gain. Medicinal marijuana can have benefits for those with cancer and AIDS – everyone else maybe less likely to benefit leading to common abuse.

  • gerridoc

    It may be all well and good to de-regulate marijuana so that there are few barriers to its use. I just prefer not to be part of the process.

  • http://www.mdwrites.com MD

    Medical uses of marijuana should only be reserved for cases in which all conventional medical treatments have been exhausted. Since marijuana is an illegal substance for most of us, it should not be given to patients without a strict evaluation by a licensed physician who has determined that is an appropriate treatment. Where do you draw the line? Give cocaine to depressed people? Prescribe alcohol regimens to people with severe anxiety resistant to other medications?

  • pfroehlich2004

    How about drawing the line at using police coercion to persuade people not to make poor health decisions?

    It is astounding that so many medical professionals passively support prohibition due to the negative health effects of illicit drugs while completely ignoring the negative effects generated by punitive drug policies, i.e. black market violence, needle-sharing, and the widespread consumption of unregulated, adulterated drugs of unknown potency.

    Physicians should not prescribe medications which are likely to cause more harm than benefit. Neither should they support government policies which ensure that recreational drug users are forced to interact with the black market.

    • Dr. Mario

      I had intended to refrain from commenting on this post, as I see valid arguments on both sides. However, I have seen this particular argument one too many times, and as it points the finger at physicians I felt compelled to respond.

      “Neither should [physicians] support government policies which ensure that recreational drug users are forced to interact with the black market.”

      This is pure irresponsibility. The argument suggests that physicians are indirectly responsible for the accoutrements of a prohibition policy, including violence, addiction, shared needles (a questionable inclusion by the author in a discussion about cannabis) and the like. This is preposterous — the “recreational drug users” are the responsible parties. THEY make the choice to use an illegal substance and undergo unsavory practices for its procurement. They are not forced. Cannabis is not a life necessity; even the previous author referred to consumers as “recreational drug users.”

      The merits and disadvantages of the current drug policy can be (and indeed have been) debated ad nauseum, and we may see changes in the future. While the policy exists, though, those who choose to use the substance illegally are solely responsible for the black markets formed and resulting violence. To claim innocence is fallacious, and to have the audacity to blame physicians is appalling.

  • Skeptic

    “and has well-studied adverse effects on memory, focus and reaction time.”

    Is this statement implying these effects have been observed in marijuana users while not high? In other words, are these “long term” effects of smoking marijuana? If so does anyone have a link to these studies? I was under the impression that no credible studies have determined this to be true.

    • http://briarcroft.wordpress.com Emily Gibson

      Here are a few:

      http://www.nature.com/npp/journal/v31/n10/full/1301068a.html

      http://www.ncbi.nlm.nih.gov/pubmed/15795138

      http://www.ncbi.nlm.nih.gov/pubmed/17497559

      A recent article on executive decision making improvement over 12 weeks of abstinence from THC is in the March 2011 Journal of Addiction Medicine but there is no web access.

      • http://www.cedarhillpt.com Paul Weiss

        I do not see where the links provided address the Skeptic’s question.

        The Skeptic asked about long term effects of smoking marijuana, presumably those that would be present even after enough time had passed without marijuana use for the drug to clear the system. The studies cited do not appear to address that circumstance.

        If decision making improved over 12 weeks of abstinence, that would point towards a lack of long term effect.

        I believe this is the paper being referenced:

        http://www.ncbi.nlm.nih.gov/pubmed/21643485

        If so, it is a single case study which is a low level of evidence.

  • ninguem

    Oh yeah. Medical use.

    And these guys are VERY religious.

    http://blog.winemag.com/editors/wp-content/uploads/2010/01/kosher-wine.jpg

    There were loopholes in Prohibition, for medical alcohol, and alcohol for religious sacrament.

    No pickin’ on the Jews, just had this picture handy. I can say the same for the Catholics, Protestants, and probably the Wiccans if they had any on those days.

    Now hey, fine. Use it for oncology. Fine That’s a drop in the bucket. Most people want it for their dandruff.

    Back to the usual disclaimer. As far as I’m concerned, legalize it.

  • http://barkingdoc.com maggie kozel, MD

    First, I have to say that the comment that jumped out at me the most aggressively here was the one calling Dr. Gibson hysterical. When was the last time you called a man that, Fam Med? There was nothing in Dr. Gibson’s reasoned, informed argument that warranted that, other than someone with an abundance of x chromosomes disagreed with you.
    Secondly, I think back to the overprescription of Valium in the 70′s and 80′s, and the nightmare that the medical community has created in this past decade with our casual prescription of highly addictive pain meds like oxycontin. I think of the tens of millions of adolescents currently on antidepressants, to treat many of the same symptoms the teens are inclined to self medicate by using alcohol or drugs. Mediacal marijuana is just one piece of a prescribing crisis that we as physicians have to deal with. Dr. Gibson focuses our attention on a current gap in our medical training – a careful, reflective assessment of our attitudes and roles in using mid- or mood-altering drugs, and a consciousness raising about the consequences, and what our threshold should be for prescribing them.

    • Fam Med Doc

      When was the last time you called a man that, Fam Med?

      I use, rarely, that term equally to both genders where appropriate. You don’t like my criticism of the bloggers post? Fine, I’m happy to hear it.

      This is a discussion on cannabis, not sexism. Let’s keep it there. I stand by my opinion. Cannabis, although a problem for a very small group doesn’t warrant widespread societal prohibition.

      • http://barkingdoc.com maggie kozel, MD

        I’m all for keeping sexism out of the discussion. I honestly do not see how you thought Dr. Gibson’s argument was “hysterical”. And if you don’t understand how loaded a word that is, especially when it is aimed at a woman who is trying to make a point, than you will have trouble keeping any discussion on topic. Yes, by all means, lets keep sexism out of the discussion! That may require choosing our words more carefully and appropriately.

        • SJ

          “Hysterical” became an appropriate word, arguably, when Dr. Gibson resorted to the Sonny Bono type argument (you can tell I’m old) of bringing up airline pilots “with positive THC levels” flying planes. I am male but I haven’t hesitated to use the term with respect to either males or females who resort to arguing against a general rule based on a very rare special situation.

  • Penny

    Currently I’m watching a very close friend lose all of his short-term memory from so-called “recreational” marijuana. (He used to be an honour student).

    The trouble with the word “recreational” is that marijuana users will call the drug recreational no matter how often they take it. They will never use the word “addictive” and will in fact deny that marijuana has any addictive properties whatsoever.

    Indeed this person is addicted. He will go to every marijuana-promoting event, write letters promoting the stuff and so on, claiming it hasn’t hurt him one bit and is entirely safe, and in fact has been the cure-all for all of his ailments. He still suffers from the convulsions he claims the marijuana has cured, and while they were seemingly kept at bay at first, they are now increasing with rapid intensity.

    Clearly such great love for a drug that it encompasses most of your life is a true sign of addiction. This person has also lost his job from doing something so dangerous he could’ve killed many people. He also can’t get another because of his known reputation from writing so many articles on the topic. What employer would want to risk liability charges for hiring people who are “out of it” half of the time from this so-called “recreational” and “harmless” drug?

    Another thing I have noticed about many marijuana users overall is that they seem “subject to depression.” It’s as if their brains are so used to being pumped up with “happy” drugs that the minute this weed isn’t available their bodies are no longer able to produce their own. Now indeed, they can hardly wait to get home to load up on their “happiness” pump.

  • Marc Gorayeb, MD

    There are laws that discourage immoral, unethical and harmful behavior, and there are laws that do the opposite. Some legislatures have been bamboozled into creating a medical marijuana industry without any reasoned, scientific input from the medical community. The result: physicians with borderline ethics have been given legal cover to participate in a fraud on the community. Tell the cowards in your government to either legalize the drug or not, but to stop making physicians the gatekeepers for recreational drug use. It is legitimizing unethical and immoral behavior by the underbelly of the medical profession.

    • ninguem

      What Dr. Gorayeb said, and then some.

      Marc, if you haven’t seen it yet, I can highly recommend Daniel Okrent’s book “Last Call: The Rise and Fall of Prohibition”

      http://www.amazon.com/Last-Call-Rise-Fall-Prohibition/dp/0743277023

      He paid close attention to the corruption of medicine during Prohibition days.

      “……physicians with borderline ethics have been given legal cover to participate in a fraud on the community. Tell the cowards in your government to either legalize the drug or not, but to stop making physicians the gatekeepers for recreational drug use. It is legitimizing unethical and immoral behavior by the underbelly of the medical profession…..”

      I can’t say it any better than that. Can I quote you? Where do I send the commission check?

  • Kristin

    I think the biggest problem I have with the debate about medical marijuana is that it’s not really a debate about medical marijuana. It’s a debate about the legalization of marijuana as a recognized substance of use, like alcohol.

    Medical marijuana, meanwhile, suffers by associaton. Its classification with the DEA means that researchers have to do backflips to work with it, so that meaningful data (particularly on long-term use) is difficult to get. And without clear and compelling data, we keep having the same arguments over and over again: It hurts people; No it doesn’t.

    I’m going to say the same thing I say about every medical topic: widespread use of EHRs, better patient-doctor communication (and you’ll need Psych research to make that happen), and analysis of EHR information. That’s what it comes down to. These questions are empirical and can and should be tested.

    Full disclaimer: I have never been a marijuana consumer, but I have seriously dated two of them. In both cases, I felt that they were addicted, and that they were not living up to their potential. They felt that I was a nag.

  • Dorothy Green

    It’s the detructive behavior, hurtfulness to others and the healthcare costs – st_p_d!

    How can anyone really, anyplace, prohibit anything!

    Addiction is a potential human condition!

    Prescription drugs – doctors????
    Alcohol – tax it more – seen a message
    Tobacco – i’ts almost as good as it is going to get)
    Cocaine (legalize the leaves, blow up the processing plants)
    Sugar – tax the processed stuff – send a message
    Salt – tax it in processed food – send a message
    Fat – tax the processed stuff – send a message
    STOP SUBSIDIZING CORN
    Various kinds of sexual activity (if IT hurt) – send to jail
    Marijuana – tax it – let it be – let it be (the least of human worries)

  • http://www.womeninpainawareness.ning.com carol

    You may be interested in this letter from the Law Enforcement Against Prohibition (LEAP) regardinig the “war on drugs”.
    http://www.leap.cc/
    http://www.leap.cc/40years/
    These are the people on the front lines.

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