Table of Contents

Volume 2, Issue 7                                                                                                July, 2016

Curbside consult


What do you think of medical marijuana? 

The PL answer:

This topic will gain in importance as we see more states legalizing marijuana in the near future.  In the states in which it has been legalized, PL has heard from colleagues that some problems have arisen.  The potency of THC in the legalized marijuana appears to be much higher than the potency in the illegal plant used in past decades.  This high-potency marijuana appears to be causing some cases of paranoia or even possibly onset of depressive or delusional states.  Further, its addictiveness is heightened if used in high potency form.  

One observation that is important is that some younger people in particular appear to be confusing legalization with safety.  Alcohol is a legal substance, but it is not safe.  Amphetamines are legal substances, with a prescription, but are not safe in many settings, or at certain doses.   The PL viewpoint is that it is important to discuss with patients the there is a difference between legalization and safety.  There are known risks of marijuana in animal studies in terms of harmful effects on the brain, just as is the case with alcohol.  This in itself is not a reason to criminalize it, but it also remains a fact, even if the substance is legalized.  

As with all substances, harms should be understood well and consented if used recreationally or medically. As with alcohol and amphetamines, whether in recreational or medical use, harms should never be ignored. 

The history of amphetamines suggests a possible repetition.  Those agents were available freely without prescription in post World War II Japan, and a huge addiction problem arose. They were available in post World War II United States with a prescription but there was no FDA control upon them.  Most prescribed amphetamines were diverted to illegal use.  Both in Japan and the US, those agents remained legal, but only in medical use, and with strict controlled substance regulation. 

In contrast, alcohol was widely used recreationally, then prohibited disastrously, and then returned to recreational use. It has never been given for medical purposes primarily. And it remains the most widely abused class of substance in the United States, leading to attention primarily by law enforcement, as with strict drunk driving punishments in most states. 

We will see what the future of marijuana use holds in the United States, whether it follows the pattern of amphetamines or alcohol or a mixture of both.  One thing is clear: it is a substance of abuse, and legalization does not imply safety. 

PL realizes that this topic is in flux, and these perspectives are presented tentatively and provisionally.  PL is open to other perspectives from readers. 

PL Reflection

William Osler’s Three Rules for Medical Practice 

1. Consume your own smoke.  Don’t complain about the inevitable trifles of the day’s routine.  Things cannot always go your way.

2. The practice of medicine is an art, not a trade; a calling, not a business. We are not here to get all we can out of life for ourselves, but to help others become happier. 

3. The hardest of all – Love, charity, requires not only beneficent acts, but an end to hard thoughts. 

O William Osler

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