Marijuana – the Panacea of Our Times? (5/12/14)
Marijuana – What Does It Treat?
“It does everything,” my colleague explained, shaking his head. “It treats pain. It treats headaches. It treats depression and anxiety. Epilepsy. They keep asking me for it, every day.”
A novel antidepressant? An extraordinary new anti-anxiety agent?
My internist friend is bombarded with requests to give the “good stuff” – “prescription grade” marijuana – to his patients. As marijuana historically ascends from “reefer madness” to decriminalization to legalization, it’s time to debate about the real import of the stuff – its effect on public health.
And clinicians I know are worried. They see varied populations where marijuana is not a pleasant weekend high but something much more complicated. Here are some concerns of this clinician:
Murder and destruction are not the first things people think about when they consider marijuana. They should be near the top of the list.
Drug cartels in many nations have used marijuana – along with cocaine and opiates – to become rich and powerful. Simultaneously they have suborned politicians, corrupted entire economies and massacred women and children in the thousands. The number of mass murders in Mexico alone is staggering. Large parts of Latin America have been convulsed by the drug trade, which has done much to destroy communities and societies, and marijuana production has played an underacknowledged role. Preoccupied with the “drug war” and locking up drug offenders, Americans have paid too little attention to the death and destruction our drug habits produce internationally. No wonder the president of Uruguay, who spent much of his life incarcerated, including time spent attempting survival at the bottom of a well, have worked to legalize marijuana.
Yet a nation which is happy to let motorcyclists ride without helmets should reflect on what widespread marijuana use will do to motor vehicle – and other accidents. Do you want your kid taking out his new bike for a “fun spin” just after hitting her bhang? We know what alcohol does to drivers and workers. Will we pay similar attention to the effects of legalized marijuana?
The Other Gateway Drug
The tobacco industry does not possess a high reputation. They hid their data about smoking and health for decades – and paid hundreds of billions when caught out.
Now they sense two major new opportunities.
One is e-cigarettes. Though people like myself have argued e-cigarettes may aid smokers to become ex-smokers, they can also addict kids to tobacco – aided by gorgeous packaging and tasty candy flavors.
So e-cigarettes will and should be regulated. And that will be a boon for Big Tobacco. It has already been making big moves into the e-cigarette industry. Its capital and marketing heft may allow it to take a large part of what that business will become.
And people may forget that marijuana legalization was also bruited about in the 1960’s. Reports of the time were that the major tobacco companies had registered a variety of trademarks – “Top Joint” and “High Joint” – to get into the coming “marijuana revolution.”
Expect them to try that again. This time they may be incentivized – at least by memories of the past – to act more according to social norms.
But many people fail to see that marijuana – the so-called “gateway” to “harder drugs” – is also a potential gateway to tobacco use.
Supposedly about two thirds of American high school students have tried marijuana. Generally, they’ve smoked it. Often, it was their first experience inhaling smoke.
How many will become tobacco smokers? Whatever the number, the public health cost may prove high.
Addictionologists I speak to are generally unhappy about potential marijuana legalization. They tell me they see many who are addicted to marijuana alone, as well as in conjunction with other drugs.
But casual smokers of marijuana usually don’t know much about the tangled, often contradictory clinical literature on marijuana and psychiatric illness.
Recent data are not particularly encouraging. The group led by Hans Breiter at Northwestern has found that marijuana cognitively impairs young people – in ways that may be different from adults. The latest findings from brain imaging studies are that the nucleus accumbens and amygdala change their form, format and shape in marijuana users aged 18-25. Since these regions are deeply involved with pleasure; sex; food; emotional response and arousal, this raises concern.
Clinically, people have known for a long time that marijuana can precipitate clinical illness – like panic attacks and psychosis. People who “casually” imbibe suddenly can find themselves feeling inchoate dread, a sense they are about to die. Others develop hallucinations that are far worse than a “good trip.”
How many of these souls would have eventually been afflicted if they never touched marijuana? Hard to say. But they got more than they bargained for.
Psychiatrists I speak with often complain that marijuana is used far too frequently by people with mood and anxiety disorders.
Just as people in manic states may self-medicate with alcohol, many folks with depression smoke dope. They feel better, they tell you. Some say it’s “the only thing” that does make them feel better.
Others may be unaware that prolonged use may prolong their depression. Many patients have told me their depressions only lifted when they quit smoking marijuana.
For marijuana can produce something else besides pleasant mood and seamless happiness. It can produce cognitive impairment where people overestimate their abilities – like their capability to drive.
And it also induces in some despair, and even more commonly – futility – the attitude of “whatever” or “it doesn’t really matter.” And that sense of futility can last, with regular use, for decades.
Perhaps we might say that marijuana may produce a state of cognitive despairment. That it may do so in a minority of people should not let those who happily imbibe forget their fellows with negative results. Futility is a horrible feeling to carry day after day after day.
The Nature of Drugs
The public often has contradictory responses to drugs. Prescription drugs are theoretically “good” in that they’re pure, but “dangerous” in that they most be regulated with all their voluminous side effects.
Conversely, over the counter drugs or “food drugs” like caffeine and alcohol are considered “safe.” You don’t need to see a doctor to get them. So, the thinking goes, they must be okay.
Except drugs are drugs. They do lots of things people want – consider the many millions of users puffing on expensive, illegally sourced marijuana – and lots of things they don’t.
This “angel and devil” element exists in all drugs. Whether prescribed by doctors, tobacco companies, or “health dispensaries,” you want to know what you’re taking and what it might do – to you and others.
For drugs have population effects. They change death and morbidity rates. They shift attitudes and societal mores. They can cost a lot directly and indirectly, from overall economic productivity to, in many cases, the costs of treatment and law enforcement.
They deserve to be viewed comprehensively for all their effects – individually and collectively, nationally and internationally, on health, diseases, politics, power and the environment.
Drugs are a big part of the public health. It’s time to think about public health first – instead of the national obsession with our fouled-up medical care system.
Health care should has as its goal improving health – physical, mental, social and spiritual wellbeing. And that includes controlling the effects of drugs.
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