I have yet to see a patient whose health was harmed by smoking marijuana, but I have treated people seriously hurt by the drug's illegality.
We don't really know how many people smoke it. Some sources say 10 million Americans, others say 35 million. But a lot of people smoke pot and they don't seem very sick. Marijuana just won't go away. Everybody talks about it—many quite fondly. About everyone I know under 55 has smoked it. And they're all right. A few have that pothead "oh wow" personality, but so what? I don't know of one case of serious marijuana-related disease among my friends, family and acquaintances.
At work I have to report the same thing. I've been in hospitals and around sick people for 26 years now. I've admitted plenty of patients who have owned up to using pot. I think I can often tell by how they act. But do the health effects of pot seem very serious? As dangerous as those of alcohol, tobacco, overworking, fashion magazines or overeating? Nope. In fact, the health effects of pot are not nearly as dangerous as the jail they throw you in for possessing it. Not even close. I'm not an oncologist but I haven't seen a case of lung cancer clearly related to dope smoking. Memory loss, depression, anxiety? Could it be as bad as turning 50? As for it being a gateway drug — how about beer?
There are some reasonable medical uses for cannabis. One patient I knew could get relief from her chemotherapy-induced nausea from nothing other than smoking joints. She was dying in the Massachusetts General Hospital from Ewing's sarcoma at 19, so no one was going to stop her. The word on our oncology floors is that pot's a pretty good appetite stimulant and anti-emetic. A few patients have asked me for it in connection with this. But no, I have never actually written an outpatient prescription for Cannabinol, THC or marijuana leaf (and I have no idea where they could get one filled anyway).
The chief dangers of marijuana, practically, seem to spring from only one of its features: it's illegal. People get beat up, shot up and locked up because of the great amount of money that rides on selling the stuff, stuff that would be about as expensive as lettuce if it weren't against the law. I have treated people seriously hurt by the illegality of pot.
Do I recommend using it? No way. Never used it, even in the bad old days, and I hope that none of my kids ever do. There's something repulsive about the half-closed, red eyes — something that's selfish and irresponsible. The biggest reason I didn't smoke it in the 70s, when everybody I knew was trying "to get me high," was that I wanted to be able to tell my kids that I didn't so that they wouldn't. I feel strongly about it—it's really not my bag. But that's who I am. I also feel pretty strongly that nearly every child should study Latin—really—but I don't think we should lock them up if they don't.
For me, it's similar to the speed-reading phenomenon. In the 70s and 80s there were all sorts of advertisements for this great system that would help you read the whole Sunday Times in 15 minutes "with complete comprehension and recall." I almost sent away for it. I still wonder about it but am now pretty sure it doesn't work. Here's how I know: I have never met a single person who could do it. Hanging around with many big readers for the past 35 years I should have bumped into at least one who took the course and could actually read that fast. I can't help but think it's the same with pot. Hanging around with all sorts of big dope-smokers for the same 35 years I should have bumped into at least one or two with those "serious health effects". The fact is I haven't. But I would listen to any docs out there who have actually seen or treated diseases truly caused by pot.
Another undeniable is that pot has cache among teens. Some kids between 13 and 19 are clearly willing to risk everything to smoke the stuff — they know how much trouble they can get in. The "smoker" label seems as important a part of their personae as their tastes in music and clothing — maybe more so because it's illegal. It's as defining for them as it was for my pothead friends in the 70s. Maybe they'll become investment bankers too.
An important "art of medicine" issue is sensitivity to the individual's right to self-determination. We work hard to respect patient choice. Lots of explaining, rebutting and cleaning up messes. And as the government should, we draw a line. I won't prescribe cyanide for a patient in pain, even if he asks for it, and the government shouldn't permit home nuclear bomb experiments, even for garage-inventors who promise to be careful.
But some people love cannabis and they're going to get it anyway. Good doctors do learn to persuade and cajole to gently make what we think is the right choice into the patient's choice. ("The girls in therapy really seem to get a kick out of you. Are you sure you don't want to go anymore?") The government equivalent of this is called "drug education" and it's fine. But when you try to change certain things by force, things close to the core about what folks love and hate, about their personalities, you just run into trouble. It doesn't work. You might knock down but you will never build up. This is why the government is better off out of the marijuana business.
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