Posted by: JDM..... | May 5, 2013

Irony, Part II…

I love irony, especially when I see it coming

As much as twenty years ago, I remember being accosted on the Post Office steps by some character in a tie-dyed shirt carrying a clipboard and a pen. He approached, and went into his sales pitch about the benefits of “medical marijuana”, tentatively holding out his petition for me to sign. I was in a good mood, so I decided to engage him briefly. I allowed as how I was supportive of any medical advances and thought it would be a fine idea if they would isolate the therapeutic components present in Delta-9-Tetrahydrocannabinol for the treatment of certain maladies. In fact, there are such pharmaceuticals, but they don’t make the headlines because patients don’t get blown away on them. I declined to sign his petition, and bade him a pleasant afternoon. I didn’t bother to tell him that I was a substance abuse counselor at the local hospital based rehabilitation center.

Many years later, their movement gained some traction and we began to see various state legislatures, including my own, approve the concept of “medical marijuana”. I was retired by then, but still hadn’t changed my mind on the matter. I fired off a few word salads to the local newspaper, suggesting that I questioned the sanity and ethics of any physician who could push patients to quit smoking tobacco products and then recommend that another set fire to a bunch of dried vegetation, inhale the resultant smoke, and hold his breath as long as he could, all in the name of living up to the Hippocratic Oath. I haven’t changed my mind about that either.

Since then, I have remained relatively quiet on the matter, but have kept a curious eye on the drama as it plays out. It was clear many years ago that the drive to legalize the recreational use of marijuana was not going to go away. Every culture throughout history has used various intoxicants in one way or another. Those with strong religious taboos restricted their use to religious purposes, though I suspect more than a few rituals were devised for reasons other than service to whatever god or gods were in favor.

Our own society has had it’s time in the ring with opium and alcohol. Opium derivatives became the preferred treatment for pain, while the “recreational” use of raw poppy byproducts became a major felony and retreated to the back alleys. We gave up on prohibition of the production and use of beverage alcohol after finding that the consequences were as bad as, or worse than the original problem.

Alcohol is now regulated, but that doesn’t eliminate the problems associated with its use such as traffic fatalities and alcoholism. “Street” use of opium products, such as heroin, is still very much with us, and in fact has seen an increase in recent years as the abuse of legitimate pharmaceutical products and an extensive black market in them developed.

So, I wasn’t particularly surprised when the folks with the tie-dyed shirts and clipboards managed to get a foot in the door, and I wasn’t surprised at the rush to get licensed as “growers” and “dispensaries” in the fledgling “medical” marijuana industry. Nor was the growth spurt enjoyed by the list of (allegedly) treatable conditions much of a forehead slapper. And, yes, I still believe that any physician who would prescribe the use of raw marijuana should have both his head and his urine examined. Don’t laugh. I had a few doctors as clients over the years.

*****

Redefining marijuana as a “medicine” hasn’t changed its innate properties or its traditional usage.

In the case of pharmaceutical “medicines”, as the field has traditionally been understood, trained and licensed providers prescribe selected compounds at specific dosages to address specific conditions, and undesired secondary effects are taken into consideration.

Take this pill for your digestive issues”. Refrain from certain foods and beverages. You may experience diarrhea and (a list of side effects).

Take this pill for your lower back pain”, but don’t engage in certain activities because your coordination, reaction time, and judgment may be affected.

“Medical marijuana”, on the other hand, presents a significantly different scenario.

Medical practitioners who prescribe marijuana aren’t required to have any expertise or special training in the field of substance abuse or addiction. Providers who dispense the product aren’t required to have any education or training in the pharmacological profession. There is no system for measuring or identifying dosages.

Marijuana has always been a recreational drug. People smoke it or ingest it to get high, and along the way it was discovered that some of the side effects could also have certain medical benefits. It is known to stimulate appetite and diminish nausea, for example.

Despite all of the passionate arguments, orations, and denials of “medical marijuana” advocates, however, the primary motivation for the use of cannabinoids is to get high. Any identifiable medical benefits are fortuitous and secondary. If the same secondary benefits could be obtained by smoking marijuana but without the “high”, the entire industry would hit the ground like an overly ripe banana within days. If legitimate pharmaceutical products such as the opiate based pain management medications could be produced with the same efficacy but without the side effects, there would be no such upheaval or change in treatment approaches.

*****

When a substance such as marijuana is inched over from the underground, recreational world of “stoners”, where it has historically been a “substance of abuse”, to the legitimate world of medical treatment of undesired conditions, that transition should include the participation of experts in the appropriate science. Physicians with A.S.A.M. certification (American Society of Addiction Medicine) should be the only ones cleared to write such prescriptions. Your neighborhood Family Practitioner cannot legally prescribe Suboxone, a pharmaceutical used in the treatment of recovering opiate addicts. Special certification is required.

Physicians prescribing Oxycodone for pain management wouldn’t think of instructing a patient to set up a mini poppy farm in his back yard to produce his own “natural” opiate supply, nor would he or she hand out prescriptions for the random ingestion of raw poppy byproducts.

I remember observing not too long ago that, in addition to being essentially stupid to begin with, the legalization of marijuana use for “medical” purposes would most likely prove to be an ironic roadblock to the age old campaign to simply legalize “weed” and regulate it much as was done with alcohol. It’s not that I approve of using marijuana, nor that I am naive to the devastating affects it can have, particularly with young people, but a half century of the SWAT team approach to the marijuana question has had about the same impact that Prohibition had. Strict regulation may be the smartest answer in the long run.

Thus, I felt somewhat vindicated in my opinions on the matter (as well as, admittedly, amused) when I began to see rumblings in the news that licensed “medical marijuana” growers and operators of “dispensaries” were among those lobbying the legislature against those still lobbying the legislature for the general legalization or decriminalization of marijuana for general recreational use. Hey, that’d be bad for business , man….

Yup. Irony.

 

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