In this bonus episode for premium subscribers, Carrie highlights concerns about the medicalization of ‘spiritual’ problems and the over reliance on medication as a solution.
I had a discussion about medical ethics recently with people my age (in their twenties) and I was amazed about how much they were convinced by the "body autonomy" thing. One of them compared surgery to getting a tattoo. In their views, doctors and surgeons are not trained professionals who makes decision based on medical knowledge and ethics (ideally) but service providers who don't know any better than their patients what they need. And if the patient regrets what has been done... well, it's just like a tattoo. People are entitled to make bad decisions about their own bodies. I find this state of mind scary to be honest. There is no sense of scale, no sense of difference between what you do to yourself and what professionnals are allowed to do to others.
I did my counseling internship at a substance use clinic and left about ten years ago after working there for four years. People were referred there from Child Protective Services and parole/probation. What was interesting is that when I started working there marijuana use was treated rather harshly still and by the time I left they were starting to ease up yet what I observed there did not match up with the narrative that marijuana use was harmless.
The acts of parental neglect that people would commit under the influence of marijuana were staggering. At the time I worked there I read a news report of a couple who left their baby in the car seat carrier on top of their car and drove off with their baby on the car roof while under the influence of marijuana, and this is the type of stuff I would see. Meth and opioid users tended to lock themselves in their rooms to use and neglect their kids in that manner. It's definitely anecdotal and I don't have any hard data to back this up.
What has been established by the research is that, despite marijuana being known to give people the munchies, when someone is dependent upon it, it acts as an appetite suppressant. I noticed this when talking with my co-workers about how the meth users would gain weight while in treatment, and they started bringing up people in my group who were putting some meat on their bare bones. I stopped them and said that each person they listed was not there for meth but marijuana. We were completely befuddled by this and when I talked to my group about it they said that when you get addicted to it you stop eating. I later found research that confirmed this observation and started to use appetite loss as a screening criteria for assessing whether or not someone was dependent on marijuana.
I was also surprised when we did a field day thing at how, despite how thin many of them would be, their coordination was horrible, worse than any other group of substance users. The heavier alcoholics were better at sports than they were, and heavy alcohol use isn't good for coordination as it is! I don't know of any good research on this though but haven't looked.
Towards the end of my four years there I saw my first case of cannabis induced cyclic vomiting. From what I understand it is recent because the amount of THC in marijuana has increased due to technological advances. Many have said it before me, but the marijuana we have now is not the marijuana people had in the 1960s. It's more potent, and this combined with widespread legalization has been a bad recipe.
The difficulty in treating people with marijuana dependence is all of the messages that they get that this is harmless and that they are being persecuted by the government who either banned marijuana for racist reasons or financial reasons. Some really had a strong martyrdom complex that I see mirrored in the Trans Rights Activists. One even told me he would die by martyrdom like Jesus. Our current culture is enabling to those who do have problems with it basically. And it was shocking how easily people could be prescribed medical marijuana, and I was always uneasy at how anecdotal evidence its purported medical benefits were. The narrative that it is a natural super medicine seemed too good to be true to me. Especially since, in the US, research into marijuana use was banned and we were legalizing it before we lifted the laws we had against conducting research into it. I felt we should have repealed the laws banning research into marijuana first and then conduct good research into it and, if the benefits were found to outweigh the risk, prescribe it as medication.
Meanwhile, like we have the TRAs, we also have a group of people that I call marijuana apologists who hear no evil and see no evil despite the evidence piling in that we may need to rethink things. While I don't think people should be sent to prison for having a substance use disorder, which is at the end of the day a mental illness, I also don't think the way we have gone about legalizing it has been responsible or ethical.
That said, when I left substance use clinic ten years ago I was completely burnt out on this population and never wanted to hear about drugs or alcohol again. Time has mellowed that somewhat, but not enough to get back into it.
One astonishing thing for me is how many parents and even therapists will just swallow the idea that their teen who is a daily cannabis user needs it 'to sleep' or 'for anxiety' and feel like there's nothing they can or should do to prevent their underage child from using an illegal substance in their house multiple times/day (cannabis is legal where I am but not for minors). I have also noted the child neglect that goes on and I would add in the cases of marijuana intoxication we see these days in children who find their parent's edibles.
Not to mention the negative impact that cannabis has on the developing brain when you're under 25. I have had a few people come to me after getting off marijuana saying they were surprised their sleep and anxiety improved. Good luck getting people with low insight to contemplate how it might be making those things worse though. And yeah, it was never legalized in my state but overnight CPS and parole/probation stopped taking it as seriously and enforcing that people who qualified for treatment needed to complete treatment, which put us counselors in a hard position, but I have heard of kids finding their parents edibles after I left.
I am firmly against the war on drugs, given my background in neuroscience as well as my current experience as a lawyer in the UK/US. But I have definitely noticed in the US that there is a massive problem in the way: bureaucracies, legal rights discourse, the lawyer-ification of all societal policy discussion, and the medical establishment, work. They all work in such a way push everything to a very all-or-nothing or theoretical/formalistic approach, where factual realities and honest analysis become sidelined.
With marijuana, constitutional law and doctrines make it so that as substances are legalized, it is very difficult to regulate the consumption/societal use. Activists chose the medical marijuana route primarily as a legal strategy to seem most amenable to the courts/public, meaning that understanding the actual basis in medical effectiveness was always a secondary factor. The medical system is also one of the only systems that exist in the US that has the institutional capacity to regulate, but the incentives of medicine, the privatized nature, and the heavily pharma-first orientation (particularly of US medicine) make it very ill-suited. I am very skeptical about trying to fit it into a purely medical model, both for the problems it creates within medicine and societally.
Even in the UK, now there is the Big Cannabis money wooing the Conservatives, leading to the opening up of medical prescriptions. Truly medical (and evidenced) reasons for the use of Cannabis are relatively small (chemo sickness, some kinds of epilepsy), NICE has been calling out for good research but it is still lacking despite the growing acceptance/funding. And trying to frame what is an issue of criminalization and cognitive liberty as a medical right ends up obscuring the harms and trade-offs and stifles the sober policy discussion that is needed to regulate cannabis effectively.
It is similar to gender in that aspect, where instead of being honest that these are matters of personal choice that include harms/risks, it instead needs to be snuck in through the legitimacy and cooption of the medical establishment.
Really interesting discussion they had and comments here. I had no idea what an issue medical marijuana is in practice, as you all are sharing. I had believed 'safe & legal' marijuana was supposed to prevent deaths, and also legalizing it in general was to put it on the same playing field as alcohol and not load up the system with low level posession crimes which were apparently targeting minorities. I do hear plenty anecdotally that today's products are much more potent, but I never hear anything specific to understand the magnitude of the issue. And, surprise surprise, are there doctors prescribing this for youth?? This has been a real eye-opener - thank you GWL.
I'm a family doctor in a jurisdiction with legalized cannabis and my pet theory is that the rise of cannabis use is the biggest contributor to the youth mental health pandemic that no one is talking about. More than half the time when I have a young person coming in complaining of depression, anxiety or seeking an ADHD diagnosis it turns out that they've been using cannabis daily for years. I'm starting to think I should be doing drug tests before prescribing SSRIs.
I had a discussion about medical ethics recently with people my age (in their twenties) and I was amazed about how much they were convinced by the "body autonomy" thing. One of them compared surgery to getting a tattoo. In their views, doctors and surgeons are not trained professionals who makes decision based on medical knowledge and ethics (ideally) but service providers who don't know any better than their patients what they need. And if the patient regrets what has been done... well, it's just like a tattoo. People are entitled to make bad decisions about their own bodies. I find this state of mind scary to be honest. There is no sense of scale, no sense of difference between what you do to yourself and what professionnals are allowed to do to others.
I did my counseling internship at a substance use clinic and left about ten years ago after working there for four years. People were referred there from Child Protective Services and parole/probation. What was interesting is that when I started working there marijuana use was treated rather harshly still and by the time I left they were starting to ease up yet what I observed there did not match up with the narrative that marijuana use was harmless.
The acts of parental neglect that people would commit under the influence of marijuana were staggering. At the time I worked there I read a news report of a couple who left their baby in the car seat carrier on top of their car and drove off with their baby on the car roof while under the influence of marijuana, and this is the type of stuff I would see. Meth and opioid users tended to lock themselves in their rooms to use and neglect their kids in that manner. It's definitely anecdotal and I don't have any hard data to back this up.
What has been established by the research is that, despite marijuana being known to give people the munchies, when someone is dependent upon it, it acts as an appetite suppressant. I noticed this when talking with my co-workers about how the meth users would gain weight while in treatment, and they started bringing up people in my group who were putting some meat on their bare bones. I stopped them and said that each person they listed was not there for meth but marijuana. We were completely befuddled by this and when I talked to my group about it they said that when you get addicted to it you stop eating. I later found research that confirmed this observation and started to use appetite loss as a screening criteria for assessing whether or not someone was dependent on marijuana.
I was also surprised when we did a field day thing at how, despite how thin many of them would be, their coordination was horrible, worse than any other group of substance users. The heavier alcoholics were better at sports than they were, and heavy alcohol use isn't good for coordination as it is! I don't know of any good research on this though but haven't looked.
Towards the end of my four years there I saw my first case of cannabis induced cyclic vomiting. From what I understand it is recent because the amount of THC in marijuana has increased due to technological advances. Many have said it before me, but the marijuana we have now is not the marijuana people had in the 1960s. It's more potent, and this combined with widespread legalization has been a bad recipe.
The difficulty in treating people with marijuana dependence is all of the messages that they get that this is harmless and that they are being persecuted by the government who either banned marijuana for racist reasons or financial reasons. Some really had a strong martyrdom complex that I see mirrored in the Trans Rights Activists. One even told me he would die by martyrdom like Jesus. Our current culture is enabling to those who do have problems with it basically. And it was shocking how easily people could be prescribed medical marijuana, and I was always uneasy at how anecdotal evidence its purported medical benefits were. The narrative that it is a natural super medicine seemed too good to be true to me. Especially since, in the US, research into marijuana use was banned and we were legalizing it before we lifted the laws we had against conducting research into it. I felt we should have repealed the laws banning research into marijuana first and then conduct good research into it and, if the benefits were found to outweigh the risk, prescribe it as medication.
Meanwhile, like we have the TRAs, we also have a group of people that I call marijuana apologists who hear no evil and see no evil despite the evidence piling in that we may need to rethink things. While I don't think people should be sent to prison for having a substance use disorder, which is at the end of the day a mental illness, I also don't think the way we have gone about legalizing it has been responsible or ethical.
That said, when I left substance use clinic ten years ago I was completely burnt out on this population and never wanted to hear about drugs or alcohol again. Time has mellowed that somewhat, but not enough to get back into it.
One astonishing thing for me is how many parents and even therapists will just swallow the idea that their teen who is a daily cannabis user needs it 'to sleep' or 'for anxiety' and feel like there's nothing they can or should do to prevent their underage child from using an illegal substance in their house multiple times/day (cannabis is legal where I am but not for minors). I have also noted the child neglect that goes on and I would add in the cases of marijuana intoxication we see these days in children who find their parent's edibles.
Not to mention the negative impact that cannabis has on the developing brain when you're under 25. I have had a few people come to me after getting off marijuana saying they were surprised their sleep and anxiety improved. Good luck getting people with low insight to contemplate how it might be making those things worse though. And yeah, it was never legalized in my state but overnight CPS and parole/probation stopped taking it as seriously and enforcing that people who qualified for treatment needed to complete treatment, which put us counselors in a hard position, but I have heard of kids finding their parents edibles after I left.
I am firmly against the war on drugs, given my background in neuroscience as well as my current experience as a lawyer in the UK/US. But I have definitely noticed in the US that there is a massive problem in the way: bureaucracies, legal rights discourse, the lawyer-ification of all societal policy discussion, and the medical establishment, work. They all work in such a way push everything to a very all-or-nothing or theoretical/formalistic approach, where factual realities and honest analysis become sidelined.
With marijuana, constitutional law and doctrines make it so that as substances are legalized, it is very difficult to regulate the consumption/societal use. Activists chose the medical marijuana route primarily as a legal strategy to seem most amenable to the courts/public, meaning that understanding the actual basis in medical effectiveness was always a secondary factor. The medical system is also one of the only systems that exist in the US that has the institutional capacity to regulate, but the incentives of medicine, the privatized nature, and the heavily pharma-first orientation (particularly of US medicine) make it very ill-suited. I am very skeptical about trying to fit it into a purely medical model, both for the problems it creates within medicine and societally.
Even in the UK, now there is the Big Cannabis money wooing the Conservatives, leading to the opening up of medical prescriptions. Truly medical (and evidenced) reasons for the use of Cannabis are relatively small (chemo sickness, some kinds of epilepsy), NICE has been calling out for good research but it is still lacking despite the growing acceptance/funding. And trying to frame what is an issue of criminalization and cognitive liberty as a medical right ends up obscuring the harms and trade-offs and stifles the sober policy discussion that is needed to regulate cannabis effectively.
It is similar to gender in that aspect, where instead of being honest that these are matters of personal choice that include harms/risks, it instead needs to be snuck in through the legitimacy and cooption of the medical establishment.
Really interesting discussion they had and comments here. I had no idea what an issue medical marijuana is in practice, as you all are sharing. I had believed 'safe & legal' marijuana was supposed to prevent deaths, and also legalizing it in general was to put it on the same playing field as alcohol and not load up the system with low level posession crimes which were apparently targeting minorities. I do hear plenty anecdotally that today's products are much more potent, but I never hear anything specific to understand the magnitude of the issue. And, surprise surprise, are there doctors prescribing this for youth?? This has been a real eye-opener - thank you GWL.
I'm a family doctor in a jurisdiction with legalized cannabis and my pet theory is that the rise of cannabis use is the biggest contributor to the youth mental health pandemic that no one is talking about. More than half the time when I have a young person coming in complaining of depression, anxiety or seeking an ADHD diagnosis it turns out that they've been using cannabis daily for years. I'm starting to think I should be doing drug tests before prescribing SSRIs.
Man. What sort of glutton is consuming that much marijuana?
At least a quarter of the teenagers who cone into my family doctor's office for one.