Advice From the Trenches

Advice from the Trenches: Medical Marijuana Debate

Dear C and Dr. B.;

I smoke marijuana nightly because it helps calm my mind and makes it easier to fall and stay asleep. What I want to know is why my psychiatrist tells me it is not really a great idea and that in the long run, I am harming myself. He also says it will interfere with the Adderall he prescribes me for ADHD. The thing is, everything I read seems to say the opposite. I think that marijuana also helps my focus. What gives with my psychiatrist? Is he just behind the times?

– Stevie Wondering

Dear Stevie;

Cannabinoid, the pharmacologically active substance obtained from the marijuana plant, is a stimulant compound that mimics the effects of endogenous agonists of the sympathetic nervous system. What this means is that what marijuana does physiologically is the opposite of what it does psychologically. Over time this creates a widening paradox. For some patients, marijuana makes them feel calm, but internally it’s speeding them up. As you build tolerance over time, not only doesn’t it calm you down but you have now been conditioned to expect calm, but instead feel stimulation and interpret it as anxiety. Eventually, this anxiety will worsen and then you will feel you are having panic attacks, but what really happened is that you screwed up your sympathetic nervous system by turning it up instead of turning it down.

If you are smoking marijuana a doctor can’t really diagnose ADHD, as marijuana can cause similar effects. The inability to focus is caused by the dopamine effect of marijuana, which controls memory and motivation. Over time marijuana affects the feedback mechanisms for dopamine in the brain causing a loss of motivation, focus and memory.  People subjectively might feel their focus improves, but studies show a drop in IQ scores in chronic marijuana use and inflexibility rather than focus. 

A lot of early studies showing the potential benefits of marijuana are now looked at with larger sample sizes and over longer periods of time, showing the opposite results. Heroin use increases with marijuana use, deaths from car accidents increase in states where marijuana is legal, and anxiety also increases, not decreases, with marijuana use. Large studies on seizures haven’t been showing the benefits of marijuana. There is a lot more to learn and watch. 

– Dr. B

C says: Yes, there is a lot more to learn! I need to make a few corrections to your response, Dr. B. You don’t seem to be discriminating between various components or potencies. CBD isn’t the only pharmacologically active substance in cannabis – there is also THC, along with a different CBD to THC balance in every plant. Someone using MM as a sleep aid would use a plant with virtually no CBD and mostly THC. The differences in effect between them would be quite distinct. And you can’t make a general guess at the possible long-term effects of “marijuana” – there is no one size fits all single strain.

Another important issue seldom addressed in most anti-legalization arguments is that of dosage. This issue is also overlooked by proponents for the legalization of recreational marijuana, and this is a mistake! Virtually 100% of emergency situations that occur with pot have to do with ingesting quantities that are much higher than any recommended dose. These people are abusing, not using. As to the people who are getting into accidents while driving high – they shouldn’t be in the driver’s seat any more than they should be when they’ve been drinking, and the two often go hand-in-hand.

Although it has been around for centuries, it is only recently that we’ve started to document the specifics of medical marijuana. It isn’t possible at this time for any FDA studies to occur because 1) pot is still classified as a schedule one illegal street drug and cannot be obtained for official studies, and 2) it is an agricultural product and FDA studies can only be conducted on pharmaceuticals. As a result, although we have a good idea of the treatment potential of various strains of the plant, no accurate dosing manuals exist for reference.

There are indeed credible studies that show detrimental effects from long-term use of pot; and there are certain people who are sensitive to it and shouldn’t touch it at all. However, I am pretty sure that the studies Dr. B mentioned collect their evidence based on heavy use, not prescribed medical use. There are many current articles on medical use of pot that show that it is not only effective, with far fewer side effects than pharmaceuticals, but in many cases doesn’t produce the euphoria or high, which is a common objection of most medical doctors.

Stevie, honestly, neither your psychiatrist nor Dr. B. really know enough to make the call here … and neither do I. Since there are no FDA approved clinical studies yet to prove the case either way, the marijuana issue remains in the realm of personal opinion. You have to use common sense – the real issue here is how YOU handle it. Please, don’t forget that pot is a powerful drug that, if misused, can fog your brain and leave you sitting on the sidelines of life.

You can visit Dr. B’s blog at