I learn from every patient I speak with – even those who seemingly have nothing to teach can offer insights into why people have decided to use medical cannabis. While cannabis is becoming more legal by the day, the decision to smoke/vaporize/eat/etc. pot is not lightly made. The police are unpredictable in how they treat possession, although a medical card usually gives you a pass. Growing violations, however, mean that the entire crop and months of work are torn up and burned. And there is still a social stigma despite incontrovertible evidence that the use of cannabis is medically indicated for their problems.
The District Attorney in my own county has flatly said that he will not prosecute possession cases – what he did not say is that it is nearly impossible for him to get a conviction anyway unless something else is going on, e.g., dealing, crime, other drugs, or otherwise bad dudes against whom possession can be used to pile on charges. However, other counties, such as the one I work in, are less enlightened, and there is always the threat of being hassled by overly-zealous policemen. If you are a grower, the indignity of having your crop torn out seems worse than threat of jail. Even when state laws are permissive, the confused and ambiguous (dare I say, ignorant) attitudes of the federal government add to the fear of retribution against those who use cannabis for legitimate medical indications.
There have been a few studies of what people say when they are asked why they use medical cannabis. The results are boring. Of course people say that they have unrelieved pain, insomnia, anxiety, depression, or migraines. These are superficial justifications that can be predicted by simply reading the list of conditions that are “approved” as legitimate indications by proposition 215 (non-Californians should Google “prop 215” to save some time). Few patients have the courage to say that they have a terrible life and job (or lack thereof) and the only relief is the predictably good feeling they get from smoking a bowl or a few hits from a vaporizer. Nearly all are trying to avoid the dangerous alternatives of alcohol overuse and overmedication with FDA-approved drugs and procedures. Many look to medical cannabis as a way to control their own medical care, as they reject expensive traditional and usually inattentive medical care. Some are not making particularly wise decisions as they give up on medicine and their doctors (if they have a doctor…and finally many do for the first time in their lives). But most are right – medical cannabis is safer and more effective than most back surgery, which makes you worse as often as it makes you better. And it works better than standard treatment for migraines – hands-down. I could go on (and probably will….).
*Apologies to Dr. Peter Kramer who wrote Listening to Prozac in 1993, describing what he called “cosmetic pharmacology”. I found it a stimulating and thoughtful discussion of the concept of modifying one’s personality at will by manipulating receptors in the brain back then, but few of our physician brethren were impressed. Turns out he was right about most of what he observed. I predict (fortunately, whether right or wrong, nobody will remember or particularly care) that the cannabis receptor system will prove as a more promising an area for psychopharmacologic research as the complex dopamine or serotonin receptor systems he was making observations about Prozac.