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Pot Is No Different

Author: James DeVore, M.D.
September, 2014 Issue

Any chemical compound—natural, synthetic, herbal, compounded, you name it—that has potential positive benefits, must have potential negative side effects.

The smell from exam room four wafted down the hallway. It was unmistakable and reminiscent of a long-ago Doobie Brothers concert—the pungent bouquet of marijuana. I knew my next patient was Jack, one of a growing number of patients who uses medical marijuana. Before we go in and “hang with my bro,” as Jack would say, let’s review a few things about pot.
First of all, we can agree that there are some medical benefits to marijuana use. Without a doubt, some people find it useful for a variety of maladies including pain, anxiety, insomnia and many other conditions. Like many other drugs, “natural” or manufactured, there are a number of physiologic effects from marijuana. The chemistry is very interesting and complex, and we’re learning more and more about its potential medical uses. Now that it’s well on its way to becoming legal and its use is out of the closet, patients are finding creative and surprising benefits that are often superior to prescription pharmaceuticals. Most doctors see this and are now willing to write a letter for select patients to obtain pot legally.
But let’s not be naïve. The use of marijuana, just like anything else that affects our physiology, can be dangerous and harmful. It seems obvious, but must be stated, that any chemical compound—natural, synthetic, herbal, compounded, you name it—that has potential positive benefits, must have potential negative side effects. This is one of my biggest gripes with all these “natural supplements” we see advertised, but don’t get me started! Here’s the bottom line: biologic activity doesn’t “know” to just do good things. Pot is no different. We must get away from the notion that because it’s a natural herb and is not addicting that it’s all good. Not so. Not at all.
The obvious downside is impairment of alertness and awareness. Marijuana is a depressant that slows down the nervous system. If you’re dealing with anxiety, a sleep disorder or a chronically painful condition, depressing the nervous system may be beneficial. But what if you’re on the way to your high school English class? What if you’re getting in your truck to commute to work? What if you just got home from a tough day at work and are thinking about going out for some exercise? Is it really a good idea to depress your nervous system at those times?
Here’s the problem: I’ve seen way too many patients over the years with serious side effects from chronic pot smoking. They come in all ages and they all have different stories. Some smoke to stay “relaxed.” Others “think more clearly” when stoned. Some “just feel good” and don’t see any harm in it. But many of these patients have something in common: They lack insight into what the drug is really doing to them. This is an important and interesting difference between marijuana and most other substances of abuse. Most people who abuse alcohol or prescription narcotics know they have a problem. This isn’t necessarily so with chronic pot smokers who think they’re just fine. Never mind that they’re flunking out of 11th grade, have few passions in their lives or don’t spend time with their kids—or that their “exercise” is sitting home watching TV, or that they have no hope of ever getting a promotion at work.
Back to room four. Jack is propped up on the exam table with his distorted left foot strangely misaligned with his leg. His body is a mass of scars and tattoos. His right arm is deformed and the muscles are wasted away. Jack’s face is weather-beaten; he has a cloudy right cornea. As always, the aromatic fragrance of marijuana permeates the exam room. But I’m always drawn to Jack with his easygoing demeanor and crooked smile. Yes, you could say this beat up Vietnam vet is a wreck. But guess what? He’s off street drugs, his debilitating chronic pain is under reasonable control and, with the assistance of three joints per day, he’s living his life.
“Hi Jack, how are you?” I begin.
“Yo, doc, my bro! What’s happening, dude?”
With the sound of “China Grove” rocking in my brain, Jack and I get to work….
Dr. James DeVore has been a full-time family physician in Santa Rosa since 1980. He’s medical director of St. Joseph Health’s Annadel Medical Group.


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