What will legalizing marijuana do to society and the field of medicine?
There are a growing number of governmental units putting forth legislations to legitimize recreational cannabis use. Though I have no empirical data, I think it is mostly due to political peer-pressure to "be cool" like Colorado and Washington. Sorry, but I hope my state realizes that doing drugs doesn't make one cool.
What's wrong with a little marijuana, though? I was asked this multiple times even before graduating medical school, let alone as a doctor with an actual degree. What's wrong with a little marijuana is the same thing that is wrong with a little alcohol, a little tobacco, or a little of anything that leads to physiological dependence. Who knows if that "little bit" of weed won't seed major metaphorical creeping bushes later on in life? After all, 30% of marijuana users develop some clinical degree of marijuana use disorder, with cannabis dependence or cannabis use disorder affecting more than 4 million Americans. This is 10 to 40 times more common than sickle cell disease, and 100 times more common than cystic fibrosis. (It is funny how medical school education and national exams seem to weigh less importantly common and practical things like addressing and treating substance abuse compared to the molecular pathobiology of uncommon genetic diseases. See more of my opinion on medical education here.)
So with this background on the prevalence of the problem comes my top 10 list of why you should advocate to keep bad things illegal, including "recreational" marijuana.
10) Alcohol, as a legal drug, is problematic enough, being involved in up to 40% of unintentional deaths, homicides, or suicides.
It is a huge contributor to potential life years lost. How do we know legalizing marijuana won't compound problems we face with alcohol? Do you really want to have to warn patients not to take certain medications with weed, and by doing so, seemingly condoning it?
9) Like alcohol, marijuana use acutely increases the risk of motor vehicle crashes. Accidents (meaning unintentional injury/mortalilty) kill more Americans annually than strokes. Do we really need something else contributing to unintentional injury and death? Aren't our trauma bays, emergency departments, and ICU's full enough without cannabis-related trauma victims to add in to the mix?
8) Alcohol intoxication is a very common diagnosis (especially on weekend night shifts) and is uniformly the least fulfilling chief complaint to deal with in the entire field of medicine (per my personal experience and a rigorous Google search landing me on fine websites such as Allnurses.com and StudentDoctor.net). It is painful because these intoxicated individuals come in and routinely get full negative workups for altered mental status, so it isn't just the emergency medicine physicians that deal with it.
Radiologists get to compare 10 other negative head CT's. And i
f there is even a hint of anything else wrong (and when is there not?), then internal medicine doctors get to share in the pain of babysitting the intoxicated while they sober up enough for discharge. Sometimes psychiatrists even gets called in. Of course, the nurses bear the worst of it and occasionally, and unfortunately, have to get security involved. To top it off, hospitals often don't get great reimbursement from such patients. If the barrier of illegality were removed, marijuana intoxication could be done more easily and with greater frequency.
Will legalizing marijuana make cannabis intoxication compete with alcohol intoxication for the most despised diagnosis of all time?
7) Tobacco, as a legal drug, is the leading cause of preventable cancer, heart disease, lung disease and overall death.
Smoking marijuana leads to similar exposure of toxins, teratogens and carcinogens compared to smoking tobacco, albeit in differing concentrations. Thus, it is no surprise that studies show chronic weed smoking is associated with heart disease, lung disease, and squamous cell cancers.
Haven't we learned a lesson that inhaling burnt particulate matter--whether from tobacco smoke, vehicle exhaust, or smoldering world trade center debris--is bad? Or are we going to have to repeat history before we agree as a society that inhaling burnt marijuana is also bad?
6) Alcohol and tobacco addictions aren't cheap, and they come at the cost of money, time, and effort. How many pediatricians and family medicine doctors out there wish that parents would funnel a little more of what they put into feeding their addictions towards their young patients' well-being?
Do we really want another reason as to why mom and dad didn't have enough resources to get little Johnny in to the doctor earlier before his illness turned from simple and managable to chronic and complex?
This has been the comparative first part of a 2-part article on how legalizing marijuana could play out problematically on the medical field.
Please see here soon for a link to the second part of this article.