Coming back from New Year’s Day

When it comes to the question of pot

And all the supporters it’s got

It just doesn’t makes sense

Because now evidence

Shows that good for depression it’s not

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Right now I’m in western Nebraska. Any patient information has been included with permission.

I’ve listened to Audio Digest Family practice for 37 years. In the beginning, my aging Karmann Ghia had no place for the tape cassettes. I wore out a tape machine about every 7 years.  Last century I upgraded my vehicles and started listening over the car stereo system.  Now that cars don’t have tape cassette decks, I get the programs on CD.

Yesterday we drove east through the flat Colorado wheat country after spending the holiday with family and friends, listening to an educational CD about medical marijuana on the car stereo.

The lecturer talked slowly, leading me to wonder about his firsthand experience with the drug.

Good evidence supports the use of medical marijuana for AIDS wasting syndrome (hardly ever seen anymore) and the nausea from cancer chemotherapy. After that the quality of research falls off with small studies and poor design.

I know a doc from Colorado who supports use of medical marijuana, and points out that the sativa variety has more THC, the stuff that gets people high, whereas indica plants have more cannabidiol. He asserts that the cannabidiol has the medicinal properties.

Even the pro-pot lecturer said that all the commercial products come from hybrids.

I put marijuana’s long tenure as an herbal remedy at the same level as Teddy Roosevelt’s touting the unique properties of champagne for dysentery and brandy for everything else. Alcohol turns out to be alcohol and while it may have a number of physiologic properties, it comes in last place as a pharmacologic agent because it doesn’t make anything better.

Marijuana does not relieve anxiety; quite the contrary, it brings paranoia. Nor does it relieve pain though it interferes with the ability to reason through questions about the 10-point pain scale.  It predictably drives down the level of testosterone for both genders which leads to terrible sexual dysfunction.  Eventually, it makes people depressed.  It might help some sleep, but they don’t rest.

Yet I would agree that the FDA needs to take it off Schedule 1 so that we can start doing decent research on it.   The plant makes hundreds of compounds that can stimulate receptors throughout our bodies, and its potential remains basically untapped.

I ask everyone past the age of puberty about use of tobacco, alcohol, marijuana, and other drugs. While most people at my current assignment avoid excesses, those who don’t account for a disproportionate share of the ones who need medical help.  If someone uses marijuana, I ask how much, and whether they’re using legal stuff from across the border or the illegal weed purchased locally.  I hope that the Colorado product has fewer adulterants, but it remains largely unregulated.

Today I attended a patient with chronic pain (and a number of other problems); two weeks ago we decided gradually decreasing the morphine dose would be a good first step towards returning functionality. You could see the improvement from across the room, and we talked about the increasing exercise tolerance.  I let the patient decide on the pace of treatment, and two weeks from now we will look for more progress after another dosage reduction.

As always, I heavily recommended exercise.


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