A doctor’s take on marijuana
On August 11th, the Drug Enforcement Administration announced its decision to keep marijuana classified as a Schedule I drug. The federal government has historically referred to this category as the “most dangerous” group of substances, including drugs like heroin and bath salts.
As a resident physician specializing in mental health, I can’t make much sense of this.
Every day, I talk to patients about substance abuse. Whether evaluating patients in clinic, in the emergency department, or on inpatient units, my colleagues and I screen patients for substance use. It’s a vital component of any clinical interview, particularly in mental health care, and helps us understand patients’ habits and their risks for medical complications.
During my medical training, I’ve learned which substances to worry about, and which ones matter less.
Alcohol is usually the first substance I ask about. Many people have seen drinking go wrong, be it a friend making a bad decision or a family member struggling with alcoholism. But clinicians see the worst of this on the front lines.
Intoxicated patients stream into emergency departments after crashing their cars, inhaling their own vomit, or falling into a coma. According to the National Institutes of Health, alcohol-related conditions contributed to more than 1.2 million emergency department visits in 2010. The Centers for Disease Control reports excess alcohol consumption causes roughly 88,000 deaths in the US each year.
And alcohol can be just as frightening when patients stop drinking. Heavy drinkers who don’t consume as much as they usually do can go into alcohol withdrawal, ranging from mild tremors to terrifying seizures and death. I’ve spent much of my residency training so far learning how to treat and recognize complications from alcohol withdrawal.
It’s not only alcohol that clinicians worry about. Cocaine can cause heart attacks, kidney failure, and complications during pregnancy like placental abruption. Methamphetamine can trigger an assortment of responses, from hyperthermia to violent agitation to cardiogenic shock. Opioids like morphine can plunge patients into respiratory failure and kill them. Intravenous drug use puts patients at risk for hepatitis, endocarditis, or even brain abscesses.
But, for most health care providers, marijuana is an afterthought.
We don’t see cannabis overdoses. We don’t order scans for cannabis-related brain abscesses. We don’t treat cannabis-induced heart attacks. In medicine, marijuana use is often seen on par with tobacco or caffeine consumption—something we counsel patients about stopping or limiting, but nothing urgent to treat or immediately life-threatening.
The federal government’s scheduling of marijuana bears little relationship to actual patient care. The notion that marijuana is more dangerous or prone to abuse than alcohol (not scheduled), cocaine (Schedule II), methamphetamine (Schedule II), or prescription opioids (Schedules II, III, and IV) doesn’t reflect what we see in clinical medicine. . .