Self-Medicating On Pot And Booze As A Life Plan

He was 50 and he told me right up front, “I need more of the medications the other doctors give me.  You can just renew them for me; that is why I am here.”

That’s probably the second most common thing a patient says to me.  The most common is, “Why didn’t my other doctors tell me that?” No, I don’t just renew prescriptions, I explained to him.  I told him that I need to get to know my patients, so that I can make sure that I give them the correct medications.

“I don’t want you to do that,” he said to me.  “All the other doctors just give me renewals.” I told him I didn’t much care, that was not how I worked, and if he wanted renewals he would have to tell me how he was doing.

This always reminds me of a rant by Dennis Miller: “As for me, I divide medical practitioners into two camps: Those who will give me a prescription for Vicodin over the phone, and those who won’t.”

According to Dennis, I must be a bad doctor.

“I self-medicate,” the patient explained. “A little alcohol and a little marijuana are what do it.”

Hmmm … during my years of researching treatments for bipolar illness with two universities, we never thought of experimenting with booze and pot.  So I had to regretfully tell him that these treatments were not experimentally validated to be helpful in bipolar management. He wasn’t very happy about that.

I wanted to talk to him about his life, which sounded abysmal.  His self-medication – although probably loads of fun — was not doing anything about his bipolar illness.

He lived in a trailer park (please withhold your judgment – that’s not always bad), had no girlfriend, no life plan, no money coming in. He lived off his friends.

At 50.

This was not one of the 19 year old kids trying to play the system and get some free drugs — with whom I am all too accustomed to dealing.  This was a mature man, who said he heard marijuana was good for bipolar illness, and he knew a little alcohol was, from his experience.  After all, he had done a couple of stints in the local jail for assault, and he hadn’t had a run-in with the law since he took up drinking.

He actually expected me to congratulate him. I didn’t. I refreshed his memory as to my credentials, quoted the published literature, and reminded him of the fact that he had come for renewals of the prescription drugs.

However, I told him that it sounded like he needed something more in his life than prescription drugs or pot or a drink.  We could really help him with benefits (such as unemployment checks and food stamps) and counseling.  Since this was a county government facility, I could hook him up with people who could get him these things. He scoffed at my psycho-pharmacology credentials.

“I know they give marijuana for bipolar at those medical centers. I just grow my own, same stuff.  I self-medicate.  It is a free country, and for me, it is a good thing.  It keeps me alive and out of jail.  That is enough.”

I had to try at least once more – I tried to convince him that I thought his prescriptions were at least a little responsible for keeping him out of jail. I tried to explain to him about medication interactions, and about how chronic marijuana use robs a man of his ambition and motivation. “I’ll try to cut down a little,” he said.  As for ambition, his plan for life was to become rich in business.  With his friend.  No special business – just business.

I wished him good luck with that. So I can’t tell you that I saved this fellow from himself or changed his life.  I’m not a miracle worker — I can’t change them all.

The best I can do is give them facts and share my knowledge, and hope that does something. Oh, and not give them Vicodin.