Time to Stop Judging and Start Healing

In this life, everything should be as simple as it is, but not simpler.  That includes this questionnaire study about marijuana as an “exit” drug for substance abuse.    This article hit a nerve because there are issues here I have come up against before.  And I mean “against.”  I don’t mean to say it isn’t “good science;” it is. I’m talking about the emotional resistance to the idea that detoxifying from a medication can be comfortable, painless, and effective.  I see this coming like I see the sun rising in the morning, because I have been to this place. A few years ago, I found myself in an informal banquet room across the parking lot from a hotel type establishment in a touristy part of San Diego.  There was a woman rep from the drug company, Hythiam.  She wasn’t an ex beauty queen like most reps, but a fairly credentialed therapist who actually knew what she was talking about.  My husband was there with me; a younger, chubbier, and more naïve me – therefore, less authoritative.

These Hythiem/Prometa folks had a great schedule of IVs that removed physiological cravings for various substances of abuse, including methamphetamine.  Basically, they use safe and older type drugs intravenously for a lovely pharmacological intervention.  The cravings stop, and the person does not “need” to use the drug. Neither they nor I was stupid and naive enough to think that was all you had to do.  Aftercare was important and I was ready to jump in.  They recommended vitamins — I recommended lots of vitamins, high dose, and chelated to cross the blood-brain barrier. But these addicted folks needed “prosthetic lives.”  When all you can muster goes to satisfying a craving or a need, there are not many hours left in the day for work or relationships.  I helped with this, too. Some people had problems, but they were mostly because of the psychosocial void left when they did not go for drugs, and their inability to fill it.  I worked my damnedest with these folks; and like the company, was eager to be accepted into the addiction community. There was this reception, and they had invited people from every substance abuse program in town.  I was there and ready to go to bat as the only physician who had experience with these folks locally. Two people showed up.  One was an older, fatherly type. The other was a young sidekick who was presumably learning from him.  This older guy said something that rings in my ears now. “You got to earn your sobriety.”

Slowly, he rhapsodized on the physical pain of withdrawal from things like opioids and alcohol.  He talked of the danger of death, and the retching and puking, along with sleepless nights.  Basically, he said if we made it too easy, just a medical thing, there would be too much recidivism and we could do nothing to stop it.  He said we just didn’t get it.  Actually, he almost excused me because doctors never really “got it.” I do not know if he could see my face turning red as my blood pressure rose.  I mean, I had heard this from the rep, but I knew and felt for the first time what we were up against.  And it was more than I could have imagined.

It was a pseudo-religious morality.  Death and redemption had to happen for these people.  I had memorized lots of delicious data about how the benzodiazepine receptor can be manipulated. Zero for two of the folks there gave a damn about science.

It took me a while to embellish what this meant.  It was Joseph Campbell type immortality for someone who may have otherwise been reviled on this earth.  There aren’t too many ways to make that happen.  There aren’t too many ways folks without an excessive amount of either spirit or education can reach that level of spiritual heroism. One thing was evident even then.  This was not practicing medicine as I knew it. I’d had the same feeling when, as a psychiatry resident, I sat in an assigned AA group where an older woman told me that doctors were her enemy, for they had started her on addictive drugs.

I have felt it a few other times.  Triumphs against the feeling had been few and passing.  Once, when I prescribed Naloxone to inhibit alcohol cravings in a patient over 50 in rural Kansas, in a clinic behind a grain elevator, I got a visit from a local AA leader.  He was a kindly, fatherly man who told me that he had come because he tended to be suspicious of physicians.  But when I described the medication and how it worked — and how it was far safer than Antabuse, which has at least a theoretical risk of death if you drink on it — he told me to do anything I could, safely, to try and help this guy get and stay sober.  I said I would.  It soon became evident that the AA man trusted me only because I was not judgmental.  He had no trust in science or medications in and of themselves.  He told me most AA people did not.  He would do his best to get the guy to take his meds, but it was a pretty sure bet that other substance abuse people would not.  The man was alive, well, and sober when I left the clinic behind the grain elevator.

It was not too long ago that I personally reported on my blog that alcohol, not marijuana, seems to be the famous “entry” drug.  It’s the one that people abuse before going on to harder stuff.

This study citing marijuana as a possibility for an “exit” drug is a questionnaire study.  The kind I used to jokingly put down colleague psychologists about while I was trying to take samples of bodily fluids to “prove” things.  The conclusion about needing clinical trials is right on.  I used to do clinical trials of pharmaceuticals in Kansas and Oklahoma.  But like Dorothy and her little dog, I am no longer in Kansas.  I do not know who does or obtains funding for such trials, as the issue is so heavily politicized.  Every time I’ve been asked if I am a doctor or researcher first — and I am surprised how many times – I say I am a doctor first.  I work with people before numbers. Sometimes people tell me “I need medical marijuana because I cannot afford the other stuff.”  But sometimes they tell me “I could not stay off the crystal meth with anything else,” or even “I would be home in a drunken stupor if I did not use a little marijuana every day.” Marijuana may be an excellent exit drug.  The problem will not be the conduction of the research, as much as getting other people to believe it.

Maybe we could take marijuana back to its traditional ritual uses and create a death-and-rebirth ceremony for users, ending the use of more “serious” substances.  But even that would require change, and admission of the existence of spiritual needs, and the admission of the pseudo-religious nature of AA.  Like the guy on Dragnet who wanted to shout “just the facts ma’am,” just like I, as a psychopharmacologist, want to shout “just the receptors.”  But nobody gives a damn.  They are in denial of the nature of the problem.

There is something in how the brain is wired, something inherited, that is biochemical.  It is as real as any illness that can be distilled into such model.  I feel like the motto for Dartmouth University, like the “Vox clamantis in deserto,” a voice screaming in the wilderness.  Nobody hears because of the social, maybe political, maybe economic reasons to believe marijuana can do no good.  This emotional pseudo-reasoning is simply wrong.  I know because I have seen both sides.

I will admit that I never did really well with doctor colleagues who told me all I would find as a marijuana doctor reviewing medical indications were young kids wanting to get high.  I have seen the sickest of the sick.  I cannot think of a single medical specialty not included in such observation.  This includes addictionology.  “I could not get off the — crystal meth, alcohol, you can almost fill in the blank — without marijuana.” Marijuana does not kill folks.  Substances of abuse often do, and sometimes, painfully.  It is time to stop judging and start healing.