Help or hassle?
Reprinted from "Cannabis" issue of Visions Journal, 2009, 5(4), p. 20
I've been a nurse for a very long time, in acute and long-term care, public health and health education for professionals and non-professionals of all ages. Over the years, I've noted that some people benefit greatly from alternative medicines. But in some cases, patients are restricted from pursuing health alternatives. Cannabis, or marijuana, is a good case in point.
The controversy about the medical use of marijuana has always interested me. I've worked with health care professionals who, flat-out, say that cannabis is bad for all people. It's easy to get along in the health field if you agree with this opinion, or if you avoid the topic altogether. But, as a nurse and mental health clinician, I've had experiences that give me a different view from those who disdain marijuana's medicinal use.
As I near the end of my career, I want to speak out for an important freedom that is being threatened: the freedom of choice in health care. Health professionals are trained—no, it's drilled into them—to respect patients' rights to self-determination and choice. Care is client-centred, based on the specific needs of the individual, and our practice decisions are made with clients and families, we have been told over and over.
When our patients seek controversial treatment, we constantly struggle with our loyalty to our clients' wishes—because health professionals have legal and ethical responsibilities to consider. But those health care providers who have rigid views that exclude offering treatment alternatives such as marijuana may be missing this important element of patient choice.
Cannabis—new uses for an old medicine
Many people with specific mental health disorders and/or severe addictions find marijuana, or "pot," to be a more effective medication than any other substance available to them, legally or illegally. Mental health consumers of all ages know that quality of life is linked to symptom management. And they make sincere attempts to improve their quality of life in ways that are effective for them, including the use of cannabis products in various forms.
I've seen people in dire circumstances—homeless, isolated, afraid and suicidal—show clear improvements when marijuana was used to reduce anxiety levels in social situations. I've noticed that many middle-aged clients (who may have used pot at some other time in their life) and crystal meth–addicted youth respond particularly well when marijuana is combined with life skills education and counselling. I've also seen marijuana aid the management of serious drug or medication withdrawal symptoms, which is essential for successful recovery and improved quality of life.
Joe was just turning 50 when I met him. He was very lonely and his addiction to alcohol had already cost him his job, his friends and his family. After his marriage broke down, Joe had a hard time controlling his intense feelings of sorrow and anger. He had no self-esteem, no family, no job and "no hope," as he told me several times.
Joe was using alcohol dangerously—and then he found cocaine. His cocaine addiction began, ironically, when he sought help at an Alcoholics Anonymous meeting and was introduced to it by a group member. He liked it a lot. And, after years of social isolation, Joe bonded quickly with the cocaine lifestyle and the people using it. It was his escape from reality and responsibility. He soon found, however, that the escape was short, and reality was inescapable.
Joe finally agreed to go to a residential cocaine treatment program after several unsuccessful attempts to quit on his own. When he returned home, he found it almost impossible to manage his drug cravings and his re-entry into the community without relapsing. So Joe started using a small amount of marijuana to control his social anxiety and to manage the cravings for cocaine that he was still experiencing. He told me he'd used pot in his "wild youth," but not as an adult. He hadn't even considered using it again until he became overwhelmed by the effects of his depression and anxiety as well as the "call of cocaine."
As I worked with Joe in his recovery, I noticed that he presented in a calmer manner and had better emotional control when he used pot. He was able to get out of the house and get involved in the community more often. He felt that his quality of life was much better.
Now, almost two years later, Joe is still free of cocaine, has stopped drinking alcohol and has reduced his marijuana intake to a rare event. At last report, he was off all his psychiatric medications and has developed a more balanced lifestyle that includes both paid and volunteer work.
Another case I clearly recall is that of a youth, just turning 19, who had been fighting the effects of early psychosis and schizophrenia since childhood. His mother had reported how Ray had changed from a happy, carefree youngster to a suspicious, delusional youth who isolated himself from everything and everybody.
When I met Ray, he was drug-free, but had significant and disturbing psychotic symptoms. He refused antipsychotic medication and, instead, found reasonable relief from smoking marijuana. Ray used pot to "ground" himself, he told me. When he wasn't smoking pot, Ray was very agitated and paranoid. When he used pot, even in small amounts, he was able to work and share the responsibilities of home maintenance with his brother. He could work, eat, sleep and play like everyone else. He fit in like never before. I saw it happen.
It's about risk assessment
There are risks to weigh against the beneficial effects when choosing to use marijuana—just as there is with any medication, prescribed or otherwise.
I do want to acknowledge the health risks associated with smoking in general,1 since smoking is the most common way that marijuana is used. Smoking tobacco is known to cause several respiratory illnesses such as asthma, bronchitis and lung cancer, and it's assumed that smoking marijuana use would have the same effects on the body. But there is a better way to use cannabis in terms of both health risks and effectiveness: vaporization,2 where the user inhales vapour rather than smoke.**
Clients who do use marijuana for medical purposes also risk legal problems—unless they get federal government approval. To get this approval, they must undergo an exhausting amount of paper work. The application isn't easy for clients with serious mental health and addictions problems to understand, let alone complete. Doctors who don't agree with marijuana use may agree to fill out the forms, but the application can lack the necessary emphasis on need, and so may be unsuccessful.
Clients not given a choice—or a chance
Many clients aren't even given a chance to choose marijuana treatment. This is because some doctors aren't willing to make the suggestion due to their own biases. But marijuana can be beneficial for some clients in the same ways that conventional treatments can be beneficial (or perhaps not so beneficial, in some cases). Each case must be assessed separately and a variety of treatment strategies must be made available, without judgment.
Marijuana should be a ready option—within all the necessary government health guidelines and warnings about its use—for those who would like to test its relief potential for themselves.
About the author
Emily is a nurse who has worked in a variety of clinical and community settings. For the past 20 years, she has been a clinician in the mental health field. Emily's article is based on her clinical observations as well as her research on the topic of medicinal marijuana use
- Health Canada. (2008). Smoking diseases. www.hc-sc.gc.ca/hc-ps/tobac-tabac/body-corps/disease-maladie/index-eng.php
- MAPS (Multidisciplinary Association for Psychedelic Studies). “MAPS/CaNORML vaporizer and waterpipe studies.” www.maps.org/mmj/vaporizer.html