Some of my finest hours have been spent on my back veranda…

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“‎Some of my finest hours have been spent on my back veranda, smoking hemp and observing as far as my eye can see.” ― Thomas Jefferson (1743–1826)

Editor-In-Chief, Chester "Trip" Buckenmaier III, MD COL, MC, USA

Editor-In-Chief, Chester “Trip” Buckenmaier III, MD COL, MC, USA

I am presently reading “Thomas Jefferson – The Art of Power” by Jon Meacham (which I recommend), and I found this Internet quote attributed to one of our most famous founding fathers rather interesting in light of recent events in Colorado. Further inquiry into the quote suggests that its authenticity is rather dubious; hemp is a variety of Cannabis sativa L. that was valued in colonial times for its fiber, not its pleasant smoking properties. In fact, the content of delta-9-tetrahydrocannabinol (THC), the compound responsible for the marijuana high, is likely too low in hemp to have any effect. Nevertheless, for fun and the purposes of this editorial, it is intriguing to imagine this founding father doing something that is rather common in our society: seeking an escape from reality.

For more than seven decades, the sale of marijuana (hemp in Thomas Jefferson’s era) has been illegal in the United States. With the new year, Colorado became the first state to legalize the sale of recreational marijuana. Proponents of this law suggest the state will reap many benefits from the regulation and taxation of marijuana sales. Needed revenue for schools and other state services, job creation and the loss to gangs and thugs of the marijuana black market are some of the advantages anticipated.

Historical support for this point of view is easy to find with a relatively recent look into our collective past at the 1920s fiasco that was Prohibition and the 18th Amendment. After more than a decade of alcohol-fueled crime and illegal trade, our experiment in sobriety was ended with the 21st Amendment in 1933, with considerable relief and celebration, I might add. It is understandable from a health maintenance perspective why folks of that era dragged the country through this legislative debacle. For indeed, the path to hell is paved with good intentions. Alcoholism plagued society in that era, and it continues to take a bloody toll today; more than 30% of the traffic deaths in 2010 were attributed to alcohol. Federal medicine providers would be hard pressed to pass a day in one of our hospitals and not come across alcohol-related health issues in our patient population.

I am not suggesting a return to Prohibition. Heavens, no! I enjoy my beer too much for such a draconian approach. Alcohol consumption is as old as society and seems to fulfill a fundamental human need to seek altered states of consciousness. Evidence for this need can be found in the tremendous amount of energy societies have invested throughout history in finding, transporting and processing substances to alter perceptions of our environment. Coffee, tea, tobacco are all representative of this phenomena, albeit these “drugs” are considered socially acceptable for the present. Perhaps the social backlash against alcohol, marijuana and other so-called “hard” drugs stems from the more pronounced and apparent mind-altering effects these substances seem to have. Abuse of these drugs has enhanced potential to cause harm to the user and those around the users in our complex society.

As healthcare providers, we accept that our patients routinely use the “drugs” in coffee, tea, tobacco and alcohol. These legal substances are woven into the fabric of society, and many federal medicine providers are routine users themselves. I certainly cannot imagine starting a workday without a large cup of coffee or withstanding the nightly news without an alcoholic beverage. Personally, and I recognize I could be very wrong, I feel my moderate use of these substances enhances my life, and I would not part easily from these pleasant habits any more than I suspect Jefferson would have easily parted from his smoking evenings on the veranda.

Despite the Colorado legalization, as a federal officer, I will not be joining Thomas Jefferson on the back veranda anytime soon, historical fiction or not. I have been passing 25 years of “whiz quizzes” and as I approach 50 do not think I can handle any more mind alteration than time has already provided. Fact is, I am not sure how I feel about Colorado’s move, and I certainly do not know what the “right” position is.

I can intellectualize the revenue and crime reduction benefits, but I remain concerned as a healthcare provider about the health risks of marijuana to society. Marijuana has many well-researched short- and long-term negative effects, especially on the cardiovascular system and the brain. Proponents of legalized marijuana would suggest that, like alcohol, it can be used responsibly, but we already know that many people cannot control their alcohol use and the drunken driving deaths and disease that results. As 21st century medical professionals, we certainly have a greater understanding of the pitfalls of smoking (anything) than those in Jefferson’s era.

I would suggest that the changes in Colorado, which will likely be emulated in other states, are a wake-up call to federal medicine providers. In the coming years, our patient population will likely experience increased exposure to the mind-altering effects and health risks of smoking marijuana. In selected patients, many claim the existence of health benefits for THC. Although I believe these claims are worthy of study, extensive research into the pharmacologic properties of THC and the human bodies endocannabinoid system will be required before any possible therapeutic benefit from THC can be substantiated.

As with caffeine, nicotine, alcohol and now marijuana, we need to be in the business of providing our patients the best evidence-based medical information about these mind-altering substances. If Jefferson is any example, and he was a man of many well-known vices, man’s need to chill on the veranda and find novel methods to do so appears to be immutable.

Comments (2)

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  1. John F. Beary, MD says:

    Dr Buckenmaier continues to provide the federal medical community with excellent writing, sound science and common sense. I enjoyed the apocryphal annecdote about Thomas Jefferson and his substitute for the martini.

    The medical efficacy of “medical marijuana” remains to be demonstrated.
    In the mean time, it is undeniable that the adolescent brain is poorly suited to the very potent products available in 2014….and that for many of them it will be a gateway drug to additional harmful drugs (heroin and cocaine) that their peer group will pressure them to try out. A substantial number of them will crash and burn and function at a low level in regard to work and social maturity.
    Finally, do not forget that the Colorado and Washington policies on cannabis are depriving the current sellers of work. They are not going to retire. Expect to see increased marketing of heroin and cocaine as illicit drug dealers aim to meet their monthly income goals while deprived of cannabis profits.

  2. Joseph Zealberg, MD says:

    I am appalled that our nation is slowly fostering the legalization of marijuana, and that public policy is being crafted to encourage this outcome. In looking at the term “medical marijuana,” there are few rigorous, randomized, placebo-controlled studies that can prove the efficacy of smoking cannabis, and fewer long-term prospective studies to support its continued widespread use.
    There have been recent claims that cannabis may be useful in rare instances, such as the recent attention given to Dravet’s syndrome (severe myoclonic epilepsy of infancy). If this is true (and it may be that Cannabidiol is the effective anticonvulsant, rather than delta-9-THC), then we should quickly design well-controlled research studies to prove such efficacy so that scientists can expeditiously isolate and purify the appropriate compound(s) for clinical use in children suffering from such life-threatening illnesses. However, we cannot generalize that such specific findings will produce other salubrious effects for the entire population. We know, for example, that phenobarbital is an effective anticonvulsant, but no one would advocate that barbiturates should be given out from “dispensaries” to the general American public.

    Jerome Groopman, MD, has written a fine article in the New York Review of Books (Feb. 20, 2014), reviewing information about cannabis. His viewpoint appears very measured. Interestingly, he does note evidence to support that cannabis impairs cognition, psychomotor responses, concentration, attention, and short-term memory. Several prospective studies in the psychiatric literature also note that there can be long-term adverse effects in young people who choose to begin using cannabis in early adolescence. These include findings of increased risk of cognitive problems and psychosis. Cannabis is addictive to susceptible people. The DSM-V does list its adverse effects in people who have Cannabis Use Disorder, and there is indeed a withdrawal syndrome which may occur if use of the drug is quickly stopped.
    Over the last 30 years of clinical practice, I have treated many people who have become dependent on cannabis. Many complain of chronic fatigue, weight gain and obesity due to having “the munchies” induced by the drug, panic and anxiety states, paranoia, lack of motivation, “ADD” symptoms (which most often completely resolve with abstinence), chronic lethargy, and depression.
    Few people aim to become severely addicted to drugs or alcohol. Most do not know, prior to exposure, who will, and who will not, be “the one” whose life is ruined by the scourge of addiction. The more people exposed to addictive substances, the more cases will be seen of ongoing abuse and dependence.
    As a nation, we should be advocating for higher values of behavior that may result in greater personal growth for our people. If we, as a nation, say that we must have a new drug available for the masses, so that we can deal with our stresses and anxieties through “dope,” rather than through more effective means of mindful relaxation, then it behooves us to further examine how we’ve come to accept and welcome such a ridiculous philosophical and political smokescreen.

    Thank you.

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