Medical Marijuana - How to Avoid Abuse and Addiction

Prescribed use of medicinal marijuana is currently legal in twenty states and the District of Columbia. It appears destined to become accepted throughout the nation in coming years. Proponents advocate its use for numerous physical and psychological disorders.

As dual diagnosis clinician, I am in the minority for advocating its use. There is growing research demonstrating effectiveness of marijuana in treating Attention Deficit Disorder and anxiety disorders (especially Post Traumatic Stress Disorder). The pitfall that is readily apparent is that there is a fine line between medicinal use and substance abuse. The line is subjective, unique to the individual, and hinges on the willingness and practice of the individual to practice rigorous honesty with themselves.

Help or Hindrance?

The use of medical marijuana is intended to improve one’s quality of life by reducing or eliminating negative symptoms of a disorder. If we are to judge its effectiveness to the individual, we must establish what a person’s baseline is prior to use, after short term use, and monitor effects of long term use. Baselines can be conceptualized as a normative range of functioning and quality of life of an individual over time. We have good days and bad days, but overall there is a range within which we holistically function (physically, mentally, emotionally, spiritually and in more quantifiable ways like productivity).

If we have a clear understanding of a person’s quality of life prior to beginning medicinal use, we can measure the frequency and intensity of the symptoms that marijuana is used to relieve. We can assess mental health and cognitive functioning, productivity, and investment in improved health. Ideally, these assessments would be made in conjunction with a clinician or medically trained professional who is able to maintain objectivity and is not biased against the use of marijuana.

Self Medicating & Self Monitoring

It’s unlikely that our use will be scrutinized as it would be if we were being prescribed pain killers or benzodiazepines.

• Medical marijuana is most often prescribed not with treatment parameters (dosage amount, frequency of use, route of ingestion) but rather with little more than governmental limits as to the amount a person can have in their possession.
  
• It is highly recommended that we check with our local dispensary or other provider as there are a plethora of marijuana strains that can be matched to our specific needs.

In the absence of ongoing medical/psychiatric assessment and monitoring, we are left to evaluate our own use and/or to seek observations from those closest to us. This is problematic. We lose our ability to be objective when we become emotionally involved and/or when we use a mood altering substance. The success of self assessment is best ensured when we externalize our insights in writing (it’s harder to rationalize or minimize in black and white). To further ensure success we can add journaling as a daily form of processing and building holistic awareness.

Consider how self surveys could help ...

Self Surveys

Self surveys provide objective information to help you make sound decisions, over the short and long-term.

Before you start:

Short term results are likely influenced by a person’s past experience with marijuana use. Those who have had positive experiences in the past may be predisposed to consider their experience of using marijuana medicinally to be beneficial. It’s common that the first time a person uses marijuana that they not experience significant effects. In a percentage of users a heightened amount of anxiety follows and for these folks continued marijuana use is likely counter indicated.

After 30 Days

Repeat the self survey questions above and contrast findings.

• Consider modifications to frequency and dosage to be made if your findings show even minor cause for concern or ineffectiveness of the medication.
• Gather impressions from friends and family. What if anything have they noticed to be different about us?

Long Term

The biggest potential pitfall of marijuana use is that long term and heavy use tends to be associated with lower levels of productivity. In assessing and monitoring continued use, what we’re really doing is weighing the pros and cons of life with and without this form of treatment. Exploring options and reevaluating with your prescribing clinician is always beneficial. 

Crossing the Line into Substance Abuse

According to the Diagnostic and Statistical Manual 5th Edition, the criteria for determining a substance abuse disorder is the presence of “cognitive, behavioral, and physiological symptoms indicating that the individual continues using a substance despite significant substance related problems.”

In the case of medically prescribed drugs, there is a significant gray area as side effects are often inevitable and can easily be viewed as “problems.” In this light, the only objective measurement would be to contrast the side effects of marijuana use to those of alternative medications and forms of treatment.

Use of any substance over time results in tolerance. The amount of marijuana required to relieve symptoms will increase over time for most users. If the amount of marijuana being used increases, we must again consider a highly subjective assessment – are we relieving symptoms or are we simply getting high?

Perhaps our best determining factor in weighing continued use is to consider that as a person develops a substance abuse problem and moves toward addiction (whether psychological or physical dependence) the use of the substance gradually becomes a focal point in their life. If we consider how much of our life is centered around using marijuana, we can spot a problem developing. Ultimately, whether marijuana causes us benefit or harm overall, it remains only one form of treating a condition. Soliciting and accepting support toward holistic health remains our best safeguard and our best medicine