Dad, you have to inhale

My wife calls them “hand-me-ups”…  things we inherit from our kids.  My ex-fashionable shirt that my son wore in college. Our semi-vegetarian diet my daughter adopted in high school. The dog at my feet that came visiting for the weekend, three years ago.   Our lives are enhanced and modified by the most unexpected of teachers, our children. The mentoring of our progeny keeps those of graying years at least partially youthful.  Still, I was astonished to hear this week, the words, “Dad, you need to starting doing drugs.”

The “dad” being addressed is 93 years old and has advancing cancer. He is tired, nauseas, anxious and sleeps poorly.  Though he likely has a number of months to live, he has become withdrawn.  Despite my usual medical brew, his incapacitating symptoms are without palliation.  Dad is miserable.  Enter his daughter with the solution.  The “drug” she is talking about is the treatment de jour, marijuana.

How did this happen?  We raise our kids to be good, honest, mature citizens; we drive them to soccer, suffer through years of homework (do you remember dioramas?), and do the whole college obsessive-compulsive tour thing.  In addition, above all, we beg our offspring to stay away from pot, pills and addictive mind-altering potions.  Now they turn on us, pushing ganja in our time of need. How did we go wrong?  Actually, it is we that missed a great opportunity.

50% of Americans have inhaled marijuana at some point in their lives.  More than 25 million of our neighbors have used it within the last year.  Those that imbibe are of a decidedly younger demographic.  The oldest citizens, especially those of the Greatest Generation, are much less likely to have experience with cannabis.  Fortunately, once again, youth presents the solution.

New Jersey’s Medical Marijuana (NJ MMP) program has been active and growing now for almost two years, making the drug available for select patients (see below).   A handful of doctors, of whom I am one, have been dispensing prescriptions for 1/4oz bags.  Having never partaken myself, this has been a learning experience as much as any other medical therapy I have administered.  As I have become familiar with its use, so have a wide range of patients, and its popularity is increasing. Recently, I saw a 35yo melanoma patient, a 48yo woman with Crohns, a 60yo multiple sclerosis sufferer and an 88yo church-going, right-wing-voting, DAR-attending, great-grandmother and they are all now are rolling and toking.

Marijuana is one of the safest drugs a doctor can order.  In the entire world literature, there has never been a documented death by overdose.  Its most common side affects are the same as its affects; it makes some people sleepy and dopy.  While it may increase the risk of heart problems, especially in the elderly, it does not punch holes in the stomach like aspirin, rot the liver like Tylenol, wipe out the immune system like chemotherapy or any of a myriad list of toxicities that horrifies us all when we read the average medicine’s packaging material.  Smoking itself can irritate those with lung issues, but especially short-term use in patients with serious disease is unlikely to cause permanent pulmonary damage.  We do need access to better oral forms, such as oil, for those with emphysema and for use in very sick children.

On other hand, marijuana really works. I do not know of another drug or treatment that produces such consistent benefit and patient satisfaction.  Every other medicine that I have prescribed for any problem, be it pain, nausea, depression or health conditions like hypertension, diabetes or heart disease, is much more likely than marijuana to have serious side effects. My patients report significant improvement in nausea, energy, anxiety, sleep and even pain from illness.  They are able to function, eat and be social.   While not a treatment for disease itself, for many patients it provides excellent symptom relief.  In the words of the stoner’s of old, “This is good s**t.”

So, based the research of one doctor and a couple dozen patients, the medical marijuana experiment is a success.  It significantly helps certain patients to feel stronger, happier and I suppose, younger.  Another gift, a hand-me-up, from our children. Nonetheless, in the words of one frustrated son whose father refused to do more than hold the precisely rolled joint, “Dad, you have got to inhale.”


NJ Medical Marijuana Program Indications

 1.              Approved debilitating medical conditions include:

◦                                  Amyotrophic lateral sclerosis

◦                                  Multiple sclerosis

◦                                  Terminal cancer

◦                                  Muscular dystrophy

◦                                  Inflammatory bowel disease, including Crohn’s disease

◦                                  Terminal illness, if the physician has determined a prognosis of    less than 12 months of life.

2.              The following conditions apply, if resistant to, or if the patient is intolerant to, conventional therapy:

◦                                  Seizure disorder, including epilepsy

◦                                  Intractable skeletal muscular spasticity

◦                                  Glaucoma 

3.              The following conditions apply, if severe or chronic pain, severe nausea or vomiting, cachexia or wasting syndrome results from the condition or treatment thereof:

◦                                  Positive status for human immunodeficiency virus

◦                                  Acquired immune deficiency syndrome

◦                                  Cancer


  • Stephanie
    Thank you for a positive article on this topic. In my first year of chemo I obtained it illegally as my state has not yet approved it. I can't begin to describe the incredible relief I got as compared to Compazine, Zofran, Emend, Aloxi, Ativan and the like. I didn't like the "high" and look forward to my state approving the low THC, high CBD version. My kids encouraged me to try it. I did have college experience from the 60's-70's. At this point, I am still on chemo for mets & would like it again LEGALLY. I think it's criminal that my state has not yet approved its use, but I think it will be soon.
  • Alyce
    An additional option for people iln need which is less damaging to the physical persona. It is probably a blessing in disguise, since the heavy duty pain killers seem to be creating more problems than they resolve, creating addictions where none were before.
  • penelope egan
    are we finding the answer in something many of us avoided all our lives? interesting! The more I read about side effects of drugs prescribed the more I'm for patients indulging in a joint for relief... thanks for you view point with a touch of positive and good thoughts to your dad...
  • The problems arising in the US public school systems from marijuana and facsimiles as well as misuse of over the counter medications and illegal possession of prescription medications has turned me completely off to tolerance for any positive support for marijuana. Some people self medicate for physiological and psychological disorders that are usually treated with limited and temporary prescription medications or ineffective over the counter medications that long term are readily available and harmful. When I started to study the increased incidence in the public schools I was horrified. The illegal uses..dealers, mules are coerced, manipulated, lured, bullied etc. What you are saying and talking about is correct..but..what you are saying will be twisted around and used for the wrong purposes. When I was in HS and in College..some of those people dealing were very wealthy..very little education...drugs, sex..rock and roll. The neurological effects and demotivating affects...not good. The Cartel and other powerful dealers..influence and override the healthy development and research for better medications. Alcohol, cigarettes..both have some positive benefits as well it seems...unfortunately...deadly and destructive to the most vulnerable..big money makers etc. Keep the info off the web! Great show on PBS about a young girl with a seizure disorder helped by marijuana but they removed the THC and increased the positive element. Colorado family refining and altering plants for varietal effects. hybrids...potentially lethal because of the levels of THC is my guess. Your info is low level and simplistic.
  • Kathleen Denny
    I'm glad to see you weigh in with your patients' positive experiences. This discussion can only help us move to policy based on concrete benefits. Unfortunately, the legal system is severely out of sync. Federal charges may still be pursued, even in states with some form of legality for medical use. Banks refuse to open accounts for legal medical marijuana growers and distributors, or issue credit cards, forcing them to hold and handle large amounts of cash with all the vulnerability that entails. The New York Times recently had an article in which a distributor armed himself before loading bags of cash into his car and heading across town. Where was he going with all that cash? To pay his taxes.
  • jerseyRN4726
    Sorry I didn't catch you before you left the ELNEC conference last month to compliment you on your blog. Look forward to every post. And to this one I say... yes! yes! yes!
  • Because of this crap I am saying I never had a child..or was married and am changing my much for the AH's who are sheltered, spoiled and power and control freaks. You don't have an impaired child? You don't have sick children who were abused by miscreants ?
  • D Someya Reed
    I'm neither a medical nor recreational marijuana user...never have been, never will be and, hopefully, will never "need" to be. I agree with you on its medical benefits and oppose any actions to keep it out of the hands of those who truly need it. But that's the problem...who "truly" needs it? In our town there are those who hand out flyers and/or place them on doors that state: "Need medical marijuana but don't have a doctor who will certify your condition? We have one who will no matter what...GUARANTEED!" I contacted the police the first time I got this flyer. They said they knew who was behind it but didn't seem too anxious to do much about it. They said they go after them every so often (I guess when they're bored) but they just come back. The money to be made is just too good. The down sides of this (to everyone) are obvious. I don't have the words to describe any licensed doctor who would participate in this but any doctor who would shouldn't remain licensed. I feel that the lines between medicinal and recreational uses get blurred when medicinal use is discussed with recreational terminology. It would be the same as describing chemotherapy regimens with the "street" vernacular of illicit drug use. The resulting public confusion allows the type of individual who would distribute these flyers to convince patients that their condition is being helped when in actuality they are nothing more than misguided recreational users. Despicable!
  • You might change your mind the day you find out you have cancer - the road to being cancer free is a torturous experience with the chemo drugs and radiation therapy leaving long lasting quality of life side effects. And then a short time passes and the cancer is back.
  • Kristine Kotoff for Isabel Kotoff
    Thank you so much for this WONDERFUL insight! My mother is patient and is interested in MM. Please doctor follow up with me upon your return from vacation.

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