Doctor Says Medical Marijuana Laws Hurt Teens

Colorado is one of more than a dozen states to legalize medical marijuana. Denver psychiatrist Christian Thurstone argues that the state's relaxed laws have made the drug widely available — and irresistible — to too many adolescents.

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And now the dark side of medical marijuana laws. Pot is legal in more than a dozen states if you have permission from a doctor. Federal law continues to ban marijuana as a controlled substance. But last year the Obama administration announced it would not prosecute users who comply with state laws. Those laws vary from state to state. But in Colorado patients with one of several conditions, cancer or AIDS, for example, can legally smoke pot.

Dr. Christian Thurstone is a psychiatrist in Denver who specializes in adolescent substance abuse. He argues that the medical marijuana laws are a mess and says that kids messed up on marijuana come in to his office every day.

We have a link to his op-ed, "Smoke and Mirrors: Colorado Teenagers and Marijuana," at npr.org. Click on TALK OF THE NATION.

If you live in a state that's legalized medical marijuana, what's been the effect there? Is this really for AIDS and cancer patients? Our phone number is 800-989-8255. Email: talk@npr.org.

Dr. Christian Thurstone, medical director of the adolescent substance abuse program at Denver Health, joins us now from a studio at member station KUVO in Denver. Thanks very much for coming in today.

Dr. CHRISTIAN THURSTONE (Adolescent Substance Abuse Program, Denver Health): Thank you for having me.

CONAN: And you wrote that the way the law works in Colorado, it's just a backdoor to legalize marijuana.

Dr. THURSTONE: Yes, I did. That seems to be what I'm seeing.

CONAN: And how does that work?

Dr. THURSTONE: Well, so I'm the medical director of an adolescent substance abuse program, and we noticed in 2009 at the beginning of the year that we were not very busy, and at the end of the year we ended up having probably tripled our referrals to the adolescent substance abuse treatment program. And 95 percent of our referrals are for marijuana.

And we started seeing teenagers talk to us about how they would get marijuana from their relatives and from their friends. And then they started talking to us about how the - how they could get medical grade marijuana on the streets and how the potency seemed to be increasing. And then we started seeing patients and adolescents come in to see us and talk to us about how marijuana was their medicine and it would help them with their anger and their other problems that they would have, such as stress and anxiety.

And then we started having patients show up with their medical marijuana license. And that's when one of the students that I work with said, you know, Dr. Thurstone, you really need to do something about this. You can't just keep complaining to us about it. You have to actually do something now. And so that's when I wrote the piece that I did for the Denver Post.

CONAN: And you argued in that piece that essentially for the $300 referral by any doctor, well, for any number of conditions, almost anybody can get a marijuana prescription.

Dr. THURSTONE: Yes. So, for example, I have a number of patients now who have their medical marijuana license. And the way they have described the process to me is as follows - that they can go into a medical marijuana doctor, and it's easy to find a list of those doctors online or in the newspaper. And then they have about a 15-minute visit, they pay about $300, and they complain - I had some patients complain of depression, some of anxiety, some of attention-deficit hyperactivity disorder or ADHD, and the doctor asks them, well, does marijuana help with that? And my patients say yes, it does help with that. And then they came out with their medical marijuana recommendation.

And in no case did any of the providing physicians call me or insist on a psychiatric consultation, and the doctors also do not have an ongoing relationship with my patients. So...

CONAN: So this is a prescription mill, is what you're talking about.

Dr. THURSTONE: It's a prescription mill. And we know that here in Denver that these physicians can practice within a medical marijuana dispensary, so you can go directly to the dispensary. It's really one-stop shopping. You go to the dispensary, you meet with the physician briefly, and then you can go over to the dispensary and get your medical marijuana, and then out you go.

CONAN: One-stop shopping. And there are a lot of people who are going to say, well, come on, it's just marijuana. It's just pot. Come on, get serious.

Dr. THURSTONE: Yeah. So I do hear that all the time. I hear, well, marijuana is not as bad as alcohol or not as bad as tobacco. And I think - I'm not - you know, I don't know how to compare the substances. But I do know that for adolescents, marijuana can be very harmful. We know that about one in six adolescents who tries marijuana as an adolescent then goes on to develop what we call a cannabis use disorder. We know that marijuana use in adolescence is associated with accidents, risky sexual behaviors that can lead to sexually transmitted diseases such as HIV. We know that adolescents who use marijuana are more likely to drop out of school, more likely to get pregnant. It's associated with a whole host of problems. We also know that in adolescence you have a developing brain.

CONAN: Mm-hmm.

Dr. THURSTONE: We know that the brain is really developing quickly during adolescent years, and so, using a toxic substance during those years can be quite damaging and produce possibly permanent deficits in memory, as well as how the brain is ends up being structured.

CONAN: Well, one of the problems with statements like that is there's the lack of research. We simple don't know a lot of the answers to some of the questions that you just raised. But nevertheless, those problems, at least, some of them do exist. I was interested that some of your patients said to you, Doctor, how can marijuana be bad for me, it's medicine?

Dr. THURSTONE: Yeah. Exactly. So I go to schools and do some prevention programs, frequently. And then I also I see my patients in the program, and I hear all the time, Doctor, marijuana is a medicine, how can it be bad for me? And, well, so we're also seeing - that's another interesting thing. We're seeing a big shift in attitudes here that adolescents have about marijuana.

CONAN: Oh, and by the way, you said, they started to really - accelerating in 2009. Colorado has had the medical marijuana law for a number of years.

Dr. THURSTONE: Correct. Exactly. So have we've had it since 2000. But then I think, you know, it's my understanding that the Obama administration saying that they will not prosecute people who get their medical marijuana in states where that have medical marijuana laws, really opened the door for opened a floodgate for us to have all these dispensaries and all these people with licenses.

CONAN: Mm-hmm.

Dr. THURSTONE: So for example, we know that in Colorado now, there are about 60,000 people, according to The Denver Post, who have medical marijuana licenses. And we have over 400 dispensaries of medical marijuana in Denver alone now. Which means that we have more dispensaries than we have Starbucks. We have more dispensaries than we have liquor stores. We have more dispensaries than we have schools. And so in 2009 we really saw the floodgates open up.

CONAN: Let's get some callers in on our conversation. We're talking with Dr. Christian Thurstone, a board certified child, adolescent, and addiction psychiatrist in Denver, Colorado. 800-989-8255. Email: talk@npr.org.

Joseph's(ph) is on the line with us from Cheyenne, in Wyoming.

JOSEPH (Caller): Hi, how are you?

CONAN: I'm well, thank you.

JOE: Hey, thank you so much for taking my call. I understand your doctor's position, but I would like to say that I did a lot of drugs early on, and marijuana is kind of the last ones that I got into. I developed an ulcer about a couple of years ago, and it's a bleeding ulcer, it's really bad.

And sometimes I have to go three to four days without being able to eat unless I smoke a little bit using my medical marijuana license card. So I understand that there is some kind of addiction issues around there, but ultimately I think that it's a big help, even if you don't have AIDS or cancer. It really can be a huge benefit.

CONAN: And Dr. Thurstone, there are people like Joseph, and indeed AIDS and cancer patients, who say this is really important for them.

Dr. THURSTONE: Yeah. I think that's a great point. I think there are a lot of case studies and a lot of case reports you'll hear of people who say how smoked marijuana has been so beneficial to them. And on the other hand, if you look at, you know, true, randomized, controlled trials, there's just a real paucity of those studies.

CONAN: Yeah.

Dr. THURSTONE: And...

CONAN: And there's very little research on this.

Dr. THURSTONE: Yeah. Exactly.

CONAN: For various reasons, most of them political.

Dr. THURSTONE: Exactly. And so the Institute of Medicine, their, you know, current recommendation that they come out within 2000 was that all other medicines should be tried that do have an FDA indication for the condition, that there should be an ongoing close medical supervision of smoked medical marijuana.

CONAN: Mm-hmm.

Dr. THURSTONE: And that there's should be a strict oversight of a committee, of the providers who are providing this the medication you know, medical marijuana.

CONAN: And let's accept that patients like Joseph and Joseph, thanks very much for the call that people like him - just accept, for the moment, get benefit from smoked marijuana, you're arguing a different point. You're arguing that in fact this is a besides that small group of people, there's a very large group of people who are abusing this law and using it just for recreational purposes.

Dr. THURSTONE: Yes. So I think there you know, there is room for common ground in this whole issue in that, you know, let's please keep it away from our kids. And right now, it's pretty clear that our kids are getting a hold of the medical marijuana, and either directly or indirectly, and they're suffering the consequences from it. So, is it there must be some way to tighten up the system if we do need, you know, given that the voters did vote this in, there must be some way to at least protect our children from the -from getting addicted to it.

CONAN: Let's get Dean(ph) on the line. Dean, with us from Chico in California.

DEAN (Caller): Yeah. How you doing?

CONAN: I'm good. Thanks.

DEAN: Yeah. I'm a medical marijuana grower/provider for local clubs in Sacramento area. And there's just something that a lot of people need to understand, kids shouldn't be smoking marijuana, they shouldn't be drinking alcohol, they shouldn't be smoking cigarettes. They also shouldn't be taking the psychotropic drugs described by psychiatrists, you know, the developing brain is the developing brain.

But as consenting adults - and we should be able to have a choice, instead of buying a drug from a doctor that's produced by a chemical (unintelligible) -pharmaceutical company that we produce our own marijuana, that's for a thousands of years has been used effectively for pain, anxiety, for lots of other reasons.

CONAN: Well, Dean, you have to accept that there have been very rigorous studies of some of these psychotropic drugs, of which you're so critical. There are plenty of people who agree with you that these are not great. But there are medical studies of their effects and what kind of use they can be. Those studies just dont exist for marijuana.

DEAN: Thats true. Thats true. Thats the whole stigma against marijuana, you know, youre just going to get high. I mean, theyve done studies regarding alcohol in the developing brain, they realize thats bad for kids. You know, its legal. The most, you know - the most illegally used drugs in the country is prescription drugs, and theyre prescribed by doctors.

CONAN: All right, Dean, thanks very much for the call. Were talking about medical marijuana law, specifically in Colorado, with Dr. Christian Thurstone. Youre listening to TALK OF THE NATION from NPR News.

And Dr. Thurstone, he and other callers and emails have a point. If kids theyre not supposed to be drinking until the age of 21. Theyre certainly getting access to alcohol through direct and indirect means. Theyre certainly getting access to tobacco and to marijuana.

Dr. THURSTONE: Yes, so we know that from prevention science, we know that teens are most likely to use things that are A, available and B, for which there is low perceived harmfulness. So as medical marijuana becomes more and more available, youll see teenagers using it more and more, and were already seeing abuse and diversion(ph) of that. And youll see the perceived harmfulness. So, how harmful they think it is to use marijuana regularly, thats going down.

And I - my own personal opinion is I would attribute some of that to the fact that its viewed as a medicine now, and that that will lead to increased use among teenagers.

CONAN: Lets go to Dawn(ph). Dawn with us from Pontiac, Michigan.

DAWN (Caller): Hi.

CONAN: Hi.

DAWN: Im wondering why its theres such aversion to just treating marijuana like you do cigarettes and alcohol. Right now, its easier for the kids to get marijuana than cigarettes and alcohol, because people who sell marijuana its illegal, theyre not going to think twice about selling it to a kid, whereas people who sell cigarettes, well, they dont want to lose their license, so theyre going to not sell it to kids, you know what I mean?

CONAN: Medical marijuana, as I understand it, is legal in Michigan, but its more tightly controlled.

DAWN: Yes, but Im just wondering why we cant just sell it like cigarettes, I mean, in the...

CONAN: Well, to do that, youd have to get a law through the, say, legislature or through Congress, which would be extremely politically difficult.

DAWN: Well, I understand that. Im just making a point.

CONAN: Okay.

DAWN: It was...

CONAN: There are a lot of people who call for it to be legalized and treated and taxed, just the way that alcohol and tobacco are, but I think there is a bill thats working its way through the California legislature that calls for that to happen. But again, that would run afoul of the federal anti-narcotics laws at this point, so wed have to see how that would work out. But Dawn, thanks very much for the call.

Heres an email that we have from San Francisco. Kaye(ph) wrote to say, doctors write these cannabis prescriptions. Why would a doctor write a script for no illness? Doctors are unethical if they conduct cursory exams with an automatic prescription for the fee.

And Dr. Thurstone, I dont think youd disagree.

Dr. THURSTONE: Yeah, no I dont disagree with that. The, you know, the word is is that there are very few, about 15, physicians in Colorado who are prescribing about 70 or recommending 70 percent of medical marijuana here. And so, most physicians are not doing this. And so, yeah, I would agree with that.

CONAN: If the federal government is not going to crack down on users who comply with state laws, what about these doctors?

Dr. THURSTONE: What to do about them? Well, I know theres legislation underway now, thats being considered in Colorado, to make sure that these doctors are in good standing, that they have a they're licensed to practice medicine in Colorado, and that they have a true doctor-patient relationship with the people theyre recommending marijuana for. So hopefully, some of those changes will tighten up the current system.

CONAN: Lets go next to Jim(ph). And Jims with us from Palmer in Alaska. How nice of you to be with us?

JIM (Caller): All right, thanks for having me.

CONAN: Go ahead, please.

JIM: I live in Alaska and up here its actually protected under the Alaska State Constitution, its legal to use within your own household. And once you take it outside of your household, thats another story and normal laws apply. But...

CONAN: You can grow and use for personal use.

JIM: Yes, you can actually grow - I believe that the state constitution legalized up to 25 plants, I believe, for your own personal use. Now, I have a few comments Id like to say...

CONAN: If you could make it quick because were running out of time here.

JIM: Yeah. Okay, well, you know, I think this whole thing having it illegal just creates, just as Prohibition did in early 1900s, it creates the market in which the criminals thrive. And, you know, you cant abolish something in which, you know, cost you a nickel to create but yet you can sell it for hundreds of dollars. And so, you know, I believe if you were to make it fully legal, that would be the way to abolish it because then you eliminate the supply.

CONAN: The incentive. And Dr. Thurstone, we just have a few seconds left, but hes got a point that many people have made before.

Dr. THURSTONE: Well, I think, you know, there are two issues here. One, my main point is medical marijuana, and right now we have a broken system with that. Legalizing it is another issue, and some people will argue that its their civil right to use marijuana legally, and I think thats a completely separate issue. But I would caution people that if its legal, itll be more prevalent and itll be more used by teenagers, especially.

CONAN: And your experience is the more teenagers that use it, the more have problems.

Dr. THURSTONE: Definitely.

CONAN: Dr. Thurstone, thanks very much for your time today.

Dr. THURSTONE: Thank you for having me.

CONAN: Christian Thurstone, professor of psychiatry at the University of Colorado in Denver, also medical director of the Adolescent Substance Abuse Program at Denver Health.

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