Opinion | Doobie No Harm: Doctors and the War on Drugs

There’s a taboo on medical doctors using cannabis, or at least discussing their use publicly, because, in my opinion, the medical boards are antiquated, undereducated, and reflexively punitive on this issue. Even using medical cannabis can get you into hot water. One can only wonder about the origins of a double standard where doctors are allowed to consume (in their free time) alcohol, sleeping pills, muscle relaxants, antihistamines — whatever intoxicating and debilitating “legal” substances they want, as long as it isn’t the “evil weed.”

As cannabis becomes legal in more and more U.S. states, and is increasingly confirmed to be less harmful than alcohol and many of the prescription drugs we so freely prescribe, it begs the question: why are the medical boards not evolving more rapidly on this issue?

I had a recent chat with someone on the Massachusetts Medical Board, and he was quite supportive of medical cannabis for patients. However, we didn’t specifically discuss use by physicians. But let me tell you, horror stories of harassment and excessive punishment abound. In 2013, when I first started as an associate director of the Massachusetts Physician Health Service — a confidential resource to address issues of physician health — I couldn’t believe that doctors were actually getting in trouble for using cannabis. At the time, it was decriminalized and approved for medical purposes in the state. The addiction doctors at the Health Service spoke about cases so suspiciously — “he said he just had a few puffs at a dinner party” — implying that the client, as we called the doctors getting help, must have been compulsively smoking cannabis since pre-school. The way these doctors spoke about it, taking a puff or two — enough to get slightly buzzed — sounded as if, intoxication-wise, it was on the same level as having injected several speedballs of cocaine and heroin. Again, lived experience is vital to accurately gauge these things.

According to a 2018 piece in the prestigious online physician magazine KevinMD, “Using marijuana 2 times a month cost this doctor his license,” a doctor, in a state where cannabis was fully legal, took a routine pre-employment drug test. He had admitted to twice-a-month cannabis use because…why not? It’s legal, generally believed to be harmless for most adults, and safer than alcohol and many of the prescription medications doctors are allowed to use. He had no idea that there was a destructive stigma against doctors using cannabis. The drug test was positive for cannabis. He was forced to go to rehab and was diagnosed with “severe marijuana dependence” and “told that he needed to stay for 90 days of inpatient treatment, which they just happened to offer on-site, at a cost of over $50,000.” He refused, and the board yanked his license. He has not practiced medicine since, in an age of severe impending physician shortages.

In some ways, our medical system is in a slow-motion collapse. This is due to the “great resignation” of many doctors, particularly primary care physicians, who are suffering the ill effects of burnout and moral injury. Many are quitting or are cutting down their hours, while others are sleepwalking through decreasingly meaningful careers as doctors continue to become commodified and treated like cogs in someone else’s machine. We are under relentless pressure from our hospitals to see more patients, for less money, and we are increasingly burdened with mundane administrative tasks. Because we can’t unionize, we are defenseless against this added load. I’ve seen patient care get more dangerous every year. We are constantly undermined by insurance companies in our attempts to procure the care that our patients desperately need. Many people — doctors included — utilize some chemical or substance to relax at night or on the weekends to “take the edge off.” It would be great if society, and people, were such that none of us needed anything to help us relax — but it isn’t and we aren’t. Until now, the only (legal) choice for doctors has been alcohol, which is more dangerous and incapacitating than cannabis on every metric.

As cannabis becomes legal in more states, there’s absolutely no reason that doctors shouldn’t be allowed to choose it instead of alcohol when they’re off duty. The relaxation, insight, mindfulness, and fellowship that cannabis provides could help many doctors work through the burnout and depersonalization they are currently suffering from. For many, this could be exactly the type of wellness they need. Cannabis, if used modestly, doesn’t give you a noticeable hangover compared to alcohol. Of course, there should be some guidelines in place about safe usage. For example, perhaps a neurosurgeon cannot use marijuana within 36 hours of performing a surgery (or whatever turns out to be evidence based, with unbiased studies).

If doctors can handle making life-or-death decisions for patients, they ought to be able to handle the recreational usage of legal cannabis. With one less punitive and senseless policy to contend with, maybe fewer of us would quit medicine.

Peter Grinspoon, MD, is a primary care physician and cannabis specialist at Massachusetts General Hospital and a certified health and wellness coach. This piece is an excerpt from his new book, “Seeing Through the Smoke: A Cannabis Specialist Untangles the Truth About Marijuana,” published by Prometheus, an imprint of Globe Pequot, the trade division of Rowman & Littlefield.