AMPLE TIME has elapsed since the "drug revolution" of the late 1960s to allow people with a history of illicit drug use to enter the medical profession. A survey of 1984 medical school graduates given during their third year of residency revealed that 65.1% had used marijuana at some time during their life, 17.1% had used in the past year, and 7.0% had used in the past month.1 Similar numbers were obtained in a 1987 survey of medical students with 66.4% lifetime use, 22.5% use in previous year, and 10.0% use in the previous month.2 The implication of these studies is that many currently middle-aged physicians have smoked marijuana.
Their prior drug use may be a source of emotional baggage for these physicians. What do they think of current teen drug use? Or of the possibility that their own children might use drugs? Where do they stand on the current debate about using marijuana as a palliative medication? As the following personal account illustrates, these questions may be quite confusing questions for practitioners who have previously used marijuana.
Everybody knew Steve (not his real name). When I joined the practice 14 years ago, I, too, would meet him. Back then, Steve was a likable 10-year-old kid with sickle cell anemia who rode his bike to our office for his frequent doctor visits and blood draws.
Steve had a quick wit and a boyish charm. Even when he missed appointments during his early teenage years, he could flash his innocent smile and all would be forgiven. It was during this time that his physician left our practice and I became Steve's doctor.
For a while, Steve seemed to have his life on track. He began attending a local university. He had both a part-time job and a steady girlfriend. Steve began to look toward the future. He asked me about becoming a dad. Would he be fertile? Would his children inherit sickle cell disease? It was a good time in his life.
Then, Steve started smoking crack cocaine and the downward spiral began. His girlfriend left him, he lost his job, and he had to drop out of school because he could no longer afford the tuition.
Steve gave in to the culture. All his friends used drugs and had ridiculed him if he did not. His family history was littered with drug abuse and alcoholism. Once Steve started down that road, there was no turning back—not with crack.
His hospital admissions became more and more frequent. Along with many others, I tried to convince him to quit. But Steve could never break the cycle. Typically, he would enter the hospital with a pain crisis and a drug screen positive for cocaine. By the end of the admission, the old, likable Steve was back. I know he was sincere when he repeatedly told me he wanted to quit using. But, once he was discharged, the siren's call seduced him and the cycle would begin again.
Then, when he was still in his mid-20s, he was admitted with what seemed to be an ordinary pain crisis. Once more, his drug screen was positive for cocaine. Eighteen hours after admission, he suddenly collapsed. A code was called. Despite resuscitative attempts lasting more than an hour, Steve could not be brought back from his refractory ventricular fibrillation.
No family members were with Steve when he died. But shortly after the code ended, his mother arrived. She wept uncontrollably as I hugged her—her baby was dead. When she caught her breath enough to speak, his mother benevolently blamed the drugs, not the doctors . . . and she blamed herself. In a voice broken by sobs, she cried, "I tried to get him to quit. I tried everything I knew."
More family arrived and tears gave way to conversation. I explained as best I could what had happened. We all agreed that an autopsy would be best. Then, Steve's mother surprised me when she said, "Steve spoke often of you. He liked you and appreciated the time you spent with him. He often felt that he let you down, but he knew that he could always count on you. You were a lot more than just a doctor to him."
Steve's sudden, unexpected death left me with an unsettled feeling. I went back to my office, closed the door, and tried to collect my thoughts. Steve may have had sickle cell disease but crack and the culture of drug abuse had killed him. Yes, I knew something about drugs. Like Steve, I was a product of my culture. I grew up in the rebellious '60s when, for many, experimenting with drugs was a rite of passage. I started smoking marijuana when I was a senior in high school and became a daily "pot" smoker in college. During medical school and residency, I began to taper off. I quit shortly after residency, not because marijuana lost its pleasure, but because I had too much to lose. I would not jeopardize my family or my career for marijuana and the police record it might bring.
In my youth, I was driven and a type A personality. Despite my accomplishments, I rarely felt good about myself. I loved the sweet release that marijuana brought. Marijuana seemed to counteract my introversion and social awkwardness. Even though 2 decades have passed, I think back on those days and smile.
One day, when I once again have nothing to lose, I may return to the familiar comforts of marijuana. Because of my personal experience with the drug, I have kept abreast of its potential for palliative use. If I ever suffer from incurable cancer or other cause of inanition, I will once again fill my lungs with marijuana's fragrant smoke. I will not settle for dronabinol. From what I have read, it is a poor substitute for the real thing. But I will not lead the fight for the legal use of marijuana by others. I am scared that I might lose my comfortable place in society if I were to advocate for the medical use of marijuana.
I know that crack is not marijuana. Crack frightens me. I thank God that crack was not around when I was young. I would never have stuck a needle in my arm and cocaine was far too expensive to consider. But those first hits of crack are affordable and smoking a drug seems a lot more innocuous than shooting up. Would I have tried smoking crack? Probably. Would I have become hopelessly trapped? Possibly. Once crack has a victim in its grasp, it never seems to let go. I know Steve's story could have been my own.
Now, I am the father of 2 beautiful teenage children. Although it may seem hypocritical, I have preached a staunchly antidrug message to them. Just like the acquired immunodeficiency syndrome and sex, crack has added the possibility of lethal consequences to teenage drug experimentation. I can only pray that my children never start using drugs. I doubt that I will ever tell them of my own drug use.
And so, on the day that Steve died I sat in my office with the door closed. As a wave of jumbled thoughts and emotions engulfed me, tears began to well up in my eyes. I cried for all those kids like Steve who had fallen into the clutches of crack. I cried for the mothers whose babies had died. I cried in fear for my own children. I cried for my own cowardice and hypocrisy. I cried for my profession, which cannot separate marijuana's past as a drug of abuse from its potential future as a drug of comfort. I cried for our society, which despite good intentions and billions of dollars, cannot seem to make any headway in solving the drug problem. But most of all, I cried because I failed to help the lovable, 10-year-old boy who rode his bike to my clinic.
