SAN FRANCISCOMEDICINE - California Society of Addiction ...

Addiction and Recovery
Not the Right Prescription
“Medical” Cannabis and Adolescents
Lynn Ponton, MD, and Sam Judice, MD
Physicians who work with young
people need to understand the
multiple and often insidious roles
that marijuana may be playing in the lives
of their young patients. The following
two cases represent patients treated by
the authors, who are practicing child and
adolescent psychiatrists. These cases illustrate
current challenges faced by physicians
working with adolescents in the Bay
Area—currently a unique culture with its
own challenges.
Case 1
Eighteen-year-old Jonathan had been
in psychiatric treatment for depression,
anxiety, and lack of initiative in high school
for approximately one-and-a-half years
when he finally shared with his psychiatrist
that he was taking prescribed marijuana in
addition to the antidepressant that she was
prescribing. With Jonathan’s permission,
and because he was experiencing more severe
difficulties, the psychiatrist called the
physician who had prescribed Jonathan’s
marijuana, letting her know that Jonathan’s
lack of initiative and impaired school performance
worsened after Jonathan began
using medical marijuana. The prescribing
doctor did not know this information
because she had planned no follow-up
visits to check on her young patient. Following
this exchange, the psychiatrist spent
months working with Jonathan and his
family, gradually helping him understand
that marijuana was not the right medicine
for him and to address the initial problem.
Case 2
David is a nineteen-year-old male who
was referred for treatment of depression,
anxiety, and failing grades in his first college
semester. Upon first interview, David
denied any marijuana or drug use. When
asked, his parents, both professionals,
were certain that David did not use drugs
but that he had inherited the family curse
of severe mood disorder. The psychiatrist
was hesitant to order a urine toxicology
screen because all parties involved seemed
highly credible and David’s initial symptom
picture suggested the proposed severe
mood and anxiety disorder.
However, his eventual urine toxicology
screen revealed a different story and
measured a level of THC over 350 ng/
ml. When asked if he was surprised that
his urine toxicology screen indicated that
he was a heavy, chronic marijuana user,
David snickered, “No,” and then asked the
psychiatrist if he would be willing to help
him get a medical marijuana card, adding
that marijuana was the only thing that
helped him sleep.
Since David was nineteen years old,
the psychiatrist needed David’s consent to
speak to his parents about these difficulties.
At this point in the treatment David
adamantly refused to give written consent,
not allowing the psychiatrist to speak with
his parents. Several months later, when the
psychiatrist finally began to confront these
issues with permission, he discovered that
David’s father was also smoking marijuana.
At this point David’s father pulled his son
out of treatment. Father and son both left,
saying that marijuana smoking was harmless
and that any treatment that focused on
abstaining from marijuana was “bad treatment.”
They felt supported by the culture
and beliefs in the Bay Area and were sure
that they could find another physician who
would give them what they wanted.
Continued on page 26 . . .
Guidelines for Teenagers and
Parents
• All teenagers take risks as a normal
part of growing up as a way to define and
develop their identities.
• Most adolescents try marijuana with
their friends (over 40%). They are often
unaware of the dangers that this drug poses.
• Brain growth and development
continues throughout life, but there is a
period of rapid growth in adolescence that
continues through the mid-twenties. Many
substances, including marijuana, negatively
affect brain development.
• Serious negative side effects of
marijuana use affecting adolescents are
diminished passion and motivation for life.
Outgoing teens can become withdrawn.
Grades in school can fall. Teenagers can lose
interest in most activities.
• Adolescents who have serious psychological
problems, such as depression,
anxiety, bipolar disorder, or other mental
health issues, are extremely vulnerable to
marijuana use, which frequently results in
a worsening of their symptoms.
• Marijuana is psychologically addictive.
Marijuana symptoms include withdrawal
and a compulsive craving for the
drug. Both psychological and substance
abuse treatments aid in stopping it.
• Teenagers and their parents can
contact the National Institute of Drug Abuse
(NIDA) for information about marijuana
abuse and treatment.
• During the last two decades, marijuana
grown in the United States has increased
its percentage of THC—tetrahydrocannabinol—more
than tenfold.
• Marijuana use is frequently found
clustered with other unhealthy risks and
other symptoms.
24 San Francisco Medicine April 2010 www.sfms.org