Drug screens for VA externs/practicum students

[Pragma]

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More often than not, people *do* know better. That's not me being arrogant, that's just a simple fact.

Dicto simpliciter? Sorry, I couldn't resist. 😀

 

[JeyRo]

So here is where I get interested, because I think it is important to understand the alternative arguments. On the surface I understand that you don't think obeying laws for the sake of obeying them is an important thing. That's not my philosophy - I do respect the government and the purpose of many laws.

But for someone to suggest that a psychologist does not always need to obey the law requires some clarification, I believe. If you aren't going to suggest a threshold for what constitutes appropriate lawbreaking (be it the law is unjust as evidenced by..., etc), then I think there is a danger to your suggestion.

Right, because then we'd have.... ANARCHY! 😱

I don't think I'd want to be in the position to suggest "appropriate lawbreaking" for anyone, it *is* a personal decision people have to make, based on their own personal morals, values, and risk tolerance. In general, if the law you're breaking has nothing to do with harming the rights of other people (rights to life, liberty, property), then I think a person has some thinking to do.

Some people break laws because they think the law is wrong, threatens their safety or livelihood, offends their personal morals, or, frankly, because they just feel like it. Others break laws for principled civil disobedience purposes (which I think is the most awesome). I can't make a general rule for "when breaking a law is appropriate" - I can just tell you that eventually everyone has their limits to what they will tolerate from the state.

Just like I don't advise anyone to follow the law just because it's the law, I also don't advise anyone to break the law just for the sake of breaking the law - after all, these people have guns and *will* throw you a small enclosure with bars on the door if you give them an excuse. And of course if your'e a professional your life will take a turn for the worse in a number of other ways. How would I advise anyone to risk that?

If my personal moral code tells me that it is okay, I am not sure if that lines up with another person's moral code. I am sure you can imagine what a slippery slope this is here in terms of which laws we might choose to break, and there could be plenty of disagreement over whether breaking those different laws causes harm.

I don't know, it seems pretty simple to me to identify when someone's been victimized. I suppose people will argue all sorts of things. I'm also OK with people having a variety of drastically different moral codes - as long as they don't impose their morals on me, it's not a problem. Smoke drugs, practice polygamy, homeschool your kids and teach them creationism, put your wife in a burkha, spank your kids, whatever, just don't expect that I'll approve of it or pay for it.

I suppose that you could argue that personal conduct should not matter for our profession, too.

Oh, but I wouldn't. I mean, it's obviously unethical to charge someone money for a psychotherapy session and (for example) show up drunk or otherwise impaired. But that's where personal conduct directly harms other people, and that's where professional ethics really should matter.

But hey, as others have noted, there is no direct statement at this point by APA saying psychologists can't use illegal drugs. But I think it is fair to assume that most reasonable clients are going to assume that their mental health practioners aren't engaging in this practice. Fortunately for you and others, I don't run the show at APA. I just was expressing my opinion on the matter in this thread.

OK, I hear yah.

 

[MBellows]

But hey, as others have noted, there is no direct statement at this point by APA saying psychologists can't use illegal drugs. But I think it is fair to assume that most reasonable clients are going to assume that their mental health practioners aren't engaging in this practice. Fortunately for you and others, I don't run the show at APA. I just was expressing my opinion on the matter in this thread.

I find that assertion funny. A while back I looked into the clinical psychology positions at the CIA for ****s and giggles. I was interested that the clinical psychology listing included a review of the drug history rules. I thought that was curious, so I looked at other job descriptions and none of them that I looked at had a similar notice of drug history rules.

 

[Pragma]

I find that assertion funny. A while back I looked into the clinical psychology positions at the CIA for ****s and giggles. I was interested that the clinical psychology listing included a review of the drug history rules. I thought that was curious, so I looked at other job descriptions and none of them that I looked at had a similar notice of drug history rules.

I may be wrong about this, but don't all FBI/CIA employees have to completely abstain from drugs and alcohol (or at least certain positions within the orgs?)? Thought that was part of the gig.

 

[Pragma]

Right, because then we'd have.... ANARCHY! 😱

I don't think I'd want to be in the position to suggest "appropriate lawbreaking" for anyone, it *is* a personal decision people have to make, based on their own personal morals, values, and risk tolerance. In general, if the law you're breaking has nothing to do with harming the rights of other people (rights to life, liberty, property), then I think a person has some thinking to do.

Some people break laws because they think the law is wrong, threatens their safety or livelihood, offends their personal morals, or, frankly, because they just feel like it. Others break laws for principled civil disobedience purposes (which I think is the most awesome). I can't make a general rule for "when breaking a law is appropriate" - I can just tell you that eventually everyone has their limits to what they will tolerate from the state.

Just like I don't advise anyone to follow the law just because it's the law, I also don't advise anyone to break the law just for the sake of breaking the law - after all, these people have guns and *will* throw you a small enclosure with bars on the door if you give them an excuse. And of course if your'e a professional your life will take a turn for the worse in a number of other ways. How would I advise anyone to risk that?

It's an interesting outlook on things. I'm much more inclined to default to obeying laws. Broadly defined, "life, liberty, and property" could encompass just about anything. When you say "has some thinking to do" I am not really sure what you are implying. People tend to do what they want...

I also think principled civil disobedience stands (for civil rights and such) are awesome. But THAT to me seems a much clearer case of injustice than something so wishy-washy and recreational like marijuana use. You brought up some obscure case where marijuana *supposedly* would save lives. But really, what we are talking about here most of the time is if people want to smoke pot illegally for recreation.

So if it comes down to "you know it when you see it" to you, I personally am not comfortable with the concept as it would apply to most laws. If you want to talk about ethics vs. law conflicts, fine - but even then you have the option of fighting the law as opposed to breaking it. But how in the world does using pot fit into a category like that?

I don't have a major issue with libertarian principles and clearly we've agreed on some things in the past (e.g., government not defining marriage). But I find this type of moral relativism to be a bit extreme when it comes to breaking laws and particularly when it comes to guild ethics. My own values lead me to be inclined to obey laws and fight ones you don't agree with the old-fashioned way. I think you'd need to make a pretty extreme case for breaking a law, and even then, you have more options at your disposal than just going ahead and breaking the law.

 

[MBellows]

I may be wrong about this, but don't all FBI/CIA employees have to completely abstain from drugs and alcohol (or at least certain positions within the orgs?)? Thought that was part of the gig.

While I imagine that there are obvious exceptions for people under deep cover, that's not very relevant to this conversation. As far as alcohol, I'm almost 100% sure it's a moderation. But yes, they are expected to abstain from illegal drug use while employed. What I was referring to was their rules regarding people with a history of drug use.

To be considered suitable for Agency employment, applicants must generally not have used illegal drugs within the last twelve months. The issue of illegal drug use prior to twelve months ago is carefully evaluated during the medical and security processing.

This is their current notice, I vaguely remember it being somewhat more stringent when I looked several years ago.

 

[Pragma]

I find that assertion funny. A while back I looked into the clinical psychology positions at the CIA for ****s and giggles. I was interested that the clinical psychology listing included a review of the drug history rules. I thought that was curious, so I looked at other job descriptions and none of them that I looked at had a similar notice of drug history rules.

Well, perhaps you've had a very different experience with clients than me, but I believe becoming a doctoral-level practioner implies a social role. I believe this is what JeyRo takes issue with - suggesting that we shouldn't have different standards applied to us than the general population when it comes to our personal conduct. I think that we do and it seems a very reasonable assumption to make for the general public.

 

[MBellows]

I have an opinion on this topic, but I'm going to reserve the right not to fully get into it. I think you both have excellent points, and frankly I'm glad to see some tension here because this sort of talk is how people find solutions to problems like this.

You brought up some obscure case where marijuana *supposedly* would save lives. But really, what we are talking about here most of the time is if people want to smoke pot illegally for recreation.

To address this issue, there is actually one case of this happening at the highest level. I assume this is what JeyRo is getting to. https://en.wikipedia.org/wiki/Gonzales_v._Raich

In this case there a woman with a rather deadly form of cancer, she had been using medical marijuana which she grew in her own home and it had effectively stopped the cancer progression. CBD, one of the major chemicals in cannabis is known to stop the growth of tumors and it has been indicated that it may even cause them to or contribute to them shrinking. The Supreme Court of the United States of America went out of their way to say that congress' ability to regulate interstate trade superseded her right to life in this case. They also bent over backward to say that her growing it herself was a matter of interstate commerce because it meant that she was not buying it from someone across state lines and that in turn had an effect on their market. This ruling is perplexing because the current supreme court (mostly the same ones who made this decision) has, in almost every other instance, ruled against interstate commerce clause as a means of congressional authority.

 

[Pragma]

I have an opinion on this topic, but I'm going to reserve the right not to fully get into it. I think you both have excellent points, and frankly I'm glad to see some tension here because this sort of talk is how people find solutions to problems like this.



To address this issue, there is actually one case of this happening at the highest level. I assume this is what JeyRo is getting to. https://en.wikipedia.org/wiki/Gonzales_v._Raich

In this case there a woman with a rather deadly form of cancer, she had been using medical marijuana which she grew in her own home and it had effectively stopped the cancer progression. CBD, one of the major chemicals in cannabis is known to stop the growth of tumors and it has been indicated that it may even cause them to or contribute to them shrinking. The Supreme Court of the United States of America went out of their way to say that congress' ability to regulate interstate trade superseded her right to life in this case. They also bent over backward to say that her growing it herself was a matter of interstate commerce because it meant that she was not buying it from someone across state lines and that in turn had an effect on their market. This ruling is perplexing because the current supreme court (mostly the same ones who made this decision) has, in almost every other instance, ruled against interstate commerce clause as a means of congressional authority.

I'm very intrigued by this - pot stops cancer progression? The way you describe it, it works like Arimidex or Avastin.

This is part of why we need a separate thread about medical marijuana. In this thread people are talking like it is a miracle drug for a variety of medical conditions. But I also am hearing some evidence that it is implicated in causing medical conditions as well.

 

[JeyRo]

I'm very intrigued by this - pot stops cancer progression? The way you describe it, it works like Arimidex or Avastin.

This is part of why we need a separate thread about medical marijuana. In this thread people are talking like it is a miracle drug for a variety of medical conditions. But I also am hearing some evidence that it is implicated in causing medical conditions as well.

Cannabis appears to be (and I've yet to hear any evidence contradicting this) pretty much the most non-toxic, biologically and psychologically active drug known to man.

I'm aware of a lot of this "evidence" implicating cannabis in causing medical conditions as well (causing violence, causing chronic apathy, gateway hypothesis, lung cancer, head and neck cancer, splitting chromosomes, masculinizing women, feminizing men, etc.) I've never seen any of it consistently replicated.

I do recall on a few occasions where I've encountered clients who have had history of psychotic disorders, who also have smoked pot, I've offered them education about cannabis psychosis, which, although it has a fairly thin evidence base in my opinion, leads me to think people with a tendency towards psychosis should exercise extreme caution about using the stuff and probably consider avoiding using it entirely.

But this is all an aside......

 

[MBellows]

I'm very intrigued by this - pot stops cancer progression? The way you describe it, it works like Arimidex or Avastin.

This is part of why we need a separate thread about medical marijuana. In this thread people are talking like it is a miracle drug for a variety of medical conditions. But I also am hearing some evidence that it is implicated in causing medical conditions as well.

Not necessarily all cancer, but a number of otherwise untreatable or treatment resistant types. One issue with this is that CBD can be separated from THC and other cannabinoids. This can allow for people to have the mood regulating effects (by leveling out brain activity), without the paranoia and cognitive impairments associated with THC. It is however ineffective at improving appetite, which is a key function in improving outcomes for cancer patients on chemotherapy. I believe that Germany in Israel are the two main bastions of research on CBD for cancer and psychiatric disorders.

You get into a paradoxical situation with THC as it was noted either here or in the other thread (I'm too lazy to bother looking) where stands of Cannabis that are absent of CBD but very high in THC have been indicated as having possible epigenetic effects on the development or onset of symptoms for people with psychotic/delusional disorders.

But I second your assertion. It would probably be nice to have either a dedicated thread or a sticky dedicated thread to the topic. It seems that there is no shortage of people who have information (accurate or not) to contribute. After some of my major projects for the semester I'll try and gather some peer-reviewed data to make a starting post if someone else hasn't already. It would be nice if we could eventually limit the conversation to peer-reviewed data, ethical considerations, and legal issues on the matter. I find it somewhat troublesome that people have been arguing with each other on this thread in ways that can basically be TL;DR'd to "Nuh uh," "Uh huh," accusation of fallacy, and little to no desire to bring the two points together to come to a reasonable conclusion about how one may take steps to solve the problem.

 

[JeyRo]

You brought up some obscure case where marijuana *supposedly* would save lives. But really, what we are talking about here most of the time is if people want to smoke pot illegally for recreation.

So if it comes down to "you know it when you see it" to you, I personally am not comfortable with the concept as it would apply to most laws. If you want to talk about ethics vs. law conflicts, fine - but even then you have the option of fighting the law as opposed to breaking it. But how in the world does using pot fit into a category like that?

You keep talking about fighting "within the system." I think that's a really quaint view, to put it mildly. A majority of Americans now support legalization of marijuana ENTIRELY, and a majority have supported the concept of medical marijuana for quite a long time. A majority of Americans are against all of these wars, believe it or not (although they're more soft about the existence of a standing army), and are for downsizing the military. The people in power really don't care that much what the majority thinks, and they certainly don't care about what the Constitution supposedly says. Look at how Obama has been ratcheting up the war on MMJ in the states? He's been out-Bushing George Bush on this one. He doesn't care what the people want, none of them do.

This is just the way I see it.

You may look at purely recreational drug use as "just recreational" and not worthy of defending (simply because some guys with guns are threatening them), just like unpopular or petty speech is more worthy of free speech protection, I think unpopular or petty behavior is more worthy of protection as well. Not that I actually think people's personal choice of how they recreate is "petty," it certainly isn't to them.

I like to fantasize (along with many others) that basically if every illegal drug user who was arrested in the next week went to court, and refused to take a plea deal, the War on Drugs and all of it's wanton death, destruction, and ruining of lives would grind to a complete halt then and there, and massive "in the system" changes would then follow. I can dream, I guess.

 

[Pragma]

You keep talking about fighting "within the system." I think that's a really quaint view, to put it mildly. A majority of Americans now support legalization of marijuana ENTIRELY, and a majority have supported the concept of medical marijuana for quite a long time. A majority of Americans are against all of these wars, believe it or not (although they're more soft about the existence of a standing army), and are for downsizing the military. The people in power really don't care that much what the majority thinks, and they certainly don't care about what the Constitution supposedly says. Look at how Obama has been ratcheting up the war on MMJ in the states? He's been out-Bushing George Bush on this one. He doesn't care what the people want, none of them do.

This is just the way I see it.

You may look at purely recreational drug use as "just recreational" and not worthy of defending (simply because some guys with guns are threatening them), just like unpopular or petty speech is more worthy of free speech protection, I think unpopular or petty behavior is more worthy of protection as well. Not that I actually think people's personal choice of how they recreate is "petty," it certainly isn't to them.

I like to fantasize (along with many others) that basically if every illegal drug user who was arrested in the next week went to court, and refused to take a plea deal, the War on Drugs and all of it's wanton death, destruction, and ruining of lives would grind to a complete halt then and there, and massive "in the system" changes would then follow. I can dream, I guess.

You bring up a much larger political picture here, and I've expressed my own concerns about the "war on drugs," but I don't view it as an all-or-nothing thing. I do think that substances should be regulated, and I am guessing you disagree with me there.

If enough people push legalizing drugs as an important issue, and if international research continues to mount supporting the use of these substances in medical care, stronger efforts to change policy can certainly follow. Your calling my view "quaint" is funny to me, because that is how I view libertarians. Lots of complaining, little creativity in actually getting their agenda moved forward. 🙄

But who has the time these days, anyways? I say that as someone who has happily voted for third party candidates over the years.

 

[Pragma]

Not necessarily all cancer, but a number of otherwise untreatable or treatment resistant types. One issue with this is that CBD can be separated from THC and other cannabinoids. This can allow for people to have the mood regulating effects (by leveling out brain activity), without the paranoia and cognitive impairments associated with THC. It is however ineffective at improving appetite, which is a key function in improving outcomes for cancer patients on chemotherapy. I believe that Germany in Israel are the two main bastions of research on CBD for cancer and psychiatric disorders.

What's the mechanism for "leveling out brain activity" and what exactly does that mean, anyhow? Just curious. I'll stay tuned for that other thread - have obviously wasted enough work productivity on this one already the past day or two.

 

[Pragma]

You may look at purely recreational drug use as "just recreational" and not worthy of defending (simply because some guys with guns are threatening them), just like unpopular or petty speech is more worthy of free speech protection, I think unpopular or petty behavior is more worthy of protection as well. Not that I actually think people's personal choice of how they recreate is "petty," it certainly isn't to them.

Given your views here, do you think that psychologists that decide, perhaps, to use cocaine or heroin on the weekends are also acting wtihin their "liberty"? I ask that because I wonder if your views shift at all depending on the drug we are talking about.

I've known some people that used cocaine and never let it become a "problem" in the sense that we usually consider substance abuse. Do you think there is more objective harm compared to marijuana? Or do you think it does not matter if psychologists use blow, inject heroin, or engage in other types of illegal drug use so long as they don't show up to therapy sessions high?

 

[MBellows]

What's the mechanism for "leveling out brain activity" and what exactly does that mean, anyhow? Just curious. I'll stay tuned for that other thread - have obviously wasted enough work productivity on this one already the past day or two.

Again, I'll try to address the neurological mechanics of this in detail in a dedicated post after I gather more data and recap with the researcher that I know who stays more up to date on the topic than I do. The short version to the best of my understanding is that it puts a sort of general floor and ceiling on brain activity in certain areas of the brain. As a treatment consideration I heard it theorized in my Drugs and Alcohol class that it could be useful in regulating polar spikes in either direction for people with bipolar spectrum disorders. One of the down sides is that like many psychopharm interventions it could limit higher level functions in the frontal/prefrontal areas leading to decreased executive functioning and higher level reasoning skills.

I think it would be a big stretch to call it a Miracle Drug, but perhaps a suitable alternative to treatments that have worse known side effects. I personally like the idea of having an anti-depressant that isn't known to cause suicidal ideation. Along that line of thinking, it is still a drug and I believe that it should be able to pass the same standards as other interventions before it is made available to the public for treatment of physical and mental disorders.

Recreational use is a social issue and I think that the APA/ACA/NASW and other professional bodies would do best to keep a mindset of public information and education on the dangers and possible benefits involved without getting into the legislation. Let the LP and NORML deal with legislation and advocacy in those regards.

 

[JeyRo]

Given your views here, do you think that psychologists that decide, perhaps, to use cocaine or heroin on the weekends are also acting wtihin their "liberty"? I ask that because I wonder if your views shift at all depending on the drug we are talking about.

My core views don't really change based on the substance in question.

I've known some people that used cocaine and never let it become a "problem" in the sense that we usually consider substance abuse. Do you think there is more objective harm compared to marijuana? Or do you think it does not matter if psychologists use blow, inject heroin, or engage in other types of illegal drug use so long as they don't show up to therapy sessions high?

I think I agree that one is putting oneself at greater risk for medical or psychological problems if one uses cocaine, heroin, alcohol ("hard" drugs) rather than something like marijuana - which can potentially affect one's ability to work effectively down the line.

 

[JeyRo]

Lots of complaining, little creativity in actually getting their agenda moved forward. 🙄

That's the Libertarian party, and they largely deserve that criticism. However, outside of the traditional political machinery there's a lot of creativity and innovation and activism going on in the liberty movement. The Ron Paul revolution (despite it's lack of formal success) is one such example, the Free State Project is another.

 

[Pragma]

I think it would be a big stretch to call it a Miracle Drug, but perhaps a suitable alternative to treatments that have worse known side effects. I personally like the idea of having an anti-depressant that isn't known to cause suicidal ideation. Along that line of thinking, it is still a drug and I believe that it should be able to pass the same standards as other interventions before it is made available to the public for treatment of physical and mental disorders.

It's a total aside, but I saw a talk a few years ago where they presented geographic data on suicide rates around the US after the black box warning came out for antidepressants. Interestingly, the warning seemed to coincide with reduced prescriptions and a spike in suicides around the country - suggesting the whole warning caused more harm than it did good.

I think it is interesting in the context of discussions like this, where I get the sense that people suggest illegal drugs might be superior to legal ones, when we politicize and demonize many drugs that do actually help a lot of people.

 

[Pragma]

My core views don't really change based on the substance in question.



I think I agree that one is putting oneself at greater risk for medical or psychological problems if one uses cocaine, heroin, alcohol ("hard" drugs) rather than something like marijuana - which can potentially affect one's ability to work effectively down the line.

Sure, but there are risks associated with marijuana use as well, even if they aren't as prominent as other substances. One could argue that alcohol use presents a very high risk - even moreso than stimulants like cocaine, for health complications. Which is why I asked you. So are you saying that you are okay with them doing it so long as they don't come to work impaired?

 

[MBellows]

It's a total aside, but I saw a talk a few years ago where they presented geographic data on suicide rates around the US after the black box warning came out for antidepressants. Interestingly, the warning seemed to coincide with reduced prescriptions and a spike in suicides around the country - suggesting the whole warning caused more harm than it did good.

I think it is interesting in the context of discussions like this, where I get the sense that people suggest illegal drugs might be superior to legal ones, when we politicize and demonize many drugs that do actually help a lot of people.

When a formal thread starts up, would you mind finding a source for that? I would be incredibly interested in seeing it, because I too wondered about the possible catastrophization of warning claims. I was speaking from more personal experience with anti-depressants.

As for the issue of legality, I think it's important to note that what is legal in some parts of the world is illegal in others an vice versa. I didn't mean to demonize traditional anti-depressants on the large scale. They do wonders for a couple of members of my extended family and I'm glad they have them. I also know a hand full of others that had extremely negative reactions to them.

That said, I would be interested to see in the future what the rates are of prescribing CBD based anti-psychotics/mood stabilizers/ant-depressants are compared to the more traditional alternatives. I think that, and correct me if I'm mistaken here, we can all come to a point of agreement that it would be nice to see more peer reviewed evidence on the subject and to ultimately, if a treatment is effective and safe, see it included in the standard of care when it comes to finding the right treatment for the right person.

 

[Therapist4Chnge]

I think I agree that one is putting oneself at greater risk for medical or psychological problems if one uses cocaine, heroin, alcohol ("hard" drugs) rather than something like marijuana - which can potentially affect one's ability to work effectively down the line.

"Harder drug" is very much a misnomer bc when you strip away cultural/social bias (drugs = illegal, bad...medications, legal, good) you are left with substances designed to cause a specific interaction/effect. Hard really has nothing to do with it. For example, the neurotoxicity of a given substance is an issue of chemistry not legalness. An overdose of acetaminophen will cause significant and possibly fatal organ damage, while an overdose on marijuana may lead to temporary psychosis or paranoia (at worst), but abstinence will return the person to their relative baseline.

The pharmacodynamics of alcohol ate far more impactful than many illegal substances. Of course, if I had my way everyone would be left to use/do whatever they'd like, but a few rounds of Darwinism and greater personal responsibility would be needed for the outcomes to not combine to be a complete societal train wreck.

 

[JeyRo]

Sure, but there are risks associated with marijuana use as well, even if they aren't as prominent as other substances.

I think you mean "aren't as significant" as other substances. There's no such thing as a risk-free activity, but marijuana use is easily the least harmful recreational substance I'm aware of by any objective measure.

One could argue that alcohol use presents a very high risk - even moreso than stimulants like cocaine, for health complications.

Absolutely agreed, although that's just speaking of "overall, objective harm." Most alcohol users seem to have no problem using alcohol in ways that seem to risk very little of their own health or the safety of others.

Which is why I asked you. So are you saying that you are okay with them doing it so long as they don't come to work impaired?

What do you mean by "okay"? Morally, aesthetically, legally, personally?

If I was a client working with a therapist and I somehow found out that my therapist was doing blow and crank on the weekends I wouldn't probably want them as my therapist - but it's really the fact that I would actually find this out about my therapist that would be potentially one of the biggest red flags for me. It speaks to loose boundaries and lack of decorum that are far more worrisome to me than whatever choice or recreation this person might be engaging in on their off-time, which I pretty strongly feel is none of my business as long as my therapist is otherwise attentive, thoughtful, insightful, skilled, experienced, well-trained, and responsible with my care.

If I found this out about my therapist somehow I certainly wouldn't want them arrested (obviously) or reported to licensing authorities necessarily, but they may get a carefully-worded but scathing Yelp review from me.

 

[Pragma]

What do you mean by "okay"? Morally, aesthetically, legally, personally?

If I was a client working with a therapist and I knew that my therapist was doing blow and crank on the weekends I wouldn't probably want them as my therapist - the fact that I would actually find this out about my therapist would be potentially one of the biggest red flags for me - it speaks to loose boundaries and lack of decorum that are far more worrisome to me than whatever choice or recreation this person might be engaging in on their off-time. It would be like if I found out somehow that my therapist liked to visit prostitutes and consumed internet porn, or other details about their private life.

Anyways, however, I obviously wouldn't want the therapist arrested and I also wouldn't even be particularly interested in seeing such a therapist necessarily be put out of business (however, they might get a scathing Yelp review from me).

Scathing yelp review....haha

I meant okay in terms of your professional opinion about personal conduct for psychologists. I made my opinion about this. It seems others have more of an open attitude about whether psychologists choose to use illegal drugs in their spare time.

 

[JeyRo]

"Harder drug" is very much a misnomer bc when you strip away cultural/social bias (drugs = illegal, bad...medications, legal, good) you are left with substances designed to cause a specific interaction/effect. Hard really has nothing to do with it. For example, the neurotoxicity of a given substance is an issue of chemistry not legalness. An overdose of acetaminophen will cause significant and possibly fatal organ damage, while an overdose on marijuana may lead to temporary psychosis or paranoia (at worst), but abstinence will return the person to their relative baseline.

The pharmacodynamics of alcohol ate far more impactful than many illegal substances. Of course, if I had my way everyone would be left to use/do whatever they'd like, but a few rounds of Darwinism and greater personal responsibility would be needed for the outcomes to not combine to be a complete societal train wreck.

Yeah, "hard" in quotes from me.... I grok you

 

[Pragma]

"Harder drug" is very much a misnomer bc when you strip away cultural/social bias (drugs = illegal, bad...medications, legal, good) you are left with substances designed to cause a specific interaction/effect. Hard really has nothing to do with it. For example, the neurotoxicity of a given substance is an issue of chemistry not legalness. An overdose of acetaminophen will cause significant and possibly fatal organ damage, while an overdose on marijuana may lead to temporary psychosis or paranoia (at worst), but abstinence will return the person to their relative baseline.

The pharmacodynamics of alcohol ate far more impactful than many illegal substances. Of course, if I had my way everyone would be left to use/do whatever they'd like, but a few rounds of Darwinism and greater personal responsibility would be needed for the outcomes to not combine to be a complete societal train wreck.

I knew a surgeon who would privately tell me how much they hated saving the lives of some people, presumably because he was preventing a round of Darwinism.

 

[JeyRo]

Scathing yelp review....haha

I meant okay in terms of your professional opinion about personal conduct for psychologists. I made my opinion about this. It seems others have more of an open attitude about whether psychologists choose to use illegal drugs in their spare time.

Yeah, honestly it really is OK with me. If such a psychologist was a friend of mine and they were using "hard" drugs regularly I would probably take them aside eventually and ask them if they've ever thought about the potential risks involved to their profession, personal freedom (e.g., legal consequences) or health, but I wouldn't tend to judge the quality or integrity of their professional work based on "off-duty" behavior. Honestly, that's exactly how I feel. Obviously you and I feel differently. Certainly an interesting difference of opinion.

 

[JeyRo]

I knew a surgeon who would privately tell me how much they hated saving the lives of some people, presumably because he was preventing a round of Darwinism.

I work in a VA medical setting and I tend to hear variations of that sentiment a lot. :-(

 

[Pragma]

Yeah, honestly it really is OK with me. If such a psychologist was a friend of mine and they were using "hard" drugs regularly I would probably take them aside eventually and ask them if they've ever thought about the potential risks involved to their profession, personal freedom (e.g., legal consequences) or health, but I wouldn't tend to judge the quality or integrity of their professional work based on "off-duty" behavior. Honestly, that's exactly how I feel. Obviously you and I feel differently. Certainly an interesting difference of opinion.

I respect the difference in opinion. But clearly there is some reason to take them aside in the way you describe. I think we interpret that reason differently. I see it as poor judgment and inappropriate risk taking.

Hopefully it is an irrelevant opinion. I haven't encountered any psychologists doing lines yet...although I certainly have wondered once or twice in the past.

 

[Pragma]

"Harder drug" is very much a misnomer bc when you strip away cultural/social bias (drugs = illegal, bad...medications, legal, good) you are left with substances designed to cause a specific interaction/effect. Hard really has nothing to do with it. For example, the neurotoxicity of a given substance is an issue of chemistry not legalness. An overdose of acetaminophen will cause significant and possibly fatal organ damage, while an overdose on marijuana may lead to temporary psychosis or paranoia (at worst), but abstinence will return the person to their relative baseline.

The pharmacodynamics of alcohol ate far more impactful than many illegal substances. Of course, if I had my way everyone would be left to use/do whatever they'd like, but a few rounds of Darwinism and greater personal responsibility would be needed for the outcomes to not combine to be a complete societal train wreck.

If we were starting a society from scratch, I'd probably agree with you. But the complete societal trainwreck you are talking about is, to me, a good reason for regulating substances. Even if druugs were legalized, at least tighter production standards and standards for safe use would be more clearly established.

It is one of those interesting areas for health professionals. You could believe in one thing politically....but at the same time be charged with trying to promote health. But maybe we'll get a new movement of Darwinistic physicians who just let people die if they aren't responsible?

 

[JeyRo]

I respect the difference in opinion. But clearly there is some reason to take them aside in the way you describe. I think we interpret that reason differently. I see it as poor judgment and inappropriate risk taking.

Hopefully it is an irrelevant opinion. I haven't encountered any psychologists doing lines yet...although I certainly have wondered once or twice in the past.

If you go by the numbers, it is likely an overwhelmingly "irrelevant" opinion as marijuana is by far the most commonly used illegal drug, where overwhelmingly the consequences of use are almost singularly manufactured in the form of legal oppression. I can see regular use of heroin or cocaine as being destructive, potentially, to a person's profession as a psychologist or otherwise, but it's a largely self-regulating situation, eventually you'll miss too many days at work, come wasted to a session or two and scare off all of your clients, get fired, etc.

Cannabis use is an entirely different proposition - I see no reason why someone can't be a regular (even daily) user and hold responsible positions in society (in fact, I know people do).

Which hopefully brings us back full circle to the question of drug testing for VA employees. What a waste of time and money, so pointless.

 

[Therapist4Chnge]

It's a total aside, but I saw a talk a few years ago where they presented geographic data on suicide rates around the US after the black box warning came out for antidepressants. Interestingly, the warning seemed to coincide with reduced prescriptions and a spike in suicides around the country - suggesting the whole warning caused more harm than it did good.

My own soap box..

The entire BBW for SSRIs was a mini-fiasco, though at the time the FDA was trying to "protect" the general public. The original data cited for the warning came from a study that was far from solid in regard to actual clinical implications of adolescents using an SSRI. IIRC the researchers found ~2x increase in the rate of reported suicidal ideations (not attempts or completions). While this was statistically significant, the rate of reported ideations for placebo were ~2% and those using SSRIs was ~4%. Again, there were no documented attempts or completions, so drawing a line from use to suicide risk was shaky at best. More frustrating was that the reaction to the BBW was a decrease in actual SSRI use, so those who may have benefitted from an SSRI were not put on them. I am not a big supporter of the rampant use of SSRIs as a first line response to all levels of depression related Sx's, but in the more severe cases I wonder how many may have benefitted from a trial on them, but they were not given the option because of fear related to the BBW.

This is from memory from a presentation I saw 7-8 years ago, so if my numbers are slightly off, sorry. 1.8% and 3.6% stick out as the figures (of an early European study I think), but they are in the same ballpark.

I think it is interesting in the context of discussions like this, where I get the sense that people suggest illegal drugs might be superior to legal ones, when we politicize and demonize many drugs that do actually help a lot of people.

I'm not sure if there have been double-blind studies done on the use of marinol v. Medical marijuana v. a trad. Anti-emetic, but anecdotally I have seen a number of my patients tolerate medicinal marijuana better than any synthetic or trad. anti-emetic available to them following chemo Tx. I have also seen positive results in regard to chronic pain (neuropathic and muscular skeletal) management. Yes there may be some cog effects, but compared to the effects from multiple doses of morphine or methadone, the effects were less. Orientation was also improved from what i observd, but still impaired compared to patients i saw not on pain meds and/or actively using medicinal marijuana. More importantly (at least to patients i saw with SCI injuries), issues with opioid-related constipation appeared less, based on patient report of symptom presentation.

I have also seen anectdotal evidence of positive response to use of medicinal marijuana for stimulation of appetite following chemo and radiation. I'm not a physician nor a licensed prescribing provider, so I never commented on use (it was also against hospital policy to endorse medicinal marijuana use, even though it was legal in the state), but the many positive outcomesi observed were enough for me to view medicinal marijuana use for specific symptoms to be worthy of further scientific study. I do want to note that I am very skeptical of medicinal marijuana use for most psychiatric dx's...but I do not see those populations, so I'll defer to others that do work with them.

 

[Therapist4Chnge]

I knew a surgeon who would privately tell me how much they hated saving the lives of some people, presumably because he was preventing a round of Darwinism.

Some of the best conversations I've had about the implications of DNR and "extraordinary measures" have been with physicians who are personally not supportive of DNR for themselves....most do/did trauma work.

 

[Therapist4Chnge]

If people are interested in the BBW for SSRI use/suicide risk stuff.....start a new thread and I can dig up the references I picked up during my Pharma training about it. There was a great poster I saw (not sure it ever got published) about increases in suicide attempts in the months following the BBW. I believe a group of clinical & research pharmacists did the initial work.

 

[Pragma]

My own soap box..

The entire BBW for SSRIs was a mini-fiasco, though at the time the FDA was trying to "protect" the general public. The original data cited for the warning came from a study that was far from solid in regard to actual clinical implications of adolescents using an SSRI. IIRC the researchers found ~2x increase in the rate of reported suicidal ideations (not attempts or completions). While this was statistically significant, the rate of reported ideations for placebo were ~2% and those using SSRIs was ~4%. Again, there were no documented attempts or completions, so drawing a line from use to suicide risk was shaky at best. More frustrating was that the reaction to the BBW was a decrease in actual SSRI use, so those who may have benefitted from an SSRI were not put on them. I am not a big supporter of the rampant use of SSRIs as a first line response to all levels of depression related Sx's, but in the more severe cases I wonder how many may have benefitted from a trial on them, but they were not given the option because of fear related to the BBW.

This is from memory from a presentation I saw 7-8 years ago, so if my numbers are slightly off, sorry. 1.8% and 3.6% stick out as the figures (of an early European study I think), but they are in the same ballpark.

Sounds like you and I may have seen some similar data presented. It was awhile ago for me too - but probably more like 4-5 years ago.

I'm not sure if there have been double-blind studies done on the use of marinol v. Medical marijuana v. a trad. Anti-emetic, but anecdotally I have seen a number of my patients tolerate medicinal marijuana better than any synthetic or trad. anti-emetic available to them following chemo Tx. I have also seen positive results in regard to chronic pain (neuropathic and muscular skeletal) management. Yes there may be some cog effects, but compared to the effects from multiple doses of morphine or methadone, the effects were less. Orientation was also improved from what i observd, but still impaired compared to patients i saw not on pain meds and/or actively using medicinal marijuana. More importantly (at least to patients i saw with SCI injuries), issues with opioid-related constipation appeared less, based on patient report of symptom presentation.

I have also seen anectdotal evidence of positive response to use of medicinal marijuana for stimulation of appetite following chemo and radiation. I'm not a physician nor a licensed prescribing provider, so I never commented on use (it was also against hospital policy to endorse medicinal marijuana use, even though it was legal in the state), but the many positive outcomesi observed were enough for me to view medicinal marijuana use for specific symptoms to be worthy of further scientific study. I do want to note that I am very skeptical of medicinal marijuana use for most psychiatric dx's...but I do not see those populations, so I'll defer to others that do work with them.

I certainly am not against researching the effectiveness of medical marijuana and authorizing its use for certain conditions. I agree - suggestions that it is good for psychiatric diagnoses make me skeptical.

I am glad that you mentioned cognitive effects of marijuana. Even though they're not permanent as far as we can tell, they can persist for days at a time.

 

[JeyRo]

Sounds like you and I may have seen some similar data presented. It was awhile ago for me too - but probably more like 4-5 years ago.




I certainly am not against researching the effectiveness of medical marijuana and authorizing its use for certain conditions. I agree - suggestions that it is good for psychiatric diagnoses make me skeptical.

I am glad that you mentioned cognitive effects of marijuana. Even though they're not permanent as far as we can tell, they can persist for days at a time.

Is this in line with what you guys are referring to?

http://www.nature.com/npp/journal/v25/n5/full/1395716a.html

Makes sense to me.....

Not to make an argument for demonizing alcohol, but it's pretty common knowledge that after tying one on with alcohol (which any number of psychologists are known to do from time to time) cognitive effects can also persist for days at a time, and I'd venture they are far more significant than those experienced by marijuana users. Cognitive changes (profound ones) as a result of alcohol use can be permanent, as we all know.

It's one thing to show cognitive changes that result from cannabis use, and I'm willing to accept that they may persist for a few days after use (e.g., active metabolites, makes sense) but establishing clinical or practical significance of such a thing is a far different animal than establishing statistical significance in a laboratory setting....

 

[JeyRo]

I certainly am not against researching the effectiveness of medical marijuana and authorizing its use for certain conditions. I agree - suggestions that it is good for psychiatric diagnoses make me skeptical.

NIDA and the DEA aren't going to be approving research like that anytime soon, I imagine, as they are the only approved source of marijuana.

Second, isn't that our traditional stance as psychologists, to be skeptical of pharmacological interventions in general? Often my non psychologist colleagues here at the hospital I work at are suprised when I express open-mindedness towards use of medications with our dementia patients - they seem to have this idea that I should have a knee-jerk bias against pharmacology, apparently this is also seen as a role psychologists are supposed to take.

 

[Pragma]

Is this in line with what you guys are referring to?

http://www.nature.com/npp/journal/v25/n5/full/1395716a.html

Makes sense to me.....

Not to make an argument for demonizing alcohol, but it's pretty common knowledge that after tying one on with alcohol (which any number of psychologists are known to do from time to time) cognitive effects can also persist for days at a time, and I'd venture they are far more significant than those experienced by marijuana users. Cognitive changes (profound ones) as a result of alcohol use can be permanent, as we all know.

It's one thing to show cognitive changes that result from cannabis use, and I'm willing to accept that they may persist for a few days after use (e.g., active metabolites, makes sense) but establishing clinical or practical significance of such a thing is a far different animal than establishing statistical significance in a laboratory setting....

If someone shows up to work hungover, I think it is fair to say their concentration is probably not going to be adequate for doing therapy either. Not to mention their clients might smell it on them.

All I am saying is that marijuana also has cognitive effects on learning and memory. Let's not pretend they are candy cigarettes here - and many people do experience problems due to marijuana use.

Edit: I'm really interested in hearing from anyone involved in assessing for substance abuse among psychologists. I recall (can't remember if I heard it on SDN or somewhere else) that it was not an uncommon reason for assessment. I'd imagine they are initiated via complaints to a licensing board or from the institution that the psychologist works at (maybe due to poor performance or patient complaints?). But I'd assume they also could be initiated after a psychologist gets into legal trouble, fails a drug test, etc. Anyone have data or familiarity with the topic to share? I wonder what the typical reason for inquiry is.

 

[Pragma]

NIDA and the DEA aren't going to be approving research like that anytime soon, I imagine, as they are the only approved source of marijuana.

Second, isn't that our traditional stance as psychologists, to be skeptical of pharmacological interventions in general? Often my non psychologist colleagues here at the hospital I work at are suprised when I express open-mindedness towards use of medications with our dementia patients - they seem to have this idea that I should have a knee-jerk bias against pharmacology, apparently this is also seen as a role psychologists are supposed to take.

I was trained to integrate approaches. Many folks aren't interested in medications at all, and many are interested in medications. For those that are, why not if it augments other forms of treatment? There are extremists on the other side of that debate as well.

That said, let's not pretend there isn't a tendency to pass out medications like it's Halloween these days.

 

[JeyRo]

If someone shows up to work hungover, I think it is fair to say their concentration is probably not going to be adequate for doing therapy either. Not to mention their clients might smell it on them.

All I am saying is that marijuana also has cognitive effects on learning and memory.

Sure, but again, what's the practical significance of such an observation?

Let's not pretend they are candy cigarettes here - and many people do experience problems due to marijuana use.

Would you say it's accurate to characterize getting arrested for pot possession as a problem "due to marijuana use"? What are other problems you'd say are typical for marijuana users that are of clinical significance?

I confess I'm not a substance abuse researcher or clinician (not that I'd ever be interested at all in working the field), so I can't say I'm up on things maybe in the way I should be - but I'm definitely interested in this issue, obviously.

Edit: I'm really interested in hearing from anyone involved in assessing for substance abuse among psychologists. I recall (can't remember if I heard it on SDN or somewhere else) that it was not an uncommon reason for assessment. I'd imagine they are initiated via complaints to a licensing board or from the institution that the psychologist works at (maybe due to poor performance or patient complaints?). But I'd assume they also could be initiated after a psychologist gets into legal trouble, fails a drug test, etc. Anyone have data or familiarity with the topic to share? I wonder what the typical reason for inquiry is.

That would definitely be an interesting angle. I would say that just focusing on situations where psychologists are brought to the attention of authorities (licensing boards, etc) probably would be a pretty biased sample. Anonymous surveys would be another route with potentially less bias....

 

[Pragma]

Sure, but again, what's the practical significance of such an observation?

That it isn't necessarily harmless, like you keep implying.

Would you say it's accurate to characterize getting arrested for pot possession as a problem "due to marijuana use"? What are other problems you'd say are typical for marijuana users that are of clinical significance?

I confess I'm not a substance abuse researcher or clinician (not that I'd ever be interested at all in working the field), so I can't say I'm up on things maybe in the way I should be - but I'm definitely interested in this issue, obviously.

Most researchers will admit that the public health issues related to marijuana use are not as severe as they are for other drugs. But there are studies documenting other psychosocial problems (and no, the only problem is not getting arrested for possession).

Here's a couple:

http://www.ncbi.nlm.nih.gov/pubmed/18482420

http://www.ncbi.nlm.nih.gov/pubmed/14672250

You'll also see studies documenting impaired cognition, although often that resolves (much like it often does in the case of other substances), increased MVAs, and some of the additional health issues you might expect with chronic use.

The other thing that I've commonly seen is how cannabis use usually exacerbates psychiatric problems (or predicts poorer treatment prognosis). I know less about it's role in the development of psychiatric conditions, but there appears to be a literature on that topic as well.

I've seen plenty of folks that use marijuana daily and struggle with a lot of psychosocial variables. While I can't say it's all due to the pot, it's pretty clear it plays a significant role. So while I acknowledge that lots of people may use it occasionally without consequences, I have also seen people struggle significantly. To hear the drug be dismissed as harmless so flippantly is a bit disturbing, especially coming from a psychologist.

That would definitely be an interesting angle. I would say that just focusing on situations where psychologists are brought to the attention of authorities (licensing boards, etc) probably would be a pretty biased sample. Anonymous surveys would be another route with potentially less bias....

Oh sure - I just am interested if anyone on here actually has experience with those evals.

 

[JeyRo]

That it isn't necessarily harmless, like you keep implying.

I think I've actually explicitly acknowledged several times in this discussion that I don't think marijuana use is harmless. However, I also don't assume that the risks involved in smoking marijuana are particularly significant, because that's not what the data seem to suggest to me.

Most researchers will admit that the public health issues related to marijuana use are not as severe as they are for other drugs. But there are studies documenting other psychosocial problems (and no, the only problem is not getting arrested for possession).

Here's a couple:

http://www.ncbi.nlm.nih.gov/pubmed/18482420

http://www.ncbi.nlm.nih.gov/pubmed/14672250

You'll also see studies documenting impaired cognition, although often that resolves (much like it often does in the case of other substances),

The literature you grabbed above seems a bit like a retread of the "amotivational syndrome" literature from the 60s - and this kind of study design seems ripe for alternative (sociological) explanations.

I'm willing to believe cannabis use results in cognitive changes, however, I, like you, tend to believe the effects are reversible upon cessation. Any lingering effects are due to the presence of active metabolites and is likely of limited practical significance for most people.

increased MVAs,

I'm skeptical, particularly as regards experienced users. I'm aware of more than a few behind-the-wheel studies done in other countries (I recall I DMV study done in Australia I believe) that found cannabis using drivers were generally no less safe than sober drivers.

and some of the additional health issues you might expect with chronic use.

What might someone "expect"? Abject violence? Chromosomal damage? Amotivational syndrome? Inevitable heroin use? Head and neck tumors? I'm not being flippant here, there's so much historical misinformation and hysteria about cannabis use and it's effects that it's hard to exactly know what to "expect" as a health effect of marijuana use.

The other thing that I've commonly seen is how cannabis use usually exacerbates psychiatric problems (or predicts poorer treatment prognosis). I know less about it's role in the development of psychiatric conditions, but there appears to be a literature on that topic as well.

I'm less skeptical about this line of thinking. Cannabis use is definitely something I would openly caution someone against if they are suffering from (EDIT: or had a history of) certain psychiatric disorders, particularly schizophrenia spectrum stuff. I think there's definitely a pretty good consensus about that.

I've seen plenty of folks that use marijuana daily and struggle with a lot of psychosocial variables. While I can't say it's all due to the pot, it's pretty clear it plays a significant role. So while I acknowledge that lots of people may use it occasionally without consequences, I have also seen people struggle significantly.

I've seen people have difficult lives and use marijuana, and I've seen people lead successful lives and use marijuana. I've heard marijuana blamed for poor outcomes in people's lives, I've also heard people attribute their personal and professional successes to marijuana use. I'm not personally swayed much either way.

To hear the drug be dismissed as harmless so flippantly is a bit disturbing, especially coming from a psychologist.

You must be confusing me with someone else. Please let me know where I dismissed marijuana use as "harmless" or where I was flippant about this subject.

For my part, I find the flippant or dismissive attitude many take towards the legalized repression of peaceful citizens disturbing as well (e.g., the drug war), from psychologists and others.

I think I'd be more amenable to talking amiably about the supposed harms of marijuana use to people's health and livelihood if people's lives weren't being regularly ruined by the legalized repression of peaceful drug users in ways that far outstrip the possible harm one could expect from use of marijuana. One is a far more pressing and serious issue than the other.

Oh sure - I just am interested if anyone on here actually has experience with those evals.

 

[Pragma]

Jeyro, we are talking about multiple topics here. You seem to minimize harm, and said you don't have much exposure to this population.

There are plenty of critiques to studies like the ones I linked quickly. Unfortunately, life doesn't occur in a vacuum and there are other contributing factors to psychosocial problems, certainly. But it seems silly to me to dismiss the notion that it can contribute to problems in relationships, occupations, etc.

If you ever worked with someone who quit smoking pot and saw other areas of their life begin to improve, would you consider that stopping the pot might have helped? Marijuana can contribute to "difficult lives" - although sure, perhaps it is more of a symptom for some people.

I've acknowledged that many people use with no apparent problem. It seems impractical to ignore that it may play a role in problems for others. I could see how "blaming" the use could be a form of avoiding for some people as well.

What kinds of harm could you see, reasonably, that may be partly due to using?

If the acute cognitive changes don't convince you that driving is a bad idea, I'll have to look up some material another day. As for health risks...there is heightened risk for respiratory illnesses, although I know some research says casual use isn't a problem. I think the jury is still out about cancer...marijuana smoke supposedly has more carcinogens. Acute cardiovascular changes run some risk, especially for people with preexisting cardio conditions. I am not familiar with the prescribed versions, but would assume those eliminate some of the risks.

Illegal drug laws and their enforcement are definitely a big issue in this country. But I didn't think we were debating drug legalization. That is a different can of worms.

 

[Pragma]

You know, I thought I had a crystal ball at one point that helped me to determine cause and effect definitively for complex psychosocial phenomena. But I am pretty sure the federal government took it away from me 😉

 

[JeyRo]

Jeyro, we are talking about multiple topics here. You seem to minimize harm, and said you don't have much exposure to this population.

There are plenty of critiques to studies like the ones I linked quickly. Unfortunately, life doesn't occur in a vacuum and there are other contributing factors to psychosocial problems, certainly. But it seems silly to me to dismiss the notion that it can contribute to problems in relationships, occupations, etc.

If you ever worked with someone who quit smoking pot and saw other areas of their life begin to improve, would you consider that stopping the pot might have helped? Marijuana can contribute to "difficult lives" - although sure, perhaps it is more of a symptom for some people.

I've acknowledged that many people use with no apparent problem. It seems impractical to ignore that it may play a role in problems for others. I could see how "blaming" the use could be a form of avoiding for some people as well.

What kinds of harm could you see, reasonably, that may be partly due to using?

If the acute cognitive changes don't convince you that driving is a bad idea, I'll have to look up some material another day. As for health risks...there is heightened risk for respiratory illnesses, although I know some research says casual use isn't a problem. I think the jury is still out about cancer...marijuana smoke supposedly has more carcinogens. Acute cardiovascular changes run some risk, especially for people with preexisting cardio conditions. I am not familiar with the prescribed versions, but would assume those eliminate some of the risks.

Illegal drug laws and their enforcement are definitely a big issue in this country. But I didn't think we were debating drug legalization. That is a different can of worms.

Well, the relative objective risk of various illegal drugs really doesn't seem that relevant either.

As an aside, though, I wouldn't advise anyone driving impaired, or sleep deprived, or whatever.

 

[Pragma]

Well, the relative objective risk of various illegal drugs really doesn't seem that relevant either.

As an aside, though, I wouldn't advise anyone driving impaired, or sleep deprived, or whatever.

I would agree with you. Personally, I believe that irresponsible driving (under the influence, overtired, etc) is one of the most disgusting abuses of "liberty" out there. It is too bad that crashes often involve innocent, personally responsible people, because otherwise they might constitute an effective dose of Darwinism.

Here's an interesting, recent review.

Http://www.bmj.com/content/344/bmj.e536

 

[erg923]

http://www.pnas.org/content/109/40/E2657.abstract

 

[JeyRo]

http://www.pnas.org/content/109/40/E2657.abstract

This is the thing - by what mechanism is a "neurotoxic" effect supposedly exerting itself in cannabis users? Keep in mind the active ingredient in cannabis apparently has a lethal to effective dose ratio of somewhere around 40K (compared to alcohol which I believe is about 8)..... "toxicity" is synonymous with "poisonous".... so what, exactly, is the poisonous compound implicated in cannabis? Has any of this been replicated with animal models under laboratory conditions?

I would venture we're getting a bit afield from the more germaine subject of this thread, which is whether psychologists should be considered to be breaching professional ethics by choosing to use marijuana (and thereby break the law) in their off-time.

 

[anotherconstruc]

You know, I thought I had a crystal ball at one point that helped me to determine cause and effect definitively for complex psychosocial phenomena. But I am pretty sure the federal government took it away from me 😉

Crystal balls for complex psychosocial phenomena are hard to come by as it is. Try inserting an amorphous substance into the mix. It seems to me that to discuss marijuana is to risk the old Tower of Babel effect. There are as many strains as there are cultures. Oddly enough, the primary effect of these strains correlate with the psychology of the people they grow around.Think of temperament, music, dress, food, rituals, etc. Carl Sagan called cannabis a camp follower to denote a mutually beneficial symbiotic evolution.

What clients describe to me as their desired effect sounds like some herbal Xanax or opiate. This corresponds to strains bred for higher THC content in Indica dominant strains. You read all these "brand names" and people think if they smoked a plant labeled "Frankenberry" or "Little Green Man" and had a nice reaction, they should expect to repeat that the next time they smoke something with the same name. Unfortunately, marijuana is not a drug in the sense that it is an isolated and standardized active ingredient. It's not even a drug in the sense that cocaine, alcohol or heroin are. Sativa is a whole different animal than indica and strikindg differences are found even beyond genus: all the way down to myriad phenotypes within a strain.

In order to pass FDA approval, a company has to isolate a compound to ensure safety and effectiveness. In the case of cannabis, however, it appears that synergistic action modifies untoward effects when individual cannabinoids get out of balance. It would seem to be the epitome of common sense to assume that inhaling burnt plant matter can't be good for your lungs. Yet a pulmonologist at UCLA received NIDA funding for 30 years to prove the harmful effects of smoking cannabis. In 2007 he granted interviews and said that pot smokers had lower rates of cancer than cigarette smokers and non-smokers alike. There must be some pretty strong protection somewhere in that stuff.

Project CBD is a good site for reviewing research on anxiety disorders and PTSD.

 

[IT514]

This is the thing - by what mechanism is a "neurotoxic" effect supposedly exerting itself in cannabis users? Keep in mind the active ingredient in cannabis apparently has a lethal to effective dose ratio of somewhere around 40K (compared to alcohol which I believe is about 8)..... "toxicity" is synonymous with "poisonous".... so what, exactly, is the poisonous compound implicated in cannabis? Has any of this been replicated with animal models under laboratory conditions?

I would venture we're getting a bit afield from the more germaine subject of this thread, which is whether psychologists should be considered to be breaching professional ethics by choosing to use marijuana (and thereby break the law) in their off-time.

Um, vascular mechanisms?

I think the choice to use marijuana, to a degree, threatens one's ability to retain a sharp mind over time. This is pretty clear in the lit and I believe its relevant to the topic at hand.