An Ontario Physician’s Concern about Marijuana

On January 22, 2018, Canada’s public broadcaster (the Canadian Broadcasting Corporation) on their program “The Current” with host Anna Maria Tremonti featured an interview with Dr. Brian Hart, an Ontario family physician who has significant concerns about marijuana, especially for young people under age twenty-five.

Here is the audio excerpt:

And the transcript:

AMT: You’re listening to The Current on CBC Radio One and Sirius XM. I’m Anna Maria Tremonti. Last week on The Current we looked into the coming legalization of recreational marijuana, and the concerns about its safety and contamination. Medical marijuana users have reported concerns. And I spoke with Dan Clarke who tests medical marijuana at A&L laboratories in London, Ontario.

SOUNDCLIP

DAN CLARKE: It is a concern. We talk about medical cannabis. It is a pharmaceutical that needs to be regulated and make sure the industry is providing a very safe product to the client.

AMT: Well the discussion generated a lot of interest from listeners, including from Dr. Brian Hart, who said contamination is not the only thing people should be concerned about. He wrote to us in part: “I am a family physician and deal with the side effects of marijuana in my practice every day. Believe me, they’re serious—but not due to pesticides—rather the drug! Marijuana is NOT benign. When an 18-year-old comes into my clinic with anxiety and a 35-pound weight loss, I put my pen down and ask how much he’s smoking. I have yet to be wrong.” Dr. Brian Hart practices in Gananoque, Ontario. That’s where we’ve reached him now. Hello.

DR. BRIAN HART: Good morning Anna Maria. Thanks for including me in the conversation.

AMT: First of all, how often do you get requests for prescriptions for medical marijuana?

DR. BRIAN HART: I would say probably, increasing frequency, but probably two to three times per week.

AMT: And what do your patients want it for?

DR. BRIAN HART: I would say there are two types of patients. A lot of patients that come in are already using it. Some of them may have cannabis use disorder. Some of them may be looking to switch from a drug that they don’t want to be on like alcohol over to marijuana. And these would be inappropriate referrals. The other type of patient are the patients that actually have really serious medical issues. Those that have essential tremor that we haven’t been able to control. People that have M.S. fatigue. People that have the indications that traditionally medical marijuana has been indicated for.

AMT: And do you not prescribe it at all then? Even in a case like that.

DR. BRIAN HART: Well it’s really difficult in that—so usually when medications come to market they come to market with a proven efficacy. There are studies that are done that show that it work. And we know that it works in a certain percentage of people. And we know what to expect in terms of short-term side effects. With medical marijuana it’s come to market and then we’re trying to find what it works for. And we really don’t have the appropriate studies to show the short and certainly not the long-term side effects. But in people that have exhausted everything else, so people that come in with severe essential tremor or with multiple sclerosis related spasms, I have no trouble referring them along to be counselled and receive medical marijuana as long as they go into it eyes open. But it is a third or fourth line intervention. It’s not a first line.

AMT: And where do you send them?

DR. BRIAN HART: Well in Kingston there’s three or four different marijuana referral centres. And I think these folks have doctors and they do interviews and then they’ll prescribe it. So when you say I don’t prescribe it, so my brother is a lawyer and he says there’s a term have done or cause to have done, and I know that if I refer them they will 100 percent of the time receive the medication and receive the drug.

AMT: And is that a problem in your mind that if they’re referred to some other clinic they’ll get it automatically or usually.

DR. BRIAN HART: Yeah, you interviewed Rosy Mondin last week and you wondered why pesticides that shouldn’t be in the marijuana were there, and she referred to it as a bit of the Wild West. And when it first started I saw everybody that went was given medical marijuana. And we do know with medical marijuana there are some absolute contraindications. For example anyone under 25 should not receive medical marijuana. Anyone with a marijuana use disorder should not be prescribed marijuana. Anybody with significant anxiety or an untreated psychiatric illness should not receive medical marijuana. And I have seen numerous cases where these people have been given the drug without much follow up or supervision.

AMT: And this goes back to your first point which is that normally if a drug comes on the market it’s been clinically tested. We know a lot more about it and we’re going by anecdotal now.

DR. BRIAN HART: Oh absolutely. And please don’t get me wrong. I go to work every day trying to help my patients. And the issue is if marijuana is proven to be a benefit I’m going to be the first one to prescribe it. And if we’ve run out of everything else and there’s a hint that it may be a benefit I will help my patients receive it. But the trouble is I do radio interviews, I guess what once every 53 years, so I Googled performance anxiety. And if you actually look at Health Canada, medical marijuana one of the indications is performance anxiety. And if you actually look at this study, 23 people were given synthetic THC before doing a simulated performance and 95 percent reported that they felt better about the performance afterwards. That’s not a study. That’s hearsay. I would argue that if I had put a little scotch in my coffee this morning I might feel a little less nervous right now.

AMT: You sound just fine Brian Hart [laughs].

DR. BRIAN HART: [Laughs].

AMT: But I want to ask you about that because you also said you wouldn’t prescribe to someone under the age of 25. Why not?

DR. BRIAN HART: I think you may have had articles on before, but the brain is under construction really until age 25 and the younger you are the more harm marijuana can do. And it can be permanent. And I see it in my clinic. My real concern is that this is an epidemic among high school students and I often see young man in particular coming in and they’re suffering from tremendous anxiety and weight loss and anorexia. And this was a bit of a learning curve for me. I mean remember back in the 80s if anyone bought marijuan, the next stop was the grocery store for Doritos. You would expect weight gain and apathy. But you’re experiencing significant anxiety and weight loss. The issue is that under 25 these folks are most susceptible to that. And there is some evidence that it can decrease long term IQ and have permanent bad effects.

AMT: You raise many questions that we in the media need to follow up on. Thank you for your letter to us and for speaking to me today.

DR. BRIAN HART: Thank you very much. It was a pleasure.

AMT: Bye bye. That is Dr. Brian Hart. He’s a family physician in Gananoque, Ontario. That’s our program for today.

Hiding in the Shadows

You are the light of the world. A city set on a hill cannot be hidden. Nor do people light a lamp and put it under a basket, but on a stand, and it gives light to all in the house. In the same way, let your light shine before others, so that they may see your good works and give glory to your Father who is in heaven. (Matthew 5:14-16; ESV)

The Great Showman Theatrical PosterI was doing my fatherly duty to my sixteen-year-old daughter during the holidays by taking her to see the movie “The Greatest Showman,” a musical based on the life of P.T. Barnum. Some time before, I had seen enough of the trailer to know I wasn’t interested. One of my older daughters told me she liked it, but didn’t say much else, except the music was contemporary, which I thought was pretty strange given that the story takes place in the mid-19th century. Strange or not, a dad’s gotta do what a dad’s gotta do; so off to the movie we went.

I am not sure when it happened – it may have been during the third musical number (“Come Alive”) – I began to see the special something of this film. By the time it was over, I concluded I had just witnessed a leap in the evolution of movie entertainment for the 21st century. The makers of “The Greatest Showman” had accomplished the convergence of compelling story-telling and superb talent as expressed via extraordinary songs and choreography, all the while upholding family values, in such a way so as to instill hope and joy in the audience. And they did it at a time that may be the most cynical in all of history.

Regarded as the movie’s anthem, “This Is Me,” recently won the best original song at the Golden Globe Awards. It captures the fundamental theme of the film, which on the surface may be taken as the overdone “follow your dreams.” While the movie is laced with a good dose of the typical “you can be whatever you want to be as long as you want it badly enough,” it goes much deeper than that. It reaches out to the hearts of those who, for one reason or another, don’t allow themselves to have dreams in the first place.

There are two levels of human oppression. The first is typified by the people of Israel in bondage in Egypt. Trapped against their will, they hold on to the great promises of the past as they cry out to their God for deliverance. In no way should we diminish the difficulty of such a state. Yet the second level of oppression is a lot worse. This is when we either do not know we are oppressed or if we do, we simply accept it. The power of this second level of oppression is chiefly derived from self. Without our cooperation, there would be hope for change. But hope can be too painful. It is a lot easier simply to accept our plight as it is, thinking we are making the best of an impossible situation.

Surprisingly, the second level isn’t often realized until sometime after being rescued from the first. We see this in Israel after the exodus. It isn’t until the people face the challenges of freedom that the depths of their internal oppression become clear. Even though they are no longer slaves to Pharaoh, it is evident they are still entrapped in their own fear and faithlessness. Unable to rise up to their high calling in God, they eventually yearn to return to their house of bondage in Egypt, where they feel more at home.

How many Yeshua followers experience something similar? Our initial encounter with the Lord is glorious as we discover freedom and a power to live beyond our wildest dreams. But it isn’t too long before “reality” sets in and we begin to wrestle with the specters of the past, not to mention new challenges and problems we never had before. That’s when we, like Israel of old, are tempted to return to our old predictable lives, preferring our former taskmasters to the scary unknown that’s ahead.

“This Is Me” is the refusal to give into that temptation. It is a call to embrace the reality of who we really are and not give in to the manipulative deception of shame designed to push us back into the shadows of disengagement. Having tasted freedom; we will not be enslaved again.

Reflecting on this song from a biblical perspective demands at least a couple of considerations. First, I am aware the film and this song in particular is being framed by many as a celebration of “diversity,” which in our day has come to take on a technical meaning in society, especially in relationship to individuals who embrace certain lifestyle choices. Tragically, more and more people regard all forms of shame as oppressive as if morality itself is the problem needing to be eradicated. But while there may be a tendency to leverage “The Greatest Showman” in this way, that’s a metaphorical stretch. The coming out of circus “freaks” Barnum provides is not a green light for the pursuit of unrestricted human desire, but a true celebration of the humanity intrinsic in the image of God embedded in all of us.

The second consideration is of particular concern to me personally. I understand the power of shame calling me into the shadows. That might surprise those of you who are only familiar with me as a speaker and writer, but for now just take my word for it. Because of my tendency to hide away, I love songs and stories that call us out to face our giants or climb the mountain – to be whatever it is we are meant to be against all odds. “This Is Me” is definitely one of those songs.

In the context of the film, the song challenges the notion of “You don’t belong here.” The temptation for many is to agree and go back into hiding. The song rejects that, asserting the opinions of others will no longer get in the way of one’s contribution to the world. But isn’t expressing this so aggressively as in “bursting through the barricades” or “gonna send a flood, gonna drown them out” arrogant? There’s a part of me that thinks so and would rather return to the shadows. In the film, however, these are metaphors to insist we be fully present in the situations we find ourselves in, not allowing others to diminish us. Yet many believers, including myself at times, think it is godly to be diminished as if that is the essence of true humility.

Some justify hiding away through an oft-misused Scripture which relates the words of John the Baptist as he neared the end of his public ministry (see John 3:22-30). When John’s disciples mentioned to him that people were beginning to flock to Yeshua, he said, “He must increase, but I must decrease” (John 3:30). I can’t tell you the number of times I have heard people use this in prayer, asking God to demonstrate his power, while keeping themselves from being noticed. Sounds humble, I know. But that has nothing to do at all with what John the Baptist was saying or with true humility. John was explaining that his task of introducing the Messiah was nearing completion, which was why more people were going to Yeshua than to him at this stage. Now that his job was almost done, it was time for him to fade into the background, so to speak. Prior to this, he had an essential part to play in which taking center stage was required.

Hiding away is not humility, but fear due to shame. The aggressive posture of “This Is Me” is not really toward others, but toward ourselves. In spite of the freedom secured by Yeshua on our behalf, we remain our own brutal taskmaster, standing in the way of all God wants us to be both in and through us. We don’t oppress ourselves completely on our own. We leverage the impressions and opinions of others, past and present, to justify our continued imprisonment. But we are no longer slaves, we are fearless children of God (see John 1:12; Romans 8:15; Galatians 4:6-7).

Far from hiding in the shadows, we are to let our light shine for the world to see. Yet many of us have been intimidated into the shadows, shamed into silence, agreeing that we don’t belong. But we do! The song declares “I’m not scared to be seen; I make no apologies.” Apologies are appropriate when we have wronged God or others. But we are not to apologize for being “me” as if we have no God-given place in the world. We have nothing to be ashamed of. How can we be when we have the very help the world is desperate for? That they don’t know it is beside the point. That we don’t know it undermines what God wants to do in the world.

God wants to do great things through his people, but he can’t use us if we are hiding away. Sure, we are weak and wounded. We make mistakes – sometimes big ones – but he can handle that, especially if we cooperate with him. Nothing is going to happen if we hide in the shadows. It’s time to come out and let ourselves be seen for who we really are.

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This early presentation of “This Is Me,” sung by  Keala Settle at a workshop session, illustrates the challenge of coming out of the shadows.