I generally do not recommend medical marijuana nor do I prescribe it. However, I have seen it help some of my patients with chronic pain and extreme anxiety.

One patient, a married male, had such severe anxiety, none of the psychiatric medications (even in aggressive doses) in combination with psychotherapy helped. Before he became ill, he was working full-time, supporting his family. After becoming ill, he became totally disabled, his wife left with the children. He was repeatedly hospitalized for suicidal behavior. His mother took him to another city to get a medical marijuana card, in a desperate attempt to improve his condition. It was remarkable to see how much calmer he was after starting marijuana treatment.

The most important question I had in mind was whether or not he was going to improve functionally.

With marijuana, he was relieved of anxiety – the primary cause of disability. However, I have yet to see him improve functionally enough to go back to work or take care of his family. He still lives with his mother, doing little each day, staying primarily at home.

Thus far, with this patient, the treatment was palliative. It reduced suffering. But it did not lead to improvement in function.

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Another patient, surprised me.

He had a history of psychosis (auditory hallucinations and paranoid delusions), mood problems, and drug abuse (which stopped after he was incarcerated in a state prison). After he was paroled from prison, he came to me after repeated hospitalizations for psychotic symptoms. I treated him for his mental illness with a combination of antipsychotics, anticonvulsant mood stabilizers and antidepressant. He also received dual diagnosis psychotherapeutic treatment. He improved in function with treatment but not enough to be productive in life. He was still totally disabled from work.

We lost contact. I thought he may have moved out of the area or returned to prison.

After about a year, I was at a grocery store one night, when I was tapped on the shoulder. A cheerful voice said, “Hey, Dr. Mariano!” I turned around, and greeted the patient. He appeared flushed in the face, with bloodshot eyes, somewhat anxious though friendly in manner.

I asked what he had been doing for the past year. He said he had stopped all of his psychiatric medications, was free of the symptoms of illness, and was going to college! I praised him for his accomplishment.

I asked how he did this. He came closer and whispered to me, “Don’t tell anyone. I use marijuana”. He smoked about a joint a day to relieve himself of stress. He found he could function better with this.

Concerned, I asked if his parole officer knew. He said the parole officer knew but was ignoring it (this occurred years before medical marijuana was not legalized).

I wished him well and asked he come back to the clinic so I could assess him further.

Unfortunately, I never saw him again.

Hopefully he did well, graduated from college and has a productive job.

But, given his history, …

When I was 17 I was smoking a joint and had an anxiety attack which spilled into OCD which I have had for 38 years now. In the few times I tried it after that I had increased anxiety and OCD symptoms. I don’t think Marijuana is as benign as some people think it is. There is also evidence that it can trigger psychotic illnesses in those who might be predisposed.