I struggle to understand...

I struggle to understand the strong presence of marijuana producers at Family Medicine Forum.
I don’t pretend to know all the answer but suspect the following:
1. They paid someone to be present.
2. They hope to make that money back and then some by being present.

The implicit messages to our student and physician membership may be that:
They can be counted to provide fair and unbiased information. (In contrast to say tobacco or alcohol producers)
They are producing a sufficiently “safe” product and their strong presence at FMF do not need to be balanced with an equal representation from those who believe marijuana may be a public health hazard.

I also struggle to understand the breakfast choices of simple carbs at FMF for ~6000 of my esteemed fellow family physicians and leaders of wellness.

Again I have no certainty but suspect:

A breakfast in line with Canada Food Guide 2019 cost more and the FMF fee needed to be allocated to a more important function and was insufficient.

The implicit messages to our student and physician membership may be that:

1. Healthy breakfast is important but there are more important matters.
2. Healthy nutrition may prevent and improve chronic physical and mental conditions for patients and physicians alike but family physicians do not have to be a good role model; may eat poorly when there are more important things to do such as learning how to treat diseases caused largely by eating poorly.
I think there are many object of human addictions; but two prominent examples are to sugar and to narcotics.

My perspective on Cycle of Addiction

Sugar addiction:  Diabetes Type 2 Epidemic (30% of Ontarians are diabetic or prediabetic in 2016)

1. Real need: Whole Foods & appropriate physical activity
2. Craving from needs unmet: hunger
3. Easy substitute: simple carbohydrates
4. Brief relieve from hunger
5. Craving recurs from needs unmet: hunger
6. Go to 3.

I struggle to understand why in this days of Type 2 diabetes epidemic, such glucose beverages or a simple carbohydrate breakfasts still remain so popular;  and why as a society we don’t seem to be all that alarmed? We focus on treating A1C to target with medications to prevent organ damage; we provide even more phenomenal and technologically advanced care once the kidney fails; but seem so bored with issue of self-management that has the potential to prevent diabetes and potentially save the system $19500 per year per person ( times 3.9 million Ontarians).

Opioid addiction: Opioid Crisis (9000 opioid related death in Canada since 2016; 2066 apparent opioid death in 2018; most death in 30ish year olds; 17 people hospitalized for opioid poisonings in Canada each day  2017)

1. Real need: wholefood, appropriate physical activity, understanding role of pain and suffering, ability to pay attention to what is truly important and self-compassion
2. Craving from needs unmet: pain & suffering
3. Easy substitute: opioids
4. Brief relieve from pain & suffering
5. Craving recurs from needs unmet: pain & suffering
6. Go to 3.

Where does marijuana fit in for most users?  My present (please correct me if I am wrong) thinking is that absorbing it daily is not a true need like being nourished by 400 grams of non-starchy vegetables daily.

While I suspect there must be some studies by now demonstrating its safety and benefits eagerly and earnestly shared by producers of such a profitable product; I am hesitant to abandon all caution.  I read not all that long ago Valium was promoted as safe and a way to safeguard the virtues of college girls who might otherwise succumb to crumbling moral standards. More recently oxycodone was prophetically promoted as the “one to start with and the one to stay with”.
Certain glucose infused beverage also contained cocaine in the past; now it’s just effectively promoted as “the real thing”.

Three challenges of addictions are: 1. Suffering caused by a real need unmet. 2. Side effects of the substitutes.  3. Vulnerability to other harmful substitutes.
I believe much more conversations at an individual and system level about the true nature of addiction are needed.

My conversation with patients about addiction.

I am sometimes asked by patient to prescribe benzodiazepines, cannabis or opioids.

My approach is similar for all medications and substances with potential addiction properties.
1. I explain to them that no one (for emphasis of course, I point out the obvious) including myself is “immune” to addiction; that given the situation, anyone can become addicted. (They usually don’t believe me at this point)
2. I then explain to them the mechanism or cycle of addiction (fear of some suffering/ craving for end of it; seeking a quick relieve / a substitute solution; relieve from suffering; effect of quick solution begin to wear out; triggers the fear of suffer... then the cycle’s intensity compounds); I talk about some real life examples; and there is no lack of stories.  By now, they begin to see how addiction applies to them personally.
3. I then help them understand the lengthy list of other unintended and serious side effects of the substitute solution ( Eg.  Increased risk of falls in seniors; respiratory arrest, quality of life, etc.; I try to use examples most relevant to the individual.
4. I ask them and help them identify what it is their suffering the are hoping to alleviate.
5. I then offer them a real solution to their sufferings.  (Eg. my Basic Wellness Messages)
https://www.whatisharewithpatients.com/2019/02/a-family-physicians-basic-wellness.html?m=1
6. In my experience, above approach has resulted in various satisfactory outcomes; many embrace the knowledge and come to attend my wellness groups and learn more about the Basic Wellness Messages.

Some are disappointed but still respect the time spent and reasoning; none leaves with a quick fix or substitute solution without a clear understanding and an agreement on a solid plan to eliminate the substitute with the real solution.

In my opinion, the key ingredient of addiction management are:
1. That I take the time.
2. That I understand addiction is a common humanity. ( remove stigma and judgement of which self-judgement or shame is most intense)
3. That I explain the mechanism of addiction in a way that can be understood by the individual
4. That I help find a real solution to replace a substitute.
5. That a reasonable plan is agreed upon to safely wean off the substitutes and apply the real solution.
6. That I use the capacity and power of “self-management groups” to help patients begin personal transformations.

Thank you for reading!

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