Category: Public Health

Free to Light Up

Freedom of choice and personal responsibility. That’s what America is all about, right?

It’s what separates the United States from what we perceive as overly-restrictive societies, such as those in Saudi Arabia or North Korea. It’s what allows us to wear the clothes we want, own guns, and legally buy alcohol and cigarettes.

It’s what we claim to support when we ridicule the so-called Nanny State.

And it’s what should allow us–as free and mature adults–to purchase marijuana legally if we so choose. That’s what the New York Times says, and I have to agree.

At the beginning of this year, interested by Colorado’s and Washington’s new adventures in legalization, I explained my feeling that the vast majority of pot consumers can be trusted to be responsible users.

man smoking at window

Smoking by Francois Karm on Flickr

Now, in a well-considered and important series, the New York Times has laid out its case for the repeal of the national prohibition on marijuana. It discusses the policies that would support such a repeal and the science behind it. It also points out how the current prohibition is unjust, racist, and based on the myth of a “gateway drug.”

So don’t just take my word for it. The Times is on board too. Now if only Congress would do something.


My Heady Soccer Tale (or How I Got a Concussion)

Photo: iStock/Getty

Photo: iStock/Getty

One minute I was running toward the soccer ball. The next, I was lying face up on the grass. What happened between those two moments has been erased from my memory.

Slowly, my awareness of the world came back, fading in like an old TV set that had just been turned on. I got up and saw the other kid also on the ground, holding his head. Somehow, as we were both going for the ball, we collided and hit our heads together. I didn’t know it yet, but we both had concussions.

Back in 1980, when I was 13, I had only a vague sense of what a concussion was. It sounded more serious than just two kids knocking heads, so I dismissed my injury and continued playing the game. I told the referee I was fine, and we got on with it.

My coach wasn’t much more informed, since he didn’t take me out of the game. My mom was concerned on the sidelines but she didn’t insist I see a doctor after the match. Taking cues from the adults in my life, I figured it was no big deal.

Concussions, though, have become a very big deal, especially those occurring during organized sports.

Former players in the National Football League have filed a major lawsuit claiming the league failed to effectively inform them of the risks of repeated concussions on the field. The NFL has recently begun to take this situation seriously, finding that retired players have a higher incidence of memory problems, depression, and dementia. The league now, in a settlement, has agreed to pay whatever is necessary to compensate retired players who suffer from these long-term neurological effects.

And recently, a new campaign has been launched to change the rules in youth soccer leagues to restrict kids younger than 14 from being able to head the ball, recognizing that jarring blows can affect brain development. The campaign is lead not by overly-cautious couch potatoes, but by former U.S. women’s soccer players. This increased attention to sports-related concussions would have been helpful back in 1980.


You see it all the time in movies and on TV: someone gets hit in the head with a heavy object and is out cold. Later, they wake up, shake it off, and go on their merry way. Reality is much different. In spite of how commonplace the term “concussion” seems to be, it is a form of brain injury and should be taken seriously.

The definition of concussion seems to be elusive. “Mild traumatic brain injury” is what the Centers for Disease Control and Prevention calls it. It can happen either with or without an impact. It is mostly identified by its signs and symptoms, including:

  • headache,
  • changes in balance or coordination,
  • confusion,
  • amnesia,
  • fatigue,
  • nausea, or
  • loss of consciousness or a “blackout.”

The worst part is that symptoms don’t always appear right away, and repeated injuries have a cumulative effect. Children younger than high school age are especially vulnerable.

I support all of this new focus on concussions and how they affect the brain. I question, though, why it has taken this long. Why were we so uninformed in 1980? Is it because there were more vexing public health issues–like polio or measles or AIDS?

I also wonder what percentage of the population has been walking around with undiagnosed brain injury. Are there correlations between youthful concussions and failed potential or criminal behavior? Have the mentally impaired been running the show all these years? Are the memory problems that so many elderly people face really just a result of too many blows to the head from a rough-and-tumble childhood?

Additionally, while I’m in favor of efforts to make sports less damaging, I think that the the proposed ban on heading the ball in youth leagues is only a band-aid on a much larger issue. The serious concussions in soccer are not from performing headers but rather–as I can attest–from collisions with other players.


The day of my soccer concussion, I had a massive headache on the brink of nausea. Somebody (my coach?) told me that if I fell asleep, that was a bad sign, so I spent the rest of that Saturday lying on the couch to nurse my headache but never quite relaxing for fear I would doze off.

As for my memory of the incident itself, it never had a chance to form. Between the moment where I am running to the ball and the moment where I’m coming around on the field, there is nothing–retrograde amnesia, it’s called. My mind blipped from one point to the next, like when you skip forward on a digital recording, the discontinuity a sign that something was omitted.

By the next morning, I was feeling better. I don’t recall talking to a doctor about it, or really anyone. By that point in my life, I had been hit in the head or face or mouth so many times that it just seemed like normal part of growing up. I can recall having had at least two other concussions prior to this one.

On Monday, the guys at school asked how I was feeling.

“Fine, I guess,” I said nonchalantly.

“Really?” one friend said. “Because you gave the other guy a concussion.” Only then did it occur to me that maybe I had one too.

I wonder now about the long term effects. Am I depressed more than average? Do I have cognitive impairments that I would not have had otherwise? Am I vulnerable to mental aging more than is typical? I’ve managed to turn out okay, but would things have been different?

I’m not sure where this leaves me. I love soccer just the way it is, in all its free-form, democratic madness. And I was just a boy being a typical boy.

But occasionally, when I think of reasons for my struggles in life, thoughts frequently bring me back to my childhood concussions.


Weed and Wine

My brother lives on the opposite coast from me, and we’ve spent many holidays apart. One year, though, he visited for several weeks in December. On Christmas Eve, as things were settling down for the night, he told me he was stepping outside.

“If you don’t mind,” he said, “I’m going in the back yard to smoke a joint.”

His casualness about it surprised me. But once the initial shock wore off, I was fine. Surprisingly fine. My brother, you see, does not fit the stereotype of a pot smoker. He’s not a hippie or some stoner who never bathes or lives on the street. He owns a house and has a steady job. He’s never had any legal troubles. He smokes marijuana to relax, get a little buzz, and feel good about life once in a while. He is a responsible user of marijuana.

Weed and wine.

Art by me.

I have never tried weed. There are several reasons for this, but mostly because I don’t want to tangle with its illegality.  I do, however, enjoy wine. Typically, I will finish off two or three bottles a week. I drink wine for basically the same reasons that my brother smokes pot. We talked about it once, when he turned down a glass of Chianti. He said he much prefers marijuana. “Alcohol,” he said “just doesn’t do it for me.”

I worry about him, that one day he’ll be in the wrong place at the wrong time and will be arrested just for preferring cannabis to alcohol. The reasons why marijuana is mostly illegal while alcohol can be purchased at your neighborhood store are complex and in many ways irrational.

What I don’t worry about is whether he’s on his way down the slippery slope to hard-core addiction. Because, while I know he’s had some youthful indiscretions, he’s not an addict any more than I’m an alcoholic.

Alcohol has its detractors. During the Temperance Movement, alcohol was considered the Devil in a bottle, to be wiped off the face of the Earth. Further back in history, however, beginning in pre-Christian times, alcohol was considered a gift from the gods. Society’s ambivalence over alcohol has led to a mish-mash of policies and a mish-mash of proposed solutions–medical, legal, psychotherapeutic, religious–that work at cross-purposes with each other.

After the repeal of Prohibition, government has, for the most part, stepped back from trying to dictate what we can and cannot drink, and rightly so, I think. In a free society, personal responsibility should be what dictates choice.Close_the_Saloons_poster_Why_Prohibition_1918

This same ambivalence seems to be spilling over to our feelings about marijuana, as evidenced by the new legalization in Colorado and Washington. Much is made of marijuana being a “gateway drug,” a term used for a substance the use of which allegedly will lead to more problematic drugs such as cocaine or heroin. But this view is not supported by any valid science, since a correlation between marijuana use and subsequent use of heroin or other drugs has not been established, according to psychologist Jeffrey Schaler. He goes on to say that, “it might not be that there is something in marijuana that causes a move to heroin, but rather that consumers are looking for the same thing in heroin that they derived from marijuana.” Even if there is a correlation, then, it cannot be assumed that one causes the other.

In fact, most studies have found that a vast majority of marijuana smokers do not become drug addicts or move on to harder substances. I guess this means that most can be trusted to be responsible users.

I realize that many will take issue with this view. To some, substance use equals substance abuse equals addiction equals disease. For others, these conditions are not all the same, and you can have substance use without it being substance abuse. Unfortunately, it’s hard to have a rational conversation about drugs when the terms mean different things to different people and there is significant disagreement over the underlying assumptions.

The regulated legal marijuana markets in Colorado and Washington are an important social experiment. And it has been a long time coming. If successful, it could loosen the restrictions on responsible pot use in many areas, such as athletics.

With some notable exceptions, getting a product off the black market and into the public eye is a good thing. At the very least, it provides greater choice for those who might otherwise turn to a substance that is less natural and more dangerous.

And I’ll raise a glass to that.

Random Scribbles: The ugly face of loneliness

[Random Scribbles are my occasional posts of half-formed thoughts, half-baked ideas, and off-the-cuff observations.] [NOTE: Updated to add additional information 1:06 p.m. EST.]

In a recent post, I discussed how a lack of privacy is not always a bad thing. What I didn’t discuss–really hadn’t gotten to yet in my thought process–is that privacy has an ugly twin.

It’s called loneliness.

People who move to the big city to become anonymous often become lonely as a result. And while Facebook can make some people feel more connected, to many, it lacks the “emotional power of connecting with people in-person.”

Writer Amy Gutman has pointed out that often we live in “a culture of private suffering and isolation, a lonely and disheartening place” where we suffer indignities rather than share our needs.

Generally speaking, people are social animals by nature. Even introverts, who have a strong need for being alone, enjoy the company of good friends and loving family. Increasingly, human health experts are realizing that many physical and mental illnesses can be linked in some way to feeling lonely. For some vulnerable populations, such as the elderly, loneliness can be death sentence.

Studies have found that monkeys and rats–also social animals–that are kept in isolation can and will dose themselves with cocaine until they pass out or even die. “If we want to understand why some people become heavy consumers of drugs,” writes psychologist Jeffrey A. Schaler, “we should ask what it is in their lives that constitutes for them the emotional equivalent of being ‘in solitary.’ ”

We should all have our privacy respected, of course. But when the isolation leads to a lack of human connection, both physical and intellectual, it takes on the bleak face of loneliness.

On Huffing While Riding the Metro

I commute to work using public transportation. In the Washington, D.C. area, that means riding the Metro with hundreds of thousands of other people. Each business day, I spend about 40 to 50 minutes on the Metro one way, or nearly two hours total. I’ve been doing this for almost 20 years. The time adds up.

Spend enough time doing something and you accumulate experiences. You see things; you hear things; you learn how things go.

Recently while I was riding the Metro, I saw a guy inhaling from one of those compressed air cans that you get for blowing dust off your computer equipment. No one was sitting next to him, and I discovered why.

He released the gas from the canister into his lungs. Within a few seconds, he began to twitch and lean to one side. His eyes were closed and he seemed to lose consciousness for a few moments. He dropped the canister.

Before long, he would fumble around for the canister, reaching around on the floor under his seat. He’d find it and begin the process again. “Squeeeeeee” went the can as he put it to his lips.

Whatever he was getting out of this little ritual did not last long. It was a quick fix. It was a series of brief trips into a chemical-induced stupor. The chemistry that produces the canister of gas is an industrial process. There is no art or craft involved. It can be purchased relatively cheaply. It’s effects, while perhaps momentarily pleasurable, are dangerous with continued use.

I can’t say I understand what brought him to this place, where he was riding the Metro while gassing his lungs over and over again. There must have been desperation there. To turn not to alcohol or marijuana or some other natural substance for altering the brain, but to reach for a can of gas, he must have been seeking to flee some heavy stuff.

Moreover, he was not demonstrating any long-range thinking. He was all about the moment of that high from inhaling the gas. Whatever was to come after was not part of his planning.

Eventually, the can would be empty and the pleasurable effects will wear off. He’d be left with some type of hangover at best, or something worse like brain damage or damage to major organs. Cans of this stuff are pretty clear about the dangers: inhalation of contents may cause heart irregularities, unconsciousness, or death. In fact, deaths from the abuse of difluoroethane are unfortunately common.

All for a quick fix.

It was not beautiful to watch this guy huffing his can while I rode the Metro train. It was ugly and it was sad.