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Thank you Justin

“But let me get to the point, let's roll another joint”

You Don’t Know How it Feels.  Tom Petty, 1994

I uphold my civic duty by casting a vote in every election at all levels of government. Voting is no longer an easy task in today’s world.  Back in 2015, a pre-family trip to India, a pre-SNC Lavalin Justin Trudeau made the election promise to legalize marijuana within two years of taking office.  To his credit, he and his party made good on their vow on October 17, 2018.  Sadly, now the former HMV flagship record store at 333 Yonge Street in Toronto houses Tokyo Smoke, a three-storey testimonial to the cannabis culture that has effectively erased the beloved video arcades and the Imperial Six movie theatre that graced the street back in the good old days when I was a lad.   Somehow the Zanzibar Gentleman’s Club continues to solider on in the midst of all this change, but if those who patronage this fine establishment can’t see the wrecking ball that is slowly working its way down from Gerrard, it’s high time they tore themselves from the stage and took a good look around. 

I cannot recall a change in government policy with a greater impact in my professional life than the change in law regarding marijuana.   Honestly (and I swear to god even though my own adult children still don’t believe it’s true) I have never touched the stuff nor do I have any plans to change in the near or distant future.  I assume, like most folks, the fact that marijuana is now legal and can be purchased right out in the open is not reason enough for me to change my daily routine whatsoever.   But not being party (pun intended) to Justin’s deliverance to the people is not the same as not being affected by his action.

With a nod to Terry O’Reilly, what does one do with patients who are under the influence?    The quick response is to equate marijuana use with alcohol or with any other drug of choice; impairment is impairment regardless if the causative agent is swallowed, smoked or sniffed.   The problem is now that marijuana is legal, anyone can saunter down the street smoking a joint on his/her way to the orthodontist’s office. Do the same with a bottle of booze (or worse) and I’m sure that will still result in a police escort.  

Once the patient is in the chair, can he or she be safely treated?  Can this patient consent to braces being put on, or braces being taken off?   Can an adjustment be performed if it involves anything more than changing elastics?   Really, the decision whether to treat or not rests solely with each and every one of us, and one’s personal interpretation of the regulations put forth by one’s respective regulatory authority.  

What about patient privacy?   Without a reference upon which to support this theory, it would reasonable to assume that marijuana is the drug of choice for the average orthodontist’s patient population; this population has the access, the curiosity and the means to get it if they want it.   If the orthodontist elects not to proceed with treatment and sends Janey or Johnny home because he or she shows up buzzed, the office is going to get a call.  You can bet on it.

“Janey/Johnny had to leave school early, miss soccer practice, take two buses in the rain and wait an hour in your office for his/her appointment and then you sent her/him home with nothing?”

“Yes. That’s correct.”

“You know we are paying you good money for them braces.  What did you do that for?”

“Sorry.  I can’t tell you.”

“You can’t tell me?”

“That’s right.  I can’t tell you.  Ask Janey/Johnny. ”

“Why I otta…%$%%^^$#.”

I’m not insightful enough nor do I possess the depth of knowledge of law and/or society required to determine if the legalization of marijuana is good or bad for the people of Canada.   My instincts tell me that the vast majority of citizens post-October 17, 2018 really haven’t given it much of a thought; the smokers continue to smoke and the non-smokers continue to abstain.   As an outsider looking in, I admit the sky has not fallen and the days pass as they always have, save for the occasional whiff from the mean streets of the city (it’s 8 am, I mean…really???) .  

Here’s the thing.  The legalization of marijuana (and the inevitable decriminalization of other easily accessible recreational drugs – its coming, for sure) has created significant problems for health practitioners who treat the public on a regular basis for non-critical purposes.  A decision was made by our representatives who were appointed on the premise that they would act on the will of the people. 

But it’s the professions like ours that are entrusted to care for the health of the people.  How do we safely treat the public when they are empowered by a government acting on their behalf?   This is where the foundational lines upon which we depend upon to make clinical decisions become fuzzy.   There are no easy answers.

All one can do is to stick to what one knows.  Justin, just so you know, we will continue to act in the best interest of our patients at all times.  Our decisions will continue to be based upon evidence-based practice and sound clinical judgement. 

Just don’t expect us to pass you the dutchie from the left hand side.

Jimmy P