Meet Doctor Narc

Meet Doctor Narc, your local cannabis prohibition physician. Is your doctor a narc? Will your doctor report you for driving “under the influence” of cannabis? They should, according to Dr. Kenny Lin, a family physician and associate director of the Lancaster General Hospital Family Medicine Residency.

Dr. Lin writes in an editorial:

“Most of us routinely ask our patients about their use of the drug and counsel them about its potential harms. But how many of us are aware that when it comes to pot and public safety, we have another duty to notify the authorities when we know or suspect that a patient is driving while using cannabis?”

The rest is, as you may have guessed, authoritarian nonsense. But Dr. Lin’s editorial highlights a worrying trend among healthcare professionals. A trend that robs us of expert opinion in place of pill-pushing doctrines.

Doctor Narc Debunked 

Doctor Narc writes, 

“The data suggest that people who drive under the influence have a statistically increased risk of being involved in car crashes. Since 2000, the percentage of motor vehicle crash deaths involving cannabis has doubled, and states that legalized cannabis for recreational use have seen a 6.5% increase in crashes resulting in injuries and a 2.3% increase in fatal crashes.”

Because the data suggests a particular trend, he concludes: “I have a duty to report to law enforcement patients who admit to cannabis-impaired driving or whom I strongly suspect are doing so.” He cites Canadian doctors as his inspiration.

But let’s look at this data. Does the evidence suggest people driving with phytocannabinoids in their system are at a higher risk? Let’s look at three of the studies Dr. Kin provides.

Study One: Read the Fine Print 

This study concludes: “The estimated increases in injury and fatal crash rates after recreational marijuana legalization are consistent with earlier studies, but the effects varied across states. Because this is an early look at the time trends, researchers and policymakers need to continue monitoring the data.”

If this is all you read, it sounds conclusive. But what are these “Estimated increases?” The study found: “The effects on fatal crash rates ranged from a 10% decrease to a 4% increase.”

With a margin like that, why not come to the opposite conclusion? Driving high means a potential 10% decrease in fatal accidents.

It seems THC has the potential to both increase or decrease your risk of a fatal car crash. Like most driving-related things – texting, talking intently to a passenger, not checking your mirrors, dealing with pets loose inside the vehicle, driving sleep deprived.

This study compared data through a model that looked at many factors. Its conclusions aren’t grounded in science. Its conclusion is simply a narrative labelled Science™.

Of course, researchers don’t limit this kind of speculative nonsense to cannabis. Anywhere you find public health busybodies, you’ll find a Doctor Narc.

Canada’s new alcohol guidelines are based on observational research (some very poor and irrelevant). Yet, “strengthening regulations on alcohol advertising and marketing, increasing restrictions on the physical availability of alcohol, and adopting minimum prices for alcohol” was the conclusion.

When did research studies begin making political value statements in their conclusions? And speaking of alcohol…

Study Two: Don’t Drive Drunk 

This study looked at cannabis and alcohol. Nobody should drive after consuming ethanol. That shit is for your car, not your body. So it’s not surprising this “multinomial mixed-effects logistic regression model cross-sectional analysis” found the following:

“The percentage of fatalities involving cannabis and co-involving cannabis and alcohol doubled from 2000 to 2018, and cannabis was associated with alcohol co-involvement.”

If Dr. Lin has patients who show up high and drunk, then yes, please call the authorities. I will not label you Doctor Narc for reporting drunk drivers.

Weed, of course, is a different substance with different effects. Consider the third study Dr. Lin refers to:

Study Three: Don’t Use This Study to Imply Impairment 

This study speaks for itself. “The study results should not be used to imply impairment or increased risk associated with drug presence.”

What we have here are media headlines taking precedence. Doctors who don’t have the time (or interest) to dive deeply into the literature. Dr. Lin should have considered the epistemology of the research. Or is his anti-cannabis bias enough to ignore the pitfalls of how the studies came to these inconclusive results?

Why Doctor Narc is Wrong 

Consider what Professor Iain McGregor, Academic Director of the Lambert Initiative, told an Australian Senate committee. Does this make more sense than any of the studies Dr. Lin refers to?

Cannabis and driving is actually a very complicated area. The tendency is to look at it through the prism of alcohol, but there are actually almost diametrically opposite effects for cannabis relative to alcohol. With alcohol, people overestimate their ability and tend to take risks as a result. With cannabis, people actually feel impaired… When they do drive, there are quite reliable effects like a lower speed and a bigger distance between them and the car in front.

McGregor doesn’t discount medical cannabis patients, either. He goes on to say:

If you give someone cannabis for the first time, they’ll be very impaired for a couple of hours after consumption, but, if someone is a patient and they have used cannabis for two years, chronically every day, you will really struggle to find any sort of impairment whatsoever. So we need more research and we need more enlightened information for patients rather than just saying: ‘Don’t drive.’

The Broader Trend

Now, I don’t like singling out doctors. Calling somebody Doctor Narc isn’t very nice. But when you write an editorial as bad as the one Dr. Lin wrote and sign your name to it, it requires a response.

I’m sure Dr. Lin means the best for his patients. But so did all the doctors that pushed Vioxx for arthritis. Approved by the FDA in 1999, they recalled it in 2004 after increased heart attacks and strokes.

Doctors also pushed Baycol, a cholesterol-lowering drug the FDA approved in 1997 and withdrew from the market in 2001. Turns out it caused rhabdomyolysis, a severe muscle disorder.

Oh, and there’s Fen-Phen. A weight loss drug the FDA approved in 1996 and withdrew a year later after discovering heart valve damage and pulmonary hypertension in the people who took it.

And let’s not forget Avandia. The FDA approved this diabetes drug in 1999 and didn’t withdraw it until 2011 after a bunch of people had heart attacks.

And what about the Dalkon Shield? Women in the 1970s and 80s used this type of intrauterine device until we realized it caused infections, infertility, and other serious complications. 

Doctor Narc’s Worldview

If he’d been practicing in the 1960s, would Dr. Lin have prescribed Thalidomide to pregnant women? 

These aren’t “gotcha” questions. These are serious inquiries into how doctors make their decisions. Do they simply trust the FDA to do its job? 

Since cannabis isn’t legal and the FDA hasn’t endorsed it as a food or medicine, it is, therefore, dangerous. Meaning police should arrest medical cannabis patients who drive.

Is that extent of their logic?

Would Dr. Lin have called the police on a patient who drove after taking Zohydro ER? The FDA approved this opioid but recently recalled it due to the potential for overdose. 

Does Dr. Lin have a problem with the prescribed opioid-addicted populace driving cars? Why or why not?