Well, I'm not actually on an airplane at the moment, but my column this month does relate to travel. My family and I went on vacation to Keystone, Colorado. We were meant to be skiing, as is our custom every winter. Unfortunately, Mother Nature did not cooperate and Keystone had only 18" of snow, so the skiing sort of, well, let's just say we didn't ski much. But we did take a day trip to Breckenridge. The kids went to the rec center with their grandparents to swim in the pool with the water slide. Jennifer and I spent a lovely day walking around the town, shopping and enjoying the sunshine, warm weather and each other's company.

Being "foodies," we enjoyed a fabulous lunch, then sampled coffees and pastries as we strolled. "Oh, look!" Jen pointed, "the Breckenridge Spice Company!" From across the street, it looked like pretty much every other shop. It wasn't until we crossed the street that we saw the sign for the "Colorado Cannabis Association." So it was that kind of spice.

Colorado is one of the two states with a reputation for the explosion of "medical" marijuana (California being the other). At one point, internet rumor had it that there were more marijuana dispensaries in Colorado than Starbucks. Given that there was one Starbucks on Main Street in Breckenridge and one marijuana shop, I can believe this. 

I am not naive. I went to college. I regularly inhaled (unlike some former Presidents). I treat AIDS patients. I understand the potential positive effects of marijuana. But I also understand that every drug that has a positive effect has a potential for a negative effect. For higher dose, more chronic marijuana use, the negative effect is apathy. I also firmly believe that some of my affective disorder patients have been de-stabilized after smoking marijuana. And let's not forget that not all marijuana is the same. Some is more potent, some more mellow.

About 6 years ago, I was walking in Key West one morning, before my lecture at the Florida Keys AIDS Education Training Center.    One of the stores I saw sold Salvia. At the time, I didn't know what that was. Later, I learned that Salvia is a smokeable plant that creates a high similar to potent marijuana. Sometimes called "super marijuana," shops sold it, legally, in many states, including Maryland, until recently. We passed a law making Salvia illegal a couple of years ago.

More recently, we've had bath salts. Bath salts is a name used to sell the product legally. The actual compound is MDPV, a stimulant you could easily call "super cocaine."  A quote from an online bath salt buyer:

Tachycardia, myocardial infarction, seizures. Just a few of the more interesting side effects.   A recent patient, who binged on bath salts for a weekend, waking only to find she was being raped by her binge partner, had persistent tachycardia for a week after. I expect bills outlawing these commercial products in Maryland this session (the ingredients are currently outlawed in over 40 states).

I recall studies about alcohol-related problems during Prohibition. When I ask residents about the rates of alcohol problems during Prohibition, they usually erroneously say there was an increase. But in fact, the rate of problems went down. Fewer people had access to alcohol, so fewer people had problems overall.  With more people exposed, more can have problems. The legalization of marijuana by calling it "medical" increases exposure through diversion to non-medical recipients. Drug dealers are everywhere, bringing Salvia and bath salts and who-knows-what next. When it comes to drug-related problems, as a friend said, "I'll take less."

But then again, I did take a moment to consider buying a t-shirt in Breckenridge. The caption read: "Dude, I think this whole town is high!"