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Confusing Information About Marijuana

written by Marsha Seidelman, M.D.
co-author Danielle Scheinman, MPH, CHES
on Friday, 19th August ,2016

Since marijuana has been legalized in some states for recreational and/or medicinal use, it may be regarded as a safe substance that has been proven to have therapeutic benefits.

After very high rates of usage in the ‘70s, rates had declined. Over the past 10 years, however, rates have increased again. This is concerning because regarding recreational use, the content of the drug is very different than it was in the ‘80s. On the medical side, adequate studies have not been done yet to prove its value. To be clear, this article is about smoking cannibus. Orally, dronabinol is a synthetic form that has been available for years to treat chemotherapy-related nausea and vomiting.

The active ingredients in botanical marijuana (Cannabis sativa) are cannabinoids, chemical compounds that act on brain receptors. There are over 60 chemically active ones with tetrahydrocannabinol (THC) being the main psychoactive component. Decades ago, it represented about 4% of the content of pot; now we are seeing percentages up to about 20-30%. Obviously, pot is not a regulated substance, so content varies substantially. Often, those who thought of this as a benign drug in the past aren’t aware of how much its composition, and therefore its risk, has changed.

Marijuana use now accounts for more daily emergency room visits than alcohol does. The drug has become a major contributor to violent deaths and accidents in adolescents. As a culture, we are very aware of the danger of drinking and driving. Driving after smoking pot is just as dangerous — judgment and coordination are impaired. Combining pot with alcohol use, which slows response time to a greater degree, is even more hazardous.

Recent evidence suggests that marijuana use in teens is especially harmful. Using special scans, we now know that during teen years, the brain is organizing and rewiring - i.e. improving roadmaps that thought processes follow. The areas of the brain responsible for problem solving, learning new ideas and good judgment are rich in cannibinoid receptors. We have natural cannabinoids in the brain; marijuana supplies excess ones, as noted above. Too much stimulation in these areas of the brain during the teen years can interfere with normal development. And these are the skills that are most important for success at school and at work.

Heavy use is associated with less motivation and energy, which can lead to absences from school and work, school failures, accidents, less life satisfaction and less career success. Additionally, high doses in the short term can cause hallucinations or paranoia.

With regular use, its reach lasts longer than just the short time that its effect is evident. A teen might think they can smoke over the weekend and have the effects gone by Monday, but that’s not necessarily true.

Other health issues associated with marijuana that we see less often include cough, lung cancer, fast and irregular heartbeats, testicular cancer, and hormone problems leading to breast growth in men and impotence. If a pregnant woman is smoking, the newborn may end up with problems involving attention and problem-solving.

Medical marijuana presents other challenges. Some experts believe that smoking marijuana can help with chronic pain control, nausea after chemo, weight loss in AIDS, intractable seizures, multiple sclerosis, glaucoma, and other diagnoses. Not all doctors agree. The discrepancy originates from variations between marijuana plants and lack of randomized studies. One strain of the plant may be useful to treat a particular diagnosis, but it has been difficult to do research on enough people with the appropriate diagnosis using a specific plant strain to prove its benefit.

On a federal level, pot is not legal. When federal and state rules disagree, federal law takes precedence. Partly for this reason, research centers have had difficulty obtaining marijuana to do further testing. For years, the University of Mississippi has been the only institution authorized to grow the drug for use in medical studies, but the DEA may soon allow other universities to apply to grow it. Perhaps that will speed the process of obtaining the information we need to decide if it is more beneficial than other drugs used for the same diagnoses.

The Drug Enforcement Agency (DEA), a federal agency, still classifies marijuana as a “Schedule I” drug, the same as heroin and LSD, signifying that it has no medicinal benefits and has potential for abuse. Even in a state like Maryland, where medical marijuana is legal, physicians can not write a prescription for it. Our licenses to write prescriptions are FEDERAL licenses, issued through the DEA - and of course we can’t write for an illegal substance. Doctors who choose to, can verify that the patient has one of the diagnoses listed above, and the patient should then be able to acquire it without being outside the law. However, they should not enter federal property, such as BWI airport carrying pot, since it would be illegal there.

Despite this confusing legal situation, physicians have rarely run into trouble for writing permits for marijuana use. Those few cases involved doctors who wrote for hundreds of prescriptions, or were benefitting financially from the dispensaries that sold the marijuana.

Overall, the take home points are that this is a different drug than it was decades ago, it can have serious consequences regarding brain development, risk of accidents and psychiatric implications. And the medical marijuana situation is quite murky at the moment.

Tags: marijuana, medical marijuana

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