Pot: A risky, mixed bag for body, mind

By Dr. Don Casebolt
Here is the skinny. Twenty-threes states plus the District of Columbia allow the use of marijuana for medical purposes. Washington, Oregon and Colorado also allow it for recreational purposes.

The fact it has been approved for recreational use appears to have led some folks to think it is relatively innocuous. Unfortunately this is not true.

Many studies have been done in the effort to determine the pluses and minuses of the use of cannabis, the scientific name for marijuana. Up-to-date information for 2015 comes from three journals: the June 23-20 Journal of the American Medical Association, the October JAMA Psychiatric, and issues of the New England Journal of Medicine (NEJM) for 2014.

It has been determined there are three or four conditions, depending on the authors, for which medical cannabis can be of benefit: nausea and vomiting due to chemotherapy; reduction of nerve pain and chronic pain; and spasticity due to multiple sclerosis.

It has been tried for a number of other conditions without significant benefit. It is crucial for people to know that even in those cases showing benefits it does not approach 100 percent effectiveness. For example, in one study it was reported 47 percent of people with nausea and vomiting from chemotherapy obtained relief.

A number of people may use edible forms of medical cannabis. Researchers studied 75 of these products in three major U.S. cities and found only 17 percent were correctly labeled for the concentration of cannabis.

The National Epidemiological Survey on Alcohol and Related conditions compared the use of marijuana for April 2001-April 2002 to its use in April 2012-June 2013. It was found that marijuana use more than doubled. About three out of every 10 users of it have either used it excessively or have become addicted to it.

Also there was a large increase in reactions from the use of marijuana.

Mild common adverse events are dry mouth, fatigue, dizziness, nausea and vomiting, disorientation, drowsiness, loss of balance, confusion and hallucination. More rare but more severe adverse events are stroke even in young people without identifiable risk factors for cardiovascular disease, fungal infections and salmonellosis. Some of these have led to death.

As for its effects on young people, there is a disturbing report by the National Institute of Drug Abuse in the June 5, 2014 issue of NEJM. Presently in the U.S. marijuana is the most commonly used “illicit” drug. Close to 12 percent of people 12 years or older have used it in the past year, with especially high rates of use among young people.

“Despite some contentious discussions regarding the addictiveness of marijuana the evidence clearly indicates that long-term marijuana use can lead to addiction,” the article states. “Indeed, approximately 9 percent of those who experiment with marijuana will become addicted.”

If they start using it as teenagers the addiction rate goes up to about 16.5 percent. Even more disturbing is evidence that the structure of the brain can be permanently altered. This can cause a decline in IQ. Cannabis use during adolescence also can increase the risk for schizophrenia in men.

The NEJM article also states that exposure to marijuana could help explain increased susceptibility to drug abuse and addiction to several drugs later in life.

Dr. Wilson Compton, deputy director of the National Institute of Drug Abuse has a significant concern about marijuana users and addicts operating heavy machinery or a car.

Dr. Carol Collins of the University of Washington has another concern voiced in the NEJM article. She points out cannabis products contain 700 distinct chemical entities and some of these could adversely affect regular medications a person might need to take.

In an editorial in the June 23-30 issue of JAMA, two doctors point out that the quality of the evidence for most of the conditions for medical marijuana use fails to meet Food and Drug Administration standards.

They suggest that high-quality trials need to be done, and until the results are available it would be wise to delay adopting medical marijuana use. Their conclusion is that the horse needs to be put in front of the cart.

As a retired doctor, I must confess that until I began researching the medical literature in preparation for writing this article I had no clue of the potential for adverse effects — especially life-threatening ones.