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April 2024I have been wanting to write this article for some time. I have just not been sure where I wanted to publish it. With the State Legislature’s recent failed bill on “medical marijuana,” it is important to get this out there. I realize that this is likely not the crowd that needs convincing of the foolishness of pursuing “legalization” of marijuana, but maybe there are enough influencers out there to discuss this with their legislators to help them understand why this foolishness should be avoided.
To say that it is disappointing that our conservative legislators would propose such a bill is an understatement. Maybe the requirement for the State to be the only legal dispensary was a brilliant poison pill, but how long before that is stripped and the next bill gains support? Make no mistake about it, the only reason to legalize marijuana is financial. A new taxable product class doesn’t come along all that often. If less is spent on law enforcement, courts and jails, the government benefits. But all of the rest of us lose. While I will not dive too deeply into the social studies aspect of this, one needs to simply look at the pioneering states to see what a disaster this has been. I would simply ask the politicians, “Do we really want to be like our neighboring states?”
Since I’m a physician, let me stick to something that I’m more familiar with. Researchers have been very busy studying the biochemistry of the receptors that respond to THC and the other cannabinoids (also known as CBD). The biochemical pathways of what is happening when we use these substances is reasonably well worked out. Humans have two receptors (CB 1 and CB 2) that can be affected by THC and the other cannabinoids. Humans have at least two classes of chemicals that can stimulate these receptors, but there are likely many more that have yet to be characterized. Stimulation of the receptors causes a reduction in neurotransmitters, the chemicals that move from one nerve to the next one to cause the next one to do whatever it is that it does. The brain has most of the CB 1 receptors and the body has most of the CB 2 receptors. THC stimulates CB 1. This explains a lot, when looking at all the bad things, neuropsychologically, that happen to people using marijuana.
Alex Berenson wrote a book “Tell Your Children, The Truth About Marijuana, Mental Illness and Violence,” copyright 2019. I would highly recommend it. Mr. Berenson does a good job explaining the research that was available to him at the time. He is pretty even handed and dispassionate about the subject. But research on marijuana had been pretty limited for a couple of reasons. First, it is a Schedule 1 controlled substance and that limits the ability of researchers to access it and use it on humans. Second, the approved strain of marijuana that has been available for research is limited to a small parcel of land in a single approved location, using a legacy strain of marijuana with a THC content of about 5%. Today’s strains average 60% and the edibles can achieve 100% THC. As states have decriminalized marijuana, more observational research has been done. These studies show just what a disaster this has been.
I have copies of the research papers that may be referenced in the remaining space I have, but since the bibliography is long, I cannot include it here for space considerations. So where do I start? One of the most concerning aspects of THC is its ability to induce psychosis. One paper noted that a single use is all it takes in some to send one down the path of schizophrenia. Young male users are more likely to have this happen than female users. The rates of anxiety, depression and bipolar are all rising at an alarming rate. THC raises the risk some 2-4x for the development of these diagnoses. We just came through a “teen mental health month” and I heard not a mention of this. The human brain is not mature until age 26, and while the risk of these mental health diagnoses due to use of marijuana does drop if one starts using marijuana as an adult, it is still considerably higher than baseline.
It was argued in the past, that marijuana was not a gateway drug. Well, guess what... That is not true either. Maybe this ties into the mental health issues above. If someone develops schizophrenia as a result of their marijuana use, they commonly start to use more substances of any sort.
I have seen its use encouraged for cancer patients who have chemotherapy induced nausea. One of the more common complications of its use, though is nausea and hyperemesis.
Physicians have placed great hope in the use of marijuana to stop the opioid crisis that this country has been in for a couple of decades. Unfortunately that is not reality either. Both compounds have unique receptors and mechanisms of action. There is no similarity or crossover so I have no idea why anyone would have thought that.
Inhaling burning vegetable matter, irrespective of the form, is not good for us. Asthma rates are higher among users. Cancer rates are also higher among users. Lung cancer is just one of at least four types of cancer that are higher in marijuana users. The list also includes head and neck cancers, oral cancers and testicular cancer. The amount of marijuana smoked that is needed to see these changes was just one marijuana cigarette per day for 10 years. While I have no love for tobacco, tobacco studies use something called “pack years,” which is defined as one pack a day for a year. There has been a big push to have everyone vaccinated against HPV. HPV is associated with several cancers, especially head and neck and oral cancers, but maybe the issue is made worse by marijuana.
Heart disease rates are higher in marijuana smokers than in nonsmokers. One study found that there was a 34% increased risk of developing congestive heart failure. Stroke risk is also higher. This is across all age brackets but is clearly worse in the older adult.
Cannabinoids of all sorts have been shown to interact with numerous medications. This may increase the levels of the medication in the blood, or may increase the amount of the cannabinoids in the blood stream. It increases the effects of warfarin, making that person more prone to bleeding. Of course, this isn’t unique to THC, many pharmaceuticals and OTC natural products are known to interact with each other to increase or decrease the effects of one another, but to tell someone marijuana is harmless is criminal.
Car accidents are on the rise with marijuana use. A review of emergency room use in Ontario showed that from pre-legalization to post legalization the rate of motor vehicle accidents related to marijuana use rose from 0.18/1000 to 1.01/1000 visits.
I am sure that over time, more bad than good will be discovered from the use of marijuana. I am hopeful that history won’t repeat itself before sanity returns to this discussion. Medical textbooks clearly showed the relationship of disease to tobacco, yet it took more than 60 years for the surgeon general to issue the first statement warning about the dangers of tobacco.
Sixty years on, we are still plagued by this scourge. As I read the articles on marijuana with the dramatic headlines about its dangers, the authors always hedge their way through the conclusions about needing more research, how small the studies are and any number of excuses as to why they cannot make a more definitive statement about the dangers of this product. All of that is probably true, but are we going to get the answers that government and industry want or are we going to get the truth?
On a hopeful note, we know that there are two receptors which have powerful biological activity. I believe that these should be researched to see if there are safe compounds that can be devised to take advantage of what they do without the serious consequences of marijuana.
I have finally written that article that I wanted to write. It is now off the bucket list. Certainly it is not of scholarly caliber, but hopefully it gives some impetus to remind those we love and those we have elected to be educated about the consequences of their decisions and not pursue this foolishness simply for the sake of a few dollars.
GenesisPrimaryCare.com
