Monday, October 18, 2010

Legalize Marijuana? This Issue Again?

Ok, I'm just going to come right out and say it.  Legalizing marijuana is the stupidest medical idea I have heard in long time.
Well, wait, a stimulus package comprised of tax dollars to an economy in recession with medical care for all when only 40% of our populous pays taxes is more brainless, but what do you expect from a congress that "doesn't read the bills" and has to "pass them before we see what's inside of the bills."
Legalization of marijuana is, again, on the ballot in Arizona for the fourth time. Voting this down three times isn't enough?
I've been asked by many my opinion of this proposition.
I thought I'd just pen my response.
Proponents of the proposition claim it relieves pain and suffering.  Yes, any analgesic can do that. However, most analgesics can do it much more effectively than THC (Delta-9-tetrahydrocannanbinol), the most potent form of the analgesics found in marijuana.
The fact that it is a weak analgesic is the first problem.
The second problem is multiple side effects.  More than 400 compounds have been isolated from the marijuana leaf, sixty of which are know as cannabinoids.
Behavioral Side Effects
THC is the strongest, producing psychoactive euphoria, relaxation, perceptual alteration and diminished memory and concentration.  If you are wanting relief from pain, this is not the medication to use.  It is a great medication if your desire is to have an "out of body experience," but that is not what a physician is attempting to do in patients with chronic pain.
Severe Dependence
A cross sectional study recently showed that by age 17 cannabis is 2 1/2 times more likely to cause dependence than other habit forming drugs. It is a "gateway" drug, one demonstrated multiple times to lead to narcotic dependence.
Cardiac and Respiratory Side Effects
THC is made available to the body through either smoking it or ingesting it.  Smoking a single joint is equivalent to smoking 20 cigarettes (not something you want to do in regards to lung cancer risk).  Ingestion is highly unpredictable and fluctuates significantly based on stomach acid content. (This is a significant problem as over-ingestion can lead to significant cardiac effects including doubling of heart rate, dizziness and loss of consciousness, heart attack and stroke.)
Mental Side Effects
I have frequently seen patients in the emergency room with side effects including delirium, mania, and paranoia due to THC.  I have a number of patients whose panic attacks are exacerbated by their use of marijuana.  I have a few patients who experience flashbacks from its previous use. Short term memory impairment is significant in these patients.
A large Swedish study of 50,000 people demonstrates a dose response relationship between frequency of cannabis use and schizophrenia over a 15 year period.  Five other studies show a 2-fold increase in risk for schizophrenia after cannabis use.
Immune System Side Effects
THC impairs the body's immune system and prevents its ability to fight viral and bacterial infection.
The tar content in a marijuana cigarette is 3 times greater than that of a cigarette and has been shown to deposit 33% more in the respiratory tract than a cigarette. There is a link between frequent cannabis use and esophageal cancer.
Hormonal and Reproductive Side Effects
Testosterone levels have been shown to decrease with THC use decreasing reproductive abilities and changing the ovulatory cycle in females. Reduced birth weight is a know side effect of cannabis use.  Three studies have shown an increased risk of leukemia  in children whose mothers used cannabis during pregnancy.

In my mind, the risks significantly outweigh the benefits and legalization of a drug with such significant side effects is not worth the limited and minimal benefit.  It is a "no brainer" and if marijuana is legalized the side effects will lead to many more "no brainer" patients.

1 comment:

Adam Nally, DO said...

I was asked by a reader to specify sources:
Significant dose dependant risk for psychosis with long term use of cannabis found in:
Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review.
Moore TH; Zammit S; Lingford-Hughes A; Barnes TR; Jones PB; Burke M; Lewis G
Lancet. 2007 Jul 28;370(9584):319-28.
McGlothlin, WH, West, LJ. The marihuana problem: an overview. Am J Psychiatry 1968; 125:126.

Significant increased risk in transitional cell carcinoma with cannabis use found in:
Association between marijuana use and transitional cell carcinoma.
Chacko JA; Heiner JG; Siu W; Macy M; Terris MK
Urology. 2006 Jan;67(1):100-4.

Infertility changes due to cannabis use:
Hembree, WC, Nahas, GG, Zeidenberg, P, et al. Changes in human spermatozoa associated with high-dose marijuana smoking. In: Nahas, GG (ed) Marijuana and Medicine, Humana Press, Totowa, NJ, 2001.

Immunosuppressive affect of cannabis:
Cannabis: pharmacology and toxicology in animals and humans.
Adams IB; Martin BR
Addiction. 1996 Nov;91(11):1585-614.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision, American Psychiatric Association, Washington, DC, 2000.

Cardiac Effects of Cannabis:
Cardiovascular system effects of marijuana.
Jones RT
J Clin Pharmacol. 2002 Nov;42(11 Suppl):58S-63S.