A place where ideas stir the waters of our mind.

Thursday, March 19, 2015

Is Marijuana HARMFUL to your health?

The push for the legalization of marijuana for medical and recreational use continues to plow ahead.  In the past week, members of Congress as well as members of my State Assembly have joined the pro-pot push. I also noticed an article describing the “useful” tax revenue generated by the legalization of medical marijuana in Colorado.  When money is in the mix, it’s often not long before legislators want a piece of the pie. 

Lost in the move to legalize recreational and medical marijuana are the questions about the health effects of marijuana use. It seems hard for pro and anti-pot proponents to have even a useful conversation to answer health-related questions concerning this drug. Repeating the mantra that “marijuana is safe and no more harmful than alcohol” (including a certain oval office holder), the legalization train keeps chugging ahead and minimizing or ridiculing data concerning harmful health effects.  The anti-marijuana crowd tends towards knee-jerk reactions to these issues, and don’t consider the plight of those struggling with painful and debilitating diseases that don’t respond to conventional treatments.
I wonder what would happen if both sides just took a deep breath (not a long toke) and took a serious look at studies documenting the physical and psychological damage that smokers of marijuana are likely to experience.  Would it then be possible to have an informed dialogue?  Government policies concerning marijuana are too important to be made by those who ignore data in pursuit of a buzz, those on the “Reefer Madness” bandwagon or politicians looking for new revenue to fund pet projects.

Difficult Answers
From the outset, several issues make the marijuana health debate more complicated.
First, the majority of medical marijuana users are those who began using cannabis in adolescence.  That means that those pushing most for legalization also have a long-term history of getting high.  Do we really want the loudest voices influencing this debate to be those looking for a legal high – justified on medical grounds?
Second, it is also clear that some proponents of legal medical marijuana are suffering from long-term intractable conditions or the side effects of cancer treatments. As a person who has a long-term, chronic disease for which there is no cure, I am highly sympathetic to anyone seeking relief from pain or other debilitating conditions. The fact that some potheads are pushing for legal marijuana does not mean that all proponents of legal marijuana are looking for a quick buzz.  There are medical conditions that respond uniquely to cannabis.
Third, there are over 100 cannabinoids marijuana. THC is the cannabinoid that receives the most attention because it is responsible for the “rush” of pleasure when marijuana is used, but is only one of a multitude of the active ingredients in pot. Science is still in the process of trying to better understand and isolate individual cannabinoids to determine their efficacy for medical use.  Is it possible to isolate specific cannabinoids to more effectively treat specific diseases, and deliver the proper dosage in a medium that minimizes or eliminates the health effects of other cannabinoids? This question should be answered, but I’m sure that anything that might eliminate the THC buzz would be quite unpopular with those who see medical marijuana as a quick route to an easy high.
Fourth, the degree to which marijuana users experience harmful marijuana side effects depends on the age of first use, as well as the frequency and duration of use. Studies on the health effects of marijuana must control for these issues, and the good news is that some research already is.
Finally, marijuana does not have uniform concentrations of cannabinoids. What someone smokes in England may be chemically different from what someone smokes in California.  Therefore, it’s important to note that studies of the health effects of marijuana need to control for this and other factors as well as the use of other substances and behaviors.

So, what are studies suggesting about the health effects of marijuana?
For a good overview of current studies about the health effects of cannabis, please check out Dr. Michael Schatman’s article, “Medical Marijuana-the State of the Science” published in Medscape Neurology, February 2015.

Effects on the brain
SPECT scans from Dr. Daniel Amen (Amenclinic.com) show marked decrease in activity in the brain’s prefrontal cortex. The prefrontal cortex is one of the biggest things that separate us from other creatures like lizards. When the prefrontal cortex is impaired, we begin to function like very relaxed lizards and lose a variety of essential brain functions.  The functions impaired include:
  • ·        the ability to effectively regulate emotions
  • ·        maintain effective real-time interactions with others
  • ·        resolve conflicts
  • ·        think creatively or resourcefully
  • ·        impulse control
  • ·        motivation and goal-directed behavior
  • ·        understand the emotional consequences of behavior
  • ·        focus attention

In addition to these problems, a study of over 1000 participants showed that cognitive impairment among adolescent users continued long after they stopped using marijuana. In fact, nobody knows how long these effects will last or if they are permanent.  Proponents of marijuana need to recognize that anything making pot more accessible to teens is dangerous to the brain, including teens or children who use marijuana for medical reasons. Do the health benefits of marijuana outweigh the known long-term cognitive impact of marijuana on the developing brain?
In response, marijuana proponents are quick to point out that only those 21 and older should be able to buy marijuana legally. They argue that the 21-year old age limit will ensure that marijuana legalization will not affect teens. Really?  Really?  How many teens already find access to marijuana now?  Can we really believe that increasing the available supply of available marijuana will somehow magically make it less accessible to kids?

Psychological Effects
Studies report that acute anxiety in marijuana users has risen as THC content has increased and studies that suggest a correlation between marijuana use and anxiety date to 1944. Some studies also suggest that depression, suicidal ideation, and increased risk for suicide are correlated to the use of marijuana. One study by Hadland and Harris found that “frequent marijuana use by teens predicted depression and anxiety later in life”, and a more recent study determined that “use of marijuana among adolescents was associated with adult-onset anxiety.” (Michael Schatman PhD Medical Marijuana-the State of the Science; Medscape Neurology February 2015)
Dr. Schatman also reports a correlation between the use of marijuana and psychotic disorders, schizophrenia and bi-polar disorder. The relationship between marijuana and these mental health issues is complicated. Frequently people with a variety of mental disorders use substances like marijuana to self-medicate, so it’s unclear if marijuana is the causative factor. Risk factors associated with marijuana use and psychosis include: early use of marijuana, childhood abuse, a family history of schizophrenia, as well as a variety of genetic factors. While it would be inaccurate to state that marijuana use leads to these mental health issues, it is equally difficult to unequivocally state that marijuana does not lead to those problems. It would be helpful if proponents of legal marijuana were willing to consider the psychological issues associated with marijuana use of repeating the mantra, “marijuana is safe”. This isn’t about fear it’s about scientifically informed decisions about marijuana use.

Physical Effects
Marijuana is not good for your lungs, and it’s been known for years that cannabis contains carcinogens. A report from The American Lung Association notes that there are 33 cancer causing chemicals in marijuana. In fact, “marijuana deposits four times as much tar into the lungs as cigarettes when equal amounts are smoked”. Add to this other respiratory problems related to marijuana including bronchitis, lung irritation and infection.
Marijuana also affects the heart.  Dr. Schatman notes studies showing a connection between inhaling marijuana and higher rates of heart attack and death. In general people who use marijuana had higher rates of death from lung cancer. They also died more frequently from car accidents. The use of marijuana can also make it more difficult for women to become pregnant. A report in WebMD indicates that marijuana also affects men’s reproductive health. In fact they state, “The smokers weren’t the only ones who got high. The drug effected their sperm too. These stoned sperm party hard and are hyperactive… they’re too fast, too early… and then poop out.” In other words, the sperm of those smoking marijuana tend to swim hyperactively initially, and then to “burn out” and stop moving before they ever reach the egg. I wouldn’t consider marijuana to be an effective form of birth control, but it does effect fertility.
I don’t know about you, but the impact of marijuana on the brain and cognitive functions, along with the psychological and physical effects, strongly suggest that marijuana is not the “harmless drug” that proponents report.

So, what can we make of this information? Is marijuana a safe drug?
It seems best to say that the data is still coming in, but studies definitely indicate there is a dark side to the use of marijuana. We need solid research to study the health effects and benefits of the many cannabinoids in cannabis. Furthermore, we need research to determine the best non-harmful delivery system for medical marijuana.  If a specific cannabinoid can treat a disease effectively, is it possible to deliver it medicinally without the harm caused by smoking marijuana?
Parents opting to use marijuana to treat diseases in children need to carefully weigh the benefits and longer term harm of cannabis prescriptions.  The evidence suggesting long-term damage to the developing brain is compelling. The accompanying psychological effects can also be serious.
Should we deny adults with conditions that tend to respond only to the use of marijuana access to the most effective treatment for their disease because anti-marijuana are afraid? As with any medication, shouldn’t patients become educated about the side effects of their prescriptions, and then be free to make their own informed decisions about usage?

In closing, perhaps it makes sense to look at the health effects of marijuana this way.  When the buzz feels good it’s hard to imagine the harmful effects of marijuana – unless you are a marijuana smoker who is dying of lung disease, stroke, or heart attack. Then it doesn’t seem quite so harmless at all.