As of Jan. 1, 2018, California’s “gold rush” or “green rush” is on. The passing of Prop. 64 legalized the recreational use of marijuana for those over 21.
Being a physician, believing in evidence-based medicine, what positive or negative health effects of marijuana are well studied?
The Shasta County Public Health Department Provider Spring 2017 bulletin points us to such a resource, the National Academy of Sciences, Engineering and Medicine 2017 report “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.”
The full report, available at nap.edu, organizes cannabis health effects as conclusive evidence, substantial evidence, moderate evidence, limited evidence and no evidence based upon the quality or lack of quality of scientific studies available. With the usage of marijuana products predicted to increase, additional quality scientific studies will be assembled to support or refute the advantages or disadvantages of marijuana.
I will concentrate on the National Academy of Sciences’ conclusive evidence, substantial evidence and moderate evidence on cannabis usage.
Respiratory disease: There is substantial evidence of a statistical association between cannabis smoking and worsening respiratory symptoms and more frequent chronic bronchitis episodes. Cessation of cannabis smoking will improve respiratory symptoms.
Injury and death: There is substantial evidence of a statistical association between cannabis use and increased risk of motor vehicle crashes. There is moderate evidence between cannabis use and the increase risk of overdose injuries, including respiratory distress, among pediatric populations in the U.S. states where cannabis is legal. (Keep cannabis and cannabinoids products away from children.)
Prenatal, perinatal and neonatal exposure: There is substantial evidence of a statistical association between maternal cannabis smoking and low birth weight of the offspring.
Psychosocial: There is moderate evidence of a statistical association between cannabis usage and the impairment of learning, memory and attention (acute cannabis use).
Mental health: There is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users. There is moderate evidence of a statistical association between cannabis use and increased symptoms of mania and hypomania in individuals diagnosed with bipolar disorders (regular cannabis use). Moderate evidence shows an increase incidence of suicidal ideation and suicide attempts with a higher incidence among heavier users, an increase in suicide completion and an increase in incidence of social anxiety disorder (regular cannabis use).
Problem cannabis use: There is substantial evidence that being male and smoking cigarettes are risk factors for the progression of cannabis use to problem cannabis use. Initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use. There is moderate evidence that during adolescence the frequency of cannabis use, oppositional behaviors, a younger age of first alcohol use, nicotine use, parental substance use, poor school performance, antisocial behaviors and childhood sexual abuse are risk factors for the development of problem cannabis use. There is moderate evidence of a statistical association between cannabis use and the development of other substance dependence and abuse including alcohol, tobacco and other illicit drugs.
Therapeutic effects: There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults (cannabis); effective for treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids) and effective treatment for improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids). There is limited evidence supporting the usage of marijuana for anxiety symptoms of public speaking or improving symptoms of posttraumatic stress disorders. There is little or no evidence cannabis or cannabinoids are effective treatment for cancer, symptoms of irritable bowel syndrome, epilepsy, motor system symptoms associated with Parkinson’s disease, or achieving abstinence in the use of addictive substances.
As with tobacco products the “gold rush” is on for those who grow, process and sell marijuana. The concentration of cannabis and cannabinoids in products are now at their highest, meaning rapid addiction and problem cannabis use present real threats to our community. Contrary to tobacco law, Prop. 64 allows advertising of marijuana on primetime TV when children watch. Marijuana products sold as gummy bears and brownies have already increased ER visits for children in Colorado. There are few medical indications for the appropriate use of marijuana; however, for most, marijuana will be “fool’s gold”.
Make it a New Year’s resolution to educate your family about the health risks of marijuana.