Marijuana

With literally hundreds of millions of people in the world using cannabis, the state of knowledge of its community ill effects is probably something like that of tobacco a hundred years ago. There was a time in the 30’s when an occasional doctor prescribed cigarettes for people with asthma, and certainly, “More doctors prefer…” was a phrase in advertisements of favorite smokes, back in the day. It is perhaps easy to predict, therefore, that unknown illnesses may lurk in the background for Marijuana, under the noise of infrequent disorders, only to emerge when use becomes more common, more usual and more consistent, with more powerful products too—and comes out of the closet with more legality.
It is indeed a crime that millions of Americans suffer more from the criminalization of marijuana than from the biochemical and physiological effects of the drug. For it is a drug. And like any drug, has its benefits and its toxicities.

So what does cannabis abuse do to people?

It is certainly associated with school dropout, other substances in the drug scene, and the endless petty adverse results such as loss of employment, failure in educational activities and other psychosocial problems. There has been association with crime.

Pure health issues other than the psychosocial ones have pretty skimpy evidence, similar in many ways to tobacco years ago.

For example, lung cancer is the obvious worry, but it is pretty common for pot users to be cigarette smokers too, confounding the situation. Its a similar problem for bladder cancer; many cancers in the body are at increased risk because of cigarettes, and marijuana definitely contains serious carcinogens.

Psychosis appears related, and indeed, here a dose-response relationship has been found, that is, the more pot, the more psychosis. Well, that kind of makes sense. It’s always hard to know which comes first though—which causes which. It’s just that there does seem to be a reasonable metabolic or chemical reason for this: affects on molecules that mediate thought processes have been observed.

There is a curious syndrome called Cannabinoid Hyper-Emesis Syndrome (a lot of vomiting), puzzling since Cannabinoid derivatives such as Nabilone have long been used to help in chemotherapy-induced nausea (though I have not found it useful in my practice). This syndrome seems to be gastrointestinal in its presentation, with nausea, vomiting and abdominal pain.

Decreased libido (loss of sex drive), impotence (inability to maintain an erection) and gynecomastia (breast development in males) are risks. For the typical male, these risks loom huge, when they know about them, even if the incidence is low or restricted to heavy users.

The weed can apparently affect sympathetic and parasympathetic nervous systems, resulting in increase or decrease in heart rate and potentially changes in electrical activity within the heart, probably risks shared with regular cigarettes to varying extent.

For those with access, a lot of the above was converted into non-medical language from the most recent Up-To-Date article on Cannabis Abuse. For reference, see below.

Certainly while I was in residence at University, I was aware of one student who seemed to become addicted to marijuana. It became all consuming for him: his grades slipped, he became depressed, and exhibited symptoms typical of a long term addiction. At one point, as I recall, he spent a lot of time in his darkened closet. Ultimately, he recognized his plight and quit—or he ran out of money, not sure which. He saved his year because he was a bright guy in a bird program, attributed the loss of a good portion of it to his addiction, and seemed not to suffer unduly from withdrawal side effects. It certainly didn’t seem as bad as alcohol or narcotic withdrawal, but I have not really had enough experience.

It is illegal, in Canada. Should it be legalized? I don’t know. But that may be the only way to generate the money needed to deal with it.

Should it be decriminalized? I think so, at the very least. It does not appear to be as bad as other addictive substances available to people, and in the states, it does not appear to be as bad as their incarceration for the crime.

Is it going away? Hasn’t yet, doubt that it will.

Can it be used responsibly? I have no idea. Is alcohol?

Should more research be done? Yes. Any legalization should be with lots of the profits going to investigate all aspects of it’s use. More research with respect to its medicinal value, and methods of delivery that do not expose others to the drug would be good. We should not allow ourselves to get back into the situation of one person’s addiction causing an assault to others around them, as so often occurs with smoking. Nor should we forget the dreadful social consequences of alcohol that have wreaked havoc on our streets and in our homes to a far greater extent than it has in our hospitals and doctor’s offices.

And we certainly need a way to monitor it and control its abuse. After all, you don’t want your neurosurgeon, or your pilot, or your dentist, or your—well, the list goes on—high on Marijuana.

Francis Jensen’s excellent and helpful book  The Teenage Brain is a must read for all parents. Jensen is a neurologist, neuroscientist who has written this highly readable book, covering many addictions, not just marijuana. It is relatively easy to understand (unless maybe you have done a lot of weed). She refers to evidence showing IQ drops in chronic marijuana use. She also points to increased risks of psychosis, correlating schizophrenia and significant depression to marijuana in a dose dependent relationship.

What are the politics?

In Canada, keep it illegal for the Conservatives, make it legal for the Liberals, and something half way in between, decriminalization, for the NDP. I guess we’ll see what the Liberals do now.

Certainly the Canadian public does not seem to want the status quo, and decriminalization without further control seems a cop-out. A beneficial way to approach the issue would be to tax the product heavily, push the profits into serious research and treatment facilities, and intensive educational programs.

Canadian cigarette smoking reached a peak in the mid 90s, but for a lot of reasons, including the lack of transparency of the producers, knowledge of the ill effects of tobacco was sadly lacking amongst the general public. If we are to legalize marijuana, a great deal of work must go into control, regulation, monitoring and education. I don’t think we can get the money to do this from decriminalization.

As a physician looking after lung cancer patients, it is tempting to ban smoking. Even after forty years of medical practice, it is hard to see these people suffer so much. And my anger at the companies that hid the truth in order to make money from it knows no bounds. To a certain extent, my desire to allow such substances and inhibit their use through taxing and education, through restriction of public use, reflects the very large numbers who participate in their enjoyment balanced against the very large number who need protection. Somehow, I am perfectly capable of banning outright things like cocaine and heroin and amphetamines, but bend to the will of 160 million people when it comes to Marijuana, and many more when it comes to tobacco. It is not logical.

But attempting to rule by logic all the time is a mug’s game. Let people have their comforts, maneuver to remove the criminal profits, but prepare to deal with the consequences by taxing the hell out of these lifestyle products and providing the social and educational services required at a cost neutral basis.

But maybe–And here is where the ‘fictioning’ comes in.

Maybe it would be better if alcohol, tobacco and marijuana all just suddenly disappeared. Maybe that should be the topic of a Science Fiction Book, for it is surely fiction. What a month that would be; all those addicted people hitting the streets. But it ain’t going to happen, so we should really build a North American strategy to deal with this problem of yet again another addictive mind bending substance. Maybe that could be with respect to Drugs, Alcohol, Firearms, and Tobacco as some new expanded government unit enforces control.

DAFT.

It’s got the right acronym. After all, we seem to be doing collectively to our bodies the same thing we are doing to the planet.

Cannabis use disorder: Treatment, prognosis, and long-term medical effects, Up-To-Date, Scott A Teitelbaum, MD Robert L DuPont, MD John A Bailey, MD. Section Editor: Andrew J Saxon, MD. Deputy Editor: Richard Hermann, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Sep 2015. | This topic last updated: Sep 22, 2014.

The Teenage Brian: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults, Frances E. Jensen, MD, Amy Ellis Nutt. HarperCollins

See Brian Dingle’s Goodreads review of The Teenage Brain

The Teenage Brain by Frances E Jensen
My rating: 4 of 5 stars

Excellent book for parents and parents-to-be from a reputable source. Evidence presented in a non-academic style suitable for general public and professional health care workers alike. Author is a parent too, as well as a highly academic individual, but gives the information that parents need to encourage their clever teens and pre-teens to accept moderation.
I have never wanted to give my kids the “because I say so argument” and they were too smart for that anyway. This book gives parents the ammunition they need by providing the evidence that convinces us, if not our children.
I am now a grandparent, and thankfully was able to raise three wonderful children without this; but this surely would have helped.

View all my Goodreads reviews