The risks and myths of mar­i­juana use

Manteca Bulletin - - Local/State - Keith Roach, M.D.

DEAR DR. ROACH: I am absolutely con­vinced that mar­i­juana is a se­ri­ous health haz­ard. As the le­gal­iza­tion of mar­i­juana ap­pears to be spread­ing, are you aware of any au­thor­i­ta­tive med­i­cal stud­ies con­firm­ing the health haz­ards of mar­i­juana and that it is a gate­way drug to more-se­ri­ous drug ad­dic­tions? -- A.D.

AN­SWER: This is an ex­tremely large and controversial topic that I can’t do jus­tice to in a sin­gle news­pa­per col­umn, but I can at least out­line some of the is­sues.

I absolutely can con­firm that cannabis has health haz­ards. Cannabis use dis­or­der is one: It is di­ag­nosed when a per­son uses cannabis in a prob­lem­atic way, lead­ing to sig­nif­i­cant im­pair­ment or dis­tress. Com­monly, this in­volves us­ing cannabis more of­ten than a per­son wants to and re­sults in prob­lems at school, work or home. Cannabis use dis­or­der is sim­i­lar, in this way, to al­co­hol use dis­or­der. How­ever, most peo­ple who use cannabis, like those who use al­co­hol, do so with­out de­vel­op­ing cannabis use dis­or­der.

There are other well-de­scribed risks. Cannabis ad­versely af­fects driv­ing abil­ity and may cause long-term prob­lems in ver­bal mem­ory (the data are con­flict­ing, and a large study is un­der­way). Smok­ing cannabis is dam­ag­ing to the lungs (sig­nif­i­cantly less so than to­bacco, though, since the amount smoked by most cannabis users is smaller). There may be an in­creased risk of tes­tic­u­lar cancer with reg­u­lar use in men, and there is a syn­drome called “cannabi­noid hy­per­eme­sis syn­drome,” caus­ing un­con­trol­lable vom­it­ing. Teens who use cannabis have an in­creased risk of schizophre­nia. How­ever, deaths from acute cannabis use are al­most un­heard of, in sharp con­trast with al­co­hol or opi­ates, and the ef­fect on driv­ing, when it comes to caus­ing a col­li­sion, is less with cannabis than it is with al­co­hol.

As far as whether cannabis is a “gate­way” drug, the ev­i­dence sug­gests that peo­ple who will go on to use other, more harm­ful sources of­ten do start with cannabis and there may be changes in a user’s brain chem­istry mak­ing this more likely. How­ever, the ma­jor­ity of peo­ple who use cannabis do not go on to use other sub­stances. It is also pos­si­ble, per­haps likely, that peo­ple who are at high risk for us­ing opi­ates, co­caine or other drugs will start with what is avail­able, and to­bacco, al­co­hol and cannabis are the most avail­able sub­stances. Cannabis is al­most cer­tainly safer than both to­bacco and al­co­hol.

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