Here’s what a physi­cian wants you to know about mar­i­juana

The Star (St. Lucia) - - LOCAL - By Dr Marc Siegel ---Fox News

Alex Beren­son’s new book, "Tell Your Chil­dren; the truth about Mar­i­juana, Men­tal Ill­ness, and Vi­o­lence", is com­ing out at the right time, as more and more states are le­gal­iz­ing mar­i­juana. Cur­rently mar­i­juana recre­ational use is le­gal in ten states (Wash­ing­ton, Ore­gon, Cal­i­for­nia, Ne­vada, Colorado, Alaska, Michi­gan, Ver­mont, Mass, Maine, and Wash D.C.). Med­i­cal mar­i­juana is now le­gal in 24 states.

There is more pub­lic sup­port for mar­i­juana law re­form than ever be­fore. The lat­est polls show that more than 50 per cent of peo­ple favour mar­i­juana le­gal­iza­tion while at the same time the Drug Pol­icy Al­liance (DPA) be­lieves mar­i­juana should be de­crim­i­nal­ized and reg­u­lated like al­co­hol and to­bacco. Beren­son him­self is not in favour of recre­ational use, in part be­cause of links to men­tal ill­ness and vi­o­lence that he ex­plores in the book, though he is in favour of de­crim­i­nal­iza­tion.

As a physi­cian, I want mar­i­juana users and ad­dicts to be treated as pa­tients—and not crim­i­nals—while at the same time I am very aware that reg­u­lar mar­i­juana use car­ries sig­nif­i­cant health risks. I be­lieve we should treat ha­bit­ual users ag­gres­sively and warn them of the as­so­ci­ated risks.

My job is to let you know that there is no free lunch med­i­cally with mar­i­juana or any drug. Even if a state or a so­ci­ety de­cides that it is wise eco­nom­i­cally and po­lit­i­cally to make mar­i­juana le­gal, at the same time we must be pre­pared for the health con­se­quences even more than the le­gal ones.

It’s clear to me that there is enough sci­en­tific ev­i­dence out there for me to dis­cour­age reg­u­lar mar­i­juana use for most peo­ple. Le­gal mar­i­juana (both med­i­cal and recre­ational) is turn­ing into a multi­bil­lion-dol­lar in­dus­try. Sales were ex­pected to hit $10 bil­lion na­tion­wide in 2017 and grow with the le­gal­iza­tion of mar­i­juana in Cal­i­for­nia at the start of this year.

In a re­port is­sued be­fore Ses­sions’ an­nounce­ment of a change in fed­eral pol­icy— the ef­fect of which is not yet de­ter­mined—BDS An­a­lyt­ics fore­cast that mar­i­juana sales in Cal­i­for­nia alone could to­tal $3.7 bil­lion in 2018 and $5.1 bil­lion in 2019.

In ad­di­tion, states stand to col­lect bil­lions of dol­lars in tax rev­enue from le­gal­ized mar­i­juana sales, and much gov­ern­men­tal money will be saved by not pros­e­cut­ing sales and use of the drug. Colorado has al­ready col­lected over $500 mil­lion from tax­ing le­gal mar­i­juana.

But what about the as­so­ci­ated med­i­cal risks from in­creas­ing us­age? This is a crit­i­cal ques­tion we must not ig­nore.

My first con­cern is traf­fic ac­ci­dents, since mar­i­juana is known to im­pair judge­ment. Statis­tics from Colorado since recre­ational mar­i­juana was le­gal­ized show a dou­bling of tetrahy­dro­cannabi­nol (THC)— the sub­stance in mar­i­juana that gets users high—in the blood of those in­volved in fa­tal car ac­ci­dents.

This is con­cern­ing. And though al­co­hol im­pairs a driver much more, THC stays in the blood­stream longer. If the two are com­bined, as they some­times are, the risk is mag­ni­fied.

A re­cent study from the Columbia Uni­ver­sity School of Pub­lic Health found that while al­co­hol in­creased the risk of caus­ing a fa­tal car crash five times, test­ing pos­i­tive for pot in­creased it by 62 per cent. Those driv­ers who had both pot and al­co­hol in their blood at the time of a fa­tal crash were six times more likely to have caused the ac­ci­dent.

An­other area of con­cern is preg­nancy. Many preg­nant women suf­fer from morn­ing sick­ness. But the Amer­i­can Col­lege of Ob­stet­rics and Gyne­col­ogy rec­om­mends against us­ing mar­i­juana while preg­nant—no mat­ter what.

And the Cen­ters for Dis­ease Con­trol warns that “mar­i­juana use dur­ing preg­nancy can be harm­ful to your baby’s health.” Why? The CDC points to re­search show­ing low birth weight in in­fants, along with de­vel­op­men­tal and at­ten­tion prob­lems in chil­dren born to moth­ers who smoke pot reg­u­larly dur­ing preg­nancy.

Un­for­tu­nately, pot smok­ing among preg­nant women is on the rise and it is bound to rise even more. A study re­leased from Kaiser Per­ma­nente in Cal­i­for­nia in 2018 and pub­lished in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion re­vealed that 7 per cent of preg­nant women sur­veyed smoked pot, in­clud­ing al­most 20 per cent of those be­low the age of 24. The num­ber of preg­nant women us­ing mar­i­juana will only in­crease now that recre­ational mar­i­juana is le­gal in Cal­i­for­nia.

Beren­son fo­cuses on men­tal health in his book and in fact, when it comes to ado­les­cents and adults, longterm mar­i­juana use has been as­so­ci­ated with de­creased school and job per­for­mance, mem­ory loss, and psy­chi­atric dis­or­ders in­clud­ing anx­i­ety and de­pres­sion.

With the in­crease in ed­i­ble mar­i­juana comes a dra­matic in­crease in Emer­gency Room vis­its from overuse, es­pe­cially among ado­les­cents, who may be get­ting more THC than they re­al­ize. Symp­toms in­clude acute anx­i­ety, rapid heart rate and para­noia.

When it comes to the heart, stud­ies show that pa­tients with known heart dis­ease are more likely to have chest pain and that heart at­tacks are more likely to oc­cur in the hour fol­low­ing smok­ing pot. Pot smoke is also known to cause wheez­ing and air­way in­flam­ma­tion, though more stud­ies on the long-term ef­fects of reg­u­lar mar­i­juana smok­ing on both the heart and lungs need to be done.

Don’t get me wrong. I must em­pha­size that I am not in­tend­ing to weigh in here on the pol­i­tics and eco­nomics of le­gal­iza­tion. In fact, I have never favoured pun­ish­ing users of any chem­i­cal sub­stance and ad­vo­cate in­stead for re­hab pro­grammes and peer-to-peer as­sis­tance for sub­stance abuse of all kinds.

But it’s im­por­tant to note that there is ev­i­dence that mar­i­juana is a gate­way drug to other drugs, both licit and il­licit, in­clud­ing nico­tine. This ev­i­dence must con­cern us even as we try to gain con­trol over the opi­oid epi­demic.

Here’s the bot­tom line: Mar­i­juana is a use­ful drug med­i­cally when it comes to treat­ing chronic pain, epilepsy, as well as the de­bil­i­tat­ing pain of can­cer and the nau­sea of can­cer treat­ments. But it should not be used to treat morn­ing sick­ness, and recre­ational use of any kind should in­clude con­sid­er­a­tion of po­ten­tial side ef­fects, es­pe­cially ef­fects on men­tal health.

The prospect of de­crim­i­nal­ized mar­i­juana sounds ex­cit­ing for some but the statis­tics of the drug’s health ef­fects are not!

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