There is No Such Thing as "Medical Marijuana"

...at least, not yet.

I work for a holistic health company that recently released several new products to their product line. One of those new products is in the cannabinoid family, which has led to me think a lot over the last couple days about the medical marijuana battle.

In January of this year, the Utah Medical Association made a statement claiming that "there is no such thing as medical marijuana" because it has not been studied and approved by science or government. For this reason, the Utah Medical Association believes that until such studies are completed, marijuana should stay illegal with penalties (read about that announcement here).

This is a responsible approach to the legalization of marijuana. Just because a substance is presumably helpful doesn’t mean it’s not dangerous. I’m not adamantly opposed to medical marijuana – but there is a lot that we don’t understand about marijuana, and a lot that we do understand about physiology, pharmaceuticals, and substance abuse. Legalizing marijuana (whether for recreational or medicinal use) based only on the information we currently have on the substance would be irresponsible.

The Argument

The very first hit on my first google search about this was an article by the Huffington post from December 2015. It begins:

With marijuana now legal in some form throughout 23 states, the number of Americans who fatally overdosed on the drug last year was significant:

Zero.

The rate of absolutely zero deaths from a marijuana overdose remained steady from last year, according to figures released this month by the Center for Disease Control. (Source)

The article went on to promote the legalization of marijuana on the pretense that it's "safe" based statistics like this one.

The problem with this argument is that the statistics being used are not relevant to the point that the article is trying to make. Lets first take a look at the study cited by the Huffington Post. The report was from the National Institute on Drug Abuse (NIDA). It begins by making this statement:

The U.S. government does not track death rates for every drug. However, the National Center for Health Statistics at the Centers for Disease Control and Prevention does collect information on many of the more commonly used drugs.

 

So the NIDA is saying upfront that not every dangerous drug is on this list. And because there were no accounts in 2014 of death by marijuana overdose, marijuana doesn’t appear on this list by the NIDA. The Huffington Post is drawing the conclusion that marijuana isn’t dangerous based on this information (or lack thereof).

But guess what substance also doesn’t appear on this list because there were no accounts in 2014 of death by overdose?

Nicotine.

People don’t die from smoking cigarettes because they’ve overdosed on nicotine (the active component in tobacco cigarettes) – just like people don’t die from marijuana because they’ve overdosed on tetrahydrocannabinol (THC – the active component in marijuana).

But the fact that you don’t usually die by overdosing on a substance doesn’t mean that that substance is safe to put in your body.

It’s a well-researched, well-documented, and well-known fact that cigarette smoking is among the leading causes of death in the United States – but not by way of overdose.

According to the Centers for Disease Control and Prevention (CDC), “lung cancer is the leading cause of cancer death and the second most common cancer among both men and women in the United States” (Source); and “cigarette smoking is the number one risk factor for lung cancer. In the United States, cigarette smoking is linked to about 80% to 90% of lung cancers.” (Source)

The Fallacy

If I was making the same case for cigarettes that the Huffington Post is making for marijuana, I could say something like, “because there have been no nicotine overdose deaths, and cigarettes have been used to effectively treat some medical conditions, tobacco is completely safe to use and should be legalized.”

See the drastic jump in logic there? The first two statements are complete true and accurate, but they don’t necessarily render the third statement valid.

A + B ≠ C, and the argument seems ridiculous.

The reason that this argument promoting cigarettes sounds unreasonable, but the very same argument for marijuana seems plausible, is because of our experience with cigarettes over the course of the last 90 years. We now know that although we needn’t worry too much about nicotine overdose, smoking cigarettes is one of the leading causes of death in the United States via lung cancer.

It is very, very possible that a similar association will come out in 90 years linking marijuana smoking to death by an effect of THC on the body. For this reason, it would be unwise to legalize a substance for medical reasons when we don’t have enough research to support the safety of the product.

But…marijuana is beneficial to health, and cigarettes aren’t. Right?

Well, maybe. But just because a substance is presumably helpful doesn't mean that it's not dangerous.

In the 1930’s and 1940’s, physicians were recommending cigarettes to help women lose weight and to sooth coughs and/or irritated throats, among other things.

According to the National Institutes of Health (NIH), “Medical professionals – having themselves joined the ranks of inveterate smokers – doubted the connection between smoking and disease.” (Source)

Is any of this sounding familiar?

Recent Information from the NIDA, managed by the US Department of Health and Human Services, says this about using marijuana to treat medical conditions:

“There has been much debate about the possible medical use of marijuana for certain conditions. A growing number of states have legalized marijuana for medical use, but the FDA, which assesses the safety and effectiveness of medications, hasn't approved marijuana as a medicine. There haven't been enough large-scale studies (clinical trials) showing that the benefits of the whole plant outweigh its risks in the patients it's meant to treat. To be approved, medicines need to have well-defined and measurable ingredients that are consistent from one dose (such as a pill or injection) to the next. 

In addition to THC, the marijuana leaf contains more than 400 other chemical compounds, which may have different effects in the body and which vary from plant to plant. This makes it difficult to consider its use as a medicine even if some of marijuana’s specific ingredients may offer benefits. However, THC itself is an FDA-approved medication. Two medicines in pill form (dronabinol [synthetic THC] and nabilone [a synthetic chemical similar to THC]) are available to treat nausea during cancer chemotherapy and boost appetite in people with AIDS. Scientists continue to investigate the medicinal properties of THC and other cannabinoids to better evaluate and harness their ability to help patients suffering from a broad range of conditions.” (Source)

So it may be possible that THC has some health benefits that can be useful to treat some conditions. But it may also be possible that that the other components in marijuana are hazardous to health, or that we haven’t been using it long enough to see the negative side effects.

For example, Phencyclidine (PCP) was developed in 1926 by Parke, Davis and Company under the trade name Sernyl for use as a general anesthetic for humans. It was also used in veterinary medicine as a tranquilizer.

Almost 40 years later, in 1965, PCP use with humans was discontinued after clinical studies revealed that patients experienced delusions, severe anxiety, and agitation when emerging from the drug’s effects. Use in veterinary medicine is now uncommon as well.

PCP emerged as a substance of abuse in the mid-1960’s according to the Center for Substance Abuse Research (CESAR). (Source).

CESAR also notes that PCP has been known to be sold under the name of THC (imagine the implications of this if THC was a recreationally legal substance), and can cause death by overdose if taken in high quantities. More often than overdose, however, PCP-related deaths result from delusions and other psychological consequence of the drug’s use; reports include death due to accidental drowning, leaping from high places, and motor vehicle accidents in addition to violent episodes of self-mutilation, suicides, and homicides. (Source)

But THC doesn’t act like this in the body – does it?

Well, it actually might. Some research has supported a correlation between PCP and the cannabinoid receptor type-1 (CB1), which is found in the central and peripheral nervous system and is responsible for psychoactive response in the body. This is also the receptor that interacts with tetrahydrocannabinol (THC), which is why using marijuana results in a feeling of euphoria (i.e. a “high” or other state of psychosis), and has been linked to schizophrenia in users. (NIDA Source; CDC Source)

Additionally, the CDC has reported marijuana-related deaths like this one from 2014 (Source), in which a teenager consumed a marijuana cookie, experienced a bout of psychosis, and then jumped off a fourth floor balcony and died from trauma. This event was clearly overlooked when the Huffington Post alluded to marijuana use being safe because no one had died of an overdose of the drug in 2014.

The Facts

The research relating to marijuana use is still in its infancy, but so far it’s pretty consistent across the board. This information is taken from the Centers for Disease Control and Prevention (CDC), the National Institute on Drug Abuse (NIDA) / National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Addiction

It is widely assumed and accepted that marijuana is not truly “addictive” or that people can’t become “hooked” on the drug, but research shows that about 1 in 10 marijuana users will become addicted. For people who begin using before the age of 18, that number rises to 1 in 6. (Source)

Brain Health

Short-term effects of marijuana use include problems with attention, memory, and learning, which can affect relationships and mood. Long-term effects of marijuana may negatively impact brain development including a reduction of attention, memory, and learning functions.

Long-term marijuana use may also affect how the brain builds connections between the areas necessary for these functions, and may temporarily or permanently reduce IQ. (Source) Recent research has shown that people with persistent marijuana use disorder who began using marijuana heavily as teens permanently lost an average of 6 or up to 8 IQ points by mid-adulthood.

(Source)

In developing brains (i.e. pregnant women that use marijuana may affect the brain of their unborn child), studies show that marijuana may be linked to problems with attention, memory, problem-solving skills, and behavior problems. (Source)

Cancer

The research about whether or not marijuana use causes cancer is inconclusive, partly because most people who use marijuana also use tobacco, a substance that does cause cancer. But researchers have found an association between current, frequent, or chronic marijuana smoking and testicular cancer. More research is needed to fully understand the relationship between marijuana use and cancer. (Source)

Heart Health

The compounds in marijuana can affect the circulatory system and may increase the risk of heart attacks and stroke. Research has found a significant increase in the risk of heart attack in the hours after marijuana use, and that smoking marijuana can harm lung tissues and cause scarring and damage to small blood vessels. (Source)

Lung Health

Smoke is harmful to lung health. Toxins and carcinogens are released when marijuana is burned. When these toxins and carcinogens are smoked, they are inhaled into the lungs, increasing health risks. Smoking marijuana can lead to a greater risk of bronchitis, cough, and phlegm production. (Source)

Many people believe that smoking marijuana is less dangerous than smoking cigarettes, but research suggests that that’s not necessarily true. Smoking five marijuana joints a day can be as harmful as smoking 20 cigarettes a day because marijuana smoke deposits four times more tar in the lungs and contains 50 to 70 percent more (potential) cancer-causing substances than tobacco smoke does. (Source)

Secondhand Marijuana Smoke

Secondhand marijuana smoke contains tetrahydrocannabinol (THC), the chemical responsible for most of marijuana’s psychological effects, and many of the same toxic compounds in smoked tobacco. Breathing it could, therefore, affect the health and behavior of nonsmokers, especially babies and children. (Source)

Mental Health

There is still a lot to learn about whether marijuana may lead to mental health problems or if having mental illness makes people more likely to use marijuana. And as with other drugs, factors like the age of users, how early they start, the amount of the drug they used, and their genetics all could make a difference in whether or not long-term problems develop. But current research shows:

·         Marijuana users are significantly more likely than nonusers to develop chronic mental disorders, including schizophrenia.

·         Some marijuana users have an increased risk for psychosis.

·         Marijuana use has also been linked with depression and anxiety, and with suicidal thoughts among teens; however, it is not known whether this is a causal relationship or simply an association.

·         Marijuana use can trigger psychosis in people with schizophrenia.

(Source)

Vehicle Safety

Marijuana use has been seen in adolescents to be associated with altered connectivity and reduced volume of specific brain regions involved in a broad range of executive functions such as memory, learning, and impulse control compared to people who do not use. This means that marijuana can affect the sense of time and coordination for the user, impacting things like driving. (Source)

Marijuana is the most commonly identified illegal drug in deadly crashes, sometimes in combination with alcohol or other drugs. By itself, marijuana is thought to roughly double a driver's chances of being in a crash, and the combination of marijuana and even small amounts of alcohol is even more dangerous—more so than either substance alone. (Source) In 2011, nearly 456,000 emergency room visits were related to marijuana use. (Source)

Poisoning (“Overdose”)

Eating foods or drinking beverages that contain marijuana have some different risks than smoking marijuana, including a greater risk of poisoning. Unlike smoked marijuana, edibles can take anywhere from 30 minutes to 2 hours to take effect, and can cause effects that last longer than expected (depending on the amount of THC in the edible, the amount of edible taken, the last food eaten, and medications/drugs/alcohol used at the same time).

The amount of THC can vary in edible marijuana products, which makes it more difficult to control how much THC is consumed.  For example, in states where recreational marijuana use is legal, one cookie or brownie might contain multiple “servings” in the product or package. That means a single marijuana cookie or brownie, or any other marijuana edible, might contain as much as 100 mg of THC. So if someone ate an entire cookie or brownie—each one a single “serving”—it would be like taking many hits of a marijuana cigarette at one time. The amount of THC in homemade marijuana edibles can vary even more. Many users can be caught off-guard by the stronger potency and long-lasting effects of edibles.

The effects of THC also take longer to feel when it is eaten instead of smoked. So some people eat too much, which can lead to poisoning and/or serious injury.

It is also important to remember that marijuana affects children differently than adults. Since marijuana has become legal in some states, children have accidentally eaten marijuana products that looked like candy and treats, which made them sick enough to need emergency care.

Currently, there are no reports of teens or adults dying from marijuana alone. However, some people who use marijuana can feel some very uncomfortable side effects, especially when using marijuana products with high THC levels. People have reported symptoms such as anxiety and paranoia, and in rare cases, an extreme psychotic reaction (which can include delusions and hallucinations) that can lead them to seek treatment in an emergency room.

While a psychotic reaction can occur following any method of use, emergency room responders have seen an increasing number of cases involving marijuana edibles.

(CDC Source; NIDA Source)

Risk of Using Other Drugs

The concept of marijuana as a “gateway drug” – where using marijuana leads a person to use other drugs – is controversial. Researchers haven’t found a definite answer yet, but it is important to remember that people of any age, sex, or economic status can become addicted to marijuana or other drugs.

Things that can affect the likelihood of substance use include: family history, having another mental health illness (such as anxiety or depression), peer pressure, loneliness or social isolation, lack of family involvement, drug availability, and socioeconomic status. (Source)

The Solution

Although it is commonly argued that what a person does with their own health is not the business of anyone except the individual, that argument does not hold up well in the case of substance use and abuse. Very rarely does an individual's use of a substance affect only the individual using or abusing; most often, substance abuse affects those close to the user by way of lost time, money, attention, missed responsibilities, or other related experiences.

The affects of using a substance medically can lead to abuse -- Utah is well-known for its prescription-abuse problem, and the nation is currently fighting an opiod epidemic for this reason. In the case of marijuana, psychosis or the impaired brain function of a user may create a dangerous environment for non-related individuals in the community by way of violent acts or poor vehicle safety. Secondhand marijuana smoke also contains THC, which has been shown to make non-users (especially children) ill. If a large majority of the community is regularly using marijuana, the reduction of IQ in those individuals could potentially negatively impact the future of the community.

There exists an argument that marijuana should be legalized for use in medical cases where an individual is terminal, the implication being that the long-term effects of the substance are largely irrelevant in these cases.

I am very much in favor of this tactic.

Experimental treatments are often used in cases where an individual is terminally ill in order to gain a more thorough medical understanding of how a substance can treat a condition, or how it interacts in the human body. Experimental treatments are used in terminal cases because of the potential that the treatment has to improve the diagnosis or treat the terminal condition when existing treatments have proven ineffective. Experimental treatments help medical professionals better understand treatments that have not yet been approved, but that have been shown to provide promising results in lab tests.

Using marijuana in experimental treatment studies a responsible and effective way to develop innovative and potentially effective treatments for some conditions. But as with any substance, it is important for medical professionals to understand the repercussions of introducing a new substance into the medical community. Until this happens with marijuana, the Utah Medical Association is wise to declare that marijuana has yet to be determined medical until further tests lead to a more sound understanding of the substance.

The Conclusion

We still don’t know enough about marijuana to determine whether or not it is safe to use medicinally. History has proven that great public health challenges can sometimes come from introducing a substance – even with the best intentions – into a community without proper education regarding the consequence of that substance on health or the community.

No substance is “completely safe.” No substance is without side-effects (chemical reactions always produce side effects). Until we better understand the interaction of marijuana on the human body, the Utah Medical Association is wise to require more research and more understanding before legalization.