Medicine For People!

April 2019: Marijuana - The Package Insert

Marijuana - The Package Insert

One day, no doubt, the federal government will get tired of putting people in jail for using Cannabis sativa. The herb will enter, for better or worse, our list of herbal remedies.

And when it does, the Federal Food and Drug Administration may generate a package insert, as you find in every bottle of aspirin.

It will go something like this:

Drug Facts

Active ingredient: Cannabis sativa containing 4% THC

Purpose: Psychoactive agent, anti-emetic, sedative, analgesic

Uses: Treatment of chronic pain, anorexia, nausea and anxiety

Warning: About 10% of people are susceptible to habitual use of Cannabis to a degree deleterious to employment and relationships. In unusual cases, people are susceptible to psychosis when exposed to Cannabis.

Marijuana: The Case Against

Rather than continue in the dry-as-dust language of the FDA, let me give one doctor's view.

Marijuana and Education

Marijuana appeals to the young.1 About 30% of our local grade 10 students admit to using it.2 And, of course, the result can be devastating.

As a mentor in our high school, it's clear to me that many of our young people don't work at learning. And while it's hard to know if any individual student is stoned on any particular day, too many students are just not on task.

Those who look at such things tell us that students who use a lot of marijuana are twice as likely as their parents to earn less than $30,000 per year.3 In today's world, that is a health problem.

High-achieving high school students tell me they need more challenge, not less. They tell me they want more opportunity for real-world experience and less time in a seat listening to someone talk. When we ask as little of them as we do, students get bored. Marijuana and other drugs deliver the excitement our current system often doesn't. Result? Some of them simply fail to make it into productive adulthood. Look it up—that's an established fact.4

So let's not imply to children that marijuana use is cool. Learning and polishing useful skills is cool. Having the discipline to be part of a team, at work or on a sports field, is cool. Keeping a clear head to deal with today's problems is cool. And not just cool—potentially lifesaving.

Many parents do not see a danger in drugs or alcohol and have a relaxed attitude about student use. 5 Let's spread the word—marijuana, like alcohol, needs to be treated with respect and avoided by the young.

Marijuana Advertising

Cannabis Sweet Relief
Photo credit Dr. Douwe Rienstra

Advertising aimed at young people is a real threat. Regulating advertising for marijuana products will not be popular. The marijuana industry points to its tax contributions from sales of their products and their high marks from Washington's Liquor Cannabis Board. 6 Like the alcohol industry, many who benefit from promoting the product will go to the mat for their paychecks. 7 They are not going to present both sides of the issue.

Marijuana Potency

We need to regulate the potency of marijuana products. Consider marijuana edibles. These come in the form of, for instance, gummy bears. People who are used to the quick high of a joint sometimes forget that the candy-like products might take several hours to take effect.

The conversation sometimes goes like this...

"you sure these contain marijuana?"

"It's been 45 minutes. I'm not feeling much."

"What is that, four of these? I don't know what all the fuss is about."

"Take me to the emergency department."

True story. Colorado reports about 1% of their emergency department visits contain diagnosis codes related to cannabis use, with higher rates among tourists, presumably people who traveled to Colorado to sample legal marijuana.8

Today's marijuana—legal or not—usually contains at least three times the THC it did 60 years ago.

Other Adverse Effects of Marijuana

Criminal behavior:

Most people who use marijuana do not commit crimes, but when people are violent, we docs get the call.

The Lancet recently published a survey of the incidence of psychosis in several European countries and in Brazil. In those areas where the use of high potency cannabis was more common, the risk of psychosis was also high.9 While the popular conception of the typical marijuana user is laid-back Dobie Gillis, people with certain mental illnesses are more likely to become violent when they use marijuana.10

Criminal behavior associated with marijuana alone and in combination with other addictive substances includes property damage, violence, police costs, court costs. Marijuana tends more to apathy than violence, but was present in half of all violent individuals treated in a Swiss hospital.11 People who cannot earn a living or find a place to live are more likely to break the rules. They may not have a choice of where to defecate— to choose an extreme but topical example—but their actions damage the community.

Impaired driving skills:

This includes avoidable deaths, injuries, and property damage. 12 Where marijuana is legal, governments report increased rates of motor vehicle accidents.13

Healthcare costs:

Most people do not become addicted to marijuana, but for those who do, costs can easily exceed $10,000 per treatment episode.

Endnotes

[1] https://www.statista.com/statistics/737849/share-americans-age-group-smokes-marijuana/ reduce font

[2]Jefferson County 2019 Profile, published in the Port Townsend and Jefferson County Leader in March 2019

31]Ibid

[4]https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-use-affect-school-work-social-life

[5]Jefferson County 2019 Profile, published in the Port Townsend and Jefferson County Leader in March 2019

[6]https://www.seattletimes.com/opinion/washingtons-cannabis-industry-needs-investment-reform/

[7]https://www.theguardian.com/media/2009/sep/08/ad-ban-devastate-media-industries reduce font

https://ncfdmedia.wordpress.com/2009/09/08/the-effects-of-banning-alcohol-advertising/ reduce font

[8]Marijuana Tourism and Emergency Department Visits in Colorado https://www.nejm.org/doi/full/10.1056/NEJMc1515009

[9]"The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe". Published online March 19, 2019

[10]Cannabis, a significant risk factor for violent behavior in the early phase psychosis. Frontiers in Psychiatry https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039574/pdf/fpsyt-09-00294.pdf

[11]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875877/pdf/pone.0195234.pdf

[12]https://www.sciencedirect.com/science/article/abs/pii/S0001457519302374
In Greece, marijuana is found in about 45% of traffic accident fatalities, more than alcohol is, at 40%. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/pdf/etm-18-03-2299.pdf

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530411/pdf/bmjopen-2018-027432.pdf

Thanks to my editor Jill Buhler Rienstra.

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.