MEDICAL MARIJUANA: WHERE WE STAND

Aspen Medical Care, in agreement with American Academy of Physicians and others, is not in favor of the use of medical marijuana, except in certain rare and unique circumstances. As a result, we do not prescribe medical marijuana. We recognize the controversies regarding this position so we’ve done a lot of investigation which we have summarized below. At the end of our summary, we have included a link to a recent article from the University of Pittsburgh School of Medicine, published in September 2013, titled “Cannabis Revisited” which reinforces our thoughts on medical and recreational marijuana.

The basis of our position follows:

  • Marijuana has about four times the tar and 50-70% more carcinogenic hydrocarbons than your typical cigarette.

. The active ingredient in marijuana is THC (delta-9-tetrahydrocannabinol).  There are, however, over 60 other poorly-understood chemically-active substances in even “high quality” marijuana.  At this time, medical marijuana is distributed by dispensaries throughout the state of Colorado but there is no regulation of purity or potency.

  • Smoking 3-4 marijuana cigarettes a day causes the same cellular abnormalities to one’s airways as is seen in people who smoke 20 cigarettes a day.  These cellular changes put an individual at higher risk of cancer later in life.

General Health Risks associated with Marijuana Use:

Heart: Heart Attack.

Lung:  Carcinogenic (cancer causing). Cough and increased risk for respiratory infection.

Gastrointestinal: Obesity. Cyclical Vomiting Syndrome in chronic users.

Genitourinary: 70% increased risk of testicular cancer, bladder cancer.

Obstetrics:  Low birth weight babies. Absent reflexes in newborns.

Reproduction:  Decreased sperm count and motility with associated infertility.

Nervous System: Impaired cognition for 24hr after use.  Hallucinations and withdrawal.

Psychiatric: Depression and suicidality.  Exposure-related structural abnormalities in brain tissue (particularly in teens and young adults).

Immunology:  Poor immune system function.  Delayed healing.

Endocrine: Decreased testosterone.  Decreased libido.  Impotence.  Gynecomastia (“man boobs”).  Weight gain.

Social: Missed days at work.  Increased use of nicotine, cocaine and heroin.

Side Effects of intoxication:

Fast heart rate

Euphoria

High blood pressure

Time distortion

Fast breathing rate

Anxiety

Red eyes

Depression

Dry mouth

Impaired short term memory

Increased appetite

Paranoia

Mystical thinking

Impaired reaction time (>= to 24 hr**)

** due to THC accumulation in fatty tissue and subsequent slow release

Symptoms of Withdrawal:

Generally occurs after 21 days of regular use but this depends on amount of use and underlying health status. Symptoms generally peak 48 hrs after cessation and can last 5 – 7 days and include: irritability, agitation, depression, insomnia, nausea, anorexia and tremor. There is no treatment for withdrawal other than time and support.

In Colorado, conditions which can be legally treated with medical marijuana include:

  • cachexia
  • cancer pain and nausea
  • glaucoma
  • HIV/AIDs
  • muscle spasm
  • seizure (though marijuana can also provoke seizures)
  • severe pain
  • severe nausea

There are medical options for these conditions such as Dronabinol (Marinol) a standardized capsule form of THC (the active ingredient in marijuana).

Testing for Marijuana may be done in a number of ways: urine, blood, breath, hair, saliva and sweat. The metabolites (breakdown products of marijuana) are stored in the body’s fat and excreted by the kidneys. Urine drug tests are able to differentiate herbal marijuana from ingested dronabinol.  Detectable levels may be present for 10 days.

Legal Issues:

Federal Law – In 1970, the Controlled Substance Act was passed and marijuana was classified as a schedule I controlled substance, with a high potential for abuse and no medically recognized use. In the 2005 Gonzales v. Raich decision, the U.S. Supreme Court upheld the right of the federal government to maintain schedule I classification.

While Colorado law permits marijuana possession and use for adults (only), it remains illegal by federal law.

References:

Cannabis Revisited:
http://www.upmcphysicianresources.com/files/dmfile/S799-UPMC_Synergies_Fall_2013_12.pdf

http://www.aafp.org/online/en/home/policy/policies/m/marijuana.html

http://www.cdphe.state.co.us/hs/medicalmarijuana/index.html

http://www.fhcrc.org/about/ne/news/2009/02/09/marijuana.html

http://www.mayoclinic.com/health/medicinal-marjuana/GA00014

http://www.nytimes.com/2010/07/13/health/views/13klass.html?_r=0

http://www.drugfree.org/wp-content/uploads/2013/02/How-to-talk-to-your-kids-about-drugs-if-you-did-drugs.pdf

Yesavage JA, Leirer VO, Denari M, and Hollister LE. Carry-over effects of Marijuana intoxication on aircraft pilot performance: a preliminary report. Am J Psychiatry 1985, 142: 1325-1329

Yucel M, Solowij N, Respondek C, Whittle S, Fornito A, Pantelis C, Lubman DI. Regional Brain abnormalities Associated with Long-term Heavy Cannabis Use. Arch Gen Psychiatry: vol 65 No 6 June 2008.