What you don’t know can hurt you

Published 10:10 pm Sunday, October 31, 2021

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Editor’s note: Dr. Kenneth Stubbs, a long-time Natchez physician and internal medicine specialist, has prepared this analysis of the risks of the use of medical marijuana.

Marijuana or cannabis, as it is also called, an illegal drug on the federal level, is a hot topic lately especially in Mississippi since the state Supreme Court rejected the voter referendum.

The many myths are alive about benefit and safety of marijuana with well-funded proponents of its use anxious to tap into the millions of dollars in revenue that will be generated as sales mount. Our politicians are drooling over the anticipated tax revenues and the recreational marijuana industry is poised to follow on the coattails o the medical industry as all states with recreational use started with medical use.

Dr. Kenneth Stubbs

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Someone I personally know earns over $300,000 per year as a part owner in a medical marijuana dispensary. With such money, a lot of information, some unfortunately not totally honest or subject to full disclosure, can be broadcast, thus contributing to widespread misperceptions which will have dangerous repercussions for the public at large.

The impact of this dishonest rhetoric is evident in a study published in the American Journal of Obstetrics and Gynecology in 2017, which showed that from 2005 to 2015, the percent of females that believed that marijuana was safe in pregnancy increased from 4.6 to 19 percent. The morbidity and mortality weekly report in August 2020 showed 9.8 percent of pregnant women self-reported marijuana use prior to pregnancy, while 4.2 percent of continued use throughout pregnancy and 5.5 percent continued after delivery.

In some lower socioeconomic groups, up to 30 percent of pregnant women reported marijuana. This was double rate of use in 2001.

Over this same time, alcohol and cigarette use in pregnancy actually declined. A 2019 study that used laboratory measurements of marijuana metabolites showed 22 percent of women in Colorado that were delivering a baby, were using cannabis, but only 6 percent reported use.

Marijuana use in pregnancy is associated with double the rate of premature delivery — 12 percent versus 6 percent in non-users — increased hyperemesis, which is a medical term for excessive vomiting, placental abruption, ICU stays post birth, and APGAR scores less than 4.

A 2018 study in the Journal of Pediatrics showed 60 percent of breast milk samples six days after the last marijuana cigarette still tested positive for THC. Repetitive marijuana use in higher potency of cannabis plants (2 percent in 1970s, but 20 to 30 percent THC in marijuana grown today) causes even higher levels in breast milk.

Transport across the placenta has been show in experimental animal models. Such studies aren’t possible in humans. After controlling for factors such as race, tobacco use and use of other illicit drugs, marijuana use in pregnancy was associated with a three-fold increased risk of newborn death rate.

In a large Canadian study, autism was 50 percent more likely in children born to marijuana smoking women.

Professional medical organizations such as the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and the Academy of Breast Feeding Medicine, all advise avoiding marijuana use in pregnancy and while breast feeding due to impairment in fetal and childhood nervous system development.

Psychological disease is also increased, especially with exposure to marijuana in teenage years. A British Journal of Psychiatry article in 2018 reported a three-fold higher rate of psychosis in young adults below age 30 in those who use of marijuana started at age 15 to 16.

A study reported in the American Psychiatric Association Journal in 2018 showed depressed patients attempted suicide more often when they smoked marijuana. The National Academy of Sciences, Engineering and Medicine in 2017 advised not to use marijuana to treat depression as the rate of suicide was increased.

Ten percent of regular users developed “cannabis use disorder,” which is associated with withdrawal syndrome if marijuana use is suddenly stopped, cognitive impairment, school-work impairment, mood disorders, psychosis, violent behavior such as domestic violence, aggravated assault and murder. From 2014 to 2018, there was a 37 percent increase in murders and 25 percent increase in aggravated assaults in the four states that first approved recreational marijuana — Colorado, Washington, Alaska and Oregon in 2015. This is far greater than the national rates over the time, which remained relatively flat.

For cancer-related problems, the evidence is very mixed for the benefits for some cannabis products. There are more than 400 compounds in marijuana, and more than 60 are called cannabinoids. (These include THC, which is the psychoactive component, mood altering, addictive chemical, and CBD.)
Two of the cannabinoids are licensed in the U.S. for use with cancer-induced vomiting, nausea and weight loss.

But smoked products and CBD are not recommended. As currently available, CBD doesn’t seem to help. The only studies that suggested some benefit for pain, mainly related to neuropathic pain, occurred with well-controlled levels of THC, not from random smoked products that have a host of side effects, including dizziness and dry mouth, nausea, fatigue, euphoria, vomiting, disorientation, drowsiness, confusion, poor balance, hallucinations, fainting, heart attacks, heart irregularities, cough, increased sputum, and wheezing. Those are just typical side effects of smoked marijuana.

Much more study is needed to clarify safety, effectiveness, drug interactions and withdrawal effects before widespread use for pain, especially cancer-related pain, can be recommended, even though that is usually the most common use in states which allow medical marijuana use.

Impaired driving is clearing seen in all studies involving marijuana use. When mixed drug users, including alcohol, which unfortunately often occurs with marijuana smokers, were excluded and only marijuana found in the drivers system, auto accidents occurred twice as often as in non-users of marijuana, and more of the accidents involve fatalities.

Blood levels related to accidents were quite low at 1 to 2 nanograms per milliliter, whereas some states with medical marijuana use allow blood levels over 5 nanograms per milliliter before the user is considered unsafe to drive.
This clearly shows the disconnect between the advocates for use and the reality of harms that cannabis causes.

A Swedish study following marijuana users for 25 years, completed back in the 1980s, showed a 10-fold increase in premature death compared to non-users primarily from auto accidents, suicide and heart and lung disease. Other drugs were often also used.

North America leads the world in the percentage of marijuana users with 14.5 percent of the population. Surveys in the U.S. suggest that in 2016, nearly 1.2 million adolescents between the ages of 12 and 17 started using marijuana. In the past year, 33 percent of 18 to 35 year olds, 0.5 percent of 12 year olds, and 2.8 percent of 13 year olds used marijuana.

This should frighten all of us given the permanent brain function changes that may occur leading to the previously mentioned psychosis that is evident when these children reach young adulthood (Three times the rate of non-users.).

A study in JAMA Internal Medicine following patients with 25 years of continuous use of marijuana, who starting using between the age of 18 and 30, had impaired verbal memory and processing speed were impaired as compared to non-users. People with multiple sclerosis using marijuana for spasticity had slower processing speed as well as visual and working memory impairment. And opiate overdose deaths have not decreased with the broader use of marijuana.

How can our society possibly think marijuana has few harms? With medical marijuana on the horizon, the slippery slope will start forming. Innocent people will be hurt with little proven benefit. Tax collections will increase and arrests for some crimes will decrease while others will increase. Society costs will be great. Much more research should be done to clarify which, if any, product in marijuana is safe and helpful. Then, we should learn how to manufacture and use it.

Inhaling a wide array of vapors, especially when heated and transformed to new unintended chemical as in vaping, is likely never to be found good for our lungs. Why would we allow such a thing? Second-hand exposure of vapors to children will cause possibly permanent harm as will the inadvertent intake of candy-like gummy products or baked good. Diversion to illegal sales to avoid taxes is already occurring where it has been legalized.

Are we ready?

Dr. Kenneth Stubbs is a Natchez internal medicine physician.