The Cannabis Chronicles

Welcome to the Cannabis Chronicles, where we’ll be discussing health and medicinal aspects of Cannabis smoking.  Many of my patients have asked about the safety of cannabis use and why such an innocent herb is such a big deal.  Of recent note is the large number of states decriminalizing or legalizing marijuana in small quantities for personal, recreational use. Even the federal government is weighing in with somewhat vague statements of not prosecuting those recreational smokers, for now. The same is true with medical marijuana.  There are no head to head and good double blind studies meeting the standards for FDA approval of cannabis for prescription as a purely smoked plant. There are many chemicals in the plant that have actions ranging from psychoactive to immune system regulation, to impact on muscle spasticity.  Some of the chemicals even may reverse the actions of others.  Smoking the plant is like a “shotgun” treatment when it comes to knowing what in the plant is making the difference. We do have studies on natural and synthetic individual chemicals whose benefits have been identified and studied in small dosages.   Let’s face it.  With some of the suffering from debilitating diseases covered by medical marijuana, the “shotgun” may be the most compassionate thing to do.

While we don’t have the best science, we still have laws and empirical studies.  The laws have made medical and recreational use legal.  There will always be those who will manipulate the requirements to get the drug.   To confound the process even more, there is our old friend placebo.  We know how powerful belief can be as a driver for response. It can cause psychological and physical changes in the body.  How much is wanting it to work and feeling the effects serving as a signal that help is on the way?  Lastly, most of the studies measuring the effects also used small, controlled doses.  Folks buying medical marijuana are generally smoking the recreational dose potencies.  That means many should be getting some euphoria; that’s the clinical term for being “high.”  So, if they’re feeling better because “they’re feeling no pain” from euphoria as well as getting some pain relief via medical effects on the nervous system…Well, who’s gonna complain about that? If comfort and compassion are our goals for those most in need, perhaps it’s   the right thing to do.

Then there are the medical risks of smoking cannabis for recreational and medical purposes.  There are always those unintended consequences.  Think about smoking a cigarette without a filter and smoking it down to the nub. That means you are getting all the tar/nicotine and other carcinogens with each inhalation.  With cannabis, most people inhale deeply and hold in the smoke to get the biggest dose.  All the carcinogens and tars (the brown stuff) are inhaled more deeply and kept longer. Cannabis smokers inhale more deeply than cigarette smokers in general. There is no evidence that cannabis is safer for the lungs than cigarettes. This may not be a big issue for those already medically disabled, but the recreational smoker will be at higher risk, especially if it’s legal, because of more regular use.  We have some clinical data that also point to an increase in impaired driving by cannabis users.  Emergency room monitoring of those in motor vehicle accidents also points to a recent increased incidence of urine tests positive for cannabis in drivers, though nowhere near the numbers for alcohol drinkers.  How will legalization impact these numbers? There are findings pointing to higher risk of psychosis and other long-term effects. Legalization means we are also accepting more costs for these natural consequences of our decisions. So, from my windshield, it’s still a cloudy picture on more mainstream inclusion of cannabis.  What are the full and objective benefits of medical marijuana? We are still “practicing” medicine. Eventually, enough will be learned to stimulate the profit motive of big companies and they will begin to research and license products.  We’ll talk next about why intoxication is enjoyable and so problematic.

Meanwhile, please, please don’t drink or smoke and drive.

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