doc
Summer 2015 • Kentucky
CONS
By Danesh
Mazloomdoost, M.D.
Since the early 1990s, scientific publications on medical
cannabis have increased
from 70 per year to over
1000 per year. As medical interest in the
endocannabinoid system has evolved, so
have political and financial interests in order
to fast-track legalization, thus trumping the
rigorous methodology of studying a drug
and its adverse effects. Raw opium, coca
leaves, and mustard gas all have derivatives
that are prescribed with medical benefit but
they rarely, if ever, prescribed in raw form.
Similarly, cannabinoids have potential benefits but, unrefined, may also pose significant
public harm.
Marijuana is composed of 500 different
compounds, of which over 60 are considered active ingredients1. Two have been the
focus of research, Cannabidiol (CBD) and
delta-9-tetrahydrocannabinol (d9THC).
CBD demonstrates medical interest and
is being studied in seizure disorders, pain,
inflammation, dementia, and cancer treatment. d9THC, on the other hand is psychoactive with limited medicinal use. Often
the ratio of d9THC to CBD is used to
determine the recreational versus medicinal
property of a crop, but even when maximizing CBD, crops still carry half to equal
ratios of d9THC2. The concentration and
bioavailability of these compounds also vary
from one plant to the next, among different
plant generations, and with altered delivery
methods. Therapeutic effects are additionally complicated with dose-dependent
effects that may contradict each other3.
Furthermore, without regulation, pesticides,
synthetic fertilizers, additives, and microbes
could all be present within distributed medical products without clinician or patient
awareness.
The media often sensationalizes failures
in conventional medicine as a rational for
legalization. Even though these cases evoke
sympathy, they are not representative of
the average medical marijuana recipient.
Following legalization in California, the
average recipient was a 32 year old white
male, of whom 50% had a life-time prevalence of cocaine use and 75% of methamphetamine use4. Vague diagnoses such as
“chronic pain” are most commonly cited as
the rationale for use5. In Colorado, 50% of
the entire state’s medical marijuana scripts
were generated by 1% of prescribing physicians6. Ill-defined diagnoses coupled with a
few physicians prescribing high quantities
are conditions similar to the opiate epidemic
and pill mills seen in Kentucky.
The benefits of marijuana legalization are
often touted as both good for local tax revenue and cost-cutting because of decriminalization. However, in the context of currently legal substances such as alcohol and
tobacco, the evidence conflicts with theory.
In Wisconsin, the revenue collected from
alcohol and tobacco tax averaged to $700
million per year, while the costs (motor
vehicle accidents, hospital admissions, fetal
effects and treatment, arrests, and addiction
treatment) totaled $11.3 billion, a 16-fold
difference7.
In the criminal justice system, there is an
impression that prisons are overflowing
because of marijuana incarcerations. These
statistics can be misleading. Any charge (e.g.
rape, murder, robbery) that also includes
a marijuana charge may be quoted as a
marijuana-related offense, thus inflating
the numbers. In reality, only 0.1% of state
prisoners are incarcerated for marijuana possession while drug traffickers encompassed
99.8% of federal drug charges8. Most possession charges are directed to drug courts for
rehabilitation services. Legalization could
actually increase marijuana-related charges
for the same reasons that alcohol, a legal
substance, outnumbers marijuana arrests by
4:19,10. For example, Washington State saw a
sizeable increase in marijuana-related DUI
arrests following legalization11.
Legalization normalizes, and consequently
increases, marijuana demand12. Terming
marijuana medicine further connotes
harmless and beneficial attributes. Lobby
interests often marginalize the many adverse
effects of marijuana. While the spectrum of
effects from each individual active ingredient is undergoing investigation, the metaeffect of raw marijuana shows detrimental
effects on memory, coordination, substance
abuse, and mental health, particularly for
vulnerable populations such as adolescents.
Memory and IQ are proportionally affected
in correlation to age of onset, duration of
use, and frequency of exposures to marijuana13-17. This effect is particularly harmful
to adolescents, who irreversibly lose an average of 8 IQ points, theoretically because of
inhibited synapse formation18. These effects
are even more pronounced in utero even at
low doses and infrequent exposure19.
Adverse effects continue throughout life.
Marijuana smokers show higher rates of
industrial accidents, injuries, and absenteeism20. Heavy users share lower income,
greater welfare dependence, unemployment, and low life satisfaction21-23. Kentucky
already ranks among the nation’s highest
rates of disability24; legalizing marijuana
risks increasing its availability and indirectly
raising disability rates further.
Proponents of marijuana often deny adverse
psychoactive properties, such as addiction and psychosis, citing anecdotal cases.
Similarly, one may argue not everyone who
tries alcohol becomes addicted. Yet, marijuana addiction rates among adults average
10%, while teens show higher rates at 20%,
and daily users at 40%25-27; all are higher )Ʌѕ́ѡ