The Dirt on Weed

The Dirt on Weed

If you have not seen dispensaries such as “Grateful Meds”, “Ganja Gourmet” and “The Happy Harvest” in Colorado, then you are not looking.  In 2009, after the federal government relaxed their policy on drug enforcement against medical marijuana, dispensaries have sprouted like, well, weeds. 

Medical marijuana (MJ) was legalized in Colorado in 2000.  Amendment 20 legalized the use of “medical marijuana for persons suffering from debilitating medical conditions”.  The conditions specified included cancer, HIV/AIDS, seizure disorder, persistent muscle spasms, and persistent nausea among other things.  For the first several years, very little medical marijuana was prescribed in Colorado because the federal government threatened to enforce its drug laws. 

While there were approximately 1600 people using medical marijuana in Colorado before 2009, as of the summer of 2010, there were 20,000 cards issued with a backlog of 50,000 cases (according to the Colorado Department of Public Health). 

This rapid increase in MJ prescriptions is concerning for many reasons.  Actual scientific evidence for marijuana’s efficacy in treating medical conditions is severely lacking.  Additionally, there is evidence that marijuana is addictive and can lead to dependence.  A simplified definition of drug dependence is that a person uses the drug despite significant problems related to use, needs increasing amounts for the same effect, or experiences a reduction in important events (social, professional, family) because of the use.  In Colorado, 70% of cards have been obtained by men and most of them are between ages of 25 and 34, which is the “demographic most likely to have addictions” (Gundersen).  Most are not getting a full medical evaluation or receiving good follow up.  The most common diagnosis for which the marijuana is prescribed is “chronic pain”.  This is a subjective diagnosis that is nearly impossible to quantify or qualify which makes it nearly impossible to establish safe prescribing guidelines.

Marijuana may be a “natural” medication, but it is a “complex alkaloid mixture of over 400 compounds” (Gundersen).  There is evidence that it can be very harmful.  Regular MJ use is associated with potentially severe problems.  There is a link between MJ use and psychosis, especially for people who begin in adolescence (age 18 or younger).   There is “good evidence that marijuana makes anxiety, depression and disorders of attention worse” (Gundersen).  Short term memory, motivation, productivity and cognitive processing have all been shown to worsen with use.  People’s ability to drive is affected and marijuana use has been associated with fatal accidents.

There are additionally severe health risks associated with use.  Heart rate is increased from smoking MJ and risk of heart attack increases five fold within the hour after smoking MJ.  Smoked MJ is associated with increased risk of lung, head and neck cancers.  Phlegm production, cough and bronchitis are all associated with smoked MJ use.

There are ethical dilemmas related to this as well.  What do you do when hiring an employee who tests positive for MJ, but has his or her card (MJ use has been linked to higher risk for workplace accidents)?  Also, recently I was involved in a case with a patient admitted to a hospital.  He had his medical marijuana card, but the hospital had a strict policy against the use of marijuana for any reason.  They did not allow him to use MJ and he was angry and not compliant during his hospitalization.  It affected his treatment in a negative way. 

I do believe that there are some (very few) cases where medical marijuana has a benefit.  The concern for me at this point is that it is being prescribed carelessly and without proper medical follow up.  Medial marijuana, like any medication, should be prescribed only after the physician has performed a very careful history, has made a specific diagnosis and established that other treatments have not worked.  The patient should additionally be informed of other treatment options not previously discussed, and should demonstrate understanding of the risks of marijuana use.  Any risk factors for addiction should be evaluated and discussed.  MJ should never be prescribed to a person with a history of drug problems or drug abuse. Careful follow up is imperative and should be planned on a regular basis to assess response, amount of use and any problems from use. 

As a physician I am concerned and embarrassed about what has happened with medical marijuana in Colorado.  I would urge anybody considering using MJ for any medical reason to have a thorough medical evaluation with consistent follow up planned and to consider more standard medical options first.

-Thanks to Dr. Doris Gundersen, “Medical Marijuana – A Prescription for Trouble?”, CPHP Newsletter, summer 2010.

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