We need to talk about the cons of marijuana Oct 08, 2019 at 12:39 pm

A patient came to my clinic recently for help with stress. She was out of work, living at home, and the lack of structure had made her anxiety worse.

As she described her symptoms, she tapped her legs nervously and shifted in her seat, her movements almost dance-like. I asked if anything had helped. “Honestly?” she said, fixing her eyes on me for the first time. “Marijuana has helped A LOT.” When it came to counseling this patient, I was at a loss. The medical establishment has largely pulled away from conversations about cannabis—commonly known as marijuana—and patients have been left to navigate health risks for themselves. Meanwhile, use keeps rising, the assumption that it is safe, and even good for our health. But as anyone who uses weed will tell you, these are not your grandma’s pot brownies.

THC, the most potent psychoactive ingredient in marijuana, has tripled in the last 20 years. And as genetic modification and processing techniques advance, the cannabis industry is poised to make billions on something that bears almost no resemblance to the marijuana humans have used for centuries. Yes, marijuana can ease pain. It can also make you vomit uncontrollably for months, experience psychosis, and change the way your brain matures. And as the content of what we are smoking, eating, vaping, and swallowing changes, we know less and less about what we are putting into our bodies and the potential consequences. Washington and Colorado were the first two states to legalize marijuana for recreational use. Our state is awash in legalized cannabis, brightly lit stores with lollipops, joints, chocolates, and vape pens that look like Willy Wonka’s after hours lounge. Packages have official-looking labels, and confident budtenders talk about the anticipated effects of different brands and modes of ingestion. But state legalization of cannabis came without a clear, scientific reckoning of what this drug does and does not do. “[Legalized marijuana] is an incredible experiment that we are doing,” said Deepak D’Souza, a professor of psychiatry at Yale University. He and others have raised concerns about the multi-billion dollar industry and its potential harms.

“If I’m running an industry, my bottom line is to sell as much product as possible,” D’Souza said. “If I get a young customer, I get a lifelong customer.” D'Souza worries also about psychosis and the effect of weed on brain development, especially with rising THC content. Industry messaging that marijuana is totally safe is “deafening,” D’Souza said. “I can’t compete with that message because it’s all over the place and it’s increasing.” T he most extreme pro-cannabis narratives claim that cannabis is harmless, even a cure-all for diseases that has been suppressed by greedy pharmaceuticals.

The anti-cannabis narrative, meanwhile, has used alarmist reporting to imply that smoking weed will turn you into a homicidal maniac. And the biggest proponent of anti-cannabis hysteria has been the federal government, said Peter Grinspoon, a physician at Harvard Medical School and director of Doctors for Cannabis Regulation. The federal government still classifies cannabis as more dangerous than methamphetamines and opium, leading to the arrest of millions of mostly black and Latinx people. Solid research about cannabis is hard to come by, largely because the federal government has made it so difficult to study — even requiring researchers to apply for a license with the Drug Enforcement Administration. But here’s what we do know about the pros and cons of marijuana for your health: Pros: ● There is strong evidence that cannabis is useful in chronic pain, treating nausea in chemotherapy patients, and muscle spasms in multiple sclerosis.

● There is some scientific support for the use of cannabis in a few other conditions, including weight loss in HIV, Tourette syndrome, but this is not conclusive. ● The first FDA approved medication derived from cannabis, epidolex, decreases the number of seizures in severe forms of childhood epilepsy. (It is comprised of CBD, which unlike THC, does not alter reality perception and may even protect against the psychoactive effects of THC) Cons: ● Chronic vomiting: While using cannabis in the short-term can ease feelings of nausea, long-term heavy use can interfere with the natural function of your digestive tract and cause recurrent, severe vomiting that often requires hospitalization. Doctors call this “cannabis hyperemesis syndrome.” One of the hallmarks of this disorder is that its symptoms are relieved with long, hot showers. The treatment and diagnosis of cannabis hyperemesis requires someone to stop using all types of marijuana for six months, which can be “an almost impossible ask” for someone using daily, Grinspoon has found. ● Brain development: Even advocates of cannabis are concerned about the effect of marijuana on young brains. People who use marijuana have been found to have impairments in memory, learning, attention, and decision-making. While it’s difficult to pinpoint the effect of cannabis on something as complex as brain development, teenagers who use even small amounts have been found to have changes in the structure of their brains. And in March this year, a study in the Journal of Neuroscience found that even one or two uses of cannabis caused changes in brain development in users 14 years old and younger.