Category Archives: Colorado

Marijuana through the eyes of a doctor in Emergency Medicine

 Warnings from a Doctor

by Brad Roberts, MD:  I recently finished my residency in emergency medicine and began to practice in Pueblo, Colorado. I grew up there, and I was excited to return home. However, when I returned home, the Pueblo I once knew had drastically changed.  (Above photo is of people lining up at the opening of a pot dispensary in 2014.)

Where there were once hardware stores, animal feed shops, and homes along dotted farms, I now find marijuana shops—and lots of them. As of January 2016, there were 424 retail marijuana stores in Colorado compared with 202 McDonald’s restaurants.These stores are not selling the marijuana I had seen in high school.

Multiple different types of patients are coming into the emergency department with a variety of unexpected problems such as marijuana-induced psychosis, dependence, burn injuries, increased abuse of other drugs, increased homelessness and its associated problems, and self-medication with marijuana to treat their medical problems instead of seeking appropriate medical care.

I had expected to see more patients with cannabinoid hyperemesis syndrome (and I have), but they were the least of my concern. Our local homeless shelter reported seeing 5,486 (unique) people between January and July 2016, while for the entire year of 2013 (before recreational marijuana) that number had been 2,444 people.2

Most disturbing, we weren’t seeing just homeless adults but entire families. It is a relatively common occurrence to have patients who just moved here for the marijuana show up to the emergency department with multiple medical problems, without any of their medications, often with poor or nonexistent housing, and with no plan for medical care other than to use marijuana.

They have often left established medical care and support to move here for marijuana and show up to the emergency department, often with suitcase in hand.

Increasingly Potent & Dangerous Drug

This new commercialized marijuana is near 20 percent tetrahydrocannabinol (THC, the psychoactive component of cannabis), while the marijuana of the 1980s was less than 2 percent THC.

This tenfold increase in potency doesn’t include other formulations such as oils, “shatter” (highly concentrated solidified THC), or “dabbing” (heated shatter that is inhaled to get an even more potent form) that have up to 80 or 90 percent THC.3

The greatest concern that I have is the confusion between medical and recreational marijuana. Patients are being diagnosed and treated from the marijuana shops by those without any medical training. I have had patients bring in bottles with a recommended strain of cannabis and frequency of use for a stated medical problem given at the recommendation of a marijuana shop employee.

My colleagues report similar encounters, with one reporting seeing two separate patients with significantly altered sensorium and with bottles labeled 60 percent THC. They were taking this with opioids and benzodiazepines.

In some cases, places outside of medical clinics, like local marijuana shops, are being used to give screening examinations for medical marijuana cards.4 Reportedly, no records are available from these visits when requested by other medical providers. A large number of things treated with marijuana, often with no cited research at all or with severe misinterpretation of research, are advertised online.

These include statements that marijuana treats cancer (numerous types), cystic fibrosis, both diarrhea and constipation, hypoglycemia, nightmares, writer’s cramp, and numerous other conditions.5–7

Although there are likely some very effective ways to use the cannabinoid receptor (probably better termed the anandamide receptor), putting shops on every street corner and having nonmedical personnel giving medical advice is a very poor way to use this as a medicine.

Furthermore, to suggest that combustion (smoking) be the preferred route of medication delivery is harmful.3,8–10 I am also concerned that this is being widely distributed and utilized as a medicine prior to safety and efficacy studies having been completed; widely varying dosing regimens, concentrations, and formulations are being developed, sold, and utilized.

Patients are not being informed of the adverse effects associated with marijuana use, but instead, they are being told, “There are no adverse effects.” I am in favor of using the anandamide receptor for treatment purposes. However, we should do this safely and appropriately. What is occurring now is neither safe nor appropriate.

There are numerous adverse effects of marijuana that are significant. Marijuana use may lead to irreversible changes in the brain.3,9,11,12 Marijuana use correlates with adverse social outcomes.3

It is strongly associated with the development of schizophrenia.13–16 Dependence can lead to problem use.17,18 There are adverse effects on cardiovascular function, and smoking leads to poor respiratory outcomes.3,19,20 Traffic fatalities associated with marijuana have increased in Colorado.1

Pregnant women are using marijuana, which may lead to adverse effects on the fetus, and pediatric exposures are a much more common occurrence.21,22

This photo represents a few of the 270 Pueblo physicians who signed a petition last fall to opt out of marijuana for the city and county.

Different Approach Is Needed

We should approach mass marijuana production and distribution as we would any other large-scale public health problem. We should do what we can to limit exposure, and we should provide clear, unbiased education.

In the case of prevention efforts being unsuccessful, we need to provide immediate treatment and assistance in stopping use. If we are going to use this as a medication, then we should use it as we use other medications. It should have to undergo the same scrutiny, Food and Drug Administration approval, and regulation that any other medication does. Why are we allowing a pass on a medication that very likely would carry with it a black-box warning?

As emergency physicians, we are on the front lines. We treat affected patients; we need to be at the forefront of public policy recommendations at both state and national levels.

Originally published by ACEPNow,  a journal of Emergency Medicine.    We also published the testimony of another emergency doctor in Pueblo, Dr. Karen Randall.

One Family, Two Sons

Our condolences to the family in Colorado who lost two sons to overdose deaths. How did this tragedy happen?   Here is what we’ve been told:

Teenage son number one got caught with a little weed.  Then it was teenage son number two.   According to the prevailing culture of Colorado, their parents didn’t think that they had that much to worry about.  It’s a rite of passage and a expression of teen-aged angst.  Everyone does it.  Be glad they aren’t smoking tobacco or eating too much junk food, we rationalize.

Teenage son number one then tried opiates. Then son number two followed.  Such progression isn’t at all uncommon.  It’s not surprising to treatment providers.   Marijuana use significantly increases the risk of opiate addiction, and there’s plenty of medical evidence to back it up.

In December, we learned that both sons — their parents’ only children — have died within six months of each other.   Can you imagine this couple’s devastation?   Our hearts break for them.

two-sons
Having two sons is normally a blessing. We must make the most of it when we have them.  A family in Colorado, starting with “it’s just pot, is now left with nothing but the memories. Let’s stop advocating for policies that interfere with our children’s well-being. (unspecified photo)

The United States cannot afford marijuana legalization.  Why are we giving young people the impression that marijuana and drug use is inconsequential.  We are contributing to the 52,000+ overdose deaths in 2015 by pretending there’s a safe way to use drugs. Promoting  “responsible use” of drugs is promoting a lie.

 

 

 

Pueblo Fights to Get Rid of Marijuana Industry

60 Minutes Explores Pot in Pueblo

Colorado’s  marijuana legalization has wreaked havoc on Pueblo, and city will be featured on 60 Minutes on November 6th. (Date has since been changed to Oct. 30)  After nearly four years of legalized pot, many in the community are rebelling.  By initiating Propositions 200 and 300,  citizens of Pueblo  hope to regain a voice in their future.  A “yes” vote on both initiatives will shut down marijuana businesses in the city and Pueblo County.

Seventy percent of the counties in Colorado opted out of Amendment 64, which commercialized marijuana. The city of Pueblo banned retail marijuana, but the county of Pueblo licensed marijuana grows and retail stores.  In 2014, we reported on the efforts to ban retail expansion in Pueblo West.  Pueblo County commissioners promoted marijuana as an opportunity to fill empty factories and create jobs.  Acting against the wishes of most of the county’s 160,000 residents, commissioners decided to license marijuana businesses..

Because of intense problems, business leaders now strongly favor Proposition 200 and Proposition 300.  The Colorado Springs Gazette supports both propositions, because  “new data show pot legalization as an insidious policy failure.”   Citizens for a Healthy Pueblo has been fighting against the marijuana industry for two and half years.  See the Citizens for a Healthy Pueblo Safety Fact Sheet.

homelesscamppueblo
A homeless camp in Pueblo is overflowing now. Migrants from other states have come to Pueblo. Many newcomers have mental health and addiction issues, putting all health services at risk.

An influx of 15,000 migrants moved to Pueblo for easy access to the drug.  Some of the newcomers also hoped to find jobs in the pot industry.  Tent villages are housing newcomers who can’t afford or find homes. Pueblo has always taken care of its homeless, but it can no longer handle the huge number of people needing services.  Social services, soup kitchens and emergency rooms are stressed to the breaking point.  Approximately one-third of county residents, 67,000 are on Medicaid.

Doctors from Three Hospitals Hold Press Conference

The medical community recently held a press conference, announcing that  237 physicians signed a statement supporting “yes” votes on the propositions.  Physicians who spoke at the event detailed some of the health risks coming from marijuana use in the community.  Dr. Steven Simerville, a pediatrician and Medical Director of St. Mary-Corwin Hospital, reports that 7-10% of the babies born are testing positive for THC.  THC is the psychoactive compound in marijuana. Dr. Simerville cited a dramatic increase in attempted suicides, a five-fold increase since legalization.  Every suicide attempt in the community, except one, involved THC.

Dr. Karen Randall an emergency medicine doctor affiliated with several of the Pueblo hospitals said that many of the newcomers to the area are coming to the emergency room with multiple and severe illnesses. Dr. Randall believes the Pueblo community could be on the verge of a public health disaster.  She explained that those living in tent camps are at risk for the same communicable diseases found in refugee camps:  flu, pertussis, cholera, tuberculosis. Randall, who previously worked in Detroit for a large city hospital as disaster coordinator, says she fears the Pueblo community health system is not equipped to deal with such an outbreak.

The black market is growing alongside the legal industry.  Sheriff’s office reports that foreign cartels from Laos, Argentina, Cuba and Russia are now operating in Pueblo. The cartels are buying or renting homes and setting up illegal grows. Law enforcement has busted sixty illegal grows in 2016, but there are 1500 other documented grows –also illegal.  Sheriff Kirk Taylor is also retooling his tracking methods to account for the increasing crimes associated with marijuana .  Currently Pueblo has the highest murder rate in the state, at 11.1 per 100,000.

Rural Areas, Crime, Gangs and High Teen Use of All Drugs Reported

“Those living in the rural areas are scared,” reports Paula McPheeters of the Citizens for a Healthy Pueblo. “The marijuana grows are despoiling the land and draining the water aquifers.  Squatters are growing marijuana and crime is increasing.” McPheeters says the community is being overwhelmed by outsiders moving in and taking over. Gang activity is increasing, drive by shootings, petty crime, auto theft are now big problems in a once peaceful community.

“Pueblo County now has 20 retail marijuana stores, compared to our 18 McDonalds, Starbucks and Walmart stores combined,” says McPheeters. The county took in 3.5 million in tax revenue from the marijuana industry, but McPheeters says, “The social costs to the community could easily be upwards of two times that amount.”

The biggest concern to those seeking to pass the ballot initiatives is the increase in youth drug use. Thirty one percent of high school students are using marijuana, three times the national average. Tragically, 12% have tried methamphetamine or heroin.  The community has inadequate drug treatment facilities, so when teens get into trouble with addiction it is difficult to get them help.

A Cautionary Tale

Pueblo offers a cautionary tale against trying to resolve a government’s financial difficulties with tax revenue from marijuana. This relatively small city with a population of 120,000 is a former steel mill town which fell on hard times.  It ranks number two in the state for poverty.

The Pueblo experience warns public officials to listen to the people’s will before allowing predatory businesses.   It warns other communities what can happen to the youth when they’re surrounded by these businesses.

Pueblo may have some of the worst crime problems in Colorado, but it is not as bad as Eureka and Humboldt County, California.   Humboldt County’s murder rate is 18.7 per 100,000 people, and it reports 250 missing persons per year.

I Wish We Had Never Moved Here…..

Born in Massachusetts, our son started out life with a very bright future.  As a toddler he was interested in things with wheels, and anything his big sister was doing. As he got older, Legos was his obsession. In his early school days he tended to get really into a subject, even those of his own choosing. For a while it was Russian language and then it was the Periodic Table.  He begged me to buy him a 2½-inch thick used Chemistry textbook before he was a pre-teen. I did.

I was able to be a stay-at-home parent until our son was 8. I tried to do all the right things. We played outside, limited screen time, and got together with other little ones and their moms for play groups. I read to him and his sister every night until they both reached middle school and wouldn’t let me anymore. Our son routinely tested in the 99th percentile on standardized tests and at least 3 grade levels above. Now, at age 17, he has dropped out of high school.

My husband and I both have Master’s degrees, and my husband is a public school administrator. His father is a retired architect. My mother is a retired elementary school teacher. Our family believes in education, we believe in learning and growing.     When asked why he continues to use drugs, mostly marijuana, my son said, “I think it’s because of the people we’re around.”

In reflecting back on “What happened?”   I blame marijuana. We now live in Colorado, where marijuana is legal and widely available to everyone.  What if we had never moved here?

How it All Began

My son’s first time using was in 7th grade when marijuana was legal only if used medicinally with a “Red Card,” if recommended by a physician.   Coloradans voted on legalization in November 2012 and marijuana stores opened in January, 2014. But back in 2012, he and some buddies got it from a friend’s older brother who had a Red Card.  From what I can tell, the use just kept escalating until his junior year in high school when he was using at least once a day…and when he attempted suicide.

Between that first incident in 2012 and the suicide attempt in 2015, his father and I waged an all-out battle on the drug that was invading our home. We grounded him; I took to sleeping on the couch outside his bedroom because he was sneaking out in the middle of the night; we yelled and screamed; I cried, we cajoled and tried to reason with him: ”You have a beautiful brain! Why are you doing things that will hurt your brain?”

We did weekly drug tests, we enlisted the school’s support, we enlisted our family’s support and we even tried talking to his friends.

But nothing worked. Our son was in love with marijuana. Our sweet, smart, funny, sarcastic, irreverent, adorable boy was so enamored with this drug that nothing we did — NOTHING — made any difference. And we slowly lost him.

At the same time I was battling marijuana at home, I was also leading a group in our community to vote against legalizing it in our small town.  I had teamed with a local business-owner and a physician and the three of us got the support of many prominent community members, including the school superintendent, the police chief, and the fire chief. We ran a full campaign, complete with a website where you could donate money, a Facebook page, and yard signs.

Tokingparents
Why does he continue to use marijuana? “I think it’s because of the people we’re around.”

My son’s use isn’t the reason I got involved. I had started advocating against marijuana legalization long before I even realized he had a problem. My background is in health communication and I work in the hospital industry.  I sit on our local Board of Health, so allowing retail stores to sell an addictive drug just doesn’t make any sense. I did think about my children; what I was modeling for them; what kind of community we were raising them in, and the kind of world I envisioned for their future. Those are the reasons I got involved. My son’s use is actually the reason that I’ve pulled away from any sort of campaigning.

Unfortunately, we lost our fight. So in 2014, it became legal in our small town to purchase pot without a Red Card. And the following year, his junior year, he almost slipped away from us forever.

It Got Scarier and Scarier

His use by then had escalated to daily (and I suspect often more than once a day). Pot seemed to be everywhere! We found it hidden all over the house — in the bathroom, on top of the china cabinet, in his closet, outside, even in his sister’s bedroom. It’s a hard substance to hide because of the strong smell. Even in the “pharmacy” bottles and wrapped in plastic bags, the skunk stench still manages to seep out. But it sure seemed easy for a young boy to get!

He started leaving school in the middle of the day, or skipping school altogether, and his grades plummeted. Where he was once an A/B student and on the varsity cross-country team, he was now failing classes and not involved in anything. This boy who had tested in the 99th percentile was failing high school. And this boy who had once been the levity in our home, who used to make me laugh like no one else could or has since, this boy became a stranger.

Our son withdrew from everything except his beloved drug. His circle of friends (never big in the first place), was reduced to only those who could supply him with marijuana. His relationship with his older sister all but disappeared. And his relationship with his father has been strained beyond almost all hope of repair.

Then in late 2015 our son attempted suicide. He was hospitalized, first overnight at the very hospital where I work, and then for a 3-day locked psychiatric unit stay. I remember very little from this difficult (and surreal) time except learning that it wasn’t his first attempt, and that he blamed us for how awful he felt. He started taking an antidepressant and after he was released we took him to a drug counselor for a total of three visits but after that he refused to go — he threatened to jump out of the car if we tried to take him. We tried a different counselor and that only lasted for one visit.

Changing Strategies and a Truce

At this point I convinced my husband that we had to approach things differently, because obviously what we were doing wasn’t working. We stopped the weekly drug tests (we knew he was using so there seemed to be no point anyway). We stopped yelling and punishing. And basically my husband stopped talking to our son altogether — they are both so angry and hurt that any communication turns toxic very quickly. He refused to go back to school so we agreed that he could do online classes.

wreckedmyself
More and more, our son is feeling isolated from the rest of his family.

There is an uneasy truce in our home right now. Now it just feels like waiting. Waiting for what will happen next. Waiting for the other shoe to drop.

Our son, 17, still lives with us.  His sister left for college this past summer. I acknowledge that he uses pot and doesn’t want to quit, but I continue sending the message that it’s not good for his brain. The one thing my husband and I won’t bend on is no drugs on our property. He has started five different online classes, but has so far finished only one. He doesn’t feel any pressure to finish school — he says he’ll get a GED, but hasn’t made any effort towards that end. He doesn’t drive and doesn’t express any desire to learn, which is probably good because I doubt he could be trusted to drive sober. He started working at a local restaurant recently and has been getting good feedback from his managers, which I take to be a positive sign.   (I’ll take any positive signs at this point!)

Trying Something Else and Blacking Out

I don’t know if the suicide attempt and hospitalization were rock bottom for our family, but I suspect not. Just this past weekend our son came home and I could tell he was on something — and it wasn’t marijuana or alcohol. I checked him periodically throughout the night and in the early morning he was awake and asked me how much trouble he was in. I replied that it depended on what he had taken. He said Xanax. He also said that he had blacked out and couldn’t remember anything that had happened from about an hour after he took it.

Later in the morning, when we were both more awake, I asked him about the Xanax (he got it from someone at the restaurant) and the pot use and what he saw for his future. He has no plans to stop using, but said that he probably wouldn’t take Xanax again (he didn’t like blacking out). He said that he’s very happy with his life right now, that he knows a lot of people who didn’t go to college who work two or three jobs and live in little apartments, and that he’s happy with that kind of future for himself.

I tried not to cry.  Imagine that as the goal for a boy who started life with so much curiosity and such a desire to learn.

It’s not that I don’t think he can have a good and decent life without a college education. But I know that he’ll have a much harder life. Statistically, Americans with fewer years of education have poorer health and shorter lives (partly due to lack of adequate health insurance), and Americans without a high school diploma are at greatest risk.   It’s not just life without a college education, but it is life with a brain that has been changed by marijuana.  Will he be able to give up pot?  If he does give up pot, will he recover the brain he had at one time?  Will he lose motivation?

I asked him why he used pot when he knew how his father and I felt about it and when we had tried so hard to steer him in a different direction.

He said: “I think it’s because of the people we’re around. And all the drugs that are around.”

I’ve finally accepted that his use is not in the range of normal teenage experimentation, and I’m barely surviving on the hope that he’ll eventually grow out of it…and that he doesn’t do any permanent damage.  In the meantime, I’m sorry that we ever moved here.