While there are FDA approved THC medicines out there to help with certain cases of nausea, there is a much more insidious adverse reaction many marijuana users are experiencing, which can leave them begging for relief, or even kill them.
Parents Opposed to Pot announces that two advisors from California have joined our advisory board made up of medical and scientific professionals.
Dr. Roneet Lev is the chief of the emergency department at Scripps Mercy Hospital in San Diego. She is current president of IEPC, Independent Emergency Physicians Consortium, which represents over 30 emergency departments in California. She served as President of the California Chapter of the American College of Emergency Physicians. In October 2012, she established the San Diego and Imperial County Prescription Drug Abuse Medical Task Force with the goal of reducing deaths and mortality from prescription drugs, using data to drive change Continue reading Parents Opposed to Pot Names Two New Advisors
Attached is a list of medical articles that document medical warnings against marijuana that are running in newspapers throughout the country, to warn in advance of participation in 420 events.
Click here to see the Parental Advisory Ad
Highly potent marijuana today is different for the 1990s, with much higher THC and much lower cannabidiol concentrations (Elsohly et al 2016).
ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States. Biol Psychiatry. 2016;79(7):613-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987131/pdf/nihms-762043.pdf
Average flower is 17.1% in one state with legal sales of recreational marijuana, Colorado, much higher than the national average (HIDTA, 2017), and as high as 30% THC in some samples (NBC News report). It should be noted that variation in testing results is quite high between laboratories (Jikomes and Zoroob, 2018).
HIDTA, Rocky Mountain High Intensity Drug Trafficking Area Report, The Legalization of Marijuana in Colorado: The Impact. 2017 Vol. 5, Rocky Mountain High Intensity Drug Trafficking Area Investigative Support Center, Denver, Colorado. https://www.rmhidta.org/html/FINAL%202017%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Impact.pdf
https://www.nbcnews.com/storyline/legal-pot/legal-weed-surprisingly-strong-dirty-tests-find-n327811
Jikomes N, Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018 Mar 14;8(1):4519. doi: 10.1038/s41598-018-22755-2. https://www.nature.com/articles/s41598-018-22755-2.pdf
Jikomes N, Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018 Mar 14;8(1):4519. doi: 10.1038/s41598-018-22755-2. https://www.nature.com/articles/s41598-018-22755-2.pdf
Marijuana use is linked to increased suicide risk.
http://www.nbclosangeles.com/news/local/I-Team-Marijuana-Pot-Pesticide-California-414536763.html
https://modernluxury.com/san-francisco/story/whats-the-matter-california-cannabis
http://www.sacbee.com/news/local/health-and-medicine/article131391629.html
http://sfist.com/2017/08/31/80_percent_of_medical_marijuana_tes.php
Association with schizophrenia and other psychotic disorders such as bipolar and schizophrenia. (Miller, 2017; Cougle et al., 2015), completed suicides and suicide attempts (Arendt et al., 2013; Silins et al., 2014; Clarke et al., 2014) and violence towards others (Arseneault et al., 2000; Dugre et al., 2017; Harford et al., 2018) particularly in those who develop marijuana-induced psychosis.
Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Arch Gen Psychiatry. 2000;57(10):979-86.
Arendt M, Munk-Jørgensen P, Sher L, Jensen SO. Mortality following treatment for cannabis use disorders: predictors and causes. J Subst Abuse Treat. 2013;44(4):400-6.
Clarke MC, Coughlan H, Harley M, Connor D, Power E, Lynch F, Fitzpatrick C, Cannon M. The impact of adolescent cannabis use, mood disorder and lack of education on attempted suicide in young adulthood. World Psychiatry. 2014;13(3):322-3.
Cougle JR et al. (2015). Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: An analysis of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). J Psychiatr Res., 66-67, 135-141
Di Forti M, et al. Proportion of patients in South London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry. 2015;2(3):233-8.
Dugré JR, Dellazizzo L, Giguère CÉ, Potvin S, Dumais A. Persistency of Cannabis Use Predicts Violence following Acute Psychiatric Discharge. Front Psychiatry. 2017 21;8:176. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613094/pdf/fpsyt-08-00176.pdf
Harford TC, Chen CM, Kerridge BT, Grant BF. Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III). Psychiatry Res. 2018;262:384-392.
Miller CL. The disconnect between the science on cannabis and public health campaigns. Addiction. 2017;112(10):1882-1883. https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13918
Silins E, Horwood LJ, Patton GC, Fergusson DM, Olsson CA, Hutchinson DM, Spry E, Toumbourou JW, Degenhardt L, Swift W, Coffey C, Tait RJ, Letcher P, Copeland J, Mattick RP, for the Cannabis Cohorts Research Consortium. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry 2014; 1(4): 245-318.
Starzer MSK, Nordentoft M, Hjorthøj C. (2018) Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis. Am J Psychiatry,175(4), 343-350
Marijuana harms unborn children (Jenkins et al., 2007; Trezza et al., 2012; Tortoriello et al., 2014; Grewen et al., 2015; Zumbrun et al., 2015; Leemaqz et al., 2016; Benevenuto et al., 2017), and may concentrate in breast milk if used repeatedly (Perez-Reyes and Wall, 1982; Grotenhermen, 2003), with consequences for the developing neonate (Astley and Little, 1990).
Astley SJ, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol. 1990 Mar-Apr;12(2):161-8.
Benevenuto SG et al., Recreational use of marijuana during pregnancy and negative gestational and fetal outcomes: An experimental study in mice. Toxicology. 2017 Feb 1;376:94-101
Grewen K, Salzwedel AP, Gao W. Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure. Front Hum Neurosci. 2015;9:601.
Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327-60. Review.
Hurd YL, Szutorisz H, High times for cannabis: Epigenetic imprint and its legacy on brain and behavior. Neuroscience and Biobehavioral Reviews 85 (2018) 93–101 https://oir.nih.gov/wals/2015-2016/high-times-drugs-epigenetic-imprint-legacy-brain
Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL; American Heart Association Council on Cardiovascular Disease in the Young. Non-inherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation. 2007 Jun 12;115(23):2995-3014.
Leemaqz SY et al. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol. 2016;62:77-86.
Perez-Reyes M, Wall ME. Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med. 1982;307(13):819-20.
Tortoriello G, et al. Miswiring the brain: Δ9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J. 2014;33(7):668-85.
Trezza,V. et al. Altering endocannabinoid neurotransmission at critical developmental ages: impact on rodent emotionality and cognitive performance. Front Behav Neurosci. 2012; 6: 02. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265033/
Zumbrun EE et al. Epigenetic Regulation of Immunological Alterations Following Prenatal Exposure to Marijuana Cannabinoids and its Long Term Consequences in Offspring. J Neuroimmune Pharmacol. 2015; 10(2):245-54.
Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review. J Med Toxicol. 2017;13(1):71-87. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330965/
Alaniz VI, Liss J, Metz TD, Stickrath E. Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy. Obstet Gynecol. 2015 Jun;125(6):1484-6.
Wilkinson ST, Stefanovics E, Rosenheck RA. Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry. 2015 Sep;76(9):1174-80.
Friedman A, Glassman K, Terras A Violent Behavior as Related to Marijuana and Other Drugs, by Albert Journal of Addictive Diseases, Vol 20(1), 2001,pp. 49-72. Marijuana users nearly as likely to engage in violent behaviors as crack users.
Hartman RL, Huestes ME, Richman JE Hayes CE, Drug Recognition (DRE) examination characteristics of cannabis impairment. Accident Analysis and Prevention 92(2016)219-229. http://www.decp.org/wp-content/uploads/2017/06/302-Marijuana-DRE-Evaluations-Study.pdf . Factors to measure cannabis impairment
Staples JA, Redelmeier, DA, The April 20 Cannabis Celebration and Fatal Traffic Crashes in the United States. JAMA Intern Med. 2018;178(4):569-572. doi:10.1001/jamainternmed.2017.8298 Rate of traffic fatalities go up 12% after 4/20 festivities, in comparison to one week before and one week after.
Bosker WM, Kuypers KP, Theunissen EL, et al. Medicinal Δ9-tetrahydrocannabinol (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in standard field sobriety tests. Addiction. 2012;107(10):1837-1844.
Compton WN, Volkow Nd, Lopez MF. Medical marijuana laws and cannabis use: intersections of health and policy, JAMA Psychiatry. 2017: 74 (6): 559-560
Del Balzo G, Gottardo R, Mengozzi S, Dorizzi RM, Bortolotti F, Appolonova S, Tagliaro F, “Positive” urine testing for Cannabis is associated with increased risk of traffic crashes, Journal of Pharmaceutical and Biomedical Analysis. https://doi.org/10.1016/j.jpba.2017.12.059
Hartman RL, Huestis MA. Cannabis effects on driving skills. Clin Chem. 2013;59(3):478-492.
Gjerde H, Morland J. Risk for involvement in road traffic crash during acute cannabis intoxication. Addiction 2016;111(8):1492-1495.
Martin J-L, Gadegbeku B, Wu D, Viallon V, Laumon B (2017) Cannabis, alcohol and fatal road accidents. PLoS ONE 12(11): e0187320. https://doi.org/10.1371/journal.pone.0187320
Ramaekers JG, Kauert G, van Ruitenbeek P, Theunissen EL, Schneider E and Manfred R Moeller, High-Potency Marijuana Impairs Executive Function and Inhibitory Motor Control. Amer Col of Neuropsychopharmacology (2006) 31, 2296–2303.
Raemakers, JG Driving Under the Influence of Cannabis: An Increasing Public Health Concern. JAMA published online March 26, 2018 Regular cannabis users wrongfully believe that cannabis does not affect their driving performance or that they can compensate for cannabis-associated impairment. Raemakers_2018 JAMA driving editorial.pdf
World Health Organization. Drug Use and Road Safety: A Policy Brief. Geneva, Switzerland: World Health Organization; 2016.
Marijuana smoke is associated with lung disease (Tan et al., 2009; Tashkin, 2015) and the development of some cancers (Efird et al., 2004; Lackson et al., 2012). High levels of the cannabinoid receptor that is preferentially activated by THC (CB1) correspond to shorter survival in many cancers (Michalski et al., 2008; Carpi et al., 2015; Suk et al., 2016)
Carpi S, Fogli S, Polini B, Montagnani V, Podestà A, Breschi MC, Romanini A, Stecca B, Nieri P. Tumor-promoting effects of cannabinoid receptor type 1 in human melanoma cells. Toxicol In Vitro. 2017 Apr;40:272-279. doi: 10.1016/j.tiv.2017.01.018. Epub 2017 Jan 26
Efird JT, Friedman GD, Sidney S, Klatsky A, Habel LA, Udaltsova NV, Van den Eeden S, Nelson LM. The risk for malignant primary adult-onset glioma in a large, multiethnic, managed-care cohort: cigarette smoking and other lifestyle behaviors. J Neurooncol. 2004 May;68(1):57-69.
Lackson et al., 2012, Population-based case-control study of recreational drug use and testis cancer risk confirms an association between marijuana use and nonseminoma risk. Cancer 188:5374-83
Michalski CW, Oti FE, Erkan M, Sauliunaite D, Bergmann F, Pacher P, Batkai S, Müller MW, Giese NA, Friess H, Kleeff J. Cannabinoids in pancreatic cancer: correlation with survival and pain. Int J Cancer. 2008;122(4):742-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225529/pdf/nihms38106.pdf
Suk KT, Mederacke I, Gwak GY, Cho SW, Adeyemi A, Friedman R, Schwabe RF. Opposite roles of cannabinoid receptors 1 and 2 in hepatocarcinogenesis. Gut. 2016;65(10):1721-32. http://gut.bmj.com/content/gutjnl/65/10/1721.full.pdf
Tan WC, et al. Marijuana and chronic obstructive lung disease: a population-based study. CMAJ. 2009;180(8):814-20
Tashkin DP. The respiratory health benefits of quitting cannabis use. Eur Respir J. 2015;46(1):1-4
Use by youth in 8th and 10th grades has gone up significantly in Washington State (Cerda et al., JAMA Pediatrics ). School districts with the highest density of legal dispensaries in Colorado have a 30% higher rate of use in students by the time they reach their senior year of high school (Healthy Kids Colorado Survey, 2015: Adolescent Health); and to compile data on density of dispensaries for each school district https://weedmaps.com/dispensaries/in/united-states/colorado)
The percentage of youth on probation testing positive for marijuana has increased steadily since 2012 (DPS, 2017)
Borodovsky JT, Lee DC, Crosier BS, Gabrielli JL, Sargent JD, Budney AJ. U.S. cannabis legalization and use of vaping and edible products among youth. Drug Alcohol Depend. 2017; 177:299-306. https://www.ncbi.nlm.nih.gov/pubmed/28662974
Cerdá M, Wall M, Feng T, Keyes KM, Sarvet A, Schulenberg J, O’Malley PM, Pacula RL, Galea S, Hasin DS. Association of State Recreational Marijuana Laws With Adolescent Marijuana Use. JAMA Pediatr. 2017;171(2):142-149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5365078/
Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RS, McDonald K, Ward A, Poulton R, Moffitt TE. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):E2657-64. doi: 10.1073/pnas.1206820109
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479587/pdf/pnas.201206820.pdf
Camchong J, Lim KO, Kumra S. Adverse Effects of Cannabis on Adolescent Brain Development: A Longitudinal Study. Cereb Cortex. 2017 Mar 1;27(3):1922-1930. doi: 10.1093/cercor/bhw015. https://academic.oup.com/cercor/article/27/3/1922/3056289
https://www.nap.edu/resource/24625/Cannabis_report_highlights.pdf
Allan GM Simplified guideline for prescribing medical cannabinoids in primary care Canadian Family Physicians Vol 64: February 2018 2018 Cannabis Prescribing Guidelines.pdf.
Richards JR, Treatment of acute cannabinoid overdose with naloxone infusion. J Toxicology Com-munications Vol 1, 2017 https://www.tandfonline.com/doi/full/10.1080/24734306.2017.1392715
Finn, K, The Clinical Conundrum of Medical Marijuana, Pain Medicine News, 2016 https://www.painmedicinenews.com/Commentary/Article/06-17/The-Clinical-Conundrum-of-Medical-Marijuana/41579
Finn, K, Current research on marijuana for pain is lacking. https://poppot.org/2017/06/26/current-research-marijuana-pain-lacking/
Olfson M, Wall M Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States American J Psychiatry. Cannabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use at 3-year follow-up. https://doi-org.proxy.hsi.ucdenver.edu/10.1176/appi.ajp.2017.17040413
Caputi TL, Humphreys K, Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically, JAddiction Medicine: April 17, 2018 https://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/Medical_Marijuana_Users_are_More_Likely_to_Use.99476.aspx?PRID=JOAM_PR_041718
Olfson M, Wall M Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States, American J Psychiatry. Cannabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use at 3-year follow-up. https://doi-org.proxy.hsi.ucdenver.edu/10.1176/appi.ajp.2017.17040413
This data is available in SAM’s Lessons Learned report https://learnaboutsam.org/wp-content/uploads/2018/04/SAM-Lessons-Learned-From-Marijuana-Legalization-Digital.pdf
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.1 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.
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
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.
