Tag 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.

Dr. Randall’s Letter Exposes Truth of Pot Legalization

Dr. Karen Randall, an emergency physician of Pueblo, Colorado, sent a letter to the physicians of Vermont.  Their state legislature narrowly passed a bill that would legalize marijuana, but it’s hoped that Governor Phil Scott will veto it.  There was not enough time to read Dr. Randall’s at a Press Conference on May, 18, 2016.  Here’s the contents of that letter:

Firstly, I’d like to thank you all for the opportunity to share some of my experiences as a physician in a region with heavy legal marijuana use.

In 2012, Coloradans voted to pass Colorado Amendment 64 which led to the state-wide legalization of recreational marijuana beginning in January of 2014. Since then, the number of medical and recreational dispensaries in Colorado has grown to more than double the number of McDonald’s and Starbucks combined. While individual counties could and did choose to abstain from allowing recreational marijuana sales, my county, Pueblo, was one of many that embraced Amendment 64 and the projected benefits of recreational legalization, even unofficially rebranding itself the “Napa Valley of Pot”.

A homeless camp along the river in Pueblo, one of many makeshift residences

This led to an influx of people looking to smoke without the risk of legal consequences and to cash in on the burgeoning “pot economy”. Unfortunately, many of these people arrived only to find that the supply of marijuana-related jobs was far outweighed by the demand, and few had backup plans. Since 2014, Pueblo’s homeless population has tripled, and our low-income housing have occupancy rates of 98% or more. We have seen a drastic increase in the number of homeless camps, and social services and outreach programs are buckling under the strain.

Our medical infrastructure is also reaching critical mass. Out of the 160,000 residents of our community, roughly 115,000 are on Medicaid. As a result, we have been losing primary care providers at an alarming and unsustainable rate.  The largest local clinic has been looking to hire 15 new doctors, but has only been able to hire 1 in the past two and a half years. My emergency medical group has been able to fill less than half of our open positions. The average wait time to see a new primary care provider is months with the wait for a specialist even longer, and many primary care physicians in the area are no longer taking new Medicaid patients.

Additionally, the legalization of marijuana has led to normalization of behavior that in my professional opinion is strongly impacting our youth. Despite sales being legally restricted to those ages 21 and over, the Healthy Kids Survey of 2015 shows:  16% of Pueblo High School kids under the age of 13 have tried marijuana, 30% of high school kids had smoked within 30 days of the survey, 64% feel that it would be easy or very easy to get marijuana, and that 6.3 and 6.6% of respondents have used heroin and methamphetamines respectively, compared to 2% for the rest of Colorado. The number of ED visits for cannabis hyperemesis syndrome, accidental

Cannabis Hyperemesis Syndrome is an illness that is sending marijuana users to ER rooms.

pediatric ingestions, accidental adult ingestions and psychosis have sharply risen. There has been an increase in the number of babies testing positive for marijuana at birth (many internet and dispensaries are now recommending marijuana for nausea in pregnancy).

The potency of marijuana has risen tremendously since legalization, which is also a cause for significant concern. Almost all of what we do know about marijuana is based on studies where the marijuana was 1-3 mg of THC. Currently, dabbing provides 80-90 mg of THC; edibles provide 10 mg THC per bite and are frequently packaged in quantities to total 100 mg of THC.  Fortunately, legislation has passed so that edibles must be packaged in safety packages and can no longer be sold as appealing candy gummies, suckers, etc.  Currently, law requires that chocolate be labeled with a stamp and dose quantity but it still looks like a chocolate bar to a child.

Ads and claims to the health benefits of marijuana are rampant on the internet with reported cures for almost every ailment, yet there is very little research, if any to support those “health benefits” and frequently people come to the area with a disease process (for instance, Parkinson’s disease) and purchase marijuana.  Many of those looking for cures are seniors who are not toleratant to the dosage/strength of the current marijuana being marked and they come to the ED with side effects.

suicide-risk
Some people compare medical marijuana sellers to snake oil dealers of the 19th century. Certainly, the “snake bites” from the marijuana industry against those who disagree are brutal.

I deeply appreciate having been given a platform to share my experiences with you today, and I strongly encourage the physicians of Vermont to consider the broader medical, economic, and social ramifications of the legalization of marijuana.

Thank you for your attention,                                                                                 Dr. Karen Randall, FAAEM                                                                          Southern Colorado Emergency Medicine Associates                             Pueblo Colorado

Dr. Randall presented her experiences at a press conference in Pueblo on October 20, 2016.

To watch the Press Conference of May 18, Orca Media presents the proceedings of the entire Press Conference.

 

Marijuana Can’t Treat the Opiate, Heroin Epidemic

Any marijuana use leads to less intelligence potential, less empathy for life, less motivation and poorer decision making.  A war on drugs is a protection and defense of our brains.   Governor Susana Martinez probably recognizes how Colorado’s marijuana problem leads to the drug epidemic and filters into New Mexico’s substance abuse issues.   Read about her veto in Part 1.

One young man who gave us a testimony explained how his marijuana use led directly to heroin addiction.

In Colorado, Dr. Libby Stuyt, addictions psychiatrist, traces a direct line from marijuana legalization to the heroin epidemic.    Colorado’s recent report on heroin has shown that the number of deaths from heroin overdose have doubled between 2011 and 2015.

In fact, Pueblo County, has suffered from heroin use and addiction more than any other Colorado county.  Pueblo, Denver and Boulder have the highest rates of youth marijuana use.   Southern Colorado is suffering the most from the heroin epidemic. Counties that have banned marijuana dispensaries have been affected the least by the heroin.

Misunderstanding of the Opioid and Heroin Epidemic

Since the government has clamped down on opiate prescriptions, more users have replaced the pain drugs with heroin.  Since the legalization of marijuana, Mexican cartels have replaced much of their marijuana with heroin.  Heroin is now cheaper and addicts find it easier to get heroin than prescription pills.

Politically there is a great deal of misunderstanding about the opioid epidemic. If it was initially caused by over prescribing of medications, that’s no longer primarily the case.   Seth Leibsohn wrote an insightful article on the subject last week. The abuse of opioid prescriptions acquired legitimately constitutes a small portion of the overdose problem, he said. *

A simple crackdown on prescriptions will not solve the problem, according to Maia Szalavitz.  Although Szalavitz misunderstands the  inherent danger in using marijuana,* she explains the underlying causes of substance abuse quite well.  Impulsive children are at high risk of becoming drug users, but so are some highly cautious and anxious young people.   Two thirds of people with opioid addictions have had severely traumatic childhoods, and the more exposure to trauma, the higher the risk.  We need to help abused, neglected, fragile and otherwise traumatized children before they turn to self-medication as teens.  On the other hand, we should also provide tools and teach coping skills to children who are impulsive, ADHD or anxious.   (Overmedicating children doesn’t allow them to develop the skills needed to transition into adulthood.)

Let’s Help People Get off ALL Drugs

Effective treatment for addictions is getting off all drugs, not going to other harmful, brain-altering substances.   “The goal in helping a loved one with a substance use problem is not to reduce their use. It is to stop drug use,” according to Sven-Olov Carlsson of Drug Policy Futures.  He gave the opening address at the World Federation of Drugs Conference in Vienna last year.  As Carlsson said, the current heroin epidemic proves that “harm reduction” is not saving lives.

No one sets out to become an addict.   Fortunately, more people and states are realizing the foolishness of allowing “medical” marijuana for intractable pain.  It opens up a Pandora’s Box of problems, as in California and elsewhere.

Addiction specialists estimate that one in five American adults is addicted to drugs or alcohol.  With such large numbers, there should be no “stigma” attached to addiction or treatment.  A new or revised health care act should maintain the provision to treat addiction.

Those who are addicted have a strong need to protect a secret.  Their brains have been hijacked and there isn’t a straight path back to previous functioning.

Optimum treatment requires a period of time when the person is not using any substance of addiction in order for the brain to heal.  During that time, the person needs to be able to learn new things. The lack of treatment resources which allows this to happen is a big barrier to recovery.   Marijuana cannot be used to treat this current drug epidemic.

___________________________________________________________________________*  Another recent article explains how doctors began to take pain seriously, treating it as a fifth vital sign.  Szalavitz based her 10% addiction rate for marijuana on the weaker pot of the ’70s and ’80s, not the pot of today.  She also disregarded teen users of pot.

 

Governor Martinez Denies Marijuana to Treat Opioid Addiction

On April 7, New Mexico Governor Susana Martinez vetoed a bill which would have made opioid addiction a qualifying condition for medical marijuana.  Governor Martinez has consistency shown leadership in working to prevent drug addiction.  Earlier this year, legislators in New Mexico wisely rejected a bill to legalize pot,.

Maryland legislators recently proposed using marijuana to treat heroin addiction.   They removed the provision from the  bill after researchers explained there’s no evidence that cannabis is effective in treating addiction.

The mass insanity surrounding cures from “medical” marijuana sometimes comes from the Press.  As the number of newsprint subscribers dwindles, newspapers are looking to marijuana for new sources of advertising money.  (The New York Times, Seattle Times, Los Angeles Times and Denver Post are pro-marijuana newspapers.)  Another problem is that the marijuana industry’s paid lobbyists are pumping unscientific information to state legislators.   Many of these lobbyists have advanced degrees in Social Policy, Law or Political Science, but not the biological sciences.

Marijuana , Opioid Addiction and Heroin

Tyler Martels, finally free of opioid addiction, was getting his life back on track when the state of Washington legalized marijuana.  On December 5, 2012, marijuana became 100% legal for those ages 21 and over.  A few days later, Martel refused to drink with his parents, but smoked marijuana before driving.  His car crossed the center lane, and both he and his fiancé, also 27, died.  Another man was badly injured in that crash.  Martels died a victim of the “safer than alcohol” phrase that the marijuana lobby used to gain acceptance for legalization.

His death also demonstrates the public’s ignorance of marijuana as a dangerous drug.  Brain science reveals a connection between marijuana and the opiate/heroin epidemic.

Dr. Mark Willenbring, an addictions psychiatrist,  believes that alternative treatments are needed for pain, but not another drug of abuse.  He doesn’t believe you can solve the problem of addiction with another drug of abuse.  “The concept on its face is absurd,” he said.  “It doesn’t work,” he said. “Like trying to cure alcoholism with Valium.”

Pam Garozzo and Carlos, who lost his life Dec. 23, after 10 months of being off drugs. She told Gov. Christie’s panel at the White House that marijuana had been a gateway for her son.

Stop Denying the Potential Gateway Effect

Generally speaking, marijuana is already in the mix of drugs used by those who abuse opiates.   Those who use heroin invariably are using other drugs, including marijuana.   In fact, a group of parents in Massachusetts recently made a video tribute to 79 of their children who died from drugs.   In all cases, the deceased sons and daughters had started their drug use with cannabis.

When Governor Chris Christie convened a panel on the drug epidemic at the White House last week, a mother, spoke.  Pam Garozzo, whose son Carlos died from drugs in December, said her son had started smoking marijuana at age 15-1/2.  For him it was a gateway drug, and he’d be the first to tell you.   He died of heroin that had been laced with fentanyl–after being clean for 10 months.

Read Part 2 to learn how marijuana leads to opiates and heroin.