The turbo-charged, high-THC marijuana of today brings out lots of marijuana mania. Jimmy Kimmel’s pot jokes at the Oscars fell flat, but Kimmel could try using these stories on his nightly comedy show. Or maybe they aren’t so funny, just a reflection of how marijuana does a number on the human brain.
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”.
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
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.
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.
The discussions of H.170, which would legalize possession and home-growing of small quantities of marijuana, have focused a lot on the danger to teenagers, which is appropriate since adolescents are in a stage of neural development that makes them much more likely to become addicted, develop mental health conditions, and suffer decreases in cognitive processing and memory retention. The problem with this focus is that people over 21, particularly up to the age of 25 or 26, are still susceptible to all of these effects, just at a lower level of risk.
That point aside, the area where every age runs the same risk is on the highway. Again, teens and young adults are more at risk because they tend to take more risks in the first place. They are also less experienced with driving and with the use of alcohol and drugs. But adults do make the same stupid mistake of driving under the influence.
According to the best data we have available, drinking alcohol before driving increases the risk of accident five-fold at the still-legal .08 blood level. Driving under the influence of marijuana doubles your risk. That being the case, we would expect to find considerably more people dying on the roads because of alcohol then because of marijuana. The data on traffic accident fatalities that we have from the Vermont Department of Safety tell a somewhat different story:
This data is based on blood tests that measure active THC, so we can be reasonably sure that the drivers had used marijuana recently enough to still be DUI.
Driving Under the Influence of Marijuana Imperils Safety
Note the small difference between the number of deaths due to alcohol and the number due to marijuana. The most likely reason for this is that many marijuana users think it’s OK to drive after using. For teenagers, we have clear evidence for that from our Youth Risk Behavior Survey.
Here’s the 2015 data:
Reports from both Colorado and Washington indicate that the same must be happening there. While accidents and fatalities involving drunk drivers went down in recent years, the numbers involving marijuana went up.
Why is this happening? Because we are not teaching people – young or old – that marijuana impairs your ability to drive. At a well-attended forum on marijuana effects held in Burlington last month, one attendee stood up and insisted that marijuana helps people drive more carefully, and this message pervades the popular websites that cater to people interested in learning more about marijuana from sources “untainted” by officials like police officers and scientists.
It’s important to note that the traffic fatality data shown above only includes deaths in accidents. It does not include the five Harwood teenagers killed on I-89 last October. The driver of the car that hit theirs, Steve Bourgoin (36, hardly a teen), has been charged with second-degree murder, so their deaths are not considered to be due to a traffic accident.
Addiction is Not a Crime
Addiction is not a crime, it is a mental health issue, and the behavior of users who suffer acute or chronic psychotic episodes goes far beyond the usual definition of addiction.
When Bourgoin’s blood toxicology report was completed, authorities withheld the contents pending trial; however, Vermont investigative reporter Mike Donoghue, writing for Vermont News First, quoted several sources in saying that there was active THC in Bourgoin’s blood at the time of the accident. Since then, Vermont Rep. Ben Joseph, D-Grand Isle-Chittenden, a retired judge, has reported being told the same thing by contacts of his in the state legal apparatus.
As reported on VTDigger, Bourgoin told friends that he suffered from anxiety and PTSD due to childhood trauma, and his former girlfriend told detectives that he self-treated with marijuana for “mood spells.” Court documents quote her saying, “It was always very evident when he was out [of marijuana], as he would be more angry and violent during those times.”
Anger is one of marijuana’s withdrawal symptoms, and it is a more addictive drug than most people think. A review of several studies of treatment methods for marijuana addiction found that one-year abstinence rates for adults, even under the most effective treatments, ranged only from 19 to 29 percent.
In a 20-year study involving more than 2000 U.S. war veterans being treated for PTSD, the vets who used medical marijuana along with the standard therapy reported more violent behaviors and worse outcomes after treatment than vets who didn’t use marijuana. The heaviest users showed the strongest effects. Another study found that marijuana use resulted in increased suicidal ideation among marijuana users.
Marijuana and Mental Health Problems
There are other correlations between marijuana and serious mental health problems. Since 2002, a series of studies in Europe have reported that individuals who use cannabis have a greater risk of developing psychotic symptoms. Not only does marijuana bring on symptoms earlier and make them worse, it is a causative factor.
A Finnish study published this past November compared sets of twins where one used marijuana heavily and the other did not. Heavy use increased the risk of developing psychosis by a factor of 3.5. Again, the data indicated that, in many cases, marijuana abuse caused the psychosis, not the other way around. The newly released report on marijuana from the U.S. National Academies of Sciences agrees with these findings.
Addiction is not a crime, it is a mental health issue, and the behavior of users who suffer acute or chronic psychotic episodes goes far beyond the usual definition of addiction. These sufferers needs effective treatment far more than jail time. And these new research findings, combined with Vermont’s recent traffic fatality data, highlight the fact that marijuana is not harmless. Legalizing recreational marijuana in Vermont would not be a simple matter.
Vermont has already decriminalized marijuana use. What we haven’t done is provide a mental health system that can deal with the thousands of cases of addiction, psychosis, and other mental illnesses that we already have in our state, nor have we done nearly enough to educate Vermonters about marijuana’s harms, in order to prevent tragedies from happening.
Legalizing marijuana – whether like alcohol or tobacco – will only make our mental health burden worse, while it makes our highways far less safe.
Last Tuesday the Vermont House of Representatives planned to vote on a bill to allow possession and home grows for marijuana. However, when it came to a floor vote, the pot proponents knew there were not enough votes to pass the bill.
Even though Vermont’s former governor supported legalization, a legalization bill failed miserably in the Vermont House last year. The new bill is less expansive than last year’s bill, but legalization appears to be headed for failure this year.
Vermont’s new governor, Phil Scott, has made it clear that the legislature needs to find safeguards against drugged driving. There is no simple test to measure stoned driving, as there is for drunk driving. Individuals have a legal right to refuse a blood test, and police must get a court order to administer the tests. THC levels in the blood may go down during the waiting period.