Back in the 1990s, I taught and did cancer research at the University of Colorado School of Pharmacy in Denver. Among my teaching assignments was the pharmacology and toxicology of marijuana and other drugs that are misused for recreational purposes, both prescription and illicit.
So, I've followed Colorado's legalization of recreational marijuana with more than a passing interest.
Yesterday, the Journal of the American Medical Association (JAMA) published a viewpoint article online from three Colorado emergency physicians who offered their firsthand perspective on the first year of this experiment.
For background, the authors mention that Colorado has permitted the use of marijuana for medical purposes by patients with "chronic debilitating medical conditions" since late 2000. Obtaining a medical marijuana license was relatively straightforward, especially for patients suffering from cancer, multiple sclerosis, and epilepsy. But licenses became more simple to come by after October 2009 when the US Attorney General released guidance that largely ceded to local governments the responsibility for prosecuting marijuana offenses. As a result, the authors state, "The number of licenses increased from 4,819 on December 30, 2008, to 116,287 on September 30, 2014."
Marijuana use in Colorado became further liberalized by the 2012 passage of an amendment to the state constitution that would allow retail sale of marijuana beginning in January 2014. As of last month, the state has nearly 300 retail marijuana dispensaries.
Colorado residents over the age of 21 can purchase up to 1 ounce of marijuana in a single transaction while out-of state residents are limited to 1/4 of an ounce. But public use of marijuana is technically illegal, similar to open container laws for alcoholic beverages. This restriction, in part, has given rise to a considerable market for edible marijuana products.
From a public health perspective, the authors noted the general expectation that more widespread marijuana use would exacerbate chronic medical conditions, particularly psychiatric disorders since the active components of the plant can cause anxiety and paranoia in some individuals. In the past, the contribution of marijuana to these effects has been difficult to ascertain because of the concomitant use of other drugs such as alcohol.
But the authors reported an unexpected uptick in "pure" marijuana intoxication: "anxiety, panic attacks, public intoxication, vomiting, or other nonspecific symptoms precipitated by marijuana use." Among the 2,000 patients seen weekly in the emergency department of the University of Colorado Hospital in the Denver suburb of Aurora, one or two patients are seen with these responses while another 10 or 15 present with other marijuana-associated illnesses that the authors didn't define. However, the authors did not indicate whether these effects occurred in inexperienced marijuana users who may not be familiar with high-dose effects.
As marijuana is often used to manage the nausea and vomiting of cancer chemotherapy, the emergence of a marijuana-associated cyclic vomiting syndrome was an unexpected finding. In unpublished data by the first author of the report, Andrew A. Monte, MD, the frequent use of high THC-containing marijuana products was linked to a doubling in this syndrome since recreational marijuana legalization. These patients reported severe abdominal pain, vomiting, and profuse sweating that can be relieved, paradoxically, by hot showers. Receptors for cannabinoids are present in the gastrointestinal tract, but have been thought to serve in an antiinflammatory capacity imparted by our own, naturally-produced endocannabinoids (the marijuana analog of endorphins at opioid receptors).
The University of Colorado burn unit has also seen an increase in hospitalizations for burns resulting primarily from flash fires that occur when a user is trying to extract THC and other active marijuana constituents using butane. Thirty-one marijuana-associated burn cases have been seen at the hospital, with some over 70% of body surface area and two-thirds requiring skin grafts.
Denver-area hospitals and the state poison control service have seen 14 cases of marijuana intoxication in children over the last two years, half of which required admission to intensive care units. These cases occurred primarily with edible marijuana products, many of which are fashioned like candies or energy bars. The problem — of which I was unaware from my teaching days — is that large doses of THC can cause respiratory depression in children.
Edible marijuana products present their own challenges because of the pharmacokinetic differences of ingested THC relative that that when the plant material is smoked. Edible marijuana products still are not tested for THC content, relying instead of manufacturer labeling. Testing by The Denver Post's Cannabist newspaper has revealed wide variations from labeled amounts of THC, from zero to one-and-a-half times the labeled amount. Moreover, the psychoactive effects may be delayed by one to four hours, thereby lacking the moment-to-moment dose titration afforded by smoking marijuana.
Caveats
One thing I found lacking in this viewpoint article was a comparison of the adverse effects of marijuana relative to other legal drugs such as alcohol and nicotine products and, in the pediatric cases, a comparison with poisonings with other products such a laundry pods or household cleaners. In addition, numbers are still not available for arrests and accidents while driving under the influence of marijuana. While the state has established 5 nanograms of THC per milliliter of blood as the threshold for intoxication, law enforcement lacks the roadside testing capability for THC that we have for alcohol.
Another issue not addressed, although this would be beyond the scope of the article, is that effect legalization has had on incarceration due to marijuana related offenses, a factor that indirectly affects state health care resource utilization.
In summary, the burn cases and pediatric intoxication cases are certainly cause for concern. But taken together, a preliminary view would be that marijuana legalization in Colorado has not resulted in a widespread increase in acute medical problems. I applaud the authors for trying to put numbers on these effects of relaxing marijuana laws in the state. The confounding variables are many, but it's this kind of research that's necessary to formulate rational drug policy and harm reduction strategies.
News Moderator: Shandar @ 420 MAGAZINE ®
Source: Information for the World's Business Leaders - Forbes.com
Author: David Kroll
Contact: Forbes Real Time
Website: Unexpected Health Effects Of The Colorado Marijuana Experiment - Forbes
So, I've followed Colorado's legalization of recreational marijuana with more than a passing interest.
Yesterday, the Journal of the American Medical Association (JAMA) published a viewpoint article online from three Colorado emergency physicians who offered their firsthand perspective on the first year of this experiment.
For background, the authors mention that Colorado has permitted the use of marijuana for medical purposes by patients with "chronic debilitating medical conditions" since late 2000. Obtaining a medical marijuana license was relatively straightforward, especially for patients suffering from cancer, multiple sclerosis, and epilepsy. But licenses became more simple to come by after October 2009 when the US Attorney General released guidance that largely ceded to local governments the responsibility for prosecuting marijuana offenses. As a result, the authors state, "The number of licenses increased from 4,819 on December 30, 2008, to 116,287 on September 30, 2014."
Marijuana use in Colorado became further liberalized by the 2012 passage of an amendment to the state constitution that would allow retail sale of marijuana beginning in January 2014. As of last month, the state has nearly 300 retail marijuana dispensaries.
Colorado residents over the age of 21 can purchase up to 1 ounce of marijuana in a single transaction while out-of state residents are limited to 1/4 of an ounce. But public use of marijuana is technically illegal, similar to open container laws for alcoholic beverages. This restriction, in part, has given rise to a considerable market for edible marijuana products.
From a public health perspective, the authors noted the general expectation that more widespread marijuana use would exacerbate chronic medical conditions, particularly psychiatric disorders since the active components of the plant can cause anxiety and paranoia in some individuals. In the past, the contribution of marijuana to these effects has been difficult to ascertain because of the concomitant use of other drugs such as alcohol.
But the authors reported an unexpected uptick in "pure" marijuana intoxication: "anxiety, panic attacks, public intoxication, vomiting, or other nonspecific symptoms precipitated by marijuana use." Among the 2,000 patients seen weekly in the emergency department of the University of Colorado Hospital in the Denver suburb of Aurora, one or two patients are seen with these responses while another 10 or 15 present with other marijuana-associated illnesses that the authors didn't define. However, the authors did not indicate whether these effects occurred in inexperienced marijuana users who may not be familiar with high-dose effects.
As marijuana is often used to manage the nausea and vomiting of cancer chemotherapy, the emergence of a marijuana-associated cyclic vomiting syndrome was an unexpected finding. In unpublished data by the first author of the report, Andrew A. Monte, MD, the frequent use of high THC-containing marijuana products was linked to a doubling in this syndrome since recreational marijuana legalization. These patients reported severe abdominal pain, vomiting, and profuse sweating that can be relieved, paradoxically, by hot showers. Receptors for cannabinoids are present in the gastrointestinal tract, but have been thought to serve in an antiinflammatory capacity imparted by our own, naturally-produced endocannabinoids (the marijuana analog of endorphins at opioid receptors).
The University of Colorado burn unit has also seen an increase in hospitalizations for burns resulting primarily from flash fires that occur when a user is trying to extract THC and other active marijuana constituents using butane. Thirty-one marijuana-associated burn cases have been seen at the hospital, with some over 70% of body surface area and two-thirds requiring skin grafts.
Denver-area hospitals and the state poison control service have seen 14 cases of marijuana intoxication in children over the last two years, half of which required admission to intensive care units. These cases occurred primarily with edible marijuana products, many of which are fashioned like candies or energy bars. The problem — of which I was unaware from my teaching days — is that large doses of THC can cause respiratory depression in children.
Edible marijuana products present their own challenges because of the pharmacokinetic differences of ingested THC relative that that when the plant material is smoked. Edible marijuana products still are not tested for THC content, relying instead of manufacturer labeling. Testing by The Denver Post's Cannabist newspaper has revealed wide variations from labeled amounts of THC, from zero to one-and-a-half times the labeled amount. Moreover, the psychoactive effects may be delayed by one to four hours, thereby lacking the moment-to-moment dose titration afforded by smoking marijuana.
Caveats
One thing I found lacking in this viewpoint article was a comparison of the adverse effects of marijuana relative to other legal drugs such as alcohol and nicotine products and, in the pediatric cases, a comparison with poisonings with other products such a laundry pods or household cleaners. In addition, numbers are still not available for arrests and accidents while driving under the influence of marijuana. While the state has established 5 nanograms of THC per milliliter of blood as the threshold for intoxication, law enforcement lacks the roadside testing capability for THC that we have for alcohol.
Another issue not addressed, although this would be beyond the scope of the article, is that effect legalization has had on incarceration due to marijuana related offenses, a factor that indirectly affects state health care resource utilization.
In summary, the burn cases and pediatric intoxication cases are certainly cause for concern. But taken together, a preliminary view would be that marijuana legalization in Colorado has not resulted in a widespread increase in acute medical problems. I applaud the authors for trying to put numbers on these effects of relaxing marijuana laws in the state. The confounding variables are many, but it's this kind of research that's necessary to formulate rational drug policy and harm reduction strategies.
News Moderator: Shandar @ 420 MAGAZINE ®
Source: Information for the World's Business Leaders - Forbes.com
Author: David Kroll
Contact: Forbes Real Time
Website: Unexpected Health Effects Of The Colorado Marijuana Experiment - Forbes
