Marijuana is the most commonly used illicit drug among adults according to the National Institute of health. What you may find surprising is that the greatest increase in use is observed in adults age 50 and older. The typical user tends to be male, unmarried with multiple chronic diseases, including psychological stress as extrapolated from epidemiology literature by NIH.
In my practice, this type of user will casually mention they’re using CBD for sleep. The age 70-plus group, who are given CBD topicals or tinctures by their children or grandchildren, often seek my advice. Usually they’re given these products by family members to help with either chronic pain or insomnia.
The doctor-patient relationship
Physicians have a federal license and therefore are legally prohibited from prescribing, or offering cannabis treatment recommendations. Drugs are categorized into 5 schedules or lists based on their medicinal value and potential for addiction and abuse. Cannabis is classified as a Schedule 1 drug, which means it’s classified in the same category as other drugs such as heroin and methamphetamines. Schedule 1 drugs are considered the most dangerous and users can be convicted for the possession of this substance. When proposition 64 passed in 2016, it decriminalized recreational marijuana in California, allowing adults age 21 or older to possess this drug. However, nationally marijuana still remains a Schedule 1 drug.
The classification makes it difficult for academic institutions to study cannabis and conduct clinical trials. For the last 50 years, the University of Mississippi had the sole contract for growing medical marijuana. A special license had to be obtained by a researcher through several federal agencies prior to getting the product to conduct research. In 2016, the Drug Enforcement Administration—or DEA—announced that it would allow other agencies to grow and distribute for research purposes, but so far no other institutions have been granted this permission.
Most medical information about cannabis comes from international studies. The Israeli government has a more liberal approach to medical cannabis research. As a result, Israel has become the leader in medical marijuana applications. The Israeli defense force practitioners administer CBD or low dose THC as a first line treatment for those who suffer brain trauma. It can also be used in Nursing homes to treat the elderly for many chronic conditions including PTSD.
As a user, the first consideration should be about the quality of the product one consumes. Like any other agricultural product, it’s important to know the level and type of pesticide exposure. A 2013 study analyzed a dispensary in California and concluded that chances of pesticide exposure is extremely high when smoked. Fungicides are used to keep fungi from growing on the crops. But when it’s smoked, the heat can change the chemical structure to something very harmful.
How you ingest cannabis also matters. If you smoke it, are you exposing yourself to carcinogens? Is vaping a safer alternative, or can it harm the lungs? How much exposure will put you at risk for these side effects? Medical science researchers don’t have clear answers to these questions yet.
Then how about edibles? Is that a safe method? Edibles can take up to 90 minutes to take effect. I have patients who have landed in the ER because they consumed large amounts due to the delayed onset of effect.
What we know so far about the negative effects of cannabis is basic. Marijuana can elevate your heart rate and lower your blood pressure, so if you have a heart condition, use with caution. It can also impair your problem solving capacity and memory.
It may cause dizziness, decrease balance and coordination and reaction times. As a physician, I would advise against driving while under this influence.
It may also cause hallucinations and paranoia and worsen depression. It’s inconclusive in the international data whether it creates or worsens psychiatric problems. In terms of abuse potential, there is a 10 percent chance of substance abuse with cannabis, compared to a 65 percent chance of abuse with smoking cigarettes and a 20 percent chance with alcohol abuse.
Daily, long-term users can get Cannabinoid hyperemesis syndrome: severe repeated bouts of vomiting. In the brain, cannabis can prevent nausea and vomiting but in the digestive tract, it can cause nausea and vomiting. With repeated use, one can be more susceptible to the gastrointestinal effect and the effect on the brain is muted.
Seeking treatment
If you have a condition that qualifies for medical cannabis, talk with your doctor about the options, benefits and risks of using it. And if your provider isn’t familiar with it, ask if there’s another clinician in the practice who can answer your questions.
Rajina Ranadive, M.D., is a board certified internal medicine physician with the Annadel Medical Group. She is also the medical director of the Petaluma Post-Acute Rehab. She can be reached at (707) 763-0802.
