By Dr. Raju Hajela
Marijuana has been in the news a lot lately, especially since 20 U.S. states and the District of Columbia have allowed ready access to “medical marijuana” over the last several years. More recently, some states, such as Colorado and Washington, have legalized the sale of marijuana to adults above age 21. Not all laws are the same and there remains a wide range of regulations and provisions for enforcement.
Interestingly enough, despite all these changes in policy, the U.S. federal government considers marijuana to have no medical use and high potential for abuse. Under federal law, it is illegal for any person to manufacture, distribute, or possess cannabis for any purpose. Moreover, it is generally agreed by even the supporters of “medical marijuana” that smoking is injurious to the lungs both short-term and long-term; hence, the research on cannabis products for medical uses has been looking at alternate delivery systems such as pills, vaporizers, sprays and edible products.
Sadly, in Colorado, even before the recent legalization, the prevalence of marijuana use by adolescents in 2008-2010 was almost twice the U.S. national average (12.2% vs. 6.6%). Traffic fatalities indicating positive toxicology for marijuana in Colorado rose from 4.5% in 1994 to 10% in 2011; the corresponding average rates in no “medical marijuana” states rose from 1.1% in 1994 to 4.1% in 2011.
There is a new organization in the U.S. called Smart Approaches to Marijuana (SAM) led by Mr. Patrick J. Kennedy (Ted Kennedy’s son and JFK’s nephew). SAM is focused on having more honest conversations about marijuana such that public policy initiatives balance the avoidance of lifelong stigma due to arrest, while preventing the establishment of Big Marijuana that would market to children just like Big Tobacco. Big Marijuana is a very likely expected result of legalization just as Big Tobacco and the Alcohol industry’s promotion of their products contributes to huge amounts of negative impacts to individuals, families and society as a whole. Even though people think that marijuana is not immediately as harmful as alcohol intoxication is known to be, there are adverse effects on the brain acutely that cause perceptual distortions resulting in accidental injuries that can be fatal; and there are chronic brain issues related to lack of motivation, decline in IQ and academic performance, together with memory problems that occur later in life even after people have stopped smoking marijuana.
There is also a new book called Reefer Sanity written by Kevin Sabet, PhD, which addresses some of the prevalent myths about marijuana. Contrary to popular beliefs, marijuana is not legal in Holland and Portugal, it is decriminalized. Uruguay is the only country in the world that has legalized marijuana and the consequences of that remain unknown as it has not been measured or followed over time.
“Medical Marijuana” has been legal in Canada since 2001, and Health Canada has recorded 37,359 legal users (2013 September). The marijuana used to come from one of three places: the user growing it themselves, authorizing someone else to grow it for them or buying directly from Health Canada for $5 a gram, who in turn sourced it from Saskatoon’s Prairie Plant Systems and kept the price down via subsidies. There were problems in regulation and diversion to non-authorized users of marijuana was increasing. So, in the fall of 2013 new rules rescinded old authorizations and new licenses were issued to 12 big companies for marijuana production and distribution. Health Canada has estimated that Canada’s “legal marijuana supply industry” could reach $1.3 billion in sales by 2024, with an estimated 450,000 Canadians eventually becoming users of “medical marijuana”.
An unintended consequence of the “medical marijuana” debate has been an increasing, erroneous public perception that because marijuana is authorized as medicine it must be safe for all users. Even more alarming is the move towards Big Marijuana industry that is all set to follow the examples of alcohol and tobacco in sales and marketing. These two legal drugs contribute to huge amounts of disease and mortality burden, in addition to the enormous, almost immeasurable costs to individuals, families and society that are affected by the harmful consequences from tobacco and alcohol. Will “medical marijuana” be regulated well? The examples of vast amounts of prescription opioid diversion and marijuana diversion under old policies do not provide confidence that the new initiatives will be good for the public. The public needs to be better informed and we need to keep talking more honestly, so that we do not cause more harm while intending (?pretending) to provide relief and reduce harm.
Health Canada states on its website (which provides information related to marijuana):
“Cannabis is not an approved therapeutic product and the provision of this information should not be interpreted as an endorsement of the use of this product, or cannabis generally, by Health Canada. Despite the similarity of format, it is not a Drug Product Monograph, which is a document which would be required if the product were to receive a Notice of Compliance authorizing its sale in Canada. This document is a summary of peer-reviewed literature and international reviews concerning potential therapeutic uses and harmful effects of cannabis (marihuana) and cannabinoids. It is not meant to be comprehensive and should be used as a complement to other reliable sources of information. This document should not be construed as expressing conclusions from Health Canada about the appropriate use of cannabis (marihuana) or cannabinoids for medical purposes.
Cannabis (marijuana, marihuana) is not an approved therapeutic substance in Canada and has not been issued a notice of compliance by Health Canada authorizing sale in Canada.”