In November of 2018, Amendment 2 was passed in Missouri, beginning the process of allowing medical marijuana dispensaries and prescriptions to be given to those with qualifying medical conditions as per their health care providers. One month before this historical vote, a scientific paper by local professionals and a Missouri S&T student was released that discussed risks that marijuana poses, and to whom the most risk lies. The authors are Dr. William V. Stoecker, an adjunct professor at Missouri S&T and doctor with the Dermatology Center of Rolla, Dr. Joseph M. Malters with the Dermatology Center of Rolla and Missouri S&T undergraduate Emily Rapp.
In the first part of this two-part series discussing the scientific research paper titled “Marijuana Use in the Era of Changing Cannabis Laws: What Are the Risks? Who is Most at Risk?”, we covered the authors’ research on the difference between tetrahydrocannabinol (THC) and cannabidiol (CBD), the increased potency of modern marijuana, biological risk factors of frequent use of the drug and the cited side effects that marijuana use causes.
According to multiple citations of recent research in the article, marijuana use is not only attributed to increased risks of psychosis in males, but also in users in their early adolescence (younger than 16). This is attributed to different biological differences in the brain between males and females, as well as in youth who are not fully developed.
The article cites that from the 1980s to 2012 there has been a general increase in the potency of marijuana, quadrupling in strength of the concentration of THC, the primary psychoactive constituent in the drug. In the United States, there is no limit on the potency of marijuana as there is in other countries such as Uruguay, however 15 states do have limits on the THC content to allow access to products such as cannabidiol oil. Studies cited show that the higher potency of THC is in direct correlation with greater memory impairment and increased chance of psychosis.
“The point we want to make on top of that is that it is not the THC fraction, the fraction that gets you high, that (helps). It is the CBD fraction, and that is already readily available.” said Dr. William V. Stoecker, an author of the article. “I have no problem with the use of CBD, it’s the THC that causes problems.”
In a cited statistic, 35.8 percent of U.S. youth from 15 to 16 years old are said to have used marijuana. In other articles discussed in this piece, questions were raised over whether the introduction of medical marijuana laws (MMLs) also saw an increase of usage in youth. While no study cited a known increase of youth usage following these laws passing in Colorado, it did show increases in Washington, and other researchers speculate on the increased daily usage of individual youth who were already users. The same study also did find an increase in the frequency of marijuana use in college-age students in Colorado after the passing of MMLs.
The Poison Control Center released data that did show an almost 33 percent increase in marijuana exposure among younger children from 2013 to 2014, with additional research showing that there has been an overall increase in pediatric exposures of the drug following MML enactment.
In a quotation from the article, superintendent of Rolla schools Dr. Aaron Zalis said that medical marijuana laws add work for school administrators.
“There is more to unwind,” said Zalis. “Alcohol, opiates and marijuana, right now, all are illegal for juveniles . The schools are required to check out all the drugs that students have. The distinction of medical marijuana makes it a lot more complicated … There will be more documentation and compliance with new regulations. Additionally, any legislation that makes marijuana available could lead to other substance abuse. I’ve always viewed marijuana as a gateway. Based on the counselors that we work with, over a 34-year period, [marijuana] leads to other things.”
In Washington, marijuana use increased in eighth and 10th graders after the passage of MMLs. Increases were also cited in Oregon, but only among students who reported recent heavy alcohol use, which the article indicates co-morbidities in students with substance abuse. A study in Colorado did show a significant difference between non-users and once-a-week or more users in grade point averages for college students.
In addition, emergency rooms are also seeing a relatively new syndrome called marijuana hyperemesis syndrome. This is a condition where persistent, cyclic vomiting is observed in cannabis users, at a rate which was shown to have increased significantly in states where MMLs has been passed. The number of visits for this condition was shown to have doubled in Colorado alone since the legalization of the drug.
Phelps County Regional Medical Center ER physician Dr. Francina Hoffman was quoted as having seen her first case of the condition in recent years.
“They [marijuana users] come in because they can’t stop vomiting. We prescribe Phenergan or Zofran, but they are often noncompliant. On the third ER visit, they get admitted,” said Hoffman.
Overall, the yearly rate of ER visits related to marijuana increased 35 percent after the passage of MMLs in Colorado alone, with hospitalizations related to the drug nearly doubling from 2011 to 2014. Stoecker also cited during the interview an article that shows marijuana use activated opioid receptors in the brain, causing an addiction to the drug due to a “reward system” that happens when the drug is consumed or smoked.
“I think one thing to emphasize is that I am most interested in those at risk,” Stoecker said. “As a doctor I want to know who is most at risk. Our love for our patients should also concern their general health which is threatened by certain things related to marijuana.”
Stoecker stated that if their research were to continue into the topic of marijuana, he would be most interested in researching fatalities associated with the drug, such as traffic accidents.
To view the study in full, visit the web address “www.ncbi.nlm.nih.gov/pmc/articles/PMC6205280/”.