Berks County Medical Society Medical Record Winter 2019 - 27

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good research to justify risk. The Medical Society did
support changing marijuana to Schedule II so that
research could be done. Now, some investigators have been
permitted to grow and study the plant for medicinal use.
So let us, as physicians, look at the reality of the situation.
One benefit of legalization of Medical Marijuana is that
it can be regulated and monitored as any prescription
medication, thereby making it safer, easier to titrate, and
subject to report of adverse events. As in Colorado, the
financial benefits are very large: job creation through
growing, formulating, dispensing, and marketing; and
large tax revenues that can be used for the public benefit.
Also in Colorado, the first state to legalize recreational
marijuana, there have been unexpected health benefits: less
use of alcohol and use in combating opioid dependence.
Colorado has not experienced any significant morbidity
from legal marijuana, there have been no reported deaths
directly related to legal marijuana use, and the ER visits for
intoxication have been primarily in children who use their
parents' edibles, or adults who do not understand that oral
dosage takes 1-2 hours to have an effect and ingest too much.
This can produce hallucinations, uncontrollable vomiting
("hyperemesis"), and psychosis in those with risk factors.
As in PA, marijuana cannot be sold to minors (which
does not stop them from getting marijuana illegally), a
vulnerable group due to greater effects on brain chemistry in
childhood and adolescence. Of note, the brainstem contains
minimal CB receptors, therefore there is minimal risk of
respiratory arrest as seen, unfortunately, in opioid overdoses.

With legalization of medical marijuana, patients can
be screened for relative contraindications such as history
of M.I., pregnancy, breast-feeding, or strong family
history of Schizophrenia. The addiction rate is 9%,
relative to double that for alcohol and triple for nicotine.
Apparently also there is evidence of less liver damage in
alcoholics who also use marijuana, although it remains to
be seen if that finding is clinically significant, especially
due to the heightened risk of accident due to DUI!
There is no credible evidence that marijuana is a "gateway
drug" although there is evidence that users also do use
other illicit drugs more frequently. There may or may
not be causation. Drug addiction has a definite heredity
component, which is not unique to marijuana users. It is
also difficult to do good research where marijuana is illegal,
as so many users will not admit it due to illegality and often
do use other drugs such as alcohol, nicotine, and opioids.
One example of the difficulty relying on current US
data is that in pregnancy it is difficult to assess which
possible fetal harms are due to marijuana when data may
come from occasional drug screens or a screen when
the patient presents in labor. Often, there are multiple
other substances being used, or nothing showing up in
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WINTER 2019

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Berks County Medical Society Medical Record Winter 2019

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