APMA News - January/February 2020 - 22

Cannabis: Updates for Podiatric Physicians and Surgeons

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By APMA Public Health and Preventive Podiatric Medicine Committee

welve states and the District of Columbia have legalized
the purchase and consumption of recreational marijuana, and 33 states plus DC have approved medical cannabis1. As the movement to legalize and increase access to cannabis grows, the APMA Public Health and Preventive Podiatric
Medicine Committee feels it is important to keep podiatric physicians and surgeons informed about the current status of legislative, academic, and public health efforts around marijuana use.

DPM Prescribing
DPMs are allowed to certify patients for medical cannabis in
Maryland2, New Mexico3, and Oklahoma4. APMA has taken a
position to support evidence-based treatment with cannabis
and to support allowing DPMs to certify medical cannabis for
their patients5. Conditions for which DPMs certify medical cannabis include chronic pain, painful neuropathy, and autoimmune/degenerative arthritides.
APMA has communicated its support to stakeholder organizations such as the Marijuana Policy Project (www.mpp.org)
to ensure that when medical marijuana legislation is drafted, it
includes DPMs as physicians. The Marijuana Policy Project
model law includes DPMs, but states sometimes modify that
model law to limit certification rights to MDs/DOs. APMA provides direct support for state components and local organizations when they are interested in drafting legislation related to
medical cannabis.

Medicinal Use
There is a fast-growing groundswell of support regarding
federal legalization/decriminalization of marijuana, but cannabis research is lagging far behind policy and reality. The cannabis supplied by the University of Mississippi, the only federally authorized medicinal marijuana cultivator in the US, is
low-quality, at least by street/consumer standards. At the 2019
North American Cannabis Summit, Igor Grant, MD, the director of the University of California Center for Medicinal Cannabis
Research, pointed out that the most potent medicinal variety
topped out at 8 percent tetrahydrocannabinol (THC, the compound that gives users a high)6. That is far weaker than most
strains sold at regulated dispensaries, which are generally in the
15- to 30-percent THC range.

Public Health Concerns
Marijuana use results in multiple health effects (see sidebar
at right), and policymakers are adapting longtime tools for preventing substance misuse to safeguard public health. The use of
proceeds from sales of substances such as tobacco and alcohol
22 APMA News January/February 2020

to benefit public health has long been supported by health advocates, as have regulations on additives, limits on potency, and
advertising restrictions, all of which are used in Colorado, one
of the first states to legalize recreational marijuana use. As part
of the legislation that legalized marijuana in the state, officials
mandated that the Colorado Department of Public Health and
Environment monitor changes in drug use patterns. As a result,
the department publishes a monitoring report every two years,
with its third report released in January 2019. Using data from
state and national surveys, the report details state patterns of
marijuana use. For example, the most recent report found that
more adults are using marijuana and using it more often. It also
found that there has been more use of edible marijuana among
high school students and that overall emergency department
visits related to marijuana have increased.
A big concern in Colorado and elsewhere is unintentional
marijuana ingestion by children. In 2019, a study published
online in Pediatric Emergency Care found that child marijuana
ingestions have been growing nationwide since 20097. Through
2017, there was a mean annual increase of 27 percent per year,
the study found, with 70 percent of marijuana ingestions among
children occurring in states that had legalized the drug.
From the beginning of legal sales, Colorado has required
all marijuana come in child-resistant packaging and be marked
with a special warning symbol about THC. Safely storing marijuana in a lockbox or safe and out of sight or reach of children
is part of Colorado's Responsibility campaign8.

Health effects of marijuana use include:
n Youth initiation and psychosocial outcomes
Some evidence of impaired learning,
memory, attention
n Dependence/Addiction
Strong evidence; increases for early
initiation and heavy use
n Pregnancy/Prenatal Outcomes
Strong evidence of low birthweight
n Injury Prevention and Control
Strong evidence of increased accidental
ingestion; motor vehicle accidents
n Mental Health Outcomes
Strong evidence of increased risk of
schizophrenia and other psychoses;
some evidence of increased risk of other
mental health outcomes
n Increased risk of abuse/dependence of
other substances
n Increased risk of respiratory effects

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Source: Overview of State Marijuana Legalization Policy:
Implications for Public Health, Gillian Schauer, PhD, MPH,
senior policy fellow, CDC Foundation
http://www.mpp.org
APMA News - January/February 2020

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