- - Wednesday, October 29, 2014

Something has changed in the past five years — pot isn’t really considered a street drug anymore by my adolescent patients. Marijuana use isn’t anything they feel a need to deny or hide. With increasing frequency, my patients openly discuss their marijuana use in front of their parents. Some adamantly deny alcohol use, yet don’t hesitate to discuss their regular marijuana use.

Just a few years ago, this wasn’t true. As soon as I mentioned the need to get a drug screen, my patients would get a nervous look on their face, often confessing marijuana use before the test results came back and begging me not to tell their parents.

My patients now recognize marijuana as a drug — a medical drug. They tell their parents how it helps with depression and anxiety. And I tell them I believe them. Marijuana probably does help them feel better. I also tell them we have other drugs to treat depression, anxiety and pain, drugs that are better regulated and have risk profiles that are better understood, drugs with standard concentrations and doses. Nicotine, too, is a stimulant that can improve ADHD symptoms, but we don’t recommend smoking as an ADHD treatment. We have better drugs for that, too.

Now that recreational marijuana is legal in Colorado, the taboo against the drug is evaporating. Other states are following — the district attorney in Brooklyn, N.Y. recently announced his plans to stop prosecuting people arrested on charges of possessing small amounts of marijuana. In Washington state, a third recreational marijuana store plans to open in October.

I spent a summer in college doing cannabinoid research at the National Institutes of Health, trying to understand the effects of marijuana in the brain. I’m the first to admit that cannabinoids are a promising class of pharmaceuticals. But marijuana is just that — a medical drug — and its recreational use should still be taboo. Here are some reasons why: 

Synthetic marijuana — A patient came into my ER hallucinating with tales of a very bad trip. He showed me his “marijuana,” a bunch of leaves rolled into a joint. And then his drug screen came back negative. His was synthetic marijuana, a bunch of herbs sprayed with some unknown chemical. Commonly known as “spice” or “K2,” synthetic marijuana use has been on the rise due to the misconception that it is safe and legal. Synthetic marijuana often contains laboratory-manufactured chemicals that have the same effect as THC, the psychoactive ingredient in marijuana. But sometimes the product is actually laced with bath salts or other street drugs. I never really know what my patient has taken, which makes it hard for me to treat them.

Emergency room visits due to synthetic marijuana use are up across the United States. According to an October, 2014 report from the U.S. Substance Abuse and Mental Health Services Administration, ER visits for synthetic marijuana more than doubled between 2010 and 2011, with 11,400 visits in 2010 and 28,500 in 2011. Worse, among those aged 18 to 20, the number of ER visits related to synthetic marijuana quadrupled, from approximately 2,000 in 2010 to over 8,000 in 2011. (More recent numbers are not yet available, but based on my personal experience, I’m sure they continue to rise.)

 Overdoses  — My 4-year-old saw a brownie at a beach bake sale and started begging me to buy it for him. The guy selling it looked me directly in the eyes and shook his head. I knew what he meant. Marijuana brownies, cookies and jolly-rancher-like hard candies are common now. The problem is that you just don’t know how much THC is in the treats. Some contain much higher concentrations than one joint, and who can eat only one cookie? The effects of edible THC can take longer to set in compared to smoked marijuana. You’re likely to eat a few treats before the full effect hits. The result is an overdose effect that can land people in the ER.  

Driving risks — People drive after smoking weed: Young people are more likely to drive after they smoke marijuana than to drive after drinking alcohol. A recent study found 44 percent of college men said they drove after smoking marijuana in the previous month, compared with 12 percent who said they drove after drinking.

We don’t really know how many people are driving under the influence of marijuana, or how many accidents involve marijuana use. There is no good field test to evaluate for marijuana impairment, and there is no such thing as a “weed breathalyzer.” Marijuana testing is usually from blood or urine, so police have to bring drivers to an ER for testing.

Infertility — Marijuana use reduces fertility in both men and women (but no, marijuana is not a form of birth-control). Anandamide is an “endogenous cannabinoid,” a THC-like chemical that is naturally occurring in all of our bodies. Anandamide also helps human conception, giving signals to sperm to “hyperactivate,” or swim faster so they can penetrate the egg. Using marijuana sends signals to sperm to hyperactivate too early, so they are all burned out before they ever reach the egg (pun intended). Marijuana use is also known to reduce the volume of sperm production. If women use marijuana, the THC is in their cervical fluids, also causing hyperactivation of sperm and reducing the likelihood of conception.

If you do get pregnant, marijuana use during pregnancy is associated with low birth weight infants. There are concerns about the long term neurodevelopmental outcomes of infants exposed prenatally to marijuana. Sadly, many pregnant moms use marijuana to treat nausea and morning sickness.

Impaired memory — What was that? That’s right, marijuana use impairs memory, a critical skill for academic success. Most of the time memory loss is subtle, just enough to cause a drop in school grades, but occasionally memory loss can be profound.

The effects of marijuana on the developing adolescent brain are an active area of research, and the data thus far is discouraging. Dr. Herbert Kleber, of the Division on Substance Abuse at Columbia University told NPR: “There is a growing body of evidence that shows that marijuana isn’t good for the developing brain. The adolescent brain is still maturing, and teens that use marijuana are more likely to become dependent on it than adults.”

Thrush — Thrush, an oral yeast infection, can result from chronic marijuana smoking. There’s a reason why some people call thrush “trench mouth.” A white film grows over the inside of your mouth and tongue. I’ve included thrush in this list because no one seems to talk about it, but I’ve seen it among my patients. It’s disgusting, painful, and no one will want to kiss you. Thrush can be difficult to treat in patients who continue to use marijuana.

Uncertainty — We don’t really understand most of the risks of marijuana, because it’s really hard to study it. Research on marijuana is difficult because participants must admit to using a drug that is still illegal in most states. Also, most long-term marijuana users also smoke tobacco, complicating outcomes. IV forms of THC are highly regulated, making research a battle against red tape. Would you take a prescription drug that is poorly researched? 

Taboo or not, my patients take marijuana because they are desperate. Desperate to dull the pains of stress, anxiety, depression and the hardships of life. But legalization of recreational marijuana is not the solution to these ills.

Kathleen Berchelmann, M.D., is assistant professor of pediatrics, Washington University School of Medicine.


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