CMDA's The Point

Unmasking Medical Marijuana

May 23, 2019
Unmasking Medical Marijuana May 23, 2019

by Amy Givler, MD

At age 60, I can pretty much say I will never recommend marijuana to any of my patients. I have far too clear memories of my teenage years, when I knew many friends and family who smoked pot, to their detriment. In high school it wasn’t hard to tell who was using regularly because it interfered with their learning. They seemed slightly disoriented and less aware of what was going on around them.

And the years since then have only reconfirmed my reluctance to embrace marijuana. For 31 years as a family physician I have actively discouraged my patients from using this drug.

“How’s it different from alcohol?” they might ask.

“I don’t want you to drink alcohol either,” I say, “at least not to the point of getting drunk. And what is the purpose of marijuana except getting high? With alcohol it is possible to drink a small enough amount that it doesn’t impair you.”

But for the first 27 years of my career, I didn’t have this conversation often. Unless people were in substance-use recovery—and wanting me to know this part of their medical history so I could support them—I seldom knew. With most patients, if I asked about drug use as part of their medical history, they denied it. Only if they had tested positive on a drug screen in the emergency room did they reluctantly admit to using “sometimes.” And if they protested they had just been around a smoker, not smoking themselves, my standard response was they would have to sit in an unventilated room with a smoker for an hour before they would get enough THC in their system to test positive.

All that changed one day in June 2015. It was the day after the Louisiana legislature passed a law allowing medical marijuana, and my very first patient asked me for a prescription for it.

“No way!” I said.

“But it’s legal!” he said.

“So I guess you have been using marijuana for a while?”

“Oh, yes,” he said, “and it really helps my anxiety.” Since he is one of my most anxious patients, I wonder about that. I suspect it is actually making his anxiety worse.

I wondered if that encounter was a harbinger for the future, and indeed it has turned out to be so. Even though Louisiana has dragged its feet on actually getting medical marijuana to market (Thank you, O my sluggish southern state), hardly a week goes by without someone asking me whether medical marijuana would help them. I think you know by now how I respond.

And when I ask new patients about marijuana use, they never hesitate any longer before telling me if they do. Clearly they consider the legality of medical marijuana to be permission granted by the medical profession to use all forms of marijuana. But of course, recreational marijuana is still illegal here. And the federal government considers marijuana to be a Schedule I drug, and thus illegal even in states which allow it to be used in any form.

The public perception is that marijuana is safe, though the facts prove quite otherwise. In the short-term, marijuana impairs memory, motor coordination and judgment. With long-term use, marijuana can cause addiction, chronic bronchitis, diminished lifetime achievement, cognitive impairment, depression, anxiety, apathy and progression to other drugs. For those who use it during adolescence, there is a greater risk of dropping out of school, abnormal brain development and developing a chronic psychosis disorder. The number of motor vehicle crashes caused by driver impairment due to marijuana is skyrocketing.

Recreational marijuana has been available in Colorado since 2013. Every year the state studies the impact with a report. The 2018 report states:

  • Yearly traffic deaths involving marijuana increased 151 percent since 2013.
  • The percentage of traffic deaths related to marijuana increased from 11 to 21 percent.
  • Within three years after legalization, the percentage of people who “had used marijuana in the past month” increased 45 percent.
  • Since 2013, marijuana-related ER visits increased 52 percent, while hospitalizations increased 148 percent.
  • The average THC content has risen steadily from 16.4 percent in 2014 to 19.6 percent in 2017. THC is the psychoactive component of marijuana.

(Note: THC percentages are rising everywhere. In the 1970s, THC in marijuana plants averaged 1 to 2 percent. Nationwide, it now averages 13 percent.)

  • The average potency of concentrated extracts increased from 56.6 percent in 2014 to 68.6 percent in 2017.
  • Highway seizures of black-market marijuana have increased 39 percent, and U.S. mail seizures have increased 1,042 percent.
  • Marijuana tax revenue is less than one percent of Colorado’s budget.
  • Violent crime has increased 18.6 percent, and property crime increased 8.3 percent.
  • The price of all forms of marijuana has dropped in half since 2014.
  • As of June 2017, there are 491 retail marijuana stores, compared to 392 Starbucks and 208 McDonald’s.

Regarding that last point, the dispensaries, it is a crying shame to tell you they are clustered in disadvantaged neighborhoods. Whereas 65 percent of local jurisdictions in Colorado have banned marijuana businesses, the poor don’t have the same resources to protect their communities. Ben Cort is a substance abuse treatment consultant and a Colorado resident who has written a rollicking book on the impact of marijuana on his state, Weed, Inc. In his “Social Justice” chapter, he writes, “If there is money to be made selling a vice substance most of it will be made in poor neighborhoods.” In one neighborhood in Denver (which is 70 to 90 percent minority), there is one marijuana shop for every 47 people. This sounds like exploitation of vulnerable people.

Why do I care about Colorado when I live in Louisiana? Because medical marijuana is now legal here, at least technically, and medical marijuana legalization is associated with increased illicit marijuana use as well as increased ER visits for marijuana-intoxicated children. Most importantly, it has proved to be the stepping-stone to legalization of recreational marijuana. Nine states have legalized recreational marijuana.

There are 14 conditions named in Louisiana’s law as potentially treatable with medical marijuana. How many on this list have evidence-based support? Exactly four, although how they are worded in the law is much too broad. One condition is “cancer,” but marijuana has only been shown to help chemotherapy-induced nausea and vomiting. It does nothing for the cancer itself. In fact, marijuana does not cure anything. It is used purely for symptoms.

The three other conditions that have some scientific support (though frankly, it is weak) for treating with marijuana are:

  1. Neuropathic pain
    Note: This is not the same thing as musculoskeletal pain, such as arthritis or fibromyalgia. And even when some pain is reduced in neuropathic pain, people report no change in physical functioning, emotional functioning or quality of life.
  2. Spasticity and bladder spasms in multiple sclerosis
  3. Epilepsy

Note: It is the CBD component, and not THC, which provides some benefit. CBD is not psychoactive.

For none of these conditions would marijuana be a first-line treatment. Since there is no scientific support to use marijuana for the other 10 conditions listed, how did they get on the list? Lobbyists? Just because a medical condition causes emotional or physical suffering, such as autism, HIV/AIDS or Parkinson’s Disease, that is not a good reason to treat it, without any evidence, with a psychoactive substance that has significant potential harms. Shouldn’t the medical profession test medications to make sure they are beneficial and safe before they are released for use? I think we are going about this process backwards.

Chances are good that your state is among the 34 that have approved medical marijuana. Seeing what “treatable conditions” are on your state’s list may surprise you. Sickle cell disease? PTSD? Alzheimer’s? ALS? Autism? Come on, people. There isn’t a shred of evidence that marijuana helps any of these.

I admit I am just sticking my pinky toe into a subject that has massive financial implications. There is a lot of money to be made in the marijuana industry. And unfortunately, the public perception—that marijuana is benign—is at odds with the mounting evidence that it is anything but. What grips my heart is that the poor and disadvantaged will be disproportionately harmed. But those of us who care about justice can speak out, remembering this proverb, “The good-hearted understand what it’s like to be poor; the hardhearted haven’t the faintest idea” (Proverbs 29:7, MSG).

Amy Givler, MD

About Amy Givler, MD

Amy Givler is a family physician in Monroe, Louisiana. She and her husband Don met in 1980 at a CMDA student event her first year of medical school, and they have both been active members of CMDA ever since. Amy graduated from Wellesley College and Georgetown University School of Medicine, and she then completed her family medicine residency at the same indigent-care hospital where she now works part time. She also works at an urgent-care clinic and is the medical director for a Shots for Tots clinic. Amy loves to write and has written many articles and one book, Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose. She and Don have a heart for missions, and hope to do more short-term trips now that their three children have launched from the nest.

5 Comments

  1. Avatar Bishop Reuben Keya Lubanga on May 23, 2019 at 1:25 pm

    I Have had the humble privilege of hosting Amy and Don as a couple on a medical mission in my home in Kenya Africa. Her love for people and generosity towards the needy and sick is quite disarming. The period we have stayed with Amy will remain unforgettable in our hearts and minds.

  2. Avatar Jeffrey Vrielink, M.D. on June 3, 2019 at 2:05 pm

    I have long known that Marijuana does something for Bipolar symptoms, as many of my patients have used it to self-medicate their symptoms (racing thoughts, irritability, and insomnia). I still tell them that I don’t recommend it. The long term negative effects by far outweigh any perceived benefits.

    Last year Michigan residents voted to legalize Marijuana in our state…and unfortunately it passed. I wish people would use their brain more than their emotions to guide their decisions and votes. Just because something in now legal doesn’t make it right. In our pluralistic society with its shifting values we will see a lot of things become acceptable and popular, that years ago would make us cringe.

    In years past it was alcohol, then abortion, now marijuana. When I was in high school in the early 80’s parents still had rights. Now minors can get contraceptives, condoms, HIV testing, and treatment of STD’s etc. without parental consent. It seems that now anything goes. Where will this nonsense stop? Sex reassignment surgery for minors? Physician Assisted Suicide? We are on a slippery slope. I no longer say God bless America, but “God have MERCY on America.”

  3. Avatar Frank Bryant MD on June 3, 2019 at 5:30 pm

    Amy, Hope you are well. I agree with your thoughts on medical marijuana. I get asked about it on a regular basis. I tell my patients I do not prescribe it. Regards to don.

    Frank Bryant MD

    • Avatar Frank Bryant on June 3, 2019 at 5:31 pm

      Don. Ooops.

      Frank

  4. Avatar Jon on June 5, 2019 at 8:21 pm

    Thank God that states are finally legalizing marijuana and I’m so glad my Dr. Is not as narrow minded as this article. Marijuana has shown to be of no aid in PTSD and since when is helping cancer symptoms such as nauseau and appetite not a medical use? I could go on but i’m pretty you have already made up your mind. One last thing though, let’s not confuse the fact that because some people will abuse any and everything including marijuana, that doesn’t prove that their are no valid uses for those that aren’t interested in abusing the drug.

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