Pubdate: Tue, 10 Feb 2015
Source: Dallas Morning News (TX)
Copyright: 2015 The Dallas Morning News, Inc.
Contact: http://www.dallasnews.com/opinion/send-a-letter/
Website: http://www.dallasnews.com/
Details: http://www.mapinc.org/media/117
Author: Jane Sadler
Note: Dr. Jane Sadler is a family medicine physician on staff at 
Baylor Medical Center at Garland. She blogs at health blog.dallasnews.com.

A DOCTOR'S VIEW OF MEDICAL MARIJUANA

As a primary care provider, I'm used to seeing medical trends emerge. 
Right now, I'm paying close attention to the debate over marijuana 
legalization.

Colorado launched legal recreational marijuana sales on Jan. 1, 2014. 
Last month, the Journal of the American Medical Association reported 
that Colorado health care providers have experienced "unexpected 
health effects" from the widespread use of marijuana. JAMA 
contributors report the state has seen an increased number of 
patients with severe burns from butane-ignited flash fires. According 
to their experts, butane is used to extract tetrahydrocannabinol, or 
THC, the active ingredient in marijuana.

Researchers also found that Colorado hospitals have seen increased 
numbers of emergency room visits for cyclic-vomiting syndrome. This 
syndrome is characterized by recurrent episodes of nausea, vomiting 
and colicky abdominal pain and is due to frequent use of highly 
concentrated THC-containing products.

Most concerning are THC health effects found among Colorado's 
children. Numbers of children brought to the emergency room for 
unintentional marijuana ingestion are increasing. For example: One 
study found that in the two years after Colorado loosened laws on 
medical marijuana in 2009, 14 children were admitted to one Colorado 
community hospital for ingestion of edible marijuana products, and 
seven of those children were placed in intensive care. In the four 
years before the laws changed, that hospital had no such cases, said 
the study, which appeared in JAMA Pediatrics in 2013.

The study said that most of these ingestions were in the form of 
marijuana-laced food products - such as candies, baked goods or soft 
drinks - and that grandparents were often the source.

Despite these dangers, evidence supports marijuana use for its 
significant medical benefits in some medical conditions, and many 
states allow medical marijuana use.

THC has proven antiinflammatory effects ( Inflammatory Bowel Disease, 
2013) for people with significant bowel diseases. Studies are 
underway to develop marijuana-infused drugs that could reduce the 
incidence of seizures in treatment-resistant patients ( Epilepsy 
Behavior, 2013). Marijuana is known to benefit people with chronic 
pain and under controlled prescribing and specific dosing schedules 
may be safer than opioids (such as Vicodin or OxyContin) for chronic 
pain management.

Notably, states with legalization of marijuana have up to 25 percent 
fewer opioid-related deaths, according to an August article in JAMA 
Internal Medicine.

I have known several patients to augment pain medications with 
marijuana for improved symptom relief. This practice, of course, is 
against medical advice and is highly illegal. I never support 
breaking the law. Many physicians have concerns about side effects of 
concomitant marijuana use with prescribed pain medications, including 
heart-related complications in those with underlying heart disease. 
The Journal of the American Heart Association reported last year that 
cannabis use alone poses a significant risk factor for heart disease 
in young people.

Many chronic pain patients suffer depression. The British Journal of 
Psychiatry reported in 2002 that THC use is associated with worsening 
of anxiety, underlying depression and other psychiatric disorders. On 
the contrary, the Journal of Neuroscience in 2007 reported marijuana 
to be a "potent" antidepressant at low doses but agreed with the 
prior study that it may "worsen depression" at high doses, confirming 
the need for close medical monitoring of its use.

We have a lot to learn from Colorado's legalization of marijuana. As 
a physician, I have many concerns with uncontrolled over-the-counter 
marijuana use. Sure, it is natural, but so is tobacco; natural does 
not mean that it is necessarily good. In addition, inhaling marijuana 
could damage lung tissue.

If so many people use marijuana to manage pain or depression, then 
health care providers need to do a better job of finding safe 
treatment solutions. In Texas, medical providers currently cannot 
prescribe THC or marijuana for pain.

The American Academy of Family Physicians "recognizes that there is 
support for the medical use of marijuana but advocates that usage be 
based on high-quality, patient-centered, evidence-based research and 
advocates for further studies into the use of medical marijuana and 
related compounds."

I intend to remain a cautious observer with an eye of interest for 
what treatment options will hold in the near future.
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MAP posted-by: Jay Bergstrom