3 Arguments Why Marijuana Should Stay Illegal Reviewed
Mo Med. 2013 Nov-Dec; 110(6): 524–528.
More Reasons States Should Not Legalize Marijuana: Medical and Recreational Marijuana: Commentary and Review of the Literature
Abstruse
Recent years have seen substantial shifts in cultural attitudes towards marijuana for medical and recreational use. Potential problems with the approval, production, impunity, road of administration, and negative health effects of medical and recreational marijuana are reviewed. Medical marijuana should exist field of study to the same rigorous approval process as other medications prescribed past physicians. Legalizing recreational marijuana may have negative public health effects.
Introduction
Contempo years take seen a cultural shift in attitudes towards marijuana. At the fourth dimension of this writing, medical marijuana is legal in 20 states and the Commune of Columbia; recreational marijuana is now legal in Washington and Colorado. A substantial and growing literature documents legalized marijuana may have adverse effects on individual and public health.
Medical Utilize of Marijuana
The term 'medical marijuana' implies that marijuana is like any other medication prescribed past a doc. Nonetheless the ways in which medical marijuana has been canonical, prescribed, and made available to the public are very different from other commercially available prescription drugs. These differences pose problems unrecognized by the public and by many physicians.
Lack of Evidence for Therapeutic Benefit
In the United States, commercially available drugs are discipline to rigorous clinical trials to evaluate condom and efficacy. Data appraising the effectiveness of marijuana in conditions such as HIV/AIDS, epilepsy, and chemotherapy-associated vomiting is limited and oftentimes simply anecdotal.1 , 2 To date, there has been merely one randomized, double-blind, placebo- and active-controlled trial evaluating the efficacy of smoked marijuana for any of its potential indications, which showed that marijuana was superior to placebo merely inferior to Ondansetron in treating nausea.3 Recent reviews by the Cochrane Collaboration find insufficient evidence to support the use of smoked marijuana for a number of potential indications, including hurting related to rheumatoid arthritis,4 dementia,5 ataxia or tremor in multiple sclerosis,6 and cachexia and other symptoms in HIV/AIDS.2 This does not mean, of course, that components of marijuana do non have potential therapeutic effects to convalesce onerous symptoms of these diseases; but, given the unfavorable side effect contour of marijuana, the evidence to justify utilize in these weather condition is still lacking.
Contamination, Concentration & Route of Administration
Dissimilar any other prescription drug used for medical purposes, marijuana is non subject to cardinal regulatory oversight. It is grown in dispensaries, which, depending on the country, accept regulatory standards ranging from strict to most not-existent. The rough marijuana found and its products may be contaminated with fungus or mold.7 This is especially problematic for immunocompromised patients,8 including those with HIV/AIDS or cancer.nine Furthermore, crude marijuana contains over lx active cannabinoids,10 few of which are well studied. Marijuana growers oftentimes brood their plants to change the concentrations of different chemicals compounds. For instance, the concentration of tetrahydrocannabinol (THC), the main psychoactive ingredient, is more than 20-fold more than than in marijuana products used several decades ago. Without rigorous clinical trials, we take no fashion of knowing which combinations of cannabinoids may be therapeutic and which may be deleterious. Equally marijuana dispensaries experiment by breeding out different cannabinoids in social club to increment the potency of THC, there may exist unanticipated negative and lasting effects for individuals who smoke these strains.
Marijuana is the simply 'medication' that is smoked, and, while still incompletely understood, there are legitimate concerns about long-term effects of marijuana fume on the lungs.11 , 12 Compared with cigarette smoke, marijuana smoke can result in iii times the amount of inhaled tar and iv times the amount of inhaled carbon-monoxide.13 Farther, smoking marijuana has been shown to be a risk factor for lung cancer in manyxiv , xv just not allsixteen studies.
High Potential for Diversion
In some states, patients are permitted to abound their own marijuana. In addition to contributing to problems such every bit contamination and concentration as discussed above, this practice too invites drug diversion. Patients seeking to benefit financially may bypass local regulations of production and sell abode-grown marijuana at prices lower than dispensaries. We do not let patient to abound their ain opium for treatment of chronic pain; the derivatives of opium, like marijuana, are highly addictive and thus stringently regulated.
Widespread "Off-label" Use
FDA-approved forms of THC (Dronabinol) and a THC-analog (Nabilone), both available orally, already exist. Indications for these drugs are HIV/AIDS cachexia and chemotherapy-associated nausea and airsickness. Unlike smoked, crude marijuana, these medications have been subject field to randomized, placebo-controlled, clinical trials. Yet despite these express indications where marijuana compounds have a proven just pocket-size effect in high-quality clinical trials, medical marijuana is used overwhelmingly for non-specific pain or muscle spasms. Recent data from Colorado show that 94% of patients with medical marijuana cards received them for treatment of "astringent hurting."17 Similar trends are evident in California.18 Bear witness for the benefit of marijuana in neuropathic pain is seen in many19 - 21 but not all22 clinical trials. There is no high-quality bear witness, even so, that the drug reduces not-neuropathic pain; this remains an indication for which data sufficient to justify the risks of medical marijuana is lacking.4 , 23 – 25
If marijuana is to be 'prescribed' by physicians and used as a medication, it should exist bailiwick to the same rigorous approval process that other commercially available drugs undergo. Potentially therapeutic components of marijuana should be investigated, but they should only be fabricated available to the public subsequently adequately powered, double-blind, placebo-controlled trials have demonstrated efficacy and adequate condom profiles. Furthermore, these compounds should exist administered in a manner that poses less risk than smoking and dispensed via standardized and FDA-regulated pharmacies to ensure purity and concentration. Bypassing the FDA and approving 'medicine' at the election box sets a dangerous precedent. Physicians should be discouraged from recommending medical marijuana. Alternatively, consideration can be given to prescribing FDA-approved medicines (Dronabinol or Cesamet) as the purity and concentration of these drugs are assured and their efficacy and side effect profiles have been well documented in rigorous clinical trials.
Recreational Marijuana
The question of recreational marijuana is a broader social policy consideration involving implications of the effects of legalization on international drug cartels, domestic criminal justice policy, and federal and land tax acquirement in improver to public health. However physicians, with a responsibility for public health, are experts with a vested involvement in this issue. Contempo legislation, reflecting changes in the public'southward attitudes towards marijuana, has permitted the recreational use of marijuana in Colorado and Washington. Unfortunately, the negative wellness consequences of the drug are non prominent in the fence over legalizing marijuana for recreational use. In many cases, these negative effects are more than pronounced in adolescents. A compelling argument, based on these negative health effects in both adolescents and adults, tin be made to abort the direction society is moving with regards to the legalization of recreational marijuana.
Myth: Marijuana is Non Addictive
A growing myth amid the public is that marijuana is not an addictive substance. Data clearly show that near 10% of those who apply cannabis go addicted; this number is college amongst adolescents.26 Users who seek treatment for marijuana addiction average 10 years of daily use.27 A withdrawal syndrome has been described, consisting of anxiety, restlessness, insomnia, depression, and changes in appetite28 and affects as many every bit 44% of frequent users,29 contributing to the addictive potential of the drug. This addictive potential may be less than that of opiates; but the belief, especially among adolescents, that the drug is non addictive is misguided.
Schizophrenia and Other Psychotic Disorders
Marijuana has been consistently shown to be a risk factor for schizophrenia and other psychotic disorders.30 – 32 The clan between marijuana and schizophrenia fulfills many, but not all, of the standard criteria for the epidemiological institution of causation, including experimental evidence,33 , 34 temporal relationship,35 – 38 biological slope,30 , 31 , 39 and biological plausibility.forty Genetic variation may explain why marijuana use does not strongly fulfill remaining criteria, such as strength of association and specificity.41 , 42 As these genetic variants are explored and farther characterized, marijuana use may be shown to cause or precipitate schizophrenia in a genetically vulnerable population. The risk of psychotic disorder is more than pronounced when marijuana is used at an earlier historic period.32 , 43
There is some evidence that compounds naturally found in marijuana have therapeutic benefit for symptoms of diseases such as HIV/AIDS, multiple sclerosis, and cancer. If these compounds are to be used under the auspices of 'medical marijuana,' they should undergo the same rigorous blessing procedure that other medications prescribed by physicians, including randomized, placebo- and active-controlled trials to evaluate rubber and efficacy, non by popular vote or state legislature.
Effects on Cognition
Early studies suggested cognitive declines associated with marijuana (peculiarly early and heavy utilize); these declines persisted long after the menstruation of acute cannabis intoxication.44 – 46 Recently, Meier and colleagues analyzed data from a prospective study which followed subjects from nativity to age 38; their findings yielded supportive testify that cannabis use, when begun during adolescence, was associated with cerebral impairment in multiple areas, including executive performance, processing speed, retentivity, perceptual reasoning, and verbal comprehension.47 Rogeberg48 criticized the written report's methodology, claiming that the results were confounded past differences in socioeconomic status; this claim, yet, was based on sub-analyses that used very small-scale numbers. Additional sub-analyses49 of the original study accomplice showed that marijuana was just as prevalent in populations of college socioeconomic status, suggesting that socioeconomic condition was not a misreckoning variable. Any epidemiological study is subject area to misreckoning biases and future research will be needed to clarify and quantify the relationship between cerebral decline and boyish marijuana apply. Even so, the findings of the original study by Meier et al show there is indeed an contained relationship between loss of intelligence and adolescent marijuana utilise. This finding, moreover, is consistent with prior studies.44
Other Negative Health Effects
Substantial testify exists suggesting that marijuana is harmful to the respiratory system. It is associated with symptoms of obstructive and inflammatory lung illness,11 , 50 an increased risk of lung cancer,xiv , 15 and it is suspected to exist associated with reduced pulmonary function in heavy users.51 Further, its utilise has been associated with harmful effects to other organ systems, including the reproductive,52 gastrointestinal,53 and immunologic10 , 54 systems.
Social Safety Implications: Effects on Driving
Marijuana impairs the ability to judge fourth dimension, distance, and speed; it slows reaction time and reduces ability to runway moving objects.55 , 56 In many studies of drug-related motor vehicle fatalities, marijuana is the most common drug detected except for alcohol.57 , 58 Based on mail service-mortem studies, Burrow et al determined that marijuana was likely an impairing factor in every bit many fatal accidents equally alcohol.59 One written report showed that in motor vehicle accidents where the commuter was killed, recent marijuana use was detected in 12% of cases.57 Other enquiry confirms a significantly increased take a chance of motor vehicle fatalities in association with acute cannabis intoxication.60
Risk Perception and Employ in Adolescents
Marijuana utilise among adolescents has been increasing. Data that has tracked risk perception and use of marijuana among adolescents over decades conspicuously shows an inverse human relationship; as boyish risk perception wanes, marijuana utilise increases.61 As more than states legalize medical and recreational marijuana, risk perception is expected to decrease, causing the prevalence of use among boyish to keep to rise. This is among the most apropos of bug about the drug'due south legalization considering so many of the negative furnishings of marijuana—including cognitive impairment and chance for brusque- and long-term psychosis— are heightened when used during adolescence.
Determination
There is some evidence that compounds naturally institute in marijuana have therapeutic benefit for symptoms of diseases such as HIV/AIDS, multiple sclerosis, and cancer. If these compounds are to exist used under the auspices of 'medical marijuana,' they should undergo the same rigorous blessing process that other medications prescribed by physicians, including randomized, placebo- and active-controlled trials to evaluate prophylactic and efficacy, not by popular vote or state legislature. Furthermore, these therapeutic compounds should be administered via a route that minimizes long-term health run a risk (i.e., via oral pill) and should be dispensed past centrally regulated pharmacies to ensure the purity and concentration of the drug and allow for the call back of contaminated batches.
Marijuana for recreational use will accept many adverse health effects. The drug is addictive, with mounting evidence for the existence of a withdrawal syndrome. Furthermore, it has been shown to have adverse furnishings on mental health, intelligence (including irreversible declines in knowledge), and the respiratory system. Driving while acutely intoxicated with marijuana greatly increases the chance of fatal motor vehicle collision. Legalization for recreational use may take theoretical (but yet unproven) beneficial social effects regarding issues such as domestic criminal justice policy, only these effects will not come without substantial public health and social costs. Currently at that place is a lack of resources devoted to educating physicians about this most unremarkably used illicit substance. The potential benefits and significant risks associated with marijuana use should exist taught in medical schools and residency programs throughout the country.
Biography
•
Samuel T. Wilkinson, MD, is in the Department of Psychiatry at the Yale School of Medicine, New Haven, Ct.
Contact: ude.elay@nosnikliw.leumaS
Footnotes
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