“It is wrong to claim for it a harmlessness which belongs to no active remedy yet discovered.”

– Physician, 1870

 

WESTBROOK – All medications carry risks as well as benefits. This truism applies to medical marijuana as well. 

The unique manner in which the state has legalized its medical use, through voting consensus rather than evidence-based evaluation, has resulted in the minimization of its harmful effects. As an addiction medicine specialist with many years of experience and study, I am concerned that these potentially harmful effects, especially in vulnerable populations, have not been adequately brought to the public’s attention.

The Maine Medical Marijuana Act was drafted to increase the access to medical marijuana for patients suffering from chronic, debilitating conditions. It does not address the potential harm that marijuana, as with any other psychoactive substance, can cause.

Adolescents are particularly vulnerable to the harmful effects of early exposure to cannabis.

We know that adolescent brains have different biological responses than adults do to exposure to all drugs of abuse, including marijuana. These include a significantly greater risk of lifelong dependence and changes in cognition and motivation that affect learning and behavior. Teen cannabis use also greatly increases the risk of major mental illness, including major depression, anxiety disorders and psychosis.

The rates of teen abuse of cannabis are directly correlated to teens’ perception of its harm. The perception of harm is decreased by the promotion of marijuana as a benign herb with pro-health medicinal properties and by its use by trusted parents and other care-givers.

Rates of use are also correlated with drug access. Both direct and passive diversion of medical marijuana will increase access. We should also be very concerned about passive breathing of cannabis fumes by children and teens.

Because of the risk of harm to the fetus, it is unethical to test medications on pregnant women. Receptors for cannabis are found throughout the brain, and we have yet to understand all of their functions. 

Smoking cannabis during pregnancy carries unknown risks to the fetus. The act is silent about the use of medical marijuana by pregnant women. Protection of the developing baby’s brain demands caution. Pregnant women should be advised to stop medical marijuana.

Addiction is characterized by an intense compulsion to use a drug with a decreased ability to resist the urge to use, despite escalating negative consequences. The drug use is pursued at the expense of naturally rewarding behaviors needed for health.

Cannabis addiction is real. Just as pain patients prescribed opioids may develop an addiction to their medication, medical marijuana patients may as well. It is important to remember that cannabis is a drug of abuse and addiction. I have many patients in good recovery from alcohol or opiate addiction who are unable to stop marijuana and who experience withdrawal symptoms. 

Most people who drink don’t develop drinking problems, and the same may be true with marijuana. However, no alcoholic would remain sober if they were prescribed alcohol as a medicine. The same can be said for medical marijuana. And what is the risk of relapse for patients in stable recovery from other addictions who use medical marijuana? How would a recovering patient be counseled about the risk of relapse if treated with medical marijuana?

The act does not require that addiction screening be part of the initial assessment by the qualifying physician. Would active addiction to cannabis or other drugs be exclusions for medical marijuana?

Regarding impairment: Are we prepared for an increase in drivers using medical marijuana? Alcohol and cannabis together increase each others’ impairment of judgment, reaction time and coordination. Should medical marijuana patients be advised not to smoke before driving?

Finally, and perhaps most disturbingly, the act is silent on the use of medical marijuana in safety-sensitive professions, including emergency and medical personnel.

Let’s understand that all medications produce risks as well as benefits. The risks of medical marijuana have not been adequately considered. These include potential harm to children, adolescents and pregnant women, the real risk of addiction, impaired driving and impaired emergency and medical professionals.

Patients and qualifying physicians must assume their responsibility to protect others, and new legislation will be needed to deal with the issue of the safety-sensitive professionals.