Vitals

Have you looked at the map where marijuana is legal in the US recently?

The number changes almost every election and it is hard to keep up.

Okay, so let me break this down for you.

As of August 2023, 38 US States, DC and several US territories have some form of medicinal marijuana legislation and 23 states that allow the use of cannabis recreationally.

And the most recent data from 2021, estimated 18% of Americans having used marijuana in the past 12 months.

I think it's safe to say that marijuana is here to stay, and why not?

The most common reason Americans say they seek to use cannabis is to treat conditions like anxiety and chronic pain.

In fact, more than 25% of US adults suffering from chronic pain use cannabis to alleviate the symptoms of their condition.

Okay, so you might be saying, duh Sheena, what's the issue?

It's 2023 and marijuana is in, so where are you going with this?

Well, recent studies are raising eyebrows about the long-term health effects of cannabis use and it's got me wondering what information is out there that we always hear about that we still need to fact check.

After all, if you do partake in this still federally illegal drug, I want you to have all the details.

I promise you it's dear to my heart.

This is not an episode about the evils of marijuana.

No scare tactics here, just the facts.

We aren't going to deny that In a lot of states, marijuana is a prescription drug prescribed by doctors to treat the symptoms of many health conditions.

In fact, there are many encouraging studies that indicate that cannabis users see positive impacts on their health when it comes to conditions such as chronic pain, anxiety, and depression.

However, just like any other drug, there are still risks to consider.

Alright, I won't keep you waiting in suspense.

Let's dive in on the myths.

Okay.

Myth number one, I'm sure you heard of before, marijuana is a natural herb and therefore healthy.

Okay, so let's look at the definition of healthy.

We are to assume healthy means something that you can take with little to no physical side effects.

However, if you smoke or vape cannabis, regardless of the amount of THC, you could be vulnerable to conditions such as heart, muscle dysfunction, chest pain, heart attacks, and strokes.

In a recent study from Stanford University, researchers wanted to better understand the effects on smoking marijuana daily on the cardiovascular system using information gathered from the National Institutes of Health.

All of Us Research Program researchers discovered that daily cannabis users were 34% more likely to have coronary artery disease or CAD than those that never used it for those occasional users once a month users, the risk of CAD was not present.

When you smoke marijuana, the effects of THC or Delta nine tetrahydrocannabinol the part of the plant that provides the euphoria feeling your blood pressure rises.

For heavy users, this might mean the blood vessels become inflamed or can cause a buildup of plaque in the arteries leading to coronary artery disease.

A condition when major blood vessels constrict and struggle to send blood and oxygen to the heart.

This is where you need to talk to your doctor about your heart attack risks, hypertension and chest pain.

I.

Proceed with caution.

If someone has unstable coronary disease, I'm very hesitant to use cannabis, but there are two ways to minimize the risk to the heart.

One is watch the dose.

I think people can get into trouble if they are new to cannabis or they take a much higher dose than normal.

You get an anxiety attack, you get a panic attack, your heart rate's racing.

That's a lot of stress on the heart.

The second thing is a lot of the harm I believe that could be coming from cannabis is from the combustion products, the tar, the benzene, the polycyclic aromatic.

The first thing is most doctors don't recommend smoking cannabis.

There are many other ways to take it and smoking is probably the least healthy way to take it.

You can use an edible, just be careful of the dosing.

You could use a tincture under your tongue again, as long as you pay attention to the dose and make an effort not to over consume it.

It's relatively safe to use.

It's just a question of being an educated consumer.

As a primary care doctor, I never think which drug is perfectly safe.

I always think which is the least dangerous option because all drugs have side effects.

Sometimes I feel cannabis is less dangerous than some of the alternatives, but generally speaking, teens, people with a history of family history of psychosis and people who are pregnant or breastfeeding shouldn't be using cannabis or if they're using it, they should be using it with extreme guidance and caution.

Myth number two, marijuana isn't addictive.

According to the CDC, three in 10 people who use marijuana have marijuana use disorder, which is defined as a person that is unable to stop using marijuana even though it's causing health and social problems in their lives.

The risk for developing this disorder is greater for young adults that started using cannabis at an early age, and for those that are frequent users.

In a 2021 US National Survey on drug use and health of people age 12 and over, an estimated 16 million people had a cannabis use disorder in the past 12 months.

This was most commonly seen in young adults aged 18 to 25.

It depends how you define the addiction...with cannabis it's very complicated because it does help people.

It helps people with anxiety, with pain, with sleep, with boredom, with loneliness.

And it's not a simple thing to disentangle and you can't just write off a third of patients.

They say with addiction, regardless of the addiction, 70 to 80% of them are untreated anxiety and depression disorders.

And with cannabis addiction, a lot of these people have untreated anxiety and depression and you're not going to get very far unless you actually diagnose and treat the underlying problem.

You sort of have to figure out what is the cannabis helping the person with in the first place and then help them find a more appropriate and healthy way to address it.

With.

Marijuana use disorder numbers at an all time high, they still trail the number of people that started misusing alcohol in the last 12 months, but it's significantly higher than cocaine, prescription pain relievers, and heroin.

I treat people for cannabis addiction and it really doesn't really destroy lives, but it can really harm their quality of life.

And you do have withdrawal symptoms when you stop cannabis abruptly.

When you go from using it heavily to stopping it abruptly, you can have grumpiness, you could have trouble eating, you could have trouble sleeping, you could have nausea.

Myth number three, cannabis is safe for the brain.

Young people listen up because this one's for you, and I know there's a lot of peer pressure.

A lot of people are smoking weed, but you need to know the facts first.

Using cannabis before the age of 18 may impact how the brain develops functions like memory, attention, and learning.

And you know, you hear people say it all the time, oh, I'm high, I can't remember things.

It's not cute.

These things might even be permanent.

Of course, this is affected by how often you use and the amount of THC consumed, but we are definitely wanting you to be mindful of your developing brains.

After all, it's your future.

A recent study estimated 30% of cases of schizophrenia among men age 21 to 30 might have been prevented by averting cannabis use disorder.

Myth number four, marijuana can replace your current prescription sleep aid.

So this one is a bit of a mixed bag.

Recent studies suggests participants were likely to switch from their prescription sleep aid to using cannabis to help sleep disorders.

However, at least a quarter of those participants reported negative symptoms similar to that of hangovers.

Though, after speaking with the doctor and lowering their THC levels, users usually felt better with no lasting issues.

We don't have enough research into how it affects the other phases of sleep.

And furthermore, all of the sleeping medications that we take affect all of the stages of sleep, and we don't really understand how they affect the different phases of sleep.

So cannabis needs to be better studied, though so do all the other sleeping medications.

And I genuinely believe it is a safer and less toxic alternative to many of the current pharmaceutical sleeping medications.

Which doesn't mean the cannabis is perfectly safe, it just means it's a less toxic alternative.

But here's the tricky part, we not going to let y'all off that easy.

You can build up a tolerance to THC and eventually a dependence.

So the longer the use, the more we have to be concerned about those eventual other health risks.

Before we recommend any medication to anybody for sleep, we have them cut down the caffeine, we have them exercise.

Myth number five, marijuana can be taken to cure anxiety and depression.

Now we all know that there is no everlasting absolute cure for anxiety and depression.

So of course, marijuana is not the first one, but last stop.

Here we are at the crux of the matter.

Why people most commonly seek out the use of medical cannabis to treat symptoms of anxiety, depression, and pain.

There are lots of studies on the impact of cannabis on anxiety symptoms as THC is generally well tolerated at low doses and stimulates the release of dopamine, that natural chemical in your body that makes you feel good, but high doses of THC can actually have the reverse effect and make you feel anxious.

Because THC turns up the volume on everything you're already feeling, you might actually worsen your anxious feelings.

Which is why we start low and go slow and try to gently and patiently titrate each patient to the correct dose.

The question is, what happens to the anxiety over time?

The anxiety stays about stable over time.

The studies I've seen is that using cannabis in the long-term for depression, it can stay the same or it can gradually get worse.

But that's exactly what happens with SSRIs.

The SSRIs don't make your depression go away.

They treat the symptoms of it.

So it's important if you're using cannabis for anxiety or depression or for that matter, if you're using an SSRI or some other pharmaceutical, that you don't just take the drug, you try to figure out what's missing in your life.

Do you need more social connections?

Do you need more adult friendships?

Do you need more exercise?

Is your sleep a poor quality?

Now, something we can't do is separate health from policy.

That's why we have public health policies in place.

Historically, legislation regulating cannabis has a shady background.

Decades of illegitimate claims were used as an impetus to kick off the war on drugs.

This is also part of the reason why research on cannabis and your health is still considered in its infancy.

Bans on using cannabis in studies for decades existed and created barriers to our understanding today.

How can we understand it if we can't study it?

Latino and Black populations in the US have been disproportionately arrested and imprisoned for minor possession of marijuana.

Charges according to our report from the ACLU Black people are 3.6 times more likely than white people to be arrested for marijuana possession despite similar usage rates.

While average arrest rates have gone down since decriminalization in many states, the issue still remains.

In October, 2022, president Joe Biden issued a new federal guidance to help in this matter.

However, work still has to be done in states that have banned the use of cannabis altogether.

Now, I know that for many THC advocates and frequent users, this episode may be a tad bit overwhelming, but trust me when I say that I have seen the positives of THC firsthand.

My close friend of over 20 years recently passed from cancer, and when she reached out to me for pain solutions when the narcotics stopped working, I most definitely advised for her to discuss THC use with her doctor.

And the edibles worked better for her pain at the time than the narcotics.

So I get it.

But everything has risks and you need to know what they are.

Just like any other medication or remedy, be smart about frequent cannabis use and how it can affect your long-term health.

And for people of color, be safe and know your rights.

That does it for Vitals this week.

Let us know what you think about the continuing wave of marijuana use in the US.

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