By Nina Henry LCPC, CADC, JCFS Chicago Addiction Specialist
Confusion about marijuana is no surprise. The medical use of cannabis is legal (with a doctor's recommendation) in 31 states, the District of Columbia, and the territories of Guam and Puerto Rico. Eight states have legalized recreational marijuana use in the United States. With the advent of legalization, attitudes about marijuana have changed dramatically in the U.S. and the information we receive about marijuana is not always accurate, fact-based, or backed by research. Many have come to think of marijuana as a benign substance. The 2017 Monitoring the Future Study, an annual survey of 8th, 10th, and 12th graders conducted under a grant from the National Institute on Drug Abuse (NIDA), found that 71% of High School Seniors do not view regular marijuana smoking as being very harmful. Teens may increasingly see marijuana as a “safe, natural” medicine rather than a harmful intoxicant.
What is marijuana? It is a plant with 500 chemical compounds and 100 cannabinoids. The two active ingredients with which we are most familiar are THC, the ingredient that produces the “high” experienced when you use marijuana, and CBD, the active ingredient found in forms of marijuana offered for medicinal use.
Is marijuana medicine? In the United States, on the Federal level, marijuana is neither legal, nor is it considered medicine in all its forms. To date, there are three forms of medicinal marijuana approved by the FDA. Epidiolex is a cannabis-based drug used in the treatment of two kinds of pediatric epilepsy. Marinol is a synthetic form of THC (Dronabinal), used to treat severe nausea. A liquid form of Dronabinal is called Syndros and has the same application as Marinol. To be clear, these are the marijuana-based substances that have been well-researched and have gone through the traditional FDA approval protocols as all other prescription medications. This does not mean there are no other possible medicinal uses. According to the National Academies of Sciences, Engineering, and Medicine, there is good evidence to suggest other medical uses for derivatives of marijuana. However, in Illinois, marijuana is neither prescribed nor dispensed like medicine. Currently, Illinois law allows the following: (1) A patient can go to their doctor to apply for a prescription for marijuana to treat one or more of 40 different diagnoses, (2) Once a patient has been approved for the state’s medical program, they can go to the dispensary they selected during the application process to buy cannabis, (3) Unlike prescriptions for any other medicine, there is no prescribed dose or form of medication. You are free to go to the selected dispensary and purchase marijuana in a variety of forms (edibles, smokables) and dosing is up to you, the patient. This begs the question: Is marijuana safe? According to a recent study in the Annals of Internal Medicine (March 2019), between 2012 and 2016, ER visits in Colorado due to overdose of marijuana edibles tripled. While this does not prove that marijuana is dangerous, it suggests potential problems from a public health perspective.
Is marijuana addictive? According to NIDA, research suggests that between 9 and 30 percent of those who use marijuana may develop some degree of Marijuana Use Disorder. People who begin using marijuana before age 18 are four to seven times more likely than adults to develop a Marijuana Use Disorder. In other words, up to 1/3 of those who use marijuana will misuse it in ways that effect their lives in negative ways.
Is marijuana, then, an “evil weed”? This seems the wrong question to ask. Perhaps we should ask, why use marijuana when it is illegal on a Federal level, has not been rigorously researched, and can lead to substance use disorder? We could also ask, why not use marijuana when we know there could be great potential for positive medicinal application? With legalization of recreational use of Marijuana in Illinois nearly accomplished, finding the answers to these questions may be critical to our personal health and the health of those we love.