Doctors, patients on the medical effects of marijuana
Recreational marijuana will soon be legal in the state of Michigan, after voters decided to legalize on November 6, but what does it do from a medical standpoint?
Very shortly, more people will have legal access to marijuana than ever before. What are the effects of marijuana on the body? Is it safer than cigarettes or alcohol? Is it possible to overdose? What are the most dangerous side effects?
Two doctors and three patients, who all use some form of marijuana, talked about the effects, both good and bad.
Dr. David Crocker, along with his wife Annette, has owned and operated Michigan Holistic Health in Kalamazoo for nearly 10 years. He advises patients on the health benefits and effects that different forms of marijuana have on the body. Crocker also sits on the Medical Marijuana Review Panel for the State of Michigan.
Of all the patient illnesses and diseases that Crocker sees, he said chronic pain is the most common, which is followed by a slew of others including nausea, post-traumatic stress disorder (PTSD), AIDS, and arthritis.
"The nice thing about cannabis is it treats a lot of different conditions. A lot of patients have found the limits of narcotics and are looking for something else for pain relief,” Crocker said.
He’s quick to point out that marijuana has two main compounds that produce its effects: Tetrahydrocannabinol (THC) and Cannabidiol (CBD).
“THC is the ingredient in cannabis that makes you high. It is important medicinally to create balance in the body,” Crocker said.
He said THC is used to help people with pain, sleep, and appetite issues.
“CBD is the second most common active compound in cannabis. CBD has good medical benefits. i.e. it helps with inflammation, with mood issues, it's helped with children and seizures in certain conditions,” Crocker said. “But it does not make you high. It's one of many compounds in the cannabis plant that have medical potential, but doesn't have the psychotropic effects that people are worried about.”
The two compounds are very different, but he says they, along with over 100 other cannabinoid compounds, provide “an entourage effect” that helps compounds balance each others’ effects.
“For people that are new to THC, it can make them anxious, a little more anxious in the beginning, or paranoid, if you will. And the CBD tends to mitigate that. When you bring the two together, a lot of what would be considered negative effects of the THC are mitigated by the CBD,” Crocker said. “A lot of people use CBD alone, during the day, when they don’t want to have THC in their system. They have jobs and things they don't feel comfortable having THC in their system.”
Crocker is also quick to point out that the two main ways of consumption, inhalation and ingestion, produce very different effects.
He said, “We have a little bit of an issue with edibles for people who are not familiar with them. Edible forms of cannabis come on a lot slower, and last a lot longer. If you inhale marijuana, it takes about a few seconds really, before you realize the full impact of it. And the main effect wears off after two to three hours. When you eat cannabis it takes about an hour before you get the full effect of it. And then it lasts six to eight hours. So if you overdo it, and you get yourself dysfunctionally high, or uncomfortably high, you're stuck there for eight hours. And that's how people wind up in the emergency room. Having panic attacks, sense of impending doom. they're worried that they're dying, they're not. It can create a real negative psychological effect.”
According to Crocker, it’s nearly impossible to consume a fatal dose of marijuana.
"There's never been a reported overdose fatality from cannabis. From a doctor's perspective, that's pretty magical,” Crocker said.
There are several side effects patients can encounter.
“A lot of the negative side effects that come with cannabis, whether it's red eyes, or dry mouth , or the munchies, all the things that are classically associated with marijuana. Most of those are isolated to either when you first use, or when you first come back to it,” Crocker said.
Dosage is key in Crocker’s view.
“If you overdo THC, it can have the opposite effect of what you were looking to achieve medicinally. A little bit can be calming, but a lot can be rattling and make you anxious or paranoid,” Crocker said. “A little bit can be very helpful for sleep, but a lot can make your brain racy and not sleep as well.”
Crocker advocates marijuana as a more effective alternative to opioids and narcotics for some patients, but warns of other side effects.
“The most common negative side effects that I have found if people are smoking it is respiratory bronchitis, with respiratory irritation,” Crocker said. “It's not a toxin, an intoxicant like alcohol, you can't kill yourself with cannabis. You take too much, you go to sleep, you can overdo it, it can be abused. And we do need to watch how people use it when they're young. The jury is still out with how much it impacts the developing brain, so we want to err on the side of caution with that.”
If you’re interested in trying marijuana, Crocker said it’s best to do your research.
“I think the best advice I could give you is to educate yourself. Right. There's a lot of information out there right now about what marijuana does and does not do. And how to discover and approach cannabis in a reasonable way that's not going to create problems for you. Go in slowly, don't jump into some very potent concentrate if you don't have any experience,” Crocker said.
Dr. William Nettleton is a family physician and public health doctor for Kalamazoo County. He is board certified in family medicine, preventative medicine and public health. He’s reviewed the latest research on marijuana as part of his role advising county-wide health initiatives. In his interview, Nettleton cited sources and studies from the Centers for Disease Control and Prevention (CDC), National Institute on Drug Abuse, the National Academy of Sciences, and the Substance Abuse and Mental Health Services Administration.
Nettleton said those organizations have found marijuana’s effectiveness in treating certain medical conditions, like chronic pain, nausea and vomiting in cancer patients going through chemotherapy, and can reduce spasticity for multiple sclerosis.
He points out that when consumed, marijuana affects your brain function.
"THC is the psychoactive component of the drug which gives people desire and pleasure when they use it. It hacks on the brain. Gives that pleasure of immediate altered sensation, hyper awareness of your environment, but with those immediate effects also brings in decreased cognition, learning problems, also memory in the short term. We're learning more, and we don't have evidence yet about long term outcomes," Nettleton said.
Nettleton said people can become addicted to marijuana, and it can be dangerous to a developing brain.
"It’s the impact of marijuana on the brain, particularly the adolescent, the youth development of the brain. We do know that marijuana is addictive. Six to nine percent of folks do become addicted to marijuana. And today's marijuana is not the marijuana of the 1970's, it's much more concentrated THC, Tetrahydrocannabinol, much more potent, which increases risk for addiction, increases risk for harmful consequences. For example, those harmful consequences include increased risk of developing schizophrenia with using marijuana, developing social anxiety disorders as well."
He said youth overdoses are common among states that have legalized recreational marijuana. He also points out the effects of using marijuana while pregnant.
"We do have evidence in states that have legalized recreational marijuana, that youth overdose has increased, we have more of those cases. That's another example, if this becomes more widely available, than intervention is limiting that exposure to youth,” Nettleton said. “I take care of kids in the hospital adults in the hospital, I see newborns with the first stool of their life, the first poop of their life has THC in it. We know that exposure to marijuana while pregnant reduces the weight of babies, but we don't know the long term consequences of that exposure.”
Nettleton points out that smoking marijuana can have similar negative effects to that of cigarettes.
"There's no major medical or public health professional organization that recommends inhalation marijuana for a potential health benefit,” Nettleton said. "We do have evidence that it does increase the risk of bronchitis, for those who use inhalation marijuana. There is a small study that shows an increased risk in heart attack.”
When asked which one is worse, he said both are harmful to your respiratory system, and cautions against comparing marijuana to cigarettes, or even alcohol. "I caution folks to compare different exposures to different outcomes. And that's a general principle. Drinking, smoking, ingesting, are all different types of exposures, they're all different substances, with different outcomes. So it's really comparing apples to oranges."
One of the biggest societal impacts Nettleton points out is the risk of people using marijuana and getting behind the wheel of a car or heavy machine.
"In partnership with our public safety officers, we need to be aware of using while driving, using while using machinery, which increases the risk for accidental deaths and motor vehicle accidents. That's a true risk we need to be aware of,” Nettleton said.
Nettleton said the risk of motor vehicle injury, overdosing on edibles and are keeping marijuana out of the hands of children are two of the biggest dangers to marijuana consumption on a societal level.
“We also need to communicate. We need to keep this away from schools, away from youth, because we have evidence it does impact the health and development of a young person's brain. To limit that exposure to youth is very important and then to note there are differences between inhalation marijuana and taking marijuana by mouth,” Nettleton said. “With orally consumed marijuana the effect is not immediate. Folks take more and more and more and then they have the consequence of having a psychotic event or having a delusional event because they consumed more and had a delayed effect of that exposure. And then limiting that type of exposure that may appeal to youth will be important to protecting the health of the public."
He would like to see much more research done on the drug before big sweeping decisions about marijuana are made.
"That's what is difficult about this topic: marijuana is a schedule 1 drug, which really is an obstacle for federal scientists, state scientists, local folks to do well designed studies that inform these decisions that impact the health of the public. So we have limited information about health impact, limited information about health benefits and we need to do more research in that context,” Nettleton said.
Three current medical marijuana patients who consume marijuana in it’s three main forms, smoking/vaping, ingesting edibles, and the use of topical creams, talked about their experience.
Elizabeth Ouding, 51, has been a medical marijuana patient since 2009. She was diagnosed with scoliosis (curved spine) and has gone through extensive surgeries to insert metal rods and plates in her back. She initially tried marijuana because she wanted to get off opioids prescribed by her doctors. She uses a medical marijuana cream on her back to deal with her pain.
Ron Morris, 62, is a Vietnam-era veteran. He’s used medical marijuana since 2010. He started using marijuana for his chronic pain and PTSD, after being frustrated with the effects prescribed opioids were having on his body. He most commonly consumes marijuana through a vaporizer.
Jay Fleming, is a cannabis consultant in Kalamazoo. He’s used medical marijuana since 2009. He was diagnosed with the chronic pain disorder fibromyalgia, and has chronic pain issues and trouble getting to sleep. He too was fed up with what doctors were prescribing him, and sought the use of medical marijuana edibles to ease his chronic pain and help him get to sleep at night.
All three patients shared the same reason for seeking alternative treatment. They all wanted off narcotics and other mood-altering prescription drugs. They all experimented with different types of marijuana that produced different effects, until they found what worked for them.
"Over a period of learning to grow myself I was able to find, OK, these are the plants that help, these are the plants that help with the type of pain that I have, these are the plants that me get to sleep at night, these are the plants that aren't going to make me drowsy when I use them,” Fleming said.
"This is a choice I made, and it wasn't because I wanted to be the first old man who runs out and gets pot. I didn't want that stigma on me. But I'd rather have that stigma on me rather than Vicodin,” Morris said.
“I’ve used heating pads, Bengay, tinge pads, and this cream is what works for me for pain relief,” Ouding said.
Fleming admits there are side effects to the edibles he uses and for smoking the raw marijuana plant.
“The effect I'm looking for with edibles is technically a side effect that most people find when they take too much. If you take too much of an edible it can knock you out. You're eyes will get so tired and droopy, and you will often fall asleep,” Fleming said. "I didn't have anything like lung infections, but I used to wake up feeling phlegmy, but now with vaping, I don't experience anything like that."
Morris said the dosage for him was key for his pain relief. He said he has never had to switch his dosage when switching from different marijuana strains that produce different effects. “I’ll (inhale marijuana) and walk away from it. You can't drive. But you're not high to the point where you can't walk around with your wife, or go out and rake leaves, or do anything that a normal person can do, that I can't do because I'm in pain.”
Ouding’s use of topicals is different than the other two forms, since her cream’s main active ingredient is CBD, and doesn’t produce a high when absorbed through her skin. She said she’s never had any rashes or irritations due to her cream.
All three patients agreed that they don’t believe marijuana is addictive, despite studies pointed out by Nettleton. They questioned the common perception of the word “addiction.”
“I use cannabis everyday, I use it medically. I think Dr. Nettleton that person is an addict if they were talking about me. Well, it's a medication. You can say the same thing about someone who takes any kind of medication. Say you're talking about an antacid. That you use like Prevacid. People get addicted to Prevacid. You can't just go off Prevacid,” Fleming said.
“You can be addicted to coffee if you drink too much of it. Addiction is a disease of not being able to do anything in moderation. A person who is addicted is going to just move from one thing or another,” Morris said.
All three said they believe that opioid and heroin use will go down now that recreational marijuana is legal. They also all agreed that marijuana should be kept away from kids under the age of 18 or 21.