The results of a study, published last week in JAMA Psychiatry, has sounded the alarm (once again) that those of us who live in states where “medical marijuana” is legal are more likely to not only use but also abuse cannabis compared to folks living in states where they are not allowed to smoke their doctor’s prescriptions.

Almost two-thirds of the citizens of the United States live in states permitting medical marijuana use for a variety of conditions, from chronic pain to post-traumatic stress disorder. Approximately 200 million Americans can now seek a physician’s recommendation to use marijuana--although the federal laws remain left in the smoke of this rush to leafy well-being. 

In other words, don’t be quick to light up in front of that DEA agent, unless you know he or she really, really likes you.

Nonetheless, the authors of this JAMA Psychiatry article state that they found that marijuana use by individuals without an official blessing by a healthcare provider increased in states with medical marijuana laws from 2001-2013, as did the number of citizens considered to have a marijuana use disorder. This becomes a public health concern, as there are those who can experience significant psychiatric disturbances as a result of heavy marijuana use. 

Some other  harms from acute marijuana intoxication as well as chronic use may include impaired driving and learning capacity, poor educational and other social outcomes, amotivation, and adverse fetal outcomes; those are just a few that are being studied.

As if cell phones and one-more-Corona were not enough to keep those of us who do value our lives off the highways, now we all must contend with the world driving stoned.

In an accompanying editorial in the same issue of JAMA Psychiatry, we are reminded that it is particularly important that those in the psychiatric and psychological worlds understand that individuals with mental illness are more likely to use marijuana, and both acute intoxication and chronic use can exacerbate psychiatric symptoms. Also, early cannabis use has been associated with onset of psychosis and risk for suicidality, and cannabis use can interfere with the treatment of mental disorders.

Of course, it is important to be reminded that the potential health benefits from cannabis and cannabinoids include treatment of childhood epilepsy and pain reliefs.

It follows that further research is needed to investigate how marijuana is consumed by those who use it for medical reasons, including doses, frequency, routes of administration, and concurrent use of other substances, including alcohol—and other psychotropic drugs.

If we are going to prescribe it, use it, and abuse it, all of us need to be educated in what it really means to prescribe it and use it and abuse it—as my guess is that cannabis use is only going to increase.

References

Hasin  DS, Sarvet  AL, Cerdá  M,  et al.  Association of US adult illicit cannabis use and cannabis use disorder with medical marijuana laws: 1991-1992 to 2012-2013  [published online April 26, 2017].  JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.0724

Compton WM, Volkow ND, Lopez MF. Medical Marijuana Laws and Cannabis UseIntersections of Health and Policy. JAMA Psychiatry. Published online April 26, 2017. doi:10.1001/jamapsychiatry.2017.0723

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