White Paper: Medical Marijuana 2018

White Paper on 

MEDICAL MARIJUANA

Table of Contents: 

Table of Contents: 

I. Marijuana Use 

II. Marijuana Use and Adolescents

III. Medical Marijuana and the FDA

IV. Other State Outcomes 

V. Marijuana and Addiction

VI. Social and Economic Impacts

VII. Marijuana Use and Safety

VIII. Glossary 

IX. Reference

Marijuana Use 

It was reported that in 2015, more than 22 out of the 27 illicit drug users in America were  monthly users of marijuana, making up 8.3% of the 262 million American population aged 12 or  older. A staggering finding of 48.1 percent of the American adult population with less than a  high school diploma reported daily use.1 These numbers have rapidly grown from the  percentages from 2002 to 2013, before marijuana was legalized for medical marijuana use.2 It  has been seen that states that have progressed to legalizing marijuana for recreational use have  seen a 155% increase in use in the three-year average since legalization. 3 

Marijuana is the most commonly used illicit drug, and likewise is associated with a lower  public health status as it negatively affects individual health and well-being, economic, and  social circumstances.4 Marijuana use is associated with lower life satisfaction, more relationship  problems, and less academic and career successes.5 It is also identified with a wide range of  health problems including hallucinations and paranoia, damages to DNA, breathing problems,  including inflammation of the lungs, symptoms of chronic bronchitis, rapid lung destruction – even more severe than tobacco smokers, possible harm to fetus’s neurological development, and  low birth weight when used during pregnancy.3,6 Furthermore, marijuana is heavily associated  with high risk of addiction, schizophrenia, psychosis, and short-term declines in memory,  attention, and learning. 7 

Marijuana Use in Adolescents 

A major concern with legalizing medical and recreational marijuana and lessening its  restrictions is the increase of use and lower quality of life in adolescents. Adolescents, compared  to any other age group, are particularly prone to risks associated with marijuana use.8 Cannabis  use is most prevalent in ages 18 to 25 in the United States, with 20% using it on a monthly  basis.2 Seven percent of 12 to 17 year olds currently use the substance, while 3% of adolescents  have a Marijuana Use Disorder.2 Unfortunately when marijuana is legalized, such as  Washington’s recent legalization for marijuana recreational use, adolescents’ perceived harm  decreases and use increases.9 Following Colorado’s legalization for marijuana recreational use,  past month use in youth increased 20% during an average 2-year span. The passage of this law  also contributed to Colorado possessing the highest ranking of adolescent marijuana users in the  United States, as their rates increased 74% above the national average in 2013/2014 from the  previous state of 39% above the national average in 2011/2012 during the time it was legalized  for medical use.4 

The increase of cannabis use in adolescents impairs overall well-being as it declines their progression in academics.8 Any type of cannabis use in adolescents is associated with a decrease in learning from brain impairment, problem-solving, memory, math, and reading.10 Brain impairment from marijuana use has shown its inability to regain its previous state of neurological function after stopping marijuana use, while it also permanently lowers adolescents’ IQ scores by up to 8 points, bringing them to the lowest third quartile of intelligence.5,11 Weekly use is correlated with decreased rates of high school graduation. 7 The negative impacts relating to educational attainment is comparative to living in a family with the poorest level of wealth.12 

It has been shown that adolescents are particularly vulnerable to harmful situations with marijuana use, as it increases psychotic symptoms such as delusions, hallucinations, feelings of emotional unresponsiveness, and paranoia, which puts them at risk for mental illnesses such as schizophrenia, depression, and suicide.8, 13 Use of marijuana in adolescents is also associated with relational harm, dating violence, disinterest in activities, isolation from family, and a lower quality of life.8 Additionally, students who use marijuana are at risk for vehicle accidents, as over  28 thousand Seniors admitted they were in at least one motor vehicle accident each year in high school after the use of marijuana.10  

Medical Marijuana and the Food & Drug Administration (FDA) 

Despite that, a total of 29 states and the District of Columbia have now legalized marijuana for medical programs and/or recreational use, at the federal level it still remains a federal offense and is classified as a Schedule I substance under the Controlled Substances Act, where  Schedule I substances have a high potential for dependence and are not for medical use.14 Although marijuana is not FDA approved, i.e. it is not certified to be safe for prescription drug use or any indication, many states are allowing patients to purchase marijuana by using a  medication card, given by a healthcare worker.  

Although there have been some studies conducted that associate benefits with cannabis use and certain ailments, the FDA cannot approve marijuana for drug use because it has been linked to harmful health outcomes and has not been proven for effective medication.14 In states that have approved medical marijuana, healthcare workers have the freedom to give patients access to a marijuana medication card for purchasing marijuana; however, proper dosages cannot be prescribed due to the limitations of not being FDA certified, allowing patients to consume potentially harmful amounts of the substance for their ailments.15 Another concern that the FDA  found with marijuana being a certified drug is the unmonitored and varying levels of THC in the cannabis Sativa plant.15 THC concentrations are continuing to increase to harmful levels, but this varies based upon the dispensary.8 Thus, it has been too difficult to produce a consistent dosage of medical marijuana to consumers.15 

There has been considerable interest in the effects of marijuana for certain conditions, such  as the attempt to decrease symptoms in glaucoma, AIDS, neuropathic pain, cancer, multiple  sclerosis, nausea, and certain seizure disorders; however, there is no current scientific evidence  that marijuana is effective for these treatments due to the harm that may occur with testing  human subjects.10, 15 The FDA has realized this interest in treatment, and thus approved two other drugs that contain a synthetic variation of a substance present in marijuana known for its  medicinal effects, while they do not contain any of the harmful compounds found in marijuana,  making them safe for medical use.14  

Cannabinoid (CBD) oil is a substance derived from separating the resin, i.e., the sticky  substance, from the flower of the cannabis sativa plant, and its purposes are typically used topically for localized pain and differ than that of marijuana use. CBD oil has been legalized in  Tennessee and can be purchased for medicinal purposes, but has been known to be used in other  ways, such as smoked and orally ingested for the effects of THC found in marijuana.16 

Other State Outcomes  

Out of the 29 states that have legalized marijuana for recreational or medical use, the most documented health outcomes have been seen in Colorado, one of the first states to legalize marijuana for recreational use.7 Alaska, Washington, and Oregon have also progressed from legalizing medical marijuana to recreational use.7 There has been a trend found in the legalization process in states—marijuana use starts from a more restrictive law of medical marijuana use, to voting in lesser restrictive laws, and then finally being voted in for recreational use. 3 

Since the passing of marijuana for recreational use in Colorado in 2012, significant health concerns have been found.3 Marijuana’s increase of use in Colorado following the legalization of recreational use was associated with a 49% increase in Emergency Department visits, an 87%  increase in vehicle crashes whose drivers tested positive for marijuana, and a 5% increase in alcohol consumption, making alcohol consumption 6% above the national average. A large concern has been found in supporting evidence for the increased burden of homelessness—there has been a 50% increase in homeless shelter utilization and higher incident rates for employer troubles, such as more employee drug test failures, absenteeism, injuries, and disciplinary problems.3,17 Other findings include a 471% increase of seizures in Colorado marijuana in the  United States mail in the 3-year average following legalization of recreational use. Also, when  Colorado had legalized medical marijuana in 2009, the average number of seizures of Colorado marijuana increased 357% in a 3-year span, showing that legalizing medical marijuana increases illegal and harmful habits among users.3  

The state of Washington, although has not documented its health effects to the extent of  Colorado, also legalized recreational marijuana in 2012. It was recorded that vehicle accidents related to a positive THC test in 2014 were doubled in 2 years.3 According to the Washington  State Traffic Safety Commission, there was a 460% increase in marijuana-only DUI’s since  2012.3 In the state of Oregon, which has had a recreational marijuana legalization since 2014, and had a medical marijuana law for the 16 years prior, currently has 11% of its population regularly using marijuana, and half of its population has used marijuana in the past.17

Knowing the detrimental health effects marijuana has on adolescents, the increasing rates of their illegal use is a great concern. Furthermore, states that have legalized it for recreational and medical purposes, also show increased adolescent use because students see marijuana as being acceptable to use.18 Out of 11th-grade students that drove in Oregon, half of the students that smoked marijuana admitted to driving within 3 hours of use, and over 62% of students reported having easy access to the substance, despite over half of students realizing that moderate consumption increased their risk for injury and decreased their state of health.18 

Marijuana and Addiction 

Addiction to marijuana is becoming an increasing problem, as clinical dependence has been found to affect roughly 10% of marijuana users, most being adolescents and young adults.4  Marijuana production has had a steady increase in THC levels over the past decades, producing a  more potent plant, which has been linked to higher addiction rates. Part of this complication could be linked to the unmonitored dispensaries of marijuana, in which concentration of THC  levels varies by producers.8 

Marijuana Use Disorder in 2015 was found among 4 million Americans, which is a  precursor for addiction.17 It has been recorded that up to 30% of individuals who use marijuana are likely to develop Marijuana Use Disorder to some degree.8 In a study conducted in 2009,  individuals between the ages of 12 and 25 comprised 66% of treatment admissions for Marijuana Use Disorder.17 It has been shown that users below the age of 18 are 4 to 7 times more likely than adults to develop this disorder leading to addiction.19 Colorado reported that their drug treatment facilities were at full capacity, the majority of patients being young in age, and almost half were admitted for their high dependence to marijuana versus other illicit drugs.10 

Societal and Economic Impacts 

Lessening the restrictions on marijuana is becoming a perpetual theme in the polls in all  states, which is also associated with poorer societal and economic outcomes.10 Many new  cannabis use laws were elected during 2016 throughout the United States, which not only  allowed over 28 states and Washington D.C. access to medical marijuana, but also lessened the  restrictions associated with its use in other states, making marijuana more easily acceptable to  the public.20 Connecticut took the lead on allowing minors to enroll in the medical marijuana  program and many states are following, while Delaware now allows minors to use Cannabinoid  oil on school buses.20 According to the State-by-State Medical Marijuana Laws Report, almost  every state that has initiated the ballot for marijuana use or less restrictive regulations associated  with its use has enacted it into law by popular vote. 20

There are many adverse side effects associated with increased marijuana use at the societal  level. According to one study, the negative impacts of expanding marijuana laws will have such  a severe impact on public health from a social and economic standpoint, there will be no turning  back.3 The costs presently cannot be determined; however, they are noted to be cruel.10 One  argument for marijuana use is that it will yield more profit to the government through increased  tax revenues. Nonetheless, this rationale is mistaken for various reasons. First, tax revenue  assessments cannot be determined because the impact of the black-market’s supply to users is  not known, although it has been documented that Colorado’s black market has increased  significantly since marijuana has been legalized.3 Furthermore, it has been observed that  Colorado’s tax revenue from marijuana is only 0.5% of total tax income. This amount may seem  somewhat of a worthy amount; however, according to the National Drug Intelligence Center, in  2011 there were over $193 billion annual losses due to negative side effects of illicit drug use,  such as sickness, accidents, loss of productivity, and crimes. Over 66% of the losses were from  poor productivity, which is heavily associated with marijuana use.3 In another study by the  National Center on Addiction and Substance Abuse at Columbia University, it was found that  much of governmental spending is towards attempting to decrease the negative effects of our  continued failure to treat the substance misuse, rather than preventing it before the damage  occurs.3 Only 3% of governmental funds is spent towards preventative care, while 60% was  spent towards healthcare costs, including alcohol and drug abuse.3 

Other economic impacts of the legalization of marijuana include negative environmental side  effects, such as an increase in air pollution from production. It was found that for every pound of  marijuana grown indoors, there is almost 5,000 pounds of carbon dioxide released into the  environment.3  

Marijuana Use and Safety  

A major concern with the use of marijuana is its negative effects on traffic accidents and  correlated deaths. It was reported in that marijuana-related traffic accidents, deaths increased  almost 50% in the three-year average after legalization of recreational marijuana, which was 40% more than the national average.3 The use of marijuana prior to driving has been shown to  double the chances of collisions, due to slower cognitive function, reaction speed, and lane weaving.3  

Other safety issues have been found among employees at work that are marijuana users, who  are at increased risks to accidents and injuries to themselves and others, due to inability to safely  multitask, lessened sensorimotor skills, and attentional deficits. 3 There are also studies that  highlight marijuana’s impacts on public safety. Short and long-term uses have been shown to  delay cognitive function, affecting sensorimotor abilities, attention span, memory, self-control,  learning, and educational attainment, which have detrimental effects on many aspects of daily 

life. There has also been moderate evidence that marijuana use has been linked to suicidal  attempts and completions.5

Glossary 

Cannabinoid: a class of diverse chemical compounds that act on receptors in the brain that repress  neurotransmitter release, including endocannabinoids (produced in the body), phyto-cannabinoids  (found in plants) and synthetic cannabinoids (manufactured chemically). There are two types of  cannabinoid receptors in the body: type one, found in the brain (basal ganglia and limbic system,  including hippocampus) and type two, found in the immune system (especially in the spleen). 

Current use: use of a substance within the past 30 days. 

Illicit drug: use includes the non-medical use of a variety of drugs that are prohibited by  international law. These drugs include: amphetamine-type stimulants, cannabis, cocaine, heroin  and other opioids, and ecstasy. 

Marijuana: dried leaves, flowers, stems and seeds from the hemp plant Cannabis sativa, which  contains the psychoactive chemical delta-9-tetrahydrocannabinol (THC), as well as other related  compounds; may also be concentrated in a resin called hashish or a sticky black liquid called hash  oil. 

Schedule I: classification for drugs, substances or chemicals with no currently accepted medical  use and high potential for abuse; pose potentially severe psychological or physical dependence. 

THC: primary psychoactive component of the Cannabis plant; delta-9-tetrahydrocannabinol;  scheduled by the international Single Convention on Narcotic Drugs (Schedule I and IV) and by  the United States Drug Enforcement Administration (Schedule I). 

Author 

Mariel Crawford, MPH  

No conflicts of interest identified.

References 

1 Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda, Board on Population Health and  Public Health Practice, Health and Medicine Division, & National Academies of Sciences, Engineering, and Medicine.  (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for  Research. Washington, D.C.: National Academies Press. https://doi.org/10.17226/24625 

2 Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United  States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH  Series H-51). Retrieved from http://www.samhsa.gov/data/ 

3 Rocky Mountain High Intensity Drug Trafficking Area. (2016). The Legalization of Marijuana in Colorado: The Impact (No.  Volume 4). Retrieved from  

https://www.sheriffs.org/sites/default/files/2016%20FINAL%20Legalization%20of%20Marijuana%20in%20Colorado%2 0The%20Impact.pdf 

4 Hasin, D. S., Saha, T. D., Kerridge, B. T., Goldstein, R. B., Chou, S. P., Zhang, H., … Grant, B. F. (2015). Prevalence of  Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry, 72(12), 1235.  https://doi.org/10.1001/jamapsychiatry.2015.1858 

5 Meier, M. H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R. S. E., … Moffitt, T. E. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences,  109(40), E2657–E2664. https://doi.org/10.1073/pnas.1206820109 

6 Panlilio, L. V., Zanettini, C., Barnes, C., Solinas, M., & Goldberg, S. R. (2013). Prior Exposure to THC Increases the Addictive  Effects of Nicotine in Rats. Neuropsychopharmacology, 38(7), 1198–1208. https://doi.org/10.1038/npp.2013.16 7 Marijuana and Public Health | CDC. (n.d.). Retrieved September 3, 2017, from https://www.cdc.gov/marijuana/index.htm 8 Abuse, National Institute on Drugs. (August, 2017). What is the Scope of Marijuana Use in the United States? Retrieved  September 4, 2017, from https://www.drugabuse.gov/publications/research-reports/marijuana/what-scope-marijuana-use in-united-states 

9 Cerdá, M., Wall, M., Feng, T., Keyes, K. M., Sarvet, A., Schulenberg, J., Hasin, D. S. (2017). Association of State Recreational  Marijuana Laws with Adolescent Marijuana Use. JAMA Pediatrics, 171(2), 142–149.  

https://doi.org/10.1001/jamapediatrics.2016.3624 

10 David Evans. (2013). The Economic Impacts of Marijuana Legalization, 39 

11Abuse, N. I. on D. (2013, August 13). Early-Onset, Regular Cannabis Use Is Linked to IQ Decline. Retrieved September 7,  2017, from https://www.drugabuse.gov/news-events/nida-notes/2013/08/early-onset-regular-cannabis-use-linked-to-iq decline 

12Chatterji, P. (2006). Illicit drug use and educational attainment. Health Economics, 15(5), 489–511.  https://doi.org/10.1002/hec.1085 

13 U.S. Department of Justice, “DEA Position on Marijuana," Drug Enforcement Administration (DEA), Washington, DC U.S.A.  July 2010, www.DEA.gov, pages 23-26 and 33-34; Speaking Out Against Drug Legalization, DEA, pages 51-53 14 State Medical Marijuana Laws. (August, 2017). Retrieved September 4, 2017, from http://www.ncsl.org/research/health/state medical-marijuana-laws.aspx 

15Commissioner, O. of the. (February, 2017). Public Health Focus - FDA and Marijuana [WebContent]. Retrieved September 2,  2017, from https://www.fda.gov/newsevents/publichealthfocus/ucm421163.htm 

16Murray, R. M., Quigley, H., Quattrone, D., Englund, A., & Di Forti, M. (2016). Traditional marijuana, high-potency cannabis  and synthetic cannabinoids: increasing risk for psychosis. World Psychiatry, 15(3), 195–204.  

https://doi.org/10.1002/wps.20341 

17 Smart Approaches to Marijuana: Preventing another big tobacco. (2016). Lessons Learned after 4 Years of Marijuana  Legalization (p. 30). Retrieved from https://learnaboutsam.org/wp-content/uploads/2016/11/SAM-report-on-CO-and-WA issued-31-Oct-2016.pdf 

18 Oregon Health Authority, Public Health Division. (2016). Marijuana Report: Marijuana use, attitudes, and health effects in  Oregon. (p. 70). Retrieved from http://www.oregon.gov/oha/ph/PreventionWellness/marijuana/Documents/oha-8509- marijuana-report.pdf 

19 Winters, K. C., & Lee, C.-Y. S. (2008). Likelihood of developing an alcohol and cannabis use disorder during youth:  Association with recent use and age. Drug and Alcohol Dependence, 92(1–3), 239–247.  

https://doi.org/10.1016/j.drugalcdep.2007.08.005 

20 Marijuana Policy Project. (2016). State-by-State Medical Marijuana Laws Report. Retrieved September 2, 2017, from  https://www.mpp.org/issues/medical-marijuana/state-by-state-medical-marijuana-laws/state-by-state-medical-marijuana laws-report/