California Medical Survey

THE ADVERSE EFFECTS OF MARIJUANA

In the past 10 years, California doctors have authorized cannabis use
by at least 350,000 patients. What have they learned about its adverse effects?

According to a survey of 19 doctors associated with the Society of
Cannabis Clinicians, side-effects are relatively rare, mild, and
transient. There have been no deaths, no major adverse events
attributed to cannabis -with one exception involving a claim by an
establishment psychiatrist that cannabis induced and exacerbated
psychosis in an 18-year old whom she had on a regimen of Lexapro and Zyprexa.

Comments by the SCC doctors follow.

Frank Lucido, MD:

Reported adverse effects are rare, in part because the patient coming
to a medical cannabis consultation has already found cannabis to be
of benefit. (I have had perhaps 10 patients in 10 years who had never
tried cannabis or who hadn't used it in many years and were uncertain
if it would effectively treat their current illness or symptoms.) Two
patients have discontinued use in response to decreased productivity.
The overwhelming majority report that they are MORE productive when
their symptoms are controlled with cannabis.

Robert Sullivan, MD:

None common (c. 1%), none "serious." Weight gain, tolerance, anxiety
(related to potential theft from an outdoor garden), dry mouth,
short-term memory decrease, anxiety, red eyes. All described in
response to my inquiry (not spontaneous). None resulted in stopping
cannabis use.

Marian Fry, MD:

The most significant negative reactions are due to fear of
incarceration and the results of abuse by officers unwilling to honor
California law.

William Toy, MD:

The most important adverse effects are respiratory problems caused by
smoking. Most patients who have respiratory problems use vaporizers
or edible forms of cannabis. We go out of our way to get patients on
vaporizers and we now have only a small percentage of smokers -mostly
people who have been smoking marijuana for 30-40 years. Most in this
group use very little, maybe one or two doses a day.

Philip A. Denney, MD:

Virtually none reported by patients except contacts with the legal
system. Patients are able to stop using easily in order to pass drug
tests or when traveling. Overdose from edible cannabis -an unpleasant
drowsiness lasting six to eight hours-is rare and transient.

David Bearman, MD:

Occasional complaints of cough. Many more complaints about Marinol
than cannabis -dysphoria, ineffective, costs too much.

Tom O'Connell, MD:

The most common is the "paranoid" reaction, in which,
characteristically, a user who is "high" develops the uncomfortable
feeling that everyone he/she sees KNOWS they are high and is critical
of them for it. It almost always occurs in a situation where the
person may be forced to deal unexpectedly with the public. It
certainly needs further study. In any event, patients deterred from
using pot aren't lining up for approvals to do so.

William Courtney, MD:

A significant number of my middle-aged patients are no longer
enamored of the psychoactive effects that previously were the
highlight of their cannabis use. For them, what was euphoric has now
become dysphoric. Such patients tolerate the anxiogenic properties in
order to enjoy the anti-spasmodic or analgesic effects -much as a
patient on chemotherapy reluctantly accepts the nausea in exchange
for the anti-tumor effects. While a few patients have discovered that
there are strains that provide relief without dysphoria, others are
excited by the possibility of daytime CBD analgesia or autoimmune
modulation without alteration of their sensorium.

Dr. A.:

We've had several reports of hypotensive reaction -a sudden drop in
blood pressure, which results in fainting. It's very rare and, as
reported by my patients, is a one-time thing. It typically happens
after a big meal, when the GI tract is opened up and absorbing a lot of blood.

Jeffrey Hergenrather, MD:

Is there a downside to the use of cannabis? The sense of intoxication
rarely lasts longer than an hour and tends to be more troubling to
the novice than to the experienced user. For some people cannabis can
induce dry mouth, red eyes, unsteady gait, mild in-coordination, and
short-term memory loss, all of which are transient. These effects are
reportedly trivial compared to those brought on by pharmaceutical alternatives.

Cannabis use is steadily finding acceptance in society. Still, for
many it remains awkward if not totally impractical in the workplace.
People whose jobs require multi-tasking such as pilots, drivers,
dispatchers, switchboard operators, and many professionals find the
intoxicating effects of cannabis inappropriate in the workplace, and
therefore reserve their use for after work.

The survey, conducted by your correspondent for the upcoming issue of
O'Shaughnessy's (and previewed exclusively on CounterPunch), does not
pretend to be rigorous. It involves the patient population least
likely to experience adverse events and a setting in which adverse
events might be downplayed (examinations in which the patient is
seeking the doctor's approval to use). As Dr. Lucido and others point
out, in the first 10 years of legality created by Prop 215, almost
all the patients seeking physician approval to use cannabis had been
self-medicating previously with positive results. Truly naive
patients have been rare -and those experiencing unwanted side-effects
would be unlikely to return to the doctor for a renewal, i.e., their
complaints would go unreported.

The charge that cannabis use caused and then increased the severity
of a psychotic break in an 18-year-old was made by a Stanford
University psychiatrist, Dr. P., who filed a complaint with the state
medical board against the doctor who had approved it. "I believe THC
caused his depression to worsen, interferes with antidepressant meds,
and clearly caused his psychosis," Dr. P advised the board. "He is
also psychologically and physically dependent on the substance. He
refuses to quit. He even admitted to seeking the medical marijuana
justification in order to use regularly 'legally.'"

The assumption that marijuana causes physical dependence is without
scientific foundation. Dr. P.'s use of the term "even admitted"
reveals a prosecutorial frame of mind. She seems appalled to learn
what all cannabis consultants know and what should come as no
surprise to any person with common sense: feeling legitimate relieves
anxiety! Dr. P.'s treatment of the mutual patient involved
anti-marijuana exhortations and the pushing of her preferred
corporate drugs. Lexapro is an SSRI antidepressant made by Forest
Pharmaceuticals. Like all SSRIs it is slowly but surely being linked
to suicide in the medical literature (while the drug companies and
their paid researchers in the psychiatric establishment challenge
each piece of evidence).

Dr. P.'s allegation that marijuana use precipitated and aggravated
the patient's break with reality can't be proved or disproved. Some
published studies indicate an "association" between marijuana use and
schizophrenia, but not necessarily a causal relationship. (A person
seeing demons or hearing voices may use cannabis because he finds
that it quiets them.) Schizophrenia occurs in about 1% of adult
populations in all countries and cultures, regardless of the
prevalence of cannabis use. The use of Marinol (synthetic THC) by
teenage cancer patients has not resulted in an increased incidence of
schizophrenia.

Ironically, the component of the cannabis plant thought to have
sedative and anti-psychotic properties -Cannabidiol (CBD)- is present
only in trace amounts in the strains available to California
patients. As indicated by Dr. Courtney, the SCC doctors are
frustrated that they don't know the cannabinoid contents of the herbs
their patients are using. They all wish a high-CBD strain was
available. They would have learned a lot in 10 years about how it
differs from high-THC cannabis. Prohibition sabotages research.