States across the country are moving more and more toward legalization of medical marijuana. And indeed, there are some conditions for which marijuana seems to have some benefit. For example there are some types of seizure disorders that seem to respond to marijuana derived chemicals. The same chemicals (not the one that causes the high) appear to help with chronic nerve pain and to reduce chemotherapy related nausea. On the other hand, there are lots of medical issues for which people take medical marijuana, but which have not (so far) been proven beneficial in research. As far as glaucoma, by the way, the American Academy of Ophthalmology isn’t impressed.

However, before we legalize it (medical or otherwise) we should probably take a step back and think carefully. There are some side effects that are not insignificant. And among the most concerning is that marijuana probably has an adverse effect on the development of young brains.

Marijuana use in childhood and adolescence can cause harm to memory, decision making, learning and motivation and can lead to many other psychosocial issues. Indeed, other research suggests a link between marijuana and schizophrenia as well as violent behavior. Of course, research is always advancing and we may learn that it’s less harmful than we thought. But these are are very legitimate concerns.

Another problem that’s increasingly common is called ‘cannabinoid hyperemesis syndrome.’ Patients, adolescent and adult, come to the ER or go to their physicians repeatedly for abdominal pain and vomiting. (At home they often take frequent hot showers which seem to help temporarily.)

After expensive workups, someone asks ‘do you smoke weed?’ ‘No, doc, not at all.’ Then, after several more visits (and a drug screen) they say, ‘yeah I do, but this isn’t from weed.’ An informal survey of colleagues suggests that patients don’t believe this until about four or five ER visits. And even then, they typically continue to use. Some of these patients become so dehydrated from vomiting that they develop kidney failure.

Are these new problems? Or are they old problems that we’re just now realizing? Sometimes it can be hard to say. However part of the issue may be that that modern marijuana has a higher concentration of the psychoactive chemical THC (tetrahydrocannabinol) than what was grown and sold in the past. Also, people seem to smoke a lot. A patient recently told me he didn’t smoke much. ‘Only five a day.’

Finally, I’m perhaps most troubled by the way that marijuana leads to abdication of responsibility and loss of drive. The man (or woman), with no job, smoking and playing video games all day is so common it’s cliche. And unlike the characters in movies, it isn’t cute. It’s sad and destructive. Especially when that man or woman is a father or mother of small children.

In fact, when legalization was moving forward in Colorado I remember reading a comment from a young mother who said, in essence, ‘we don’t need our men to be less motivated.’ Indeed.

There isn’t space here to discuss the issues of taxation, federal drug laws or the persistence of black market sales after legalization; but these are all concerns as well.

On the other hand, I don’t remember wrestling with or restraining patients smoking marijuana. Plenty of drunks have given me grief on the job. And alcohol is related to about 50 percent of all violence but is still legal. In addition, you can be drunk all weekend and not get fired on Monday. Not so much for a positive drug screen. That seems unfair. I’m sure many people use recreationally and without adverse effects. And while I am personally opposed to the use of mind altering substances for several reasons (theology included), I’m not at all suggesting that all use is devastating or all users reprobates.

The thing is, I just don’t know the answer. We live in a time when any resistance to a new freedom or ‘right’ is considered old-fashioned, Puritanical or just cruel. ‘It will help people not to suffer! What’s wrong with you?’

And yet, we don’t have all the facts. And many of the facts we do have are very worrisome. As such, we should proceed with extreme caution.

I’ll close with an anecdote. A patient told me he used crack cocaine for chronic pain. ‘I know I shouldn’t, and I can’t afford it, but it helps.’

‘Every considered weed?’ I asked.

‘No way, that’s too strong for me!’

That comment alone may speak volumes.

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Dr. Edwin Leap

Contributing Columnist

Dr. Edwin Leap is the associate medical director of the Emergency Department at Newberry County Memorial Hospital.