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Pearce-ings: marijuana--the good, the bad, and the ugly.

With the recent legalization of marijuana in many states, marijuana and its uses are a hot topic in most social circles. As physicians, we see the full spectrum, from its healing properties to its destructive ones. The goal of this article is not to persuade you into changing positions on its legalization, but rather to stress the importance of remaining neutral and educating families on the facts and potential pros and cons as they relate to the health of their children.

On Jan. 26, 2015, the American Academy of Pediatrics released its policy statement on marijuana and its use (Pediatrics 2014 [doi: 10.1542/peds.2014-4146]). The AAP does not support the legalization of marijuana because of the harm that it poses to children and adolescents, nor does it support legalization of medical marijuana outside the regulatory process of the Food and Drug Administration. It does recognize that marijuana may be an option for children with life-threatening or debilitating illnesses. The AAP does support the decriminalization of marijuana use or possession and advocates for less-harsh criminal penalties. Many of the recommendations were made because of the current research on marijuana and its use.

According to 2014's Monitoring the Future survey of drug use and attitudes among American 8th,

10th, and 12th graders, marijuana is the most common illegal drug used by adolescents. Among 8th graders, 6.5% reported use; among 10th graders, 16.6% reported use; and 21.2 % of 12th graders reported use. A total of 81% of 12th grade students stated it was easy to get. Marijuana use at all three grade levels was higher than cigarette use (National Institute on Drug Abuse. Drug Facts, 2014). Another study found that early initiation of marijuana use was 6.5 times more likely to result in addiction than if it was initiated after the age of 21 years (Adolescent substance use: America's #1 public health problem. CASA Columbia, 2011).

One thing we can agree upon is that an adolescent using any substance to mask or lessen the pain of a situation is in trouble. Whether adolescents are overeating or denying themselves food, or using drugs to get high, or behaving promiscuously to get attention, overindulgence is never good. So when we evaluate the effects of marijuana use among teens, we have to separate out the underlying emotional issues from the effects related to the drug. Adolescents are at particular risk for overuse because most lack the experience or maturity to stop when things get out of hand. And they are at risk when using anything that will give them a "high." Substances like glue, gasoline, and cold medicine can bring them that high, and marijuana is no different--except that it is illegal.

Alcohol, cigarettes, and prescription medications are also vehicles to that desired high. Each has greater addictive properties than marijuana does. According to the Monitoring the Future study, most high school seniors do not think occasional use of marijuana is harmful, with only 36% saying regular use puts you at greater risk, compared with 39.5% in 2013 and 52% in 2009. The perception that marijuana is harmful has definitely declined.

Cannabis smoke contains three times the amount of tar found in tobacco smoke and 50% more carcinogens (N. Engl. J. Med. 1988;318:347). It also can irritate the airways, causing exacerbations of asthma, cystic fibrosis, sputum production, and pharyngitis (Arch. Intern. Med. 2007;167:221). Long-term studies showed that extended use was associated with increased obstructive lung diseases.

There is substantial evidence that indicates that cannabis use can cause psychosis. One review noted evidence that genetic factors may influence the risk of psychosis in adults who used cannabis as adolescents (Biol. Psychiatry 2005;57:1117). Cannabis is believed to release dopamine in the body, which may lead to the psychosis. Another study found that the onset of psychotic illness occurred more than 2 years earlier in patients who were heavy cannabis users (Arch. Gen. Psychiatry 2011;68:555).

Another important finding is that marijuana can suppress testosterone secretion in men, which may result in decreased libido, impotence, and gynecomastia (N. Engl. J. Med. 1974;290:872). Many teens believe cannabis is safe because it's a plant, and consequently, may not relate these symptoms to its use.

The research on cannabis smoke and its relationship to cancer are limited by inadequate sample sizes and confounding factors not taken into account, but there does seem to be a relationship between cannabis smoke and lung cancer and bladder cancer (J. Psychoactive Drugs 1994;26:285; Urology 2006;67:100). However, head and neck cancers have not shown a relationship to marijuana use (Cancer Epidemiol. Biomarkers Prev. 2009;18:1544-51). Cardiovascular effects have been related to the increased sympathetic activity and decreased parasympathetic activity that can result in bradycardia and hypotension with high doses. This may be of particular concern in older people with coronary artery disease (J. Clin. Pharmacol. 2002;42:58S).

The medicinal properties of marijuana are an important consideration. Marijuana has been shown to be particularly effective in controlling some forms of seizure, pain, nausea from chemotherapy, muscle spasms caused by multiple sclerosis, and Crohn's disease. The FDA has approved tetrahydrocannabinol, or THC, a key ingredient in marijuana, to treat nausea and improve appetite. In states that have legalized cannabis, qualifying patients can get prescriptions from their physicians to use at authorized dispensaries. For some patients, the effects can be life changing; for others, it can help with pain management and the discomfort associated with certain illnesses.

Beyond the scope of medicine is the economics of the legalization of marijuana. States that have already legalized it have seen revenues in the billions. Marijuana cash crops are estimated at $14 billion in revenue. Jon Gettman's 2007 study, "Lost Taxes and Other Costs of Marijuana," states that the prohibition of marijuana costs the government $113 billion, while it costs taxpayers $31.1 billion each year. The study projects that legalization of cannabis may save the criminal justice system $10.7 billion and an additional $6.2 billion for taxpayers. That sort of money does talk: Regardless of current opposition to the legalization of marijuana, it is probably just a matter of time before marijuana is legalized in every state.

The scope of marijuana issues is broad and, for many, controversial. The drug can serve as a healer, create health challenges, lead to drug addiction, or even become a significant revenue source to a state's coffers. As providers, we need to be able to provide our patients with research-based information and resources, and dispel myths, so that they can make informed decisions for themselves that are in the best interests of their children.

Dr. Pearce is a pediatrician in Frankfort, III. She had no relevant financial disclosures. E-mail her at pdnews@frontlinemedcom.com. Scan this QR code to view similar articles or go to pediatricnews.com.

BY FRANCINE PEARCE, M.D.
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Title Annotation:OPINION
Author:Pearce, Francine
Publication:Pediatric News
Date:Feb 1, 2015
Words:1150
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