Monday, January 06, 2014

Getting high

Two states have legalized marijuana use. On the one hand, there's a libertarian argument for this trend. The "war on drugs" has led to the paramilitarization of the police. The police are increasingly like a foreign occupation force. That's a bad development.

On the other hand, legalizing marijuana will likely make the streets more dangerous. Drinking in moderation doesn't seriously impair your faculties. But from what I've read, it takes very little marijuana intake to seriously impair your faculties. In the nature of the case, if you're under the influence, you're a poor judge of your faculties. 

So it's easy to imagine many more DIU incidents with the legalization of marijuana. More innocent drivers, pedestrians, and bikers killed or maimed by other drivers who had a few puffs on a joint, then got behind the steering wheel. 

I also expect this will hike car insurance and accident insurance for everyone.

Finally, there's the question of "medical marijuana." In principle, I'm not opposed to medical marijuana if, in fact, that provides symptom relief that's unavailable by other means. 

However, I think "medical marijuana" is usually a sentimental trojan horse to legalize marijuana in general. Also, I've never read or heard this discussed by medical experts who specializes in pain management. 


  1. Yes, my state of Colorado sucks due to this.
    The instances of children getting a hold of pot has shot up something like 300 percent in Colorado and that was before it was officially legal, only medical. It will continue to rise and at least every other day there is some story in the local news about some kid going to the emergency room.

  2. I'd like to add to what Steve said based on the medical literature I've read. The info I have is culled from various sources, especially UpToDate and Harrison's Principles of Internal Medicine (both of which are standard resources in medicine - indeed gold standard), and which in turn likewise cull from various sources. However, I can give specific citations and references if necessary. Much of this info is similarly available online for free if people simply Google or search well-known databases like PubMed.

    At any rate:

    1. Broadly speaking, the cannabis plant is turned into three different drugs (all of which can be eaten or smoked): herbal cannabis which is from dry leaves and flowers; hashish which is from dry resin; and hash oil which is of course oil. Hashish is the predominant form in Europe. But in the US it's herbal cannabis.

    2. Cannabis contains over 400 compounds, but its main active ingredient is delta-9-tetrahydrocannabinol (THC).

    3. A typical marijuana or cannabis cigarette contains approximately 0.5 to 1.0 grams of plant product. The typical THC concentration is generally between 10 to 40 mg, although there have been concentrations with >100 mg per cigarette.

    As for hashish, THC concentration is between 8% to 12% (according to weight). While hash oil contains between 25% to 60%, but hash oil is often added to hashish or herbal cannabis.

    4. If cannabis is smoked, anywhere from 25% to 50% of THC is absorbed in the lungs. Nearly 100% of the THC that's absorbed is bound to proteins which in turn widely distribute THC around the body including causing it accumulate in fatty tissue, whereupon THC is gradually released. THC can cross into the brain within a few mins after absorption (bypassing the blood-brain barrier), and then bind on to receptors in the brain.

    5. THC has reinforcing properties as well as a significantly severe withdrawl syndrome, and its chronic abuse leads to repeated stimulation of central nervous system (brain) receptors, which then causes desensitization of the receptors and eventually leading to increased tolerance to THC's effects by the CNS. As such, repeated stimulation leads to a sort of vicious cycle.

    6. There are various neurocognitive and neurophysiological changes that can occur as a result of chronic cannabis use, although some studies disagree. Potential issues (depending on dose and cumulative cannabis use or exposure) include deficits in attention, deficits in memory, deficits in executive functioning, deficits in psychomotor speed, among several others (e.g. reduced volumes in the hippocampus and amygdala which are two areas in the brain with plenty of receptors for THC to bind).

    7. I'll leave aside the psychotic disorders, even though they are significant. That's because, while there's definite correlation between chronic cannabis use and psychotic disorders, correlation isn't necessarily causation.

    1. 8. Apart from the CNS, long-term use of cannabis also has effects on other systems in the body.

      a. Pulmonary. Cannabis smoke contains many of the same particles found in tobacco smoke, and indeed in larger quantities (e.g. cannabis smoke contains approximately three times more tar than tobacco smoke, and 50% more carcinogens). Not to mention a hand-rolled marijuana cigarette is not filtered and often inhaled deeply, worsening its effects. Cannabis smoke, like tobacco smoke, can damage the lungs and lead to chronic cough, sputum, wheezing, bronchodilatation, bronchitis, dyspnea. Individuals with pre-existing lung diseases like asthma will likely see their asthma or other lung disease(s) worsen.

      b. Cardiovascular. Chronic high cannabis use decreases sympathetic activity ("fight or flight") and increases parasympathetic activity ("rest and digest"). This leads to bradycardia and hypotension. People with pre-existing cardiovascular diseases like coronary artery disease or cerebrovascular disease may be at greater risk for cardiovascular events (e.g. arrhythmias).

      c. Immune system. Cannabis use may suppress the immune system. But it's undetermined whether this in turn will lead to greater risk of infection.

      d. Reproductive. Cannabis use suppresses testosterone in men, thereby decreasing libido and potentially leading to impotence and gynecomastia. Cannabis use also decreases sperm count and damages sperm (e.g. sperm motility). Heavy cannabis use can cause infertility.

      In women, cannabis use increases prolactin levels, thereby potentially causing galactorrhea.

      We could discuss risks to babies in utero as well. THC can easily cross the placenta and so could directly affect the baby. For example, chronic marijuana abuse has correlated with preterm labor and growth retardation in the baby.

      As for the mother, chronic marijuana use correlates with (among other things) increased respiratory problems (e.g. bronchitis, emphysema), and all that this entails.

      e. Dental. Cannabis use is associated with increased periodontal disease.

      f. Vision. Cannabis use leads to corneal vasodilation and reduces intraocular pressure in the eyes.

      9. Cannabis use significantly increases the risk of use of other harder drugs. Especially alcohol, nicotine, and cocaine. But also opioids, stimulants, sedatives, and hallucinogens.

      10. Plus, cannabis use at earlier ages increases the risk even more so.

      11. Medicinal marijuana has been proposed in clinical contexts. Perhaps the most common clinical contexts are chemotherapy patients, AIDS patients, glaucoma patients, and patients with neurological disorders like multiple sclerosis. However, medicinal marijuana is not clearly superior to other currently available therapies for any of these, with the possible exception of AIDS patients with cachexia.

    2. 12. Related, quoting from the UpToDate article titled "Cancer pain management: Adjuvant analgesics (coanalgesics)":

      "Although severe or chronic pain accounts for over 90 percent of the qualifying conditions for use of medicinal marijuana among registered users in several states in which it is legal [33-36], there are no controlled studies demonstrating the efficacy of inhaled marijuana as an adjunct to traditional pain medications for patients with cancer-related pain, and, particularly in view of concerns for higher cancer rates among cannabis smokers [37], its use cannot be recommended."

      [33] Montana Department of Health and Human Services. Montana Medical Marijuana Program. Data available online at

      [34] Colorado Department of Public Health and Environment. The ColoradoMedical Marijuana Registry. Data available online at

      [35] Oregon Department of Human Services. The Oregon Medical Marijuana Program. Data available online at

      [36] Nevada Department of Health and Human Services. Medical Marijuana Program. Data available online at

      [37] Bowles DW, O'Bryant CL, Camidge DR, Jimeno A. The intersection between cannabis and cancer in the United States. Crit Rev Oncol Hematol 2012; 83:1.

  3. A few more thoughts:

    1. Sometimes people who argue for the legalization of marijuana fail to mention FDA approved medicinal marijuana already exists - i.e. dronabinol or its brand name Marinol.

    Of course, proponents would say dronabinol is substandard in contrast to their idea of what medicinal marijuana should be. But that's a different debate than the fact that we should legalize marijuana for medicinal purposes, which is already legal in dronabinol.

    2. Also, I suspect marijuana legalization proponents wish for more than mere medicinal marijuana. For one thing, I think they wish to smoke marijuana.

    However, smoking isn't generally speaking a good way to deliver a drug to the body. It can cause all sorts of respiratory problems for starters.

    Plus, cannabis smoke has a lot of the same ingredients as tobacco including carcinogens.

    Not to mention marijuana has on average three to four times the amount of tar as well as 50% more carcinogens than in a tobacco cigarette. This is mainly due to the lack of a filter. But I suppose marijuana smoking proponents could argue they wouldn't have to roll their own joints and make due without a filter if smoking marijuana were legal.

    And smoking would place others within the vicinity at risk from secondhand smoke.

    3. Similarly, the FDA approves other drugs like morphine (based on opium) for medicinal use. But it doesn't approve of smoked opium. Would most marijuana proponents accept, say, legalized marijuana so long as it's not smoked nor consumed in foods like brownies? Say legalized marijuana in the form of pills? I could be wrong, but I doubt it.

    4. It's ironic liberals are in favor of increased smoking bans, but they're also in favor of smoked marijuana.

    Libertarians are more consistent in allowing for both within limits.

  4. This is from a standard book used by physicians called Current Medical Diagnosis and Treatment 2013 (pp 1084-1085):

    Cannabis sativa, a hemp plant, is the source of marijuana. The parts of the plant vary in potency. The resinous exudate of the flowering tops of the female plant (hashish, charas) is the most potent, followed by the dried leaves and flowering shoots of the female plant (bhang) and the resinous mass from small leaves of influorescence (ganja). The least potent parts are the lower branches and the leaves of the female plant and all parts of the male plant. Mercury may be a contaminant in marijuana grown in volcanic soil. The drug is usually inhaled by smoking. Effects occur in 10–20 minutes and last 2–3 hours. "Joints" of good quality contain about 500 mg of marijuana (which contains approximately 5–15 mg of tetrahydrocannabinol with a half-life of 7 days). Marijuana soaked in formaldehyde and dried ("AMP") has produced unusual effects, including autonomic discharge and severe though transient cognitive impairment.

    With moderate dosage, marijuana produces two phases: mild euphoria followed by sleepiness. In the acute state, the user has an altered time perception, less inhibited emotions, psychomotor problems, impaired immediate memory, and conjunctival injection. High doses produce transient psychotomimetic effects. No specific treatment is necessary except in the case of the occasional "bad trip," in which case the person is treated in the same way as for psychedelic usage. Marijuana frequently aggravates existing mental illness and adversely affects motor performance.

    Studies of long-term effects have conclusively shown abnormalities in the pulmonary tree. Laryngitis and rhinitis are related to prolonged use, along with chronic obstructive pulmonary disease. Electrocardiographic abnormalities are common, but no chronic cardiac disease has been linked to marijuana use. Long-term usage has resulted in depression of plasma testosterone levels and reduced sperm counts. Abnormal menstruation and failure to ovulate have occurred in some women. Cognitive impairments are common. Health care utilization for a variety of health problems is increased in long-term marijuana smokers. Sudden withdrawal produces insomnia, nausea, myalgia, and irritability. Psychological effects of long-term marijuana usage are still unclear. Urine testing is reliable if samples are carefully collected and tested. Detection periods span 4–6 days in short-term users and 20–50 days in long-term users.