With cannabis legalization on everyone’s mind, there is a growing PR push to imply that cannabis is harmless. This makes great political baloney, but very bad science and public health policy.
Every substance, legal or illegal, medical or recreational, has its risks. All medications have risk. Alcohol has risk. Implying that cannabis is somehow uniquely without risk is politically motivated magical thinking. We need policy that is rational, data-driven, and protects the public.
1) Overdose
It’s fashionable to say “No one has ever overdosed on cannabis.” This is patently false. Many, many people have overdosed on cannabis. It would be accurate to say that no one has fatally overdosed on cannabis. While this is reassuring, it’s certainly not a good reason to ignore the other risks of cannabis. As any clinician, or anyone who has had a relative with dementia, can attest, there are potential outcomes that are as bad as, or maybe worse than, death.
2) Dependence
Becoming dependent on a substance can be harmful and life-altering. Dependence means that you develop unpleasant physical reactions to stopping a substance. These vary by the substance. Cannabis is relatively mild – typically a week or so of cranky mood, agitation, and insomnia. However, for some these symptoms can be intolerable.
Thankfully, cannabis dependence is relatively uncommon: about 7% in the general population (compare to 15% for alcohol, 18% for benzodiazepines, 25% for opioids). Moreover, this risk is higher in teens and young adults (about 18%) but lower in older adults (about 3%). This is part of the reason that we don’t recommend cannabis in the young.
However, the risk is dependent on dose as well. Less is more. Less cannabis not only leads to fewer side effects, like any medication, but also to lower risk of these longer-term complications.
3) Cannabis Use Disorder
Cannabis Use Disorder (CUD) is what we used to call Addiction. This is different from physical dependence although dependence can lead to Use Disorders. UD are a set of maladaptive behaviors that stem from using a substance. This is where things get really hairy.
People can essentially “check-out” leaving their life, responsibilities, and important people behind while they pursue substance use. This can wreak families, harm children, and lead to financial hardship. It can also lead to guilt, recrimination, divorce, depression, and other forms of self-harm. Ideally, we’d avoid all this.
Part of the problem is that many heavy cannabis users will point to themselves and say that since they can use large amounts, everyone should. It is true that a large part of the diagnosis of CUD depends on the patient’s self-assessment of harm to their life. It also hinges on their behavior toward others. Many CUD patients simply change their life-goals and the social circumstances to fit their need for cannabis. As a result, it’s not a good argument on which to base social policy or medical practice.
4) Heart Disease and Stroke Risk
Thankfully the preliminary data that we have that suggests that cannabis users have some increased risk for both heart attack and stroke is quite preliminary, and also shows only a small increase of risk. However, by the nature of how substances create these risks, it’s likely that the risk grows with increasing cannabis dose.
5) IQ Loss
This one I don’t worry too much about for my older patients. Due to the outlawing and stigmatizing of cannabis, over the past 50 years countless studies have looked for harms attributable. Studies ranging from IQ tests, to EEGs, fMRI, and structural MRI have been conducted over and over again. Our best data to date shows that “heavy” users may suffer an about 8 point drop in their verbal memory (but not quantitative, spatial, or executive function) over about a 30 year interval. For most people, this is not a significant change and the studies (done on healthy volunteers aka recreational users) do not address normal changes due to aging. More recent studies done on medical patients actually show improvement of cognitive function, presumably due to treating illness that is, itself, cognitively impairing (like pain).
So with all these risks, maybe you shouldn’t use cannabis? That would be throwing the baby out with the bath water. All medications have risk. Using cannabis is precise, measured, low doses mitigates against all of these risks. It is the job of your doctor to help you evaluate that risk for yourself and to weigh those risks against the anticipated benefits.
Consult with a Qualified Boston Medical Marijuana Expert Today
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically. Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them. For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.