The latest debate in Florida is the legalization of medical marijuana. This is a highly debated issue because of the lack of evidence using marijuana for certain medical conditions, and the adverse effects and consequences of marijuana, particularly on youth. In addition, Floridians are just now recovering from a terrible prescription drug epidemic, and the introduction of another addictive substance creates some concern.To understand what “medical marijuana” is you really have to focus NOT on the herb, but the subtances contained in that herb, known as cannabinoids. Specifically, marijuana contains several psychoactive ingredients. Marijuana is like a salad; there are some things in it that are beneficial and some that are not. THC (tetrahydrocannabinol) is the major psychoactive compound, which creates the euphoria and “high”, while cannabidiol and cannabinol are also psychoactive, but tend to reduce the excitatory effects of THC.
The biggest problem with medical marijuana is the fact you are burning it and inhaling the products of combustion. Like tobacco, marijuana contains carbon monoxide, ammonia, hydrogen cyanide, acetaldehyde, acetone, benzene, toluene, phenol, naphthalene, benzanthracene, and benzpyrene. In fact, compared to tobacco smoke, each inhalation of marijuana is typically 2/3 larger, inhaled 1/3 deeper, held 4 times longer, and 50% higher in tar. Therefore, 2-4 marijuana cigarettes are roughly equivalent to 20+ tobacco cigarettes.
There is a disproportionate negative effect of marijuana on youth. Specifically, the rate of marijuana dependence or addiction is roughly about 10% for anyone over 18 who experiments (which is the same rate of addiction to anything in the general population), 27 % for age < 18, and 9% for age > 18. This is because the human brain does not fully develop until about age 21, and the parts that develop last are the prefrontal and frontal areas, which are responsible for decision making. Anyone who has teenagers knows that this population often makes poor decisions; because their brains have not matured.
Cannabinoids are produced naturally in our brains and responsible for their development. If outside cannabinoids are introduced to a developing brain, they can cause changes in brain development. Studies have shown a relationship between early cannabis use and a host of psychological conditions, including psychosis, bipolar disorder, schizophrenia and addiction. Also, the marijuana consumed today contains much higher concentrations of THC than that consumed in the 1960’s-1990. High THC cannabis can cause psychosis, paranoia, and extreme stimulation.
Marijuana disrupts short term memory, increases appetite, and reduces spontaneous motor activity. Competitive athletes know this because being off a second in your response time can mean the difference between victory and defeat.
So with all of these effects, how has marijuana been used medically and why is there such a push to legalize its medical use. Well, THC (Marinol) can be prescribed by physicians to treat protracted nausea and loss of appetite frequently seen in cancer patients and the chronically ill. Marijuana has been used to treat spasticity as seen in multiple sclerosis. High cannabidiol marijuana, (low in THC) has been used to treat intractable epilepsy in children, the so called “Charlotte’s Web” strain, which has been legalized in Florida, but cannot be smoked and is only approved for epilepsy and myospastic disorders. Sativex spray which is made from marijuana (GW pharmaceuticals) is available in Canada and the EU to treat cancer pain (currently undergoing trials in the US).
Clearly there is potential for the medical use of cannabinoids, not necessarily marijuana. Cannabinoids bind to 2 types of receptors, one in the brain (CB1) responsible for the psychoactive effects, and the other (CB2) in blood, spleen, and intestines. The CB2 receptor has been shown to modulate pain and there is research being conducted to develop CB2 receptor drugs to manage chronic pain (without the euphoria).
We are still a long way off from fully appreciating and understanding the medical use of marijuana. We know cannabinoids can be useful for certain medical conditions. The question is how to make them available to the public in a safe and effective manner.
