Marijuana: to use or not to use?

By Danielle Fixen ~

In the United States, there are currently 30 states in addition to the District of Columbia that have legalized medical marijuana. Of those 30 states, 9 have legalized recreational marijuana use; however, under federal law, marijuana remains illegal. It is classified as a Schedule I controlled substance, along with heroin and lysergic acid diethylamide (LSD). The Drug Enforcement Administration states “Schedule I drugs, substances or chemicals are defined as drugs with no currently acceptable medical use and a high potential for abuse.”

In Colorado, the June 2018 Medical Marijuana Registry Program had 86,755 active patients. Approximately 20% of patients on the registry are 61 years and older and report using medical marijuana for severe pain. Unfortunately, these numbers do not indicate the number of patients who use recreational marijuana for medical conditions. There are many residents of Colorado who use marijuana for medical conditions that do not have a medical marijuana card. If someone is using marijuana or decides to use marijuana without consulting their healthcare provider, it is important to understand the effects of marijuana.

Marijuana plants are composed of many different cannabinoids or chemicals. Two cannabinoids commonly found in available marijuana products include tetrahydrocannabinol (THC), cannabidiol (CBD), or a combination of both. The biggest difference between THC and CBD is that THC can cause feelings of being “high”, or psychoactive effects, whereas CBD does not. Other side effects of THC include rapid heartbeat, dizziness, a happy or relaxed feeling, dry mouth, slower reaction time and coordination, difficulty thinking, increased appetite, and red eyes. Many of these side effects may worsen current medical conditions, increase the risk of falls, or impact memory in older adults. On the other hand, CBD is well tolerated and thought to have effects on anxiety, pain, and inflammation; however, long-term safety data is unknown.

There are different ways to use marijuana such as smoking or vaporizing, eating or drinking, and applying creams, ointments, and patches. It is important to know that lasting effects and side effects depend on the route of administration, strength or potency, and cannabinoids. Inhaled formulations, such as smoking and vaporizing, begin working immediately and can last up to 2 hours. Vaporizing is preferred over smoking because of the decreased risk of inhaling toxic components; however, patients often report coughing and increased sputum production when using inhaled formulations. Oral formulations such as edibles and oils have a variable onset. Patients have reported onset between 60 minutes up to 6 hours with effects lasting up to 8 hours. It is recommended to start with very low doses because of the variable onset, especially in older adults who have a slower drug metabolism. Another option would be to use a combination THC and CBD product, which decreases the psychoactive effects of THC. Topical formulations generally begin working 15 to 45 minutes after use and can last up to 2 hours. Topical products are usually applied multiple times a day. Studies have found that topical agents containing CBD absorbs better than THC containing products. These products may be safer and have fewer side effects compared to oral and inhaled products.

Lastly, when thinking about marijuana, it is important to consider drug interactions. Marijuana may interact with your medications, especially if you are taking a medication that can cause any of the above side effects or if you are consuming alcohol. If you are using or considering using marijuana, it is important to discuss the risks and benefits with your healthcare provider or pharmacist.

Volkow ND, Baler RD, Compton WM, et al. Adverse health effects of marijuana use. N Engl J Med. 2014;370:2219-2227.
M. A. Huestis, Chem. Biodiversity 2007, 4, 1770–1804.

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