Marijuana: a major public health epidemic
Lucio N. Margallo II, MD
President, South Dakota State Medical Association
November 1, 2022
Medical marijuana, also known as medical cannabis, is a term for derivatives of the cannabis sativa plant that are used supposedly to ease symptoms caused by certain medical conditions.
Cannabis sativa contains many active compounds such as delta-9 tetrahydrocannabinol (THC), the ingredient in marijuana that makes people "high,” and cannabidiol (CBD).
Cannabis use disorder is diagnosed using the DSM-V criteria where problematic patterns of cannabis use lead to clinically significant impairment or distress occurring within a 12-month period. This usually manifests as taking larger amounts of cannabis or over a longer period of time than intended, spending a great deal of time acquiring cannabis, using or recovering from use, cravings, use resulting in failure to fulfill major obligations, use in high-risk situations, and more. Increased frequency and consumption of more potent products in particular is associated with higher risks of cannabis use disorder.
Marijuana is classified as a schedule 1 controlled substance by the federal government. Schedule I drugs are considered the highest potential for abuse and potential for severe physical and psychological dependency. In December 2014, the Rohrabacher-Farr amendment was enacted, prohibiting the Justice Department from prosecuting individuals acting in accordance with state medical cannabis laws. And recently, President Biden announced he pardoned those who have prior federal offenses of “simple possession” of marijuana. Along with his announcement of the pardons, Biden said his administration would review whether marijuana should remain in the schedule I category.
State laws define different conditions under which patients may qualify for treatment with medical marijuana.
On a state-by-state basis, a patient may qualify for treatment with medical marijuana if certain conditions are present, such as severe and chronic pain, severe nausea or vomiting caused by cancer treatment, epilepsy and seizures, and multiple sclerosis and muscle spasms, mental health conditions as PTSD. In South Dakota, under the medical cannabis program, those 18 years and older with a debilitating medical condition may be approved for up to 3 ounces of cannabis with an approved patient card. The following qualifying conditions are in state statute: cachexia or wasting syndrome, severe or debilitating pain, chronic nausea, seizures, severe and persistent muscle spasms, including those caused by multiple sclerosis. Minors are allowed access to medical marijuana as long as they are diagnosed with any of these listed conditions.
The South Dakota State Medical Association has many concerns about marijuana use. Data from states that have legalized marijuana demonstrate concerns particularly around unintentional exposures in children, resulting in increased calls to poison control centers and emergency department visits, as well as an increase in traffic crashes and deaths due to impaired driving. In addition, marijuana legalization results in increased frequency of use in adolescents, pregnant women, and women who are breastfeeding.
Negative health consequences with both short- and long-term use are well-documented by research, including impaired short-term memory and decreased concentration, attention span, and problem solving. Alterations in motor control, coordination, judgment, and reaction time have also been documented. Studies have also found negative health effects on lung function associated with smoking marijuana, and marijuana use has been linked with higher rates of psychosis in patients with a predisposition to schizophrenia. Evidence shows that the drug may cause brain atrophy and permanently change the structure and physiology of the developing brain.
While the state may generate revenue through taxes on marijuana sales, the costs to society in terms of public health and safety should not be minimized.
As a practicing general internist and assistant professor of medicine for more than 50 years, I believe we have not had adequate or well controlled studies of marijuana and related cannabinoids to prove its efficacy in the treatment of diseases.
I encourage you to download and review the SDSMA’s legal brief on medical cannabis laws and regulations. Let’s protect our youth, community, state and our country.