Marijuana Legalization: Impact on Physicians and Public Health

Abstract

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health.

PTSD: from neurobiology to pharmacological treatments

“…First, there has long been the concern for impairing cognition, as well as paranoia (Yarnell, 2015). Second, there is a concern for potential long-term worsening of PTSD outcomes with cannabis (Wilkinson, Yarnell, Radhakrishnan, Ball, & D'Souza, 2016). Marijuana use is positively correlated with PTSD symptoms, but, according to self-reports, cannabis was used with intent to cope with these PTSD symptoms (Bonn-Miller, Vujanovic, Feldner, Bernstein, & Zvolensky, 2007).…”

“…Therefore, the directionality of the effects of cannabis use on PTSD symptoms cannot be fully differentiated (Yarnell, 2015). Regardless, there appears also to be a correlation between PTSD and problematic cannabis use (Wilkinson et al, 2016; Yarnell, 2015). Third, extended use may result in down-regulation of CB1 receptors (Leweke & Koethe, 2008), predisposing to a rebound anxious/depressive phenotype (Haller, Bakos, Szirmay, Ledent, & Freund, 2002; Haller, Varga, Ledent, & Freund, 2004).…”

Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain

“…The rapidly changing epidemiology of medical cannabis highlights the importance of research on the potential beneficial and adverse effects of cannabis use (Volkow et al, 2017). Although a long line of research has established associations between recreational cannabis use and adverse health outcomes (Wilkinson et al, 2016), the relationship between cannabis use and sleep appears to vary as a function of dose and timing of administration (Babson and Bonn-Miller, 2014; Conroy and Arnedt, 2014). Evidence indicated that cannabis has sedative and excitatory effects (Babson and Bonn-Miller, 2014), and cannabis withdrawal is associated with sleep disruptions (Bolla et al, 2010; Gates et al, 2016).…”

Prevalence and correlates of marijuana use among HIV-seropositive and seronegative men in the Multicenter AIDS Cohort Study (MACS), 1984–2013

“…However, nearly all of these were among adolescents. Given that most state MMLs list HIV/AIDS as a qualifying condition for medical use of marijuana (27), passage of MMLs may be associated with increased marijuana use among HIV+ individuals.…”