In November 2018, Missouri voters approved a constitutional amendment legalizing the use of marijuana for medical purposes. The state of Missouri is now implementing a process to make medical marijuana available to residents.

The Kansas City Medical Society recognizes the growing support for marijuana legalization and the individual stories of those who have benefited from medical marijuana. However, physicians have four areas of concern related to protecting the safety of our patients. These are:

1. Lack of research on the effects of marijuana;
2. Marijuana is not administered with the evidence-based protocols used for prescription medicines;
3. The impact of marijuana availability on youth; and
4. Effects on public safety.

Medical Marijuana Information Briefing

Updated June 2019

In November 2018, Missouri voters approved a constitutional amendment legalizing the use of marijuana for medical purposes.

While physicians recognize the growing support for marijuana legalization and the individual stories of those who have benefited from medical marijuana, members of the Kansas City Medical Society have four areas of concern. These are related to protecting the safety of our patients. Our concerns are 1) lack of research on the effects of marijuana; 2) marijuana is not administered with the evidence-based protocols used for prescription medicines; 3) the impact of marijuana availability on youth; and 4) effects on public safety.

Currently, 33 states allow medical marijuana and 10 states allow recreational use. Map of states and marijuana status.

1. Lack of research on the effects of marijuana

Before being introduced to the public, new medications and treatments in the United States undergo vigorous research and testing under recognized standards. Commonly prescribed medications, as well as treatment procedures for diseases and conditions, all have a strong evidence base in which the appropriate conditions and administration of the medication or procedure are well documented. By comparison, there is little known about the effects of marijuana and how to administer it for medicinal purposes.

In January 2017, the National Academies of Sciences, Engineering and Medicine released a comprehensive review of current knowledge of the health effects of the use of cannabis and cannabis-related compounds, both synthetic and natural (cannabinoids). A task force examined more than 10,000 scientific abstracts.¹

The review found conclusive evidence of modest therapeutic effect of cannabinoids on three conditions: in the treatment of chronic pain, most often neuropathy; in reducing muscle spasms related to multiple sclerosis; and in treating chemotherapy-induced nausea and vomiting. Available prescription medications may perform just as well or better, the study noted. In addition, a limitation of these studies is that they were conducted outside of the United States or not using the form of cannabis available commercially in the U.S. “Very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States,” the report said.¹

Insufficient evidence was found to support any therapeutic effects of cannabis and cannabinoids on many other conditions such as glaucoma, cancer, irritable bowel syndrome, anorexia, Tourette syndrome, amyotrophic lateral sclerosis, Huntington’s disease, Parkinson’s disease, dystonia, dementia and more.¹

Their overall conclusion: “Despite increased cannabis use and a changing state-level policy landscape, conclusive evidence regarding the short- and long-term health effects—both harms and benefits—of cannabis use remains elusive.”¹

The National Academies report recommends the nation address current research gaps, highlighting the need for a national cannabis research agenda that includes clinical and observational research, health policy and health economics research, and public health and public safety research.¹

2. Marijuana is not medicine

When a physician prescribes a medication for blood pressure or diabetes, the selection of the drug is based on years of study and evidence of its effectiveness for the condition. In addition, the drug manufacturer provides specific guidelines for the size of the dose, frequency, etc. These may vary by the patient’s age, weight, etc.—again, based on years of research and testing. Drugs are approved by the Food & Drug Administration which also supervises their manufacture. If there are safety issues, the FDA can issue a recall. Drugs are dispensed by a pharmacist. No such standards exist for marijuana.

Where cannabis is legalized for medicinal use, physicians can only “certify” or “recommend a qualifying patient” for the medical use of cannabis. Physicians cannot prescribe cannabis for medical purposes because it is illegal under federal law. Cannabis is classified as a Schedule I controlled substance.² The physician’s supervision of a patient using medical cannabis is no more specific than a recommendation to exercise or take vitamins.

3. Effect on youth

Data shows that marijuana use among young people is higher in states where it is legal for medical or recreational use. In non-medical marijuana states, an average of 6.19% of youth ages 12-17 report using marijuana in the last 30 days. This compares to 8.25% in medical marijuana states and 10.09% in recreational marijuana states.³ In Colorado, youth usage in the past 30 days grew from 7.6% in 2006 to 10.5% in 2012 as legal medical marijuana expanded but before full recreational usage began in 2013.³

For young people, marijuana use can have permanent impact on the developing brain. Research suggests that the effects on attention, memory, and learning can be long-term and even permanent in people who begin using marijuana regularly as teens. Marijuana use has been linked to a range of mental health problems in teens such as depression or anxiety. Research shows that about 1 in 6 teens who repeatedly use marijuana can become addicted.⁴ Evidence also suggests that cannabis use in adolescence and early adulthood is associated with poor social outcomes, including unemployment, lower income, and lower levels of life and relationship satisfaction.²

Another concern for children and youth is accidental exposure to marijuana. In Colorado, the average annual number of marijuana-related calls to the poison and drug control center concerning youth age 18 and under grew from 24 to 40 between 2006-2008 and 2009-2012 when medical use of cannabis was expanded.³

4. Public safety

Impaired driving under the influence of marijuana has increased significantly in Colorado after medical marijuana legalization was expanded in 2008. Marijuana-related traffic deaths when a driver tested positive for marijuana grew from 33 deaths in 2006 to 65 deaths in 2012, to 125 in 2016 after full legalization. These deaths represented 6.2% of all traffic fatalities in 2006 compared to 13.8% in 2012.³ Compared to alcohol, it is more difficult to measure the level of intoxication related to the amount of marijuana consumed.

Hospital emergency departments nationally treated some 455,000 cases of marijuana intoxication in 2011, according to the Drug Abuse Warning Network.⁵ The yearly rate of marijuana-related hospitalizations in Colorado increased from 810 per 100,000 hospitalizations in 2006 to 1,417 in 2012, a 75% increase.³ Another study showed that marijuana-related hospitalizations in California were 6.8% higher among individuals living within one square mile of a dispensary.⁶

References



1. National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: The National Academies Press.
2. American Medical Association Council on Scientific Affairs Report: Clinical Implications and Policy Considerations of Cannabis Use, May 2017. https://www.ama-assn.org/sites/default/files/media-browser/public/hod/i17-csaph05.pdf
3. Rocky Mountain High Intensity Drug Trafficking Area. The Legalization of Marijuana in Colorado: The Impact, Vol. 5. October 2017. http://www.rmhidta.org/html/FINAL%202017%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Impact.pdf
4. Centers for Disease Control and Prevention website, Gateway to Health Communication & Social Marketing Practice. https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/marijuana-teens.html
5. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. https://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.htm
6. Mair C, Freisthler B, Ponicki W, et al. The impacts of marijuana dispensary density and neighborhood ecology on marijuana abuse and dependence. Drug and Alcohol Dependence.