The Drug Class Blog

Dec 16

Is there Moderation with Marijuana?

How Much is too Much ??  From Yahoo News

In more than half the states in the USA and soon all of Canada, marijuana has, or will be, in some form, been legalized. From New Hampshire to New Mexico, weed is permitted for medical purposes -- despite remaining a controlled substance with use prohibited under federal law. And in eight states, including Maine and California, as well as the District of Columbia, measures have been passed to make it legal to use marijuana recreationally as well.

Political acceptance of marijuana remains in flux, as experts expect that President-elect Donald Trump's choice for Attorney General, Jeff Sessions, would take aim at marijuana businesses. But whatever the blowback may be under the incoming administration, public health agencies are somewhat hamstrung in providing expert guidance on safe marijuana use -- if there is such a thing -- since the science on claimed benefits and potential harms lags behind widespread acceptance in many states where it's legal.

On alcohol consumption, the public health message is consistent: Drink in moderation, if you plan to imbibe. And doctors and other health experts advise those who smoke cigarettes or use tobacco in any form to quit to lower their risk of cancer and a host of other health issues. However, because research on marijuana has been limited, since it's a controlled substance, health advice on marijuana is cloudy. That goes for smoking weed, ingesting pot edibles or inhaling it using flash vaporization, or dabbing -- a controversial way to get a more intense high that's grown in popularity but divides even marijuana advocates.

While some say dabbing is just one more option for consuming marijuana, others fear the quick, strong hit will increase risk associated with the drug. "Public health messaging is developing and going to be evolving as more states and localities get more experience," says Dr. Lawrence Deyton, senior associate dean for clinical public health at the George Washington University School of Medicine and Health Sciences in the District of Columbia. "Just because something's legal doesn't mean it's safe," he says, adding that cigarettes are a perfect example of that. [See: What Only Your Partner Knows About Your Health.]

In the Dark About Lighting Up Even for medical use -- let alone recreational purposes -- Deyton says research is insufficient to make evidence-based clinical recommendations regarding marijuana. What's more, it's not a standardized product like over-the-counter or prescription drugs, which are regulated to ensure everything from dosage to ingredients is consistent. "If I want a patient to use marijuana to reduce nausea, I don't know how to do that. Because I don't know, is it one brownie, is it one joint, is it 1 gram? Because there's no standard," Deyton says. Different cannabis plants and the synthesized chemical tetrahydrocannabinol, or THC -- which is the main mind-altering ingredient in marijuana -- taken from those plants have different potencies as well. And though there's a push to do the research necessary to create such standardization of marijuana for medical use, it hasn't been done to date, making it difficult to make clinical recommendations based on research that, for example, finds marijuana might be helpful in reducing pain or nausea. As a result, public health experts in places where marijuana is legally available say there isn't enough information to advocate that no one use it -- as with tobacco -- or to say it's safe to consume sparingly, like alcohol. "We don't have a message of prohibition, nor do we have a message of moderation or use allowance, and quite frankly it's because we don't have the data," says Dr. Larry Wolk, executive director and chief medical officer of the Colorado Department of Public Health & Environment. Adds Deyton: "I'm a physician that is licensed in the District of Columbia, and I happen to also be licensed in California, where medical marijuana is theoretically available. So on one hand, the federal government says 'no'" to marijuana, he says, while on the other hand its use is approved by the state and locally. "So I don't know how to advise my patients because federal law has inhibited the development of standards by which [I] as a physician, or a pharmacist, can understand what the product is and how to recommend its use." [See: 11 Ways to Cope With Back Pain.] If You Plan to Use Marijuana -- for Medical Reasons or Recreation ... Even the dearth of clear guidance on marijuana use serves as its own sort of caution to anyone considering using it for medical or recreational purposes -- neither of which public health officials explicitly endorse.

Here's what else experts advise: Talk to your doctor. If you use marijuana or plan to do so for medical or recreational purposes, let your health provider know, even if you'd prefer not to divulge this information. Experts say it's important to discuss risks, such as the potential for addiction, psychoactive effects including hallucinations from long-term use and harmful interactions between marijuana and certain medications. Keep out of reach of children. In some cases, where marijuana is legal and more widely available, there's been an increase in poison control calls related to accidental ingestion by children. While accidental poisonings from medicines and alcohol are still more common, experts say it's imperative that marijuana be kept locked away and out of reach of children.

Reflecting alcohol laws, state measures making marijuana available for recreational use do so for individuals 21 and up. Health experts emphasize the importance of holding that line with children and adolescents who wish to partake. "Marijuana can affect the developing brain," says Kristen Haley, media and priority populations consultant in the marijuana prevention and education program at the Washington State Department of Health. Though it's not clear how, or what the long-term consequences are, Haley notes that the adolescent brain is still developing -- and typically continues to develop into a person's 20s -- and that children and adolescents are also much more likely to become addicted to pot, compared with adults. If you're pregnant or breast-feeding, take a break from pot. Health experts say women who are pregnant or breast-feeding shouldn't use marijuana. Wolk adds that women who are unable to quit should discontinue breast-feeding. "Knowing what we know about THC and its affinity for fat and fat cells, and that breast-milk is fat-rich, and a baby's brain is kind of a fat gobbler, we don't want that developing brain to get too much exposure to THC," he says. However, some health experts assert that given the proven benefits of breast-feeding, and the limitations about what's known regarding the effect of marijuana in breast-milk, women who occasionally smoke weed should continue breast-feeding. Even so, clinicians roundly emphasize that not using marijuana during this period is the safest, most prudent course of action. [See: 10 Things No One Tells You About Breast-feeding.] Don't drive high. It might seem to go without saying, but despite driving-under-the-influence laws that take into account marijuana levels in the blood, there's no uniform understanding of how much may impair a person's driving. As such, health experts say always make plans not to get behind the wheel if you've used: "Don't drive, period," Wolk emphasizes. The bottom line -- with so much still up in the air -- isn't to treat the unknowns like a green light for the green stuff. But rather, exercise caution going forward, experts advise, if you plan to use marijuana for a medical reason or recreation.

Michael Schroeder is a health editor at U.S. News. He covers a wide array of topics ranging from cancer to depression and prevention to overtreatment. He's been reporting on health since 2005. You can follow him on Twitter or email him at [email protected]

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