Legal marijuana reduces chronic pain, but increases injuries and car accidents
Overall hospital stays remain steady after colorado legalized cannabis
May 15, 2019
Science Daily/University of California - San Francisco
The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses, and car accidents, but does not significantly change health care use overall, according to a study by researchers at UC San Francisco.
In a review of more than 28 million hospital records from the two years before and after cannabis was legalized in Colorado, UCSF researchers found that Colorado hospital admissions for cannabis abuse increased after legalization, in comparison to other states. But taking the totality of all hospital admissions and time spent in hospitals into account, there was not an appreciable increase after recreational cannabis was legalized.
The study, appearing online May 15, 2019, in BMJ Open, also found fewer diagnoses of chronic pain after legalization, consistent with a 2017 National Academy of Sciences report that concluded substantial evidence exists that cannabis can reduce chronic pain.
"We need to think carefully about the potential health effects of substantially enhancing the accessibility of cannabis, as has been done now in the majority of states," said senior author Gregory Marcus, MD, MAS, a UCSF Health cardiologist and associate chief of cardiology for research in the UCSF Division of Cardiology.
"This unique transition to legalization provides an extraordinary opportunity to investigate hospitalizations among millions of individuals in the presence of enhanced access," Marcus continued. "Our findings demonstrate several potential harmful effects that are relevant for physicians and policymakers, as well as for individuals considering cannabis use."
According to the 2014 National Survey on Drug Use and Health, more than 117 million Americans, or 44.2 percent of all Americans, have used cannabis in their lifetime, and more than 22 million Americans report having used it within the past 30 days. While its use is a federal crime as a controlled substance, 28 states and the District of Columbia now allow it for treating medical conditions. Nine of those states have legalized it for recreational use.
To understand the potential shifts in health care use resulting from widespread policy changes, Marcus and his colleagues reviewed the records of more than 28 million individuals in Colorado, New York and Oklahoma from the 2010-2014 Healthcare Cost and Utilization Project, which included 16 million hospitalizations. They compared the rates of health care utilization and diagnoses in Colorado two years before and two years after recreational marijuana was legalized in December 2012 to New York, as a geographically distant and urban state, and to Oklahoma, as a geographically close and mainly rural state.
The researchers found that after legalization, Colorado experienced a 10 percent increase in motor vehicle accidents, as well as a 5 percent increase in alcohol abuse and overdoses that resulted in injury or death. At the same time, the state saw a 5 percent decrease in hospital admissions for chronic pain, Marcus said.
"There has been a dearth of rigorous research regarding the actual health effects of cannabis consumption, particularly on the level of public health," said Marcus, holder of the Endowed Professorship of Atrial Fibrillation Research in the UCSF School of Medicine. "These data demonstrate the need to caution strongly against driving while under the influence of any mind-altering substance, such as cannabis, and may suggest that efforts to combat addiction and abuse of other recreational drugs become even more important once cannabis has been legalized."
The study findings may be beneficial in guiding future decisions regarding cannabis policy, the researchers said.
"While it's convenient and often most compelling to simplistically conclude a particular public policy is 'good' or 'bad,' an honest assessment of actual effects is much more complex," Marcus said. "Those effects are very likely variable, depending on each individual's idiosyncratic needs, propensities and circumstances. Using the revenues from recreational cannabis to support this sort of research likely would be a wise investment, both financially and for overall public health."
The researchers could not explain why overall health care utilization remained essentially neutral, but said the harmful effects simply may have been diluted among the much larger number of total hospitalizations. They said it also may be that some beneficial effects, either at the individual or societal level, such as violent crime, counterbalanced the negatives.
https://www.sciencedaily.com/releases/2019/05/190515110341.htm
Legalizing marijuana and the new science of weed
March 23, 2015
Science Daily/American Chemical Society (ACS)
More than a year into Colorado's experiment legalizing marijuana, labs testing the plants are able for the first time to take stock of the drug's potency and contaminants -- and openly paint a picture of what's in today's weed. At the 249th National Meeting & Exposition of the American Chemical Society (ACS), one such lab will present trends -- and some surprises -- that its preliminary testing has revealed about the marijuana now on the market.
Three major patterns have emerged over the past few months since Andy LaFrate, Ph.D., and his lab began testing marijuana samples. Those patterns concern potency, amounts of a substance called CBD and contaminants in the products.
"As far as potency goes, it's been surprising how strong a lot of the marijuana is," LaFrate says. "We've seen potency values close to 30 percent THC, which is huge." LaFrate is the president and director of research of Charas Scientific, one of eight labs certified by Colorado to do potency testing.
THC is an abbreviation for tetrahydrocannabinol, which is the psychoactive compound in the plant. He explains that three decades ago, THC levels were well below 10 percent. Its content has tripled in some strains because producers have been cross-breeding them over the years to meet user demands for higher potency, he says.
But an unexpected consequence of this breeding has occurred, says LaFrate. Many of the samples his lab has tested have little to no cannabidiol, or CBD. CBD is a lesser known compound in marijuana that is of increasing interest to medical marijuana proponents. Researchers are investigating CBD as a treatment for schizophrenia, Huntington's disease and Alzheimer's disease. It is also being considered for anxiety and depression. But unlike THC, CBD doesn't get people high -- that's a key trait for many people who are wary of buzz-inducing drugs and for potential medical treatments for children. As for recreational users, the lack of CBD in marijuana means that many of the hundreds of strains they select from could in actuality be very similar chemically, according to LaFrate.
"There's a lot of homogeneity whether you're talking medical or retail level," he says. "One plant might have green leaves and another purple, and the absolute amount of cannabinoids might change, which relates to strength. But the ratio of THC to CBD to other cannabinoids isn't changing a whole lot." That means there might be little difference in how the varieties make you feel, even though some people claim one kind will make you mellow and another will make you alert, LaFrate explains.
As for contamination testing, although Colorado doesn't yet require it, some producers have voluntarily submitted samples to see what's in their products. LaFrate says the results have been surprising. His lab looks for both biological and chemical contaminants, such as pathogenic microbes and solvents.
"It's pretty startling just how dirty a lot of this stuff is," he says. "You'll see a marijuana bud that looks beautiful. And then we run it through a biological assay, and we see that it's covered in fungi."
The lab also finds varying levels of chemical contaminants such as butane, which is used to create marijuana extracts. Contamination isn't necessarily a cause for alarm, but it does signal a need to figure out what levels are safe.
"It's a natural product," LaFrate says. "There's going to be microbial growth on it no matter what you do. So the questions become: What's a safe threshold? And which contaminants do we need to be concerned about?"
In other words, legalizing marijuana has raised a lot of issues that still have to be hammered out. LaFrate, who has been involved with the policy side of Colorado's new marijuana market, as well as the laboratory side, says he expects regulations will continue to evolve as scientists, lawmakers and others learn more about the plant and its products.
https://www.sciencedaily.com/releases/2015/03/150323075237.htm