Thoughts on Legalization by Jon Shapiro, MD Medical Director, Physicians’ Health Programs of the Medical Society of Pennsylvania

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Thoughts on Legalization by Jon Shapiro, MD Medical Director, Physicians’ Health Programs of the Medical Society of Pennsylvania

Our recent trip to the PHP [Federation of State Physician Health Programs] conference in Denver highlighted some of the controversy surrounding the recent legalization of marijuana. It has raised several complex issues.

I endorse the American Society of Addiction Medicine policy on medical marijuana. Marijuana is not a standardized product. It has not been adequately studied as a treatment for the many indications for which it is recommended. Also smoking is an unhealthful delivery system. In states with medical marijuana physicians do not prescribe it in a specific fashion but rather give the patients a certificate which allows them to use any dose they choose.

There is some consensus in the medical field that marijuana is not good for growing brains. Studies have suggested stunted intellect and emotional growth in young people who use large amounts of marijuana on a regular basis. The use of cannabis similar to the use of alcohol should be restricted to adults.

The safe operation of motor vehicles is extremely important. Mothers Against Drunk Driving has been an exceptionally influential and informative group-no doubt saving countless lives on our highways. The correlation between blood THC level (the active chemical fraction of marijuana) and performance is quite complex. It is difficult to set a safe level of THC for driving or other critical functions.

In the addiction field we frequently refer to the common final chemical nature pathway of a variety of substances in the brain. People in recovery are advised to avoid all mood altering substances including marijuana to avoid triggering urges and relapse.

Never forget the law of unintended consequences. Colorado is reporting an increase in THC poisoning. The new marijuana is much stronger than the classic weed of the 70’s so adults are showing up in emergency rooms with anxiety and other symptoms of overdose. There is also concern that candy and pastries laced with THC could be eaten accidentally by children.

Research with airline pilots has demonstrated that marijuana can reduce performance. Importantly test pilots were unaware of their own temporary impairment. Until safe levels of marijuana usage are determined its use must be prohibited in people in critical positions. A zero tolerance policy should be advocated for transportation workers and health care workers.

What is at issue for us here is not the public policy of legalization of marijuana but rather maintenance of public safety. Marijuana use should be disallowed for young people, for recovering addicts and for those in whom we entrust our lives.