Doctors

In 2016 surveys, just 9% of medical schools had documented content on medical marijuana in the Association of American Medical Colleges Curriculum Inventory, and 85% of 258 surveyed residents and fellows reported having no education about medical marijuana in medical school or residency. Presented at a 2017 meeting, a single-site study of 51 resident physicians found that 76% did not know which category marijuana belonged to under the Controlled Substances Act (marijuana is currently categorized as a Schedule I drug, signifying a high potential for abuse and no accepted medical uses), and 38% believed that medical marijuana was a prescription drug approved by the US Food and Drug Administration. Other studies indicate that practicing physicians often have limited knowledge about marijuana’s health effects and want more training.”
That more than a third of the doctors surveyed in the small sample cited by Dr. Morris believed that marijuana is FDA-approved is shocking. I submitted a comment that was immediately published by JAMA. 
 

1. Legalizing cannabis has been shown to increase the rates of motor vehicle accidents.
2. Cannabis use is a risk factor for mental illness.
3. Inhaled Cannabis use is a risk factor for respiratory infections.
4. Cannabis use increases the rate of vascular disease. Cannabis is the third most often identified drug of abuse
5. Cannabis use during pregnancy has been associated with increased risk of adverse birth outcomes
6. Legalization of cannabis has been shown to increase cannabis exposure in the pediatric population.
7. Heavy cannabis use is associated with diminished lifetime achievements.
Doctors must educate the public about the potential harm cannabis causes with heavy, and possibly moderate, widespread use just as they do about the dangers of tobacco use. Tobacco use has declined in the United States in large part because of the knowledge the public now holds about its adverse effects, as opposed to legislative action.

We should approach mass marijuana production and distribution as we would any other large-scale public health problem. We should do what we can to limit exposure, and we should provide clear, unbiased education. In the case of prevention efforts being unsuccessful, we need to provide immediate treatment and assistance in stopping use. If we are going to use this as a medication, then we should use it as we use other medications. It should have to undergo the same scrutiny, Food and Drug Administration approval, and regulation that any other medication does. Why are we allowing a pass on a medication that very likely would carry with it a black-box warning?

“While marijuana can cause anxiety and paranoia, addiction, decreased cognition, behavioural problems and impaired driving,” doctors said, Trudeau’s promise to legalize it means all they can do is try to persuade him to anticipate future health costs, introduce measures to protect public safety, and ensure there is appropriate surveillance of consequences.

Studies show that children exposed to marijuana in utero have lower scores on tests of visual problem-solving, visual and motor coordination, and visual analysis, compared with children not exposed to the drug, the report states. Prenatal marijuana exposure also has been associated with decreased attention span and behavioral problems. The nervous system of a human fetus can respond to the chemicals in marijuana within 14 weeks of gestation, and studies have shown that 14-year-olds are more likely to be marijuana users if their mothers used the drug during pregnancy.

Because regulatory standards of the production process vary by state, the composition, purity, and concentration of the active constituents of marijuana are also likely to vary. This is especially problematic because unlike most other prescription medications that are single active compounds, marijuana contains more than 100 cannabinoids, terpenoids, and flavonoids that produce individual, interactive, and entourage effects.

No other prescription medication is smoked; concerns remain about the long-term risks of respiratory problems associated with smoking marijuana, which are a subject of active investigation.
5 THCis already available in a pill approved by the FDA, yet this form seems to be less desirable to those seeking medical marijuana; this may in part be because its euphoric effects are not immediate and cannot be reliably controlled, unlike smoked marijuana. 6

The current system of dispensing marijuana does not safeguard adequately against the potential for diversion and abuse.