The Legalization of Cannabis: Health and Social Implications ...

The Legalization of Cannabis: Health and Social Implications ...

The Legalization of Cannabis: Health and Social Implications of Marijuana Use By: Phyliss Nicole Taylor, MD Medical Director, Assistant Professor UF Health Psychiatry Financial Disclosures None Objectives

1. Understand what Amendment 2 means for FL physicians and patients. 2. Explain the medical benefits and health risks of cannabis use. 3. Explore how legalization of cannabis in other areas have affected the society. Compassionate Medical Cannabis Act of 2014 Allowed for access to non-smoked, low-THC marijuana for qualified patients 1. cancer

2. chronic seizures 3. severe, persistent muscle spasms Low THC = 0.8% or less tetrahydrocannabinol and more than 10% of cannabidiol Provision for terminally ill patients to use any type of medical cannabis - Diagnosis must be confirmed by a 2nd doctor of appropriate specialty Compassionate Medical Cannabis Act of 2016: What does Amendment 2 do? Expands what medical conditions are considered treatable with medical marijuana

Adds ID card requirement for patients and caregivers Before dispensing medical cannabis, dispensary must check the patients ID card and the compassionate use registry Clarifies requirements for parental consent for the use of medical marijuana by minors What specific diseases are treatable with medical marijuana?

Cancer Epilepsy Glaucoma HIV/AIDS Multiple Sclerosis Amyotrophic Lateral Sclerosis (ALS) Crohn's disease

Parkinsons Disease Post Traumatic Stress Disorder (PTSD) Requirements of FL Physicians who want to Order Medical Cannabis Active, unrestricted license (MD or DO) Complete an 8 hour class sponsored by FMA/FOMA and pass exam every 2 years; $995 Website: http://www.flcannabisce.com Obtain voluntary, written, informed consent from the patient or legal guardian Enter the order for low-THC or medical cannabis into Compassionate Use Patient

Registry Must be updated within 7 days after any change to original order May not order more than 45 day supply at a time Can order a cannabis delivery device (i.e. vaporizer) More Legal Requirements for Ordering Physicians Must have treated patient during the immediate preceding 3 months Must have conducted a physical exam and a full assessment of medical history Must determine that the medical use of marijuana benefits >> potential

health risks Must maintain a treatment plan: dose, route of administration, planned duration, and monitoring of patient symptoms and other indicators of tolerance or reaction Must be submitted quarterly or any time the plan changes to UF College of Pharmacy Potential Medical Benefits of Cannabis Use

Cancer = relief of chemotherapy induced nausea and vomiting Epilepsy = reduced seizure frequency Glaucoma = transient reduction of intraocular pressure HIV/AIDS = appetite stimulation and weight gain in wasting syndrome Multiple Sclerosis = neuropathic pain, spasticity, sleep disturbances Post Traumatic Stress Disorder = reduced hyper-arousal symptoms, flashbacks, and sleep disturbance (short term) Short Term Side Effects of Cannabis

Dizziness or lightheadedness (30%-60%) Dry mouth (10%-25%) Fatigue (5%-40%) Muscle weakness (10%-25%) Myalgia (25%)

Palpitations (20%) After repeated smoked or oral marijuana doses, tolerance is rapidly acquired (in 2-12 days) to many of its adverse effects Potential Health Risks of Cannabis Psychosis Cognitive impairment

Impaired pulmonary function Vascular conditions Psychosis Acute symptoms: depersonalization, derealization, a feeling of loss of control, fear of dying, irrational panic and paranoid ideas Chronic Psychosis Risk Factors

Young users with early exposure (15-18 years old) Pre-existing genetic vulnerability Heavier use Greater potency THC Cognitive Impairment Impaired short-term memory, making it difficult to learn and to retain info Related to age of onset of use Related to the frequency and duration of use Structural brain changes involving structures affecting

memory and emotional processing reduced volume of the hippocampus, temporal cortex, insula, and orbitofrontal cortex Impaired Pulmonary Function and Smoking Cannabis Short-term exposure: bronchodilation Long-term marijuana use: increased respiratory symptoms suggestive of obstructive lung disease Lower risk of cancer with cannabis than tobacco smoking The use of a vaporizer is associated with higher plasma THC concentrations than smoking marijuana cigarettes, little if any

carbon monoxide production, and significantly fewer triggered respiratory symptoms. Cardiovascular Conditions Dose-dependent in heart rate and blood pressure Decrease of the time until the onset of chest pain in patients with angina pectoris One study has shown that marijuana may trigger the onset of myocardial infarction Tolerance develops to the acute effects of marijuana over days to a few weeks

Patients who have CHD or significant risk factors should be cautioned about the potential hazards of marijuana use Social Implications of Cannabis Use Cannabis Dependence = 9% in overall users, 17% of those who begin use in adolescence Legalization of Cannabis sends the message that it is okay to teens Cannabis withdrawal syndrome - Irritability or dysphoria, anxiety, sleeping difficulties, decreased appetite, drug cravings

- Physical symptoms: stomach pain, shakiness/tremors, sweating, fever, chills, headache Increased Substance Abuse and Dependence of other drugs Social Implications of Cannabis Use (2) Altered judgment = risk of sexual behaviors that facilitate STDs Impaired performance in school or at work risk of injuries on the job

Impairment in driving ability 3-7 x more likely to cause motor vehicle collisions - Impairs cognitive function, reaction times, divided-attention tasks, and lane tracking. How Has Colorado Been Affected? Legalized medical marijuana (2000); recreational (2014) No increased youth marijuana usage (but state had high prelegalization rates) % Youth who described marijuana as "highly risky" after legalization, but the

% Youth who reported ever trying marijuana Higher rates of unintentional poisoning in children > 9 years old, associated with various edible products containing cannabis Increase in traffic fatalities involving drivers who tested positive for marijuana What Did Colorado Learn? Limit marijuana use to over 21 years of age Amended Colorado's Clean Indoor Air Act to extend smoking restrictions to marijuana Created surveillance systems to monitor the numbers of ED visits and hospitalizations related to marijuana use, as well as data on calls to poison-control centers

Public awareness campaign about safe storage of marijuana products Child resistant packaging and changes to the labelling Set a limit of 5 ng of 9-THC per milliliter of blood at which drivers are considered to be operating under the influence The Colorado Department of Transportation launched a public education campaign about impaired driving in 2014 How have other states be affected? One study found that states with medical marijuana laws had a 24.8% lower average annual opioid overdose death rate compared to states

without similar laws Medical cannabis laws were associated with a lower rate of overdose mortality that generally strengthened over time Washington and Colorado have seen increased tax revenues - Colorado = $129 million and Washington $220 million in 2nd year after legalization Arrests for cannabis related charges have decreased, but people of color are still 2x to be arrested despite using marijuana at similar rates to white people What Else Should Be

Considered 1. Only limited number of studies on cannabis due to its Schedule I classification. More research is needed, but until that classification changes, it is not going to be possible to study it to the extent that it needs to be. 2. No governmental standardization = constituents and potency? 3. No guidelines based on reliable evidence about dosing, frequency, duration 4. Legal liability = What is the standard of practice in your community?

Who is signed up to Order Medical Cannabis in FL? http ://www.floridahealth.gov/programs-and-services/office-of-co mpassionate-use/_documents/completed-cme.pdf The EndAny Questions?

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