Medical Cannabis FAQs
The information presented in this website should not be misunderstood as a promise of healing or as a suggestion to try therapy with cannabis, but is merely for your information to stimulate medical and scientific conversation. We hope to provide you with a serious introduction to the complex topic of cannabinoid therapy on the basis of scientifically sound sources, but do not claim our info to be complete and recommend a deeper self-study. Warning: some of the content on this page is more scientific in nature. It may be a little more challenging to understand, but the information included here provides a deeper look into the risks and benefits of using cannabis. I leave it published as a reference, and resource for people who desire a deeper understanding and are able to muddle through it.
Background
"Cannabis" refers to a variety of plants. Medical cannabis refers to specific chemicals obtained from a cannabis plant that may be medically helpful for some patients. The primary ingredients in medical cannabis that will be contained in products approved for use in Utah are THC (tetrahydrocannabinol) and CBD (cannabidiol). A 2017 cross-sectional study with 2774 cannabis consumers that was published in the Journal of Pain Research revealed that 46% of those surveyed used cannabis as a replacement for prescription drugs. While these figures only illustrate self-reported data, certain tendencies are observable: the most frequently substituted classes of drugs were narcotics/opiates (35.8%), anxiolytics/benzodiazepines (13.6%) and antidepressants (12.7%).
Abuse Potential
A study published in 2007 by Nutt et al. in Lancet shows that the abuse potential of cannabis is far lower than that of illegal narcotic drugs like heroin or cocaine, but also of many prescription drugs like buprenorphines, benzodiazepines and barbiturates and legally available luxury goods like alcohol or tobacco. In 2018 the World Health Organization (WHO) re-rated the risk of using cannabis, designating it ”relatively safe drug“ which – other than heroin, cocaine or even legal substances like alcohol, nicotine and various pharmaceuticals – has never led to overdose-related deaths. At most, potential side effects such as an impaired short-term memory, motor coordination and potential risks for the cognitive development of adolescents need to be considered. In contrast, the use of synthetic cannabinoids, so called ”legal highs“ (Spice, Bath Salts), recently led to the death of several teens.
Side Effects
Cannabis extracts, flowers or prescription medications like Dronabinol, Nabilon, that are rich in THC show a comparable range of side effects that mainly result from CB1 receptor activation. These acute side effects mostly effect the mind and coordination, as well as the heart and circulation (rapid heart beat, drop in blood pressure, dizziness, feinting). These effects usually vanish after a short acclimatization phase. Above an individual dosage threshold, effects on thoughts, mood, perception and behavior are common. These are usually considered pleasant and relaxing. However, for some, these effects can also turn into unhappy feelings, anxiety and panic. Because of these latter effects, cannabis and cannabis medication are not recommended for people who have severe personality disorders and who have a higher risk for psychoses. This may indicate a so-called ”challenging psychedelic experience“ (due to its effect on the serotonergic system cannabis might act as a weak psychedelic), that is characterized by anxiety, feeling of loneliness and captivity, disorientation in terms of time and space, confusion and the fear of losing control. Psychedelic states can potentially bring up trauma and fear from the subconscious to the waking consciousness. Other known side effects are dryness of the mouth, increased appetite, decreased formation of tears and reddening of the eyes, altered perception of time and senses, disruptions in orientation and balance, and muscle relaxation.
Developing a psychological addiction with moderate doses is unlikely. However, the long term use of THC-containing products and medications usually leads to the development of tolerance (strictly speaking, to a mild physical ”addiction“). Tolerance leads to the vanishing of unwanted side effects like fatigue, dizziness, cardiovascular and psychological effects after some time. A sudden discontinuation of use can temporarily lead to mild withdrawal symptoms (like insomnia, irritability, increased sweating. However, despite of the relatively low abuse potential, permanent and heavy use of cannabis (especially during adolescence) can lead to psychological and behavioral disorders (e.g. psychological addiction, psychotic episodes).
Common Side Effects. The most common side effects of using medical cannabis products are dizziness, fatigue, dry mouth, lightheadedness, drowsiness, and nausea. Side effects are usually mild to moderate in severity and last only a few hours, but sometimes severe side effects occur. A person’s response to medical cannabis can depend on many things, such as the amount of THC and/or CBD in the product and other medications the person is taking. You should not take medical cannabis with other medications and/or substances that may cause drowsiness. Substances that may cause drowsiness include alcohol, sleep medicines, and antihistamines. If you have questions about side effects, contact a pharmacist at the medical cannabis pharmacy where you purchased the product, your recommending healthcare provider, or the Utah Poison Control Center at 1-800-222-1222.
Many physicians and patients worry that medical cannabis may trigger drug-induced psychosis or schizophrenia. Cannabis-induced psychosis, which symptomatically is similar to psychotic episodes of paranoid schizophrenia, at least shows a more favorable prognosis compared to other drug-related psychoses (also alcohol). It is no news that regular use of cannabis correlates with schizophrenic diseases, especially when already used during puberty. However, it is less well-known that this connection is not causal but only correlative. Psychologic disorders like schizophrenia are triggered by various acute and chronic stressors (e.g. social, psychological, biological) along with an increased “susceptibility” (due to genetic, cognitive and also external factors). In contrast to THC cannabidiol (CBD) from the cannabis plant shows antipsychotic properties along with a more favorable profile in terms of side-effects than conventional neuroleptic drugs.
The brains of schizophrenic patients show histo-architectural abnormalities, for example qualitative as well as quantitative alterations primarily in the temporal lobes, frontal lobes and ventricles. It is very unlikely that these kind of alterations are caused by the use of cannabis, which is known to merely modulate neurotransmission. Due to several identified gene mutations that correlate with schizophrenia and also relationship studies showing that susceptibility to schizophrenia is hereditary, a scenario of a fundamentally defective neuronal development or psychosocial factors is more likely for the etiology of the disease.
A study published in 2018 even compared maternal and paternal cannabis use during pregnancy in order to investigate the causal effects of intra-uterine cannabis exposure during fetal neurological development. Interestingly, for the increased risk of psychotic episodes in the progeny it made no difference whether it was mother or father who consumed cannabis during pregnancy. This argues against a causal relationship of cannabis use.
Neuroleptics (reduce emotions and psychomotor activity) primarily act on dopamine metabolism. Since dopaminergic neurotransmission strongly influences motor control, here the most severe side-effects can be observed (leading to symptoms similar to Parkinson´s disease). Other neuroleptics often lead to a strong increase in body weight and diabetes mellitus. These side-effects can be so grave that affected individuals often discontinue their treatment. Hence, scientists keep searching for modern pharmaceuticals with fewer side-effects.
Cannabidiol (CBD) is a naturally occurring component of the cannabis plant that – in contrast to THC – exhibits antipsychotic effects and counteracts the intoxicating effect of THC. Current scientific and clinical studies emphasize CBD´s potential for the treatment of a large number of diseases and disorders, inter alia, that of schizophrenia. In clinical studies an improved profile in terms of side-effects was demonstrated for CBD along with a stable antipsychotic effect (no gain of body weight, no prolactin increase, no movement dysfunctions).
Start Low, Go Slow. Every patient reacts differently to the chemicals in cannabis, specifically THC and/or CBD, so it is best to start with a low amount of cannabis and then increase the amount slowly over time until symptoms are relieved or side effects develop.
Tell your healthcare providers about the medical cannabis product(s) you are using because cannabis may interfere with other drugs you are taking. Your healthcare providers may need to conduct blood tests or adjust the amounts of other medications you are taking. It is especially important to tell all of your healthcare providers when you are going to receive anesthesia or major sedation in an office or operating room. Cannabis use can increase the amounts of the medications you may need for sedation or anesthesia.
Medical Cannabis and Other Medications
Do not take cannabis if you are taking Cilostazol (Pletal), Clopidogrel (Plavix), Clobazam (Onfi or Sympazan), or Citalopram (Celexa). Several other medications will require careful monitoring by your recommending healthcare provider; Warfarin (Coumadin) is one such medication. Be sure to talk to Dr. Walker about other medications you are taking.
Risk of Impairment when Driving and Operating Machinery
Using medical cannabis can affect perception, reaction time, motor skills, and attention in ways that make it dangerous to drive or operate machinery. The length and severity of this kind of impairment changes from patient to patient and depends on multiple factors. Impairment is more common when taking medical cannabis products with higher THC content. Drinking alcohol while taking medical cannabis worsens the impairment.
Risk of Dependence and Addiction
Using medical cannabis could lead to cannabis dependence. The risk of developing a cannabis-use problem is higher with products that are higher in THC content, and for people who already have a substance use disorder or have had one in the past. Medical cannabis should be used with caution and with input from your healthcare provider, especially if you have a substance use disorder. Among heavy, regular users of cannabis products (whether or not they are medical), stopping use abruptly can lead to withdrawal symptoms. The risk of withdrawal symptoms for medical cannabis products varies by product content (THC and/or CBD) and amount.
Risk of Excessive Vomiting
In rare instances, cannabis use can carry the risk of excessive, severe vomiting, daily nausea, and abdominal pain that repeats in one to three week cycle. If you experience these symptoms, you should stop using the cannabis product and contact your healthcare provider.
Risk for Use by Persons with Heart or Liver Disease
Use medical cannabis with caution if you have heart or liver disease. Cannabis use could cause a heart attack in patients known to have heart disease. Cannabis use increases heart rate and lowers blood pressure. This can result in harmful effects in patients with heart disease. Liver disease could cause problems with how the body uses and processes cannabis, affecting the safety and potency of medical cannabis.
Risk for Use by Individuals Younger than Age 22
People under the age of 22 may have a higher risk of harm from cannabis use. There is evidence that cannabis use during the active period of brain development can lead to permanent brain damage. There is also an association between use of cannabis in this age group and developing mental illnesses, such as schizophrenia. The younger a person is when they start using cannabis, the more likely they are to develop a cannabis use disorder.
Risk for Use by Women Who are Pregnant or Breastfeeding
Women who are pregnant, are planning to get pregnant, or are breastfeeding should talk to a healthcare provider before using cannabis. There is evidence that using cannabis while pregnant can cause harm to the developing baby, such as low birth weight, premature birth, and/or brain damage (as noted above). Cannabis use by a mother while breastfeeding can transfer the chemicals in cannabis to the infant through the breast milk, and could cause harm to the infant.
Risk of Mental Illness
Cannabis use may be associated with severe periods of mental illness (psychotic episodes) and frequent, recurring periods of mental illness (psychotic disease). This risk appears to be higher with cannabis products that have higher amounts of THC and lower amounts of CBD. There is evidence that cannabis use adds to the risk of developing psychotic disorders such as schizophrenia – especially in people who also have other risk factors. A family history of schizophrenia or other psychotic disorders can put you at higher risk. For that reason, cannabis should not be used or should be used with great caution in patients with a family history of psychotic disorders such as schizophrenia.
Keep Medications Secure and in Their Original Containers
Medical cannabis products may look similar to common household products, as well as other medications, making it easy to accidentally consume a medical cannabis product. When medications are not in their original containers, it is easier to mix up the identity of a medication. As with any medication, medical cannabis should be kept in a secure place where others, especially children, cannot access it. Please remember that edible cannabis products that are designed to look like other food items, such as cookies or brownies, are not allowed under Utah law. If you have concerns about a child or adult who accidentally consumed cannabis in any form, call the Utah Poison Control Center at 1-800- 222-1222.
Use Medical Cannabis Legally
Under Utah law, medical cannabis may only be used in a legal form. Smoking or burning cannabis products for inhalation is not a legal form. However, a medical cannabis cardholder can warm their medical cannabis into a vapor for inhalation without the use of a flame (vaping). Please remember that the Utah Indoor Clean Air Act prohibits vaping in all indoor places of public access, publicly owned buildings, offices, and many publicly accessible outdoor areas. The only exception to vaping medical cannabis in these prohibited indoor places and outdoor areas is to treat a serious medical emergency.
Do Not Sell, Resell, or Gift Medical Cannabis In Utah, sharing medical cannabis is a crime, and can result in criminal charges, civil monetary penalties, or expulsion from the Utah Medical Cannabis Program. Under Utah law, it is illegal for a medical cannabis cardholder to sell or gift cannabis products, cannabis devices, or cannabis residue to another person.
Disclaimer for Marijuana Use
Medical marijuana use is legal in Utah with a certification and when purchasing from a certified Utah pharmacy.
Marijuana is federally classified as a Schedule I drug. This means that cannabis users are NOT protected federally under states laws. Employers can terminate employment for having THC in their blood or urine upon drug testing, even if you have a state approved medical marijuana card or if using cannabis has no effect on their job performance. Rightful termination may depend on whether the employment contract contains a provision with the requirement of following all federal laws and refraining from using illegal drugs.
There are restrictions on medical cannabis use and carrying firearms. Check with the Utah state at:
https://medicalcannabis.utah.gov or with an attorney to determine how the laws affect you.
Utah has a unique law called DRIVING WITH A MEASURABLE CONTROLLED SUBSTANCES (DMCS). Six other states have a similar law. Under this law, Utah Code section 41-6a-517, “a person may not operate or be in actual physical control of a motor vehicle within this state if the person has any measurable controlled substance or metabolite of a controlled substance in the person’s body.” If an officer stops you and believes he/she has reasonable grounds to arrest you, the officer will usually “request” that you take a chemical test of your breath or blood under Utah’s Implied Consent statute. If you don’t take the chemical test under the Implied Consent statute, you can lose your Utah Driving Privilege for 18 months, even if you are not impaired.
Field Sobriety Tests
There are lots of reasons a cop might ask you to take a field sobriety test. It might be because you admitted to using marijuana at some point. It might be because they smell, or have already found, marijuana in your car. It might be because they have noticed “signs of drug use or impairment,” such as “droopy eyes,” “blood-shot eyes,” “dilated pupils,” “slow speech,” “lack of coordination,” “blistered tongue,” or “green tongue.” There are also many reasons for a cop to think he/she has justification to search your vehicle. For example, they can pat-down your body and the “reachable” area of the car if they have a reasonable suspicion that you’re armed and dangerous. Or they can arrest you for the traffic infraction and search your car during an “inventory” search.
The DMCS statute criminalizes driving a vehicle with any traces of illegal drugs in the body even if the driver is not impaired. This means people who legally smoke marijuana, in states like Colorado or Washington, and later drive a vehicle in Utah can be arrested for having traces of the marijuana in their system. In fact, marijuana can be detected in the blood for weeks after use.
CONSEQUENCES OF DRIVING & MARIJUANA USE
The consequences of being charged under the DMCS are similar to those of an alcohol DUI. A person convicted of driving with a measurable controlled substance may be required to serve jail time, perform community service, or other penalties. The officer does not have to prove the driver was impaired by marijuana to meet the legal requirements to convict someone under DMCS law. All they have to do is expose traces of illegal drugs in the driver’s system. If ever asked about drug use by an officer during a traffic stop, take caution, invoke your right to remain silent and advise the officer politely that you do not wish to answer any questions without first speaking to an attorney. If you have already experienced such an arrest or citation, contact a qualified criminal defense attorney immediately.
Mignon Walker, MD is not liable for any and all legal, medical, or side effects complaints or issues that certified patients may have while using marijuana.
