Bailey Deitch

Deitch 1
Professor Doran
ENC 2135
1 November 2016
Should Medical Marijuana Be Legalized in America?
Definitions
Acute pain- short-term pain
Adverse Effects (AE)-undesired reactions to medicine
Botanical marijuana-the natural marijuana plant
Cannabidiol (CBD)- active ingredient in marijuana plant does not have psychotropic properties
Cannabinoids- chemical compounds derived from marijuana, extracted naturally from the plant,
gained by isomerization of cannabidiol (CBD), or synthetically produced that are believed to be
the healing component of marijuana, also includes THC.
Cannabinoid system- a newly discovered system within the body that is made up of receptors
that react with THC and CBD that doctors can also manipulate with drugs to alter effects of
drugs.
Cannabis- the botanical marijuana plant
Chronic pain- Long-term pain
CINV-Chemo-induced nausea and vomiting
Drug-Free Action Alliance (DFAA)- Drug-Free Action and Alcohol and Drug Abuse Prevention
Association of Ohio
FDA-Food and Drug Administration
HIV/AIDS- Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Medical cannabis (MC)- the use of the marijuana plant or natural or synthetic cannabinoids as
medical therapy to treat disease or alleviate symptoms

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MML-Medical Marijuana Legalization
MS- Multiple Sclerosis
Neuropathic pain- Chronic pain usually comes from a tissue injury.
Prescribed cannabinoids- Legal FDA-approved drugs made from synthetically produced
cannabis, exxamples: dronabinol capsules, nabilone capsules, oromucosal
RTC-Randomized Controlled trials
Spasticity-Altered muscle performance accompanied by paralysis
THC-Active ingredient found in marijuana plant that has psychotropic effects, ie hallucinations
OTC- Over-the-counter

Thesis
The landscape of America is changing right before our eyes. In the article, Medical
Marijuana: A Treatment Worth Trying, Julius Metts, Steven Wright, Jawahar Sundaram, and
Nastran Hashemi report that nearly half of America, including twenty-three states and
Washington, DC has legalized medical cannabis (178). Factors that have contributed to this
phenomenon include the changing attitudes of the American public. In the article, The Effects
of Medical Marijuana Laws On Illegal Marijuana Use, Yu-Wei Luke Chu adds that a decreased
perception of risk has changed the opinion of marijuana and will likely influence this years
election on November 8, 2016 (44). Several states, including Florida will be voting, many for the
first time, on whether or not to legalize medical cannabis. Based on an extensive review of
research, medical cannabis should not be legalized nationally until further research can be
conducted to determine the effectiveness of medical marijuana in treating specific disease states,

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controlling all risks and dangers to patients. The needed clinical trials would require limited
legalization of marijuana for the sole purpose of research.

Introduction
According to an article written for the Journal of Family Practice Medicine, marijuana
has been smoked, drank, eaten and burned for thousands of years (Metts et al. 179). Likewise, a
researcher by the name of Michael Bostwick claims in the article, Blurred Boundaries: The
Therapeutics and Politics of Medical Marijuana that surprisingly, citizens used cannabis as
medicine and to make rope as far back as ancient Rome (173). Additionally, he adds, medieval
Europeans ate marijuana seeds and used the fibers to make paper, and the Chinese emperor also
used it for pain over 5,000 years ago (Bostwick 173). Furthermore, since drafting the
Declaration of Independence on paper made from marijuana, it has experienced as many highs
and lows in America as the actual effects of the drugs (Bostwick 172). Confirming this
fluctuation in American consumption of marijuana in an article entitled, The Case for Medical
Marijuana, Edward Maa and Paige Figi report that marijuana was widely available in America
from the time it was placed on the U.S. Dispensary as an OTC medicine in 1854 until 1941
when access was limited and regulated following the Marijuana Tax Act, before finally being
made illegal in 1970, on the basis that it provided no medical benefit and a high risk of
addiction (784).
Marijuana is not new to the medical industry, only opinions and attitudes have changed.
Unfortunately, the change is not based on medical science. Surprisingly, the majority of
Americans support medical marijuana use today and the ballot box is showing the results. Many
argue, including the Food and Drug Administration, as reported by Karen Kaplan in the article,
Most Uses of Medical Marijuana Wouldnt Pass FDA Review that the decision to legalize

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weed has become a political phenomenon and is not based on clear-cut scientific evidence.
Consequently, physicians in several states have begun recommending marijuana for many of the
same ailments it was compounded for in the past, including: pain, nausea/vomiting, spasticity
and convulsions (Bostwick 179). These recommendations come as laws are passed to legalize
the drug for specific disease states, due to citizens voting in favor of MML. Physicians may or
may not agree with the treatment, but because the drug is approved for medical use and the
patients demand it, they write the recommendations based on the state law. In support of this, an
article entitled Medical Marijuana for Pain: What the Evidence Shows, author, Steven King
reports that doctors ignore the guidelines for recommending MC and eagerly write prescriptions
for what patients want in states with MML (8). More importantly, evidence to determine
whether or not the treatment they are receiving actually works is unavailable, despite being
approved for that diagnosis. According to Metts, Wright, Sundaram and Hashemi double blind
studies to evaluate the safety and efficacy of cannabis hardly exist because it has been illegal to
obtain the drug needed to conduct clinical trials due to the federal Schedule I Controlled
Substance classification of the drug (180). As a result, the synthetically produced and FDA
approved cannabinoids have substituted smoked marijuana in recent studies because they are
legally available and doctors can prescribe them, unlike the recommendations that physicians are
only allowed to give in MML states (Bostwick 181). An online article entitled, The FDAs
Opposition to Medical Marijuana Legalization Is Based On Science created by The Drug-Free
Action Alliance and Alcohol and Drug Abuse Prevention Association of Ohio (DFAA) claims
that greater marijuana support than ever has not ceased the debate among researchers as to
whether or not it is safe and effective, or changed the mind of the FDA ( ).
Medical Marijuana and Pain

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Every state with a medical marijuana law includes pain as one of the diagnoses that MC
is approved for treating. In fact, the majority of current and available studies attempt to evaluate
the effectiveness of treating chronic pain with medical marijuana. However, most of these studies
have significant inconsistencies and inaccuracies involving the statistical significance, and the
reliability and/or validity issues, suggesting the need for additional clinical trials. According to
the article, Cannabinoids for Medical Use: A Systematic Review and Meta-Analysis by Penny
Whiting, Robert F. Wolff, Sohan Deshpande, Marcello Di Nisio, and Steven Duffy published in
the Journal of the American Medical Association, a a review of 28 studies were examined for
the effect MC had on alleviating chronic pain and reported a 30% reduction in medical marijuana
patients when compared to the placebo (2460). It is important to note that only one study
showed smoked THC as having the greatest benefit, and that study was biased and did not reach
statistical significance and the decrease in pain was self-reported (2467). Similarly, another
article entitled Medical Marijuana for Pain: What the Evidence Shows, written by Steven A.
King for Psychiatric Times reported that four out of five patients experienced a decrease in pain
with cannabinoids when compared to a placebo but a difference in cannabinoids was not noted,
making it impossible to determine of smoke MC improved pain level at all (5). Ironically, most
patients prefer, and receive smoked cannabis for medical treatment and the majority of available
studies have evaluated the effects of synthetic or FDA approved, medical marijuana, most often
in the form of pills or spray. In fact, the newly MML states all offer smoked cannabis as a form
of therapy. The group of international experts that reviewed the above study for the effectiveness
of treating pain with MC confirmed that researchers failed to report that 70% were at risk for
bias, only 57% were appropriately blinded, and pain was measured using the Visual Analog
Scale which is deemed inappropriate for measuring the chronic pain that patients were being

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evaluated for (Whiting et al. 2460). Despite the fact that these studies were not conducted
accurately according to the authors, some patients did experience moderate quality evidence to
support medical marijuana decreases pain (Whiting et al. 2467). To some advocates this may
seem like enough proof. However, additional studies showing the same results are unavailable
and are needed to support the reliability of using marijuana to treat pain. Interestingly this study
used a technique approved only for measuring acute pain and these patients were being
evaluated for chronic pain which skews the results (Whiting et al. 2464). This must be noted
because the most important aspect of any treatment is improvement in functioning over time
and/or the reduction in other pain medications such as opioids. In this case, the pain was
measured for at that particular time. Furthermore, King points out that the patients did not
discontinue their usual pain medications (3). Lastly, it is important to note that the decrease in
pain was self-reported, suggesting the possibility that patients in support of MC reported
benefits because they knew that had received MC, due to not being blinded (King 4). Either
way, the results are indeterminate. Undeniably, it is widely known that most medical marijuana
patients report having used marijuana recreationally prior to using it medically. In fact, Bostwick
reports that in a Canadian study of HIV patients as many as 80 % were prior recreational users
(174). This may strongly influence a patients decision to adopt medical marijuana therapy. As
referenced above, it adds the question as to whether or not patients may be trying to obtain
marijuana for the reduced medicinal and insurance costs in order to use it recreationally. These
factors, along with the absence absence of strong clinical evidence to support the use of medical
marijuana for treating pain is sufficient evidence not to legalize medical marijuana across
America.

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Medical Marijuana and Multiple Sclerosis
The only other disease state that researchers found to moderately benefit from medical
marijuana was pain and spasticity associated with MS. It is important to note, however, that in
most cases smoked cannabis is not being studied. The FDA approved cannabinoids are being
used to evaluate whether or not MC is effective in treating pain and spasms. For that reason and
others, we are reminded that the American Academy of Family Physicians, the American
College of Physicians and the Institute of Medicine all call for additional research before
endorsing the controversial drug to determine or invalidate the therapeutic benefits of marijuana
for the treatment of pain and other illnesses (Metts et al. 178). Interestingly, a 70-year follow-up
study examined by the international experts found cannabinoids, including smoked cannabis
extract to decrease MS pain associated with spasticity when compared to a placebo, in seven out
of eleven trials (Whiting et al. 2463). As a result of this study, the Academy of Neurology
confirmed that cannabis extract may be beneficial in treating patient-centered measures of
spasticity associated with MS, despite the fact that pain levels were self-reported, the study
lacked appropriate measures for evaluating chronic pain and did not reach statistical
significance (Metts et al. 181). Medical marijuana advocates will argue that this is enough
evidence to give them cannabis, however, the greatest overall improvement in pain was found in
patients taking cannabinoids (Whiting 2463), often not the drug of choice. Conversely, in a
Canadian crossover study, King reports that dihydrocodeine, was a better analgesic when
compared to nabilone, a synthetic cannabinoid, indicating traditional medicine as being more
effective than medical marijuana (6). Obviously, opioids are of great concern across America,
and one might argue that they provide more risks to the patient in the long run in the long run.
However, in most cases, patients are not discontinuing the traditional treatments and adding

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marijuana as an adjunct therapy that obviously intensifies the risk. Interestingly, it was reported
that neither functional status nor quality of life was correctly evaluated and none of the studies
in the 70-year trial compared smoked cannabis to standard analgesics which would have been
exceedingly beneficial had the trials been conducted correctly (Metts et al. 180). Therefore, these
studies lack inclusive and accurate data to support the use of MC in treating MS patients, despite
physicians approval because pain was not measured correctly, statistical significance was not
achieved, confirming the studies as valid and reliable, and there are indications that traditional
medications worked better at relieving pain than medical marijuana, despite self-reported claims
of reduced pain.
Sleep and Other Disease States
Medical marijuana has also been approved for the treatment of a variety of other diseases,
including insomnia. Therefore, as part of the meta-analysis review, researchers examined sleep
and Tourette syndrome and discovered low-quality evidence to support synthetic cannabinoids
helped with sleep and/or tics, when compared to a placebo, but identified amitriptyline to work
better than cannabinoids for sleep (Whiting et al. 2464). Again, these results were for medical
cannabis, not solely smoked cannabis. Despite the findings, data supported standard medical
treatment as more effective in treating insomnia, suggesting MC in not needed for this diagnosis.
Similarly, there was low quality evidence noted for no effect on psychosis, very low quality
evidence noted for no effect on depression or anxiety, and no evidence to support cannabis
differed from cannabinoids in promoting sleep, all insufficient levels of data to support medical
cannabis for treating these diagnoses (Whiting et al. 2467). Examining further, the international
researchers found no difference between the placebo and cannabinoids on measures of
intraocular pressure in a trial of six subjects, further disproving the treatment of these diseases

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with medical cannabis evidence (2464). Interestingly, in all cases, cannabinoids were associated
with a much greater risk of short term adverse events (AE), serious AE, withdrawals due to AE,
and a number of specific AEs to include: balance problems, confusion, dizziness, disorientation,
diarrhea, euphoria, drowsiness, dry mouth, fatigue, hallucinations, nausea, somnolence and
vomiting (Whiting et al. 2467). This review of diseases noted above, does not support medical
marijuana as treatment for any of the conditions based on the results of clinical trials, suggesting
a lack of valid and reliable evidence and the presence of undesirable and dangerous AEs.
Medical Marijuana and CINV
Physicians have been prescribing medical cannabis for chemotherapy-induced nausea and
vomiting patients since 1999 when a study gave cancer patients hope by reporting therapeutic
benefits and relief of nausea and vomiting with smoked marijuana (Bostwick 173). However, a
study in 2001 by M.R. Tramer, D. Carroll, F.A. Campbell, D.J. Reynolds, R.A. Moore, and H.J.
McQuay found prescribed cannabinoids to be more effective for treating CINV, but severe side
effects caused many to exit the study (qtd. in Metts et al. 181). As a result, the Natl Cancer
Network does not recommend any form of cannabinoids as treatment of CINV today, due to the
adverse reactions, medical and legal concerns, and the availability of safer and more effective
drugs for the treatment of CINV (Metts et al. 182).
Medical Marijuana and Weight Gain
When examining appetite and weight gain in HIV/AIDS patients, experts found low
quality evidence to suggest greater weight gain among patients who took one of two synthetic
cannabinoids when compared to smoking marijuana or being given a placebo (Whiting et al.
2467). The finding associated with low-quality evidence is insufficient, and ample evidence to
question the efficacy of synthetic cannabinoids and/or smoked marijuana in stimulating appetite

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(Whiting et al. 2467). With that in mind, the researchers examined two additional RCTs [more
closely] and discovered FDA-approved synthetic cannabinoid, megesterol to work better than the
only other approved cannabinoid for weight gain, dronabinol, in one study (Metts et al.182). The
second study was terminated when no difference in appetite, quality of life, or toxicity was
observed (Metts et al. 182). Interestingly, the two studies find conflicting results leading
researchers to question the validity of one or more of the trials. These findings support the need
for re-evaluating the effectiveness of MC in treating end-of-life diseases. Many of these patients
are currently being treated with synthetic cannabinoids and smoked marijuana. However, nausea
and vomiting already burden these patients and additional AEs if present would negate this
treatment methodology. By all accounts, it should be noted that terminal illness, such as ALS,
cancer and AIDS are diagnoses that should allow a patient to have their treatment of choice, but
all other available treatment regimes should be exacerbated first to avoid additional side effects.
If more effective treatment options are available, those medications should be used to avoid the
risk of AEs. Pain is difficult to measure and treat and each patients case needs to be
individualized. However, one must also consider the impact the patients treatment has on others
and/or the community, as well as the risk to the individualized patient.
Evaluating marijuana is also challenging because it contains 60 active cannabinoids
including the most prevalent THC and CBD, and the recently discovered endogenous
cannabinoid system found in the body, that reacts with external cannabinoids, allowing
manipulation of drugs to obtain a specific response (Metts et al. 179). This is very important as
scientists begin to pioneer more effective and better-tolerated medication. Bostwick reminds us,
in an article published for the Mayo Clinic Proceedings, THC, one of the two main
cannabinoids found in marijuana is psychotropic and causes hallucinations, the other CBD, is

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thought to have antipsychotic properties and better treatment potential (174). Interestingly,
many experts believe it is the low concentration of THC and/or the ratio of THC to CBD that
may contribute to the positive therapeutic effects that have been observed while researching the
effect of medical marijuana on illness (Maa and Figi 785). It is understood that these patients do
not experience the euphoric high from the drug. This belief has spurred the current national
interest and recent legislation of medical marijuana. This belief has also caused patients desiring
treatment for seizures and epilepsy, who are unable to obtain MC in their home state, to travel to
the newly legalized state of Colorado for treatment, even for children as young as five ears old
with a life threatening disease.
Marijuana and Seizures
The case of medical marijuana and epilepsy has long been debated. It initiated when
Carlini discovered in 1973 that CBD acts as an anti-convulsant in cats, but remains a mystery
today due to a lack of human trials (qtd. in Maa and Figi 784). Promising results are noted in a
recent article written for the professional journal, Epilepsia, when they discovered a very
unique homegrown blend of low ratio THC to high CBD MC controlled seizures in a young girl
from Colorado (Maa and Figi 784). This formula, known as Charlottes Web, decreased her
seizures from 50/day to one every two to three months using 4mg CBC per pound of body
weight (Maa and Figi 785) and virtually saved her life. Unfortunately, available research is
limited and conflicting with respect to marijuana and seizures. Although this is very promising
news to Charlottes mother, Paige who co-authors the article, it is discouraging to others who
have not seen the same results due to lack of sufficient evidence supporting that cannabinoids,
including the non-psychoactive form of drug reduces seizures in children (Maa and Figi 784).
Interestingly, quite the opposite was seen in another study conducted by Keeler and Reifler who

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reported that smoking marijuana causes convulsions (qtd. in Maa and Figi 784). Some
researchers believe that the discrepancy may involve the complexity of the plant and/or the
mode of administration because the heat of smoking and the acidic environment of ingesting pot
alters the plants properties, negatively affecting the drug Maa and Figi 784). It is most
commonly believed, however that to be a combination of both, and the endocannabinoid
system that causes the conflicting results (Maa and Figi 784-785). Studies to evaluate the
efficacy of medical marijuana in children with seizures are primarily based on anecdotal
evidence because Colorado is the only state where it has been allowed. However, the few studies
available were re-examined in a Cochrane review and found to lack sufficient evidence that
cannabinoids, including the non-psychoactive form of marijuana, reduce seizures in children
(Maa and Figi 784). Charlottes isolated incident is not sufficient evidence to begin treating an
underage child when the dangers have not been assessed and the results are not fully understood.
Additional studies, in children, although difficult to conduct, could proved beneficial in
situations where there was other alternative to save a childs life. Lastly, additional research
would clear the air of these very conflicting results.
Differing Views Among Experts
According to the online report by the Drug-free Action Alliance, additional research is
needed before the FDA, whose approval is required for legalization, would change their current
position, against MML, despite limited evidence to support mild-moderate therapeutic benefits
of medical cannabis. It requires scientifically sound clinical trials to influence professionals
such as these and the group of Yale professors that have adamantly condemned the use of MC.
According to Kaplan, in an article she wrote for the Lost Angeles Times, this particular group of
the most highly regarded physicians in the world claim that state approved medical marijuana

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laws are based on low-quality evidence, anecdotal evidence and testimonials, questioning as to
whether or not legislation is a backdoor approach to legalize recreational weed, disregarding its
place in medicine (qtd. in Kaplan). Their argument, if all medicines were legalized in this way,
allowing voters to determine which drugs to approve, would make a mockery of medicine (qtd.
in Kaplan). In other words, we may be taking a Trump Pack, instead of a Z-Pack for our next
bacterial infection. Statements such as these suggest that it is imperative for patients, voters,
parents, caregivers, and physicians to understand the facts before using or recommending
medical marijuana. Reiterating, that it is crucial to obtain additional research before advancing
the industry of medical marijuana. Necessary action must be taken to stop state legislation from
enacting further MML until additional RCTs can be conducted to disprove the potential
therapeutic benefits or define the risks.
Legalization and Illegal Access
As previously mentioned, most patients who are given medical cannabis experience
severe adverse events (AE), beyond the often preferred state of euphoria (Whiting et al. 2464).
Although AEs are of particular concern, public health officials are troubled about the impact
MML will have on the community and others, especially teens, regarding access and availability.
In other words, will MML directly impact teens use of weed? After all, they are the primary
users of the drug. This concern is well defined in an article by Bridget Freisthler, Paul J.
Gruenewald, and Jennifer Price Wolf entitled, Examining the Relationship between Marijuana
Use, Medical Marijuana Dispensaries, and Abusive and Neglectful Parenting (171). The authors
report, states that allow marijuana distribution through dispensaries have more residents using
it (Freishler et al. 171). More worrisome evidence is discovered in the article written by Chu for
the Journal of Health Economics and reported newly passed MML states had more residents

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seeking first time treatment for substance abuse than states without MML (44). Andrea
Barthwell, former Deputy Director of the National Drug Council Policy adds, by characterizing
illegal drug use as quasi-legal, state-sanctioned legalizers destabilize societal norms that drugs
are dangerous (qtd. in Chu 43). She clarifies her point in a provocative statement that sheds new
light on the thoughts of our youth by stating that children entering drug abuse treatment
programs often report that they believe pot is medicine and good for them (qtd. in Chu 43).
Obviously, children and teens are confused by the movement toward MML and statements such
as these profound and should be addressed immediately. It is the responsibility of parents,
educators, physicians, and other adults to avoid causing misinterpretations in this already very
influential age group to change their attitudes and to immediately clear the air. Voters also should
take the opinions of these experts very seriously and educate themselves of potential health risks
and other impacts of marijuana like the incidence of crimes up from ten to twenty percent seen
in newly legalized MML states (Chu 44). Other factors, some of which will be discussed later
are not limited to the all-to-common amotivational syndrome often seen on TV.
Teenagers
It is not surprising that teenagers endure the greatest risks from marijuana because they
are the primary users of the drug (Bostwick 175). As previously mentioned, a 2011 study
conducted by Wall, et al found MML to be associated with a lower perceived risk and higher
prevalence of use among juveniles (qtd. in Chu 44). The authors add, three out of four teens
already report having possession of someone elses marijuana (Metts et al. 183). Imagine the
increase in this number as more families begin to bring marijuana into their home. It could be
staggering. Surprisingly, a survey conducted by Richard N. Swartz, Meghan N. Cooper, Marife
Oria, and Michael J. Sheridan in an article for Clinical Pediatrics, entitled Medical Marijuana:

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A Survey Of Teenagers And Their Parents, found that teens admitted smoking marijuana was
harmful and MML made it easier for them to start using (549). This admission by students
should send up a red flag to all adults in hopes of discouraging their influence on the passage of
marijuana legislation, for obvious reasons. Evidence from the U.S. National Household Survey
that authors, Wayne Hall and Michael Lynskey report, with an increase [seen] in marijuana use
among 12-20 year olds in the year after MML was passed is sufficient evidence to prove that
teenagers know what they are talking about and it is imperative that we listen to them (1769).
Statistics such as these are alarming and dangerous and the reason why public health officials
like the FDA and the Deputy Director have not backed down from their strong stance against
legalizing medical marijuana. Drastic measures are needed to keep adolescents and teenagers
away from marijuana and other drugs. Needless to say, these professionals need the support of
others to make change. If critics continue to take hold of statistics like the risk to users drop
significantly after the age of 18, students perceptions of the drug will continue to soften,
resulting in more illegal use (Bostwick 177). As a result, the consequences to the teens and the
community will worsen. If there is a chance of losing one teen to drug addiction, legalization of
medical marijuana should be halted and reexamined until further research can be done.
Adverse Events and Risks
According to Bostwick, marijuana has the reputation as being a harmless, non-addictive
drug with medical benefits and addiction rates significantly lower than other drugs like alcohol,
tobacco, heroin and cocaine (175) with most users only experiencing mild perceptual changes
while using the drug (177). It is obvious that recent MML has changed the perceptions and
opinions of a potentially very dangerous drug and contributed to this stigma. There is sufficient
research to disprove this claim, and is the reason why it is essential that teens be educated

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immediately to reverse the deceiving image that MML is depicting. It is widely accepted that
risks and dangers to teens are more severe than in adult users and include, but are not limited to,
a potential gateway drug, academic failure, delinquency, memory deficits, reduced attention
span, abnormal social behavior, mood and anxiety disorders when use is initiated in early
teenage years (Bostwick 175-176). Of much greater concern, however are the dangers of
anxiety, depression, brain development interference, mental illness, psychosis, schizophrenia
and addiction that have been all been documented in clinical findings (Bostwick 176). In fact,
one in six users who start before the age of 16 will become addicted, compared to one in eleven
users who start after the age of 18 (Bostwick 177). Equally severe, is the risk of mental illness
in teenagers who smoke marijuana before the age of eighteen years old.
When examining psychosis and schizophrenia, Bostwick examined the effect marijuana
has on teenagers with mental illness to include psychosis and schizophrenia and discovered that:

Although users over the age of 18 are immune to cannabis-induced psychoactive

adverse effects, these conditions do exist in younger teens and is why marijuana is
sometimes viewed as a potential cause, aggravator or masker of psychosis, to
include schizophrenia that is sometimes seen in heavy pubertal users. The
question whether or not marijuana causes schizophrenia remains unanswered, and
is not supported by the results of one Australian study that found an increase in
cannabis use, but lacked corresponding increase in schizophrenia. Conversely,
another study found that cannabis precipitated the onset of the disease in patients
with a potential for disease, and exacerbated the symptoms in those who already
had it. Although most users only experience mild perceptual changes while high,

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in individuals with a potential for psychosis, the more they smoke, the more likely
they are to develop schizophrenia, drastically increasing as the age of onset
decreases. This is seen in a 27 year Dutch follow-up study revealing those who
used cannabis more than 50 times before the age of 16 were 7 times more likely to
get schizophrenia if they were predisposed to the condition. Among psychosisfree individuals, a Dutch study reported 8% of non-users developed psychotic
symptoms compared to 2.2% of users developing psychosis (177-178).

These statistics are significant and of great concern to patients, caregivers, physicians, parents
and teenagers alike. Despite any evidence of health benefits, these numbers should take
precedence over using marijuana to treat diseases, especially when more effective medical
treatments are available, until further research can be conducted to determine the effectiveness of
medical marijuana in treating specific diseases.
Contraindications for Marijuana Use
Marijuana is not for everyone. The increased risk of addiction and psychosis, in young
marijuana users is evidence and suggests it should never be prescribed or recommended to
teenagers. In addition, benefits should always outweigh the risks in all patients before
administering any form of marijuana (Metts et al. 183). This paper clearly defines the
expeditious need for further research. Kaplan reminds us that in addition to the above
recommendations, the FDA encourages physicians to ensure all other legally approved methods
of treatment have been exacerbated, without any other available options before recommending
cannabis for treatment of disease. Of upmost importance, according to Metts, Wright, Sundaram
and Hashemi all patients should be screened thoroughly and red flags assessed to identify risk

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factors that would eliminate them as potential candidates for cannabis therapy (183). The list of
reasons to not recommend medical marijuana is much longer than the list for recommending it
and is mentioned below. It is essential that the public familiarize with these guidelines before
advocating for MML. A primary reason to restrict MC is whether or not the patient is using
recreational marijuana, because there is a common overlap among MML and recreational users
that may indicate a cannabis abuse disorder (Metts et al. 184). Other reasons to not recommend
MC are: pregnancy, a safety-sensitive job, being less than 25 years old, any form of
dyscognition, concurrent use of opioids and/or alcohol abuse (Metts et al. 184). If physicians
were observing these guidelines all potential patients would be eliminated. Obviously,
medications do not exist without side effects, but to recommend a controversial drug that lacks
concrete evidence in favor of treating specific diseases and disorders is highly irresponsible and
indirectly dangers certain populations. A drug that is so controversial that requires a
comprehensive list of warnings, side effects and potentially dangerous health risks to individuals
should be cautiously, carefully and thoroughly researched before being made available to
patients.
Marijuana and Child Neglect
Unfortunately, at times the risks to children and teens are not incurred on their own. Their
dependency status requires that someone else look out for them. Parents who are high may often
not be able to effectively carry out that responsibility. A parent who does not store or dispose of
medication, including marijuana, properly, may allow a child to come in contact with it. These
events appear to increase when a parents mental state is altered or incapacitated, like when
someone is in a euphoric state. As a result, this irresponsible behavior negatively affects the
welfare of a child. A recent article in the professional journal, Child Neglect and Abuse

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references a study by G. S. Wang, G. Roosevelt, and K. Heard, originally published in JAMA
Pediatrics that reports an increase in childhood poisonings from ingestion in states with new
MML (qtd. in Freisthler et al.171). This tragedy could have potentially been avoided had the
parents not been given medical marijuana. These are the kinds of occurrences that must be
examined before further MML is enacted. Additional research would allow scientists to
determine if patterns exist and persist, indicating an urgency to make changes in laws. Events
such as this should be taken into consideration before advocating for MC therapy. Other factors
to consider would be whether or not MC patients have difficulty holding jobs or caring for their
children in some other way because this is also a form of neglect also. Incidentally, a study
originally conducted by C. Thurstone, I.A. Binswanger, K.F. Corsi, J.D. Rinehart and R.E. Booth
and published in Adult Psychiatry discovered that parents using marijuana in Colorado believed
smoking improved their parenting skills by allowing them to relax, preventing them from
hitting and yelling at their children, when in fact the same study found that parents living in
states with recent MML or in close proximity to a dispensary hit their children more often (qtd.
in Freisthler et al. 171). One must not forget, as originally reported in Neuroscience and
Behavioral Reviews by M.J. Fernandez-Serrano, M. Perez-Garcia, and A. Verdejo-Garcia that
marijuana impairs attention span, short term memory and motor coordination, all which also
interfere with a parents ability to care for themself or their child (qtd. in Freishler et al. 171).
The effect that marijuana has on youth is profound, worrisome and dangerous even if the child
abstains. Medical marijuana affects kids both directly and indirectly and is the responsibility of
the medical marijuana user. If left unattended, this phenomenon could become an epidemic as
more states legalize medical marijuana. There is no time to waste regarding MML. Advocates
must be educated. Parents need to take a stand and create Face Book pages, Twitter accounts and

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other social media to educate their friends and family. Physicians should also be confronted and
held accountable to every recommendation they right. Voters have made decisions prematurely,
lacking sufficient data to back their decision to advocate for MML. This entire paradox is in the
hands of the people. Additional research must be carried out to disclose the health and safety
risks of medical marijuana before legalizing further.

Pharmacologic Measures
There is a considerable amount of concern for the terminally ill patient and the rare
extreme patient like Charlotte in terms of medical marijuana. Obviously it is difficult to deny
patients in this condition the type of treatment that they believe is best for them. At the very
most, these patients should be an exception to the rule while awaiting new pharmacologic
measure and/or new and improved clinical trials. After all, they may be taking their last breath.
This belief is even supported by many scientists who are not in favor of CM. The author agrees
in a recent study, and suggests botanical cannabis may be justifiable for experienced users with
terminal illness and a tolerance for its psychoactive effects, particularly while awaiting new
drugs that will soon be available and may discontinue the need for medical marijuana (Bostwick
178-179). Although this would require a re-classification of the diagnoses that are currently
recommended for medical marijuana, it does not address other adverse events, such as CINV that
may complicate this treatment. One must also keep in mind, as mentioned in the article by the
DFAA, that hastily premature approval of medical marijuana could hinder the development of
new, more effective FDA-approved drugs that may obviate the need for marijuana as doctors
use them to increase the efficacy of treatment by manipulating the endocannabinoid system
(Bostwick 180). There are many factors involved in the lengthy process of MML, and as it

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seems, many have not been thoroughly examined, leaving voters to make the decision as to
whether allow MC as a legalized alternative treatment regimen.
Conclusion/Call to Action
There is a substantial body of evidence to support medical marijuana should not be
legalized nationally until additional studies have proven results in use of MC for treating specific
disease states, while limiting all subsequent adverse effects and dangers to patients. Addiction
and psychosis, including schizophrenia are very serious side effects, and medical marijuana
should not be legalized as long as there is an association between the two. The additional
consequences mentioned above, such as arrests, poisonings, child abuse, etc. are also of
imminent concern and should be re-evaluated. Because only a few of studies are available that
suggest low- moderate evidence that support using marijuana for treating pain, MS and epilepsy,
additional studies must be conducted to substantiate or disprove these claims. Funding is needed
and should be made available to conduct these much-needed trials, in an attempt to clear the
inconsistencies and inaccuracies within the available research. Smoked marijuana should be reclassified to allow reputable institutions limited legal access to conduct scientifically approved
randomized controlled trials. All clinical trials should include and evaluate smoked marijuana as
a type of MC, because the majority of studies do not reflect this method and most patients in
search of MC are requesting this form. This is essential to rule out users seeking a less expensive
and alternative way of obtaining recreational weed. Funding should be allocated to continue
educational programs informing adolescents and teens of the risks and dangers of using
marijuana in early pubescent years, because these programs have been shown to curb appeal.
Pharmaceutical companies should eagerly and anxiously work towards developing new drugs
used to replace medical marijuana. The FDA and other professional medical organizations should

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remain open-minded to new research. Marijuana should not be legalized through voter or
legislative initiative and should be evaluated in the same scientific manner as any other drug
seeking approval, with clinical trials undergoing closely supervised, scientific, peer-reviewed
scrutiny. Medical marijuana patient screenings should be enforced and monitored, and
dispensaries should be closely regulated in MML states. Physicians should be held accountable
for assessing each patients safety and tolerance to MC. Parents receiving medical marijuana
should be educated and held responsible for proper disposal and storage of MC. A cautious mind
should always be exercised when dealing with medical marijuana. Action should be taken to halt
current and future MML until appropriate clinical trials have been conducted. Every measure
should be taken to ensure the safety and health of all children and other dependents. Take heed.
Theres no time to waste, lives are on the line. After all, do we really want to live in a society that
encourages you to be high? What is your vote?

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Works Cited
Bostwick, J. Michael. "Blurred Boundaries: The Therapeutics and Politics of Medical
Marijuana." Mayo Clinic Proceedings, Vol. 87, No. 2, Elsevier, Feb. 2012, pp. 172-186.
Chu, Yu-Wei Luke. "The Effects Of Medical Marijuana Laws On Illegal Marijuana Use."
Journal Of Health Economics, Vol. 38, Aug. 2014, pp. 43-61. Academic Search
Complete, Web, Accessed on 13 Oct. 2016.
Drug-Free Action Alliance and Alcohol and Drug Abuse Prevention Association of Ohio. "The
FDA's Opposition to Medical Marijuana Legalization Is Based on Science." Marijuana,
edited by Noah Berlatsky, Greenhaven Press, 2012, pp. 219, ISBN: 9780737757330
0737757337 9780737757347 0737757345.
Freisthler, Bridget, Gruenewald, Paul J., Wolf, Jennifer Price. Examining the Relationship
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Parenting. Child Abuse and Neglect, Vol. 48, Pergamon Press, Oct. 2015 pp.170-178.
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Hall, Wayne, and Michael Lynskey. "Evaluating The Public Health Impacts of Legalizing
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Kaplan, Karen. Most Uses of Medical Marijuana Wouldnt Pass FDA Review. Los Angeles
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