This is an analysis of the "Compassion Act," which legalized marijuana in Alabama. It is a two-part series based on the research of Dr. Michael Brown, a retired gastroenterologist who obtained his medical degree from the University of Alabama School of Medicine. He is a fellow of the American College of Physicians as well as the American College of Gastroenterology. He has continued his work in research and also as a GI Hospitalist.
In case you missed it, the Alabama Legislature passed, and Governor Ivey signed into law, the Compassion Act in May 2021.
Compassion is certainly a good thing. As a parent, I have attempted to be compassionate toward my children and as a physician, I have made it my goal to have compassion for my patients.
With that having been said, I do not believe that the government has a role in compassion. Compassion cannot be legislated. The government cannot be sympathetic or empathetic, but rather it must generate and enforce just laws that provide a sufficiently ordered societal structure to allow for the flourishing of its citizens. That is the ideal, but as governments are run by people and all people are subject to corruption, it is incumbent on the citizen to stay well-informed and maintain a healthy degree of distrust of political power.
For us, in Alabama, that means we must keep a watchful eye on all the mischief that too often transpires at our state capital.
My contention is that this so-called Compassion Act, which provides for the distribution of marijuana to the people of Alabama, is anything but compassionate. I believe that the title of this act is just a ruse and that the only compassion in this act is for those who are assured to profit from the widescale use of marijuana throughout our state without regard for the suffering that will be inflicted on our children, families and communities, as has been the case in every other locale where this has been done.
You may be wondering why I am even bringing this matter up. After all, the marijuana activists are succeeding in expanding access and use in an ever-increasing number of states. The siren call of the gods of this age has convinced our governing authorities that since so many states have done this, then they should do so likewise. But as long as there is life, there is hope, and so with the legislature in session, it is my prayer that together we can encourage those in power to address the concerns raised here.
You may also be wondering if I am in any position to be questioning this marijuana dispensary law. As a physician with over 40 years of experience, who has also been involved in medical research, public policy as well as drug and alcohol rehabilitation, I have at least some degree of standing to speak to this issue.
See also from Dr. Brown: Mary Jane without her make-up; my personal encounterBut actually, as parents, grandparents and individual citizens, we all have the right and I would say even the duty to question the wisdom of laws that may cause harm and to seek appropriate remedies. My concerns about this law certainly relate to the harms I have seen inflicted upon my patients by the use of marijuana, as well as the trouble such use has caused for those in rehab.
IT’S ALL IN YOUR HEAD: WHAT CANNABIS RESEARCH HAS UNCOVERED
Medical research has been making advances in our understanding of the effects of marijuana use on the developing brain. Pertinent to this discussion is the fact that brain development has been found to extend into young adulthood, typically the early 20s for females and mid-20s for males.
Back in the "Age of Aquarius," as the use of marijuana began to flourish, there was very little scientific knowledge about its actual effects on the structure and function of the central nervous system. But that is no longer the case today. Now there is a wealth of information available to help us gain awareness and understanding of these effects.
What is being discovered is not pretty with regard to healthy brain development.
Observational studies came first, which have indicated that marijuana use by teens and young adults is associated with various cognitive issues, including adverse effects on memory, problem-solving, learning and motivation as well as executive function which has to do with the ability to plan and accomplish tasks as well as to monitor and regulate emotions and habits. These effects in turn, more often than not, lead to reduced educational attainment, poor job performance, diminished income and need for social support services. A tendency for increased intensity of cravings which predispose to binge use has also been noted among teens and young adults as compared to older age groups.
Marijuana use in this younger demographic, with its adverse effects on impulse control and judgment, also increases the likelihood of experimenting with and subsequent addiction to other substances of abuse.
In the mid-1960s THC (tetrahydrocannabinol) was discovered to be the principal psychoactive phytochemical constituent of marijuana. Back in those days, the THC content of the marijuana typically available in the US averaged, at most, 3-4% - whereas today it is at 16-18%.
More recently, there are even cultivars that have been bred to have THC levels of 25% or more. Additionally, the CBD (cannabidiol) content, which tends to attenuate the psychotropic effect of THC, has progressively declined over this time period which serves to heighten the user's response to THC.
Over the years, marijuana advocates have loudly proclaimed the myth that marijuana is not addictive. Of course, the weed typically smoked a half-century ago with its low THC content did result in a somewhat low incidence of addiction, but with the high THC levels of marijuana in vogue now, addiction rates as high as 30% are being observed. Those who begin using marijuana early in life on a daily basis have the highest risk of becoming addicted, but no one is excluded from this game of Russian roulette.
This more potent marijuana has resulted in increased adverse mental health issues, particularly in teenage users and young adults.
The most obvious form of self-destruction is suicide. Large cross-sectional, as well as prospective studies, have noted significantly increased suicidality in teenage and young adult marijuana users. In locales that have permitted the purveyors of marijuana to prey upon its citizens, THC is now the substance most frequently identified at death in completed teen suicides when postmortem toxicological evaluation is performed.
There are also increased rates of paranoia, depression and social anxiety disorder in this demographic among marijuana users. Most disturbing is the increasing number of reports of abusive behavior and violent crime associated with marijuana use during brain development. It is no wonder that the antecedent use of marijuana is frequently identified on evaluation of the perpetrators of school shootings and mass murders.
As the science regarding marijuana advanced, it was discovered that the central nervous system has natural THC-like neurotransmitters and associated receptors on various brain cells. This carefully regulated endocannabinoid system becomes dysfunctional when it is overwhelmed by the addition of competing THC brought in from the outside world. This unnatural flooding of the system with THC is what produces the intoxicated state of euphoria as well as decreased alertness, recall, balance, reaction time and motor coordination. Such effects obviously have an adverse impact on learning and work.
It is especially troubling for such individuals in this destabilized state of brain function to attempt to drive a vehicle, operate heavy equipment, use power tools, handle weapons, perform surgery, make life-altering decisions or be responsible for the care of a child. Fortunately for most who are past the age of brain development, this derangement in brain function is transient.
Even though THC does decline below the intoxicating level fairly quickly, it usually takes several weeks for it to completely leave the brain since it is fat-soluble; therefore, the associated brain dysfunction will persist to varying degrees over that interval. Of course, with regular use, there is insufficient time for the brain to restore its internal endocannabinoid system and so it remains continuously in a dysfunctional state.
In the developing brain, the endocannabinoid system plays an additional role in the formation of various regions of the brain and the generation of important neural pathways. Because of the fine-tuning required for these critical steps, overwhelming the central nervous system with competing THC results in permanent alterations in brain structures and functions.
It does not take a rocket scientist to realize that in utero, exposure during pregnancy is particularly risky with the potential for great harm. Cohort studies have shown diminished growth and intellectual deficiencies in children subjected to such exposure by their mothers.
Likewise, marijuana use during the years of continued brain development after birth is also a dangerous endeavor. Longitudinal studies of this demographic using MRI imaging have shown frontal lobe cortical thinning and PET scan evaluation reveals the increased density of endocannabinoid receptors in these regions. Conversely, certain regions in the brain associated with pleasure and craving have been noted on imaging evaluation to be enlarged in those suffering from marijuana addiction.
Intelligence testing has revealed associated declines in IQ, and other psychometric testing has shown increased impulsiveness as well as other troubling behavioral issues. One such behavioral issue that is especially important has to do with addiction, now euphemistically renamed in “woke world” as Cannabis Use Disorder (CUD).
Pharmacognosy is the identification of the various biochemical constituents of plants (aka, phytochemicals) as well as from other biological species that might have utility as medications.
A medication is a specific, purified chemical substance useful in the treatment of a medical disorder. And in fact, pure THC has been found to be useful in the treatment of some medical disorders. It has been approved by the FDA with the generic name of dronabinol, marketed as Marinol or Syndros, and can be obtained by prescription for improving appetite in patients with AIDS or cancer, as well as in controlling nausea and vomiting in those who are taking chemotherapy.
It has also been used with some benefit in patients with otherwise refractory sleep apnea. Another related THC-like product with the generic name of nabilone, marketed as Cesamet, has also been approved by the FDA and is available by prescription for use in patients having nausea and vomiting from chemotherapy.
Additionally, though not the focus of this present discussion, the other popular marijuana phytochemical CBD (cannabidiol), marketed as Epidiolex, is also FDA approved and available by prescription for the treatment of various childhood seizure disorders.
But all of these medications are chemically pure, so a physician can know exactly what the patient will be receiving, unlike medical marijuana.
It is instructive to note that the dosing for prescription THC rarely exceeds 40 mg a day and more typically is dosed at 5-10 mg a day as the current standard of care. But our governing authorities decided that they knew better and wrote in the law that 50-75 mg of THC per day is what should be utilized instead, all without any restriction on driving.
Furthermore, they are so eager to increase access to their so-called medical marijuana that they provide in the law that it may be taken orally in tablet, capsule or liquid form; chewed and swallowed in gelatinous form; sucked on as a lozenge; applied topically as a gel, oil, cream or patch; inhaled with a nebulizer or inhaler, and even inserted rectally as a suppository.
And just to add insult to injury there is no restriction for use during pregnancy or concern for fetal harm.
Friday, Part II: MONTGOMERY GOES TO POT: FOLLOW THE MONEY
and AS CBD BUSINESS GROWS, SO DO CONCERNS OVER ACCESS BY CHILDREN
