In the past several years, the advancement of marijuana for medical use and its legalization have been promoted in our country, quite often with scant medical data to justify those actions. Fortunately, we now have a large amount of medical information to show not only its relative lack of effectiveness, but the damage it can do to individuals’ mental and physical health and to our society at large.

Cannabis has more than 400 compounds, 60 of which are pharmacologically active. Delta-9 THC is a common one, along with 120 other cannabinoids, with great variation of THC content among products.

This variable highlights the first major health concern: The average THC content is 17% to 28% in today’s marijuana plant, compared to 2% to 4% in the 1960s-1980s. And the THC content in marijuana that is synthetically concentrated can be up to 85% to 90%. There is no research that THC concentrate greater than 10% is beneficial. And the Dutch, hardly a conservative people, have concluded that concentration more than 15% should be considered a hard drug. Today’s marijuana is definitely not your grandmother’s “pot.” Higher potency equates to higher risks with use.

The frequency of marijuana use also has grown dramatically. Before 2000, the average user inhaled or ingested it two nights per week. Today’s average use is daily or near daily. The combination of increased frequency and potency equates to 70 times the marijuana intake for the U.S. population compared to times before 2000 (J. Caulkins, Carnegie Mellon University data).

With increased potency comes another major medical concern, the increased rate of psychosis in marijuana users.

Dr. Libby Stuyt, addiction psychiatrist in Pueblo, Colo., noticed a change in her patients several years ago: “I started seeing people with the worst psychosis symptoms I have ever seen, and the worst delusions I have ever seen.”

Parents have had a hard time understanding the episodes of hallucinations and breaks from reality in their college students who regularly use marijuana, since this was an uncommon occurrence among users when the parents went to school.

Furthermore, a European medical study showed THC potency above 10% made the risk of a first episode of psychosis three to five times more likely. A similar Denmark study showed a rate of schizophrenia four times more likely with the increased THC level (Lancet Psychiatry, 2019, JAMA Psychiatry, 2021).

I recently saw a young man in my office with a psychotic break, with suicidal ideations. He had been a daily marijuana user for years. Dr. James Berry, chairman of psychiatry and director of addictions at WVU Medicine in Morgantown, relates that the psych unit in Morgantown has seen a dramatic increase in cases of marijuana-induced psychosis. The Morgantown unit is a referral center for our area. (I also used Berry’s “pothole” imagery for the headline of this column).

The most vulnerable population in our country is the age group 17 to 25. A study of 12th graders showed that marijuana use increased as the perceived harm of it decreased. Some 17% of tenth graders report using cannabis, even though no state has legalized the drug for people under 21 (National Institute on Drug Abuse, 2019).

Our country has been successful in decreasing tobacco use in teenagers, who finally came to understand the harmful effects of cigarettes. We need to make similar efforts to educate our youth about the medical harm of marijuana.

The nationwide Drug Abuse Warning Network (DAWN), which captures data on emergency department visits, reported that in 2020 marijuana was the second-most common substance involved in substance-related emergency room visits. It trailed behind methamphetamine but was more frequent than incidents related to alcohol, heroin and cocaine. In California, from 2005 to 2019, there was a 1,808% increase in elderly emergency room visits associated with cannabis use.

With regard to motor vehicle fatalities, from 2000 to 2018, the percentage of fatalities involving cannabis and cannabis with alcohol more than doubled, increasing from 9% to 21.5%.

There is no medical doubt that marijuana use is associated with addiction. CUD, or cannabis use disorder, reflects users who are unable to stop using marijuana even though it’s causing health and social problems in their lives. There is a one-in-five risk of CUD in all users. That risk increases to 33% if use starts early and happens frequently.

When I talk with the residents of the recovery center where I volunteer, the majority of them say they started marijuana in their preteens or teens.

A study from JAMA Psychiatry showed that obtaining a medical marijuana card was linked to a three times more likely risk of developing cannabis use disorder, with no improvement in pain, anxiety or depression.

Epigenetics is a relatively new field, which studies how genes and cell division can be changed by the environment, including drugs, and in some cases, transmit hereditary changes to our children. It has been reported that cannabis use by men is associated with changes in their sperm (DNA methylation). Further animal studies demonstrated that marijuana can cause changes in the brain, sperm and heart in their offspring (Journal Epigenetics and Chromatin, 2022). It is imperative that we improve our understanding of how marijuana exposure in one generation can shape the health of future generations. Our children deserve this information!

There are scores of other medical concerns with cannabis.

Adolescent consumption of marijuana is associated with increased risk of developing depression and suicidal behavior later in life.

The use of marijuana by pregnant women in the U.S. doubled from 2009 to 2016.

Use in pregnancy is linked with low birthweight, low gestational weight and stillbirth. THC is excreted in breast milk, yet more than 50% of dispensaries still recommended it to pregnant women, according to Journal of Obstetrics/Gynecology, 2018. There also is a greater risk of autism spectrum disorder if used during pregnancy.

THC is proinflammatory and adversely affects blood pressure, platelet activity and dysfunction of blood vessel lining. These things increase the risk for cardiovascular disease, cardiomyopathy and atrial fibrillation.

As far as the lungs are concerned, marijuana use contributes to emphysema with decline in pulmonary function and increases in bronchitis and infections.

Cannabinoid hyperemesis syndrome involves intense and persistent episodes of nausea, vomiting, dehydration and abdominal pain. In Colorado, emergency rooms reported visits for this condition doubled after marijuana legalization (BMJ 2019).

Contrary to popular opinion, legal medical marijuana — when available through retail dispensaries — is associated with higher opioid mortality.

A study in 2014 suggested a decrease in fatal opioid deaths with legalized marijuana, which was used to support legalization. But in June 2019, researchers at Stanford University extended this study another seven years and found that states that had legalized marijuana had a 23% increase in fatal opioid overdoses (Proceedings of the National Academy of Science, 2019). The Journal of Addiction Medicine found that medical marijuana users were more likely to use and misuse prescription opioids. Marijuana is not a solution to the opioid epidemic.

Legalization of medical marijuana is a political/legislative initiative, not one supported by the medical system.

The AMA, American Psychiatric Association, American Academy of Pediatrics, the American Society of Addiction Medicine and the American Academy of Neurology to name a few do not support legislation or voter approval to legalize cannabis for medicinal use.

Medicalizing a recreational substance has unintended consequences, and more research is needed.

As far as what can be done, we need to be compassionate (why is someone using?), we need to educate each other, advocate for stricter regulations and continue to study and promote research.

West Virginia is a beautiful state with wonderful people, and I have enjoyed living here my whole life. We have endured and suffered through the opioid epidemic, and I feel we must do all in our power to head off the marijuana epidemic.

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Dr. Stephan Hanna, M.D., has practiced family medicine in Parkersburg for more than 40 years and volunteers at a local rehab and recovery center.