Cannabis leaf on grunge background, shallow DOF.Something has changed in the past five years– pot isn’t really considered a street drug anymore by my patients.  Marijuana use isn’t anything they feel a need to deny or hide.   With increasing frequency, my adolescent patients openly discuss their marijuana use in front of their parents.  Some adamantly deny alcohol use yet don’t hesitate to discuss their regular marijuana use.

Just a few years ago, this wasn’t true.  As soon as I mentioned the need to get a drug screen, my patients would get a nervous look on their face, often confessing marijuana use before the test results came back and begging me not to tell their parents.

My patients now recognize marijuana as a drug– a medical drug, that is.  They tell their parents how it helps with depression and anxiety.  And I tell them I believe them.  Marijuana probably does help them feel better.  I also tell them we have other drugs to treat depression, anxiety, and pain, drugs that are better regulated and have risk profiles that are better understood, drugs with standard concentrations and doses.  Nicotine, too, is a stimulant that can improve ADHD symptoms, but we don’t recommend smoking as an ADHD treatment.  We have better drugs for that, too.

Now that recreational marijuana is legal in Colorado, marijuana is just losing its taboo identity.  Other states are following– the district attorney in Brooklyn, New York recently announced his plans to stop prosecuting people arrested on charges of possessing small amounts of marijuana.

I spent a summer in college doing cannabinoid research at the NIH, trying to understand the effects of marijuana in the brain.  I’m the first to admit that cannabinoids are a promising class of drugs.  But marijuana is just that — a drug — and its recreational use should still be taboo.  Here’s why:

1) Is it synthetic?  A patient came into my ER hallucinating with tales of a very bad trip.  He showed me his “marijuana,” a bunch of leaves rolled into a joint.  And then his drug screen came back negative.  His was synthetic marijuana, a bunch of herbs sprayed with some unknown chemical.  Synthetic marijuana often contains laboratory manufactured chemicals that have the same effect as THC, the psychoactive ingredient in marijuana.  But sometimes the product is actually laced with bath salts or other street drugs.  I never really know what my patient has taken, which makes it hard for me to treat them.

2) How much THC is in that candy?  My four-year-old saw a brownie at a beach bake-sale and started begging me to buy it for him.  The guy selling it looked me directly in the eyes and shook his head.  I knew what he meant.  Marijuana brownies, cookies, and jolly-rancher-like hard candies are common now.  The problem is that you just don’t know how much THC is in the treats.  Some contain much higher concentrations than one joint, and who can eat only one cookie?  The result is an overdose effect that can land people in the ER.  Dr. Dan Hehir is an ER physician at Telluride Medical Center is Colorado who recounts his stories of recreational marijuana overdoses, especially in marijuana baked goods and candies.

3) Infertility: Marijuana use reduces fertility in both men and women (but no, marijuana is not a form of birth-control).  Anandamide is an “endogenous cannabinoid,” a THC-like chemical that is naturally occurring in all of our bodies.  Anandamide also helps human conception, giving signals to sperm to “hyperactivate,” or swim faster so they can penetrate the egg.  (Anandamide is also in chocolate, perhaps one reason people often use the words “sex” and “chocolate” in the same sentence).  Using marijuana sends signals to sperm to hyperactivate too early, so they are all burned out before they ever reach the egg (pun intended).  Marijuana use is also known to reduce the volume of sperm production.  If women use marijuana, the THC is in their cervical fluids, also causing hyperactivation of sperm and reducing the likelihood of conception.

4) Impaired memory: What was that? That’s right, marijuana use impairs memory, a critical skill for academic success (marriage, too).  Most of the time memory loss is subtle, just enough to cause a drop in school grades, but occasionally memory loss can be profound.  A case report published last month describes a patient with marijuana-induced transient global amnesia.

5) Paranoia: Marijuana can cause paranoia, especially in patients who have underlying mental illness.  In a study published in July, 2014, intravenous THC was administered to 121 patients.  The authors write, “THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity.”

6) Thrush: Thrush, or an oral yeast infection, can result from chronic marijuana smoking.  There’s a reason why some people call thrush “trench-mouth.”  A white film grows over the inside of your mouth and tongue.

7) We don’t really understand most of the risks of marijuana: This is perhaps the biggest problem with Marijuana– it’s really hard to study it.  Would you take a drug that is poorly researched?  Research on marijuana is difficult because it is illegal in most states.  There are possible associations with some forms of cancer, but because most marijuana users are also tobacco users it is difficult to determine the effects of the marijuana alone.  There seems to be an association with lung disease, especially among people that smoke marijuana long term.  Its addictive nature is perhaps most controversial.  The bottom line is we don’t understand this drug like we do most pharmaceuticals.

Taboo or not, my patients take marijuana because they are desperate.  Desperate to dull the pains of stress, anxiety, depression, and the hardships of life.  Legalization of recreational marijuana is not the solution to these ills.

Do you have a stressed or depressed teen?  Here are 8 other ways teens are dulling the pain.