The use of medical marijuana is one of the topics that stir up strong emotions from a wide range of individuals including policymakers, scientists, researchers, doctors, and the public. It is correctly used for pain control in most states in the United States, and evidence suggests that it is safer for the management of chronic pain when compared to opioids (Grinspoon, 2018).The use of marijuana for medicinal purposes is a topic that has gained popularity and attention over the last few years primarily due to the surrounding controversies. Cannabis use sparks ethical, societal and legal concerns and multiple research studies have attempted to establish the safety of its use (Wilkinson, Yarnell, Radhakrishnan, Ball, & D’Souza, 2016)

Some of the pharmacological factors that have been studied concerning the medical use of marijuana include therapeutic indications, safe administration doses, adverse health consequences, and the risk of death due to intoxication. The main controversies surrounding the medical use of marijuana are supported by the fact that it is a Schedule I controlled substance, which has a high potential for abuse (Wilkinson et al., 2016). Moreover, there is no safety data available for the use of cannabis medically. Despite these controversies, marijuana has its place in the history of existence, where it is believed that it was used more than 5000 years ago as a medicinal agent. The use of cannabis is however surrounded by stigma because it is considered a gateway drug to other substances, as well as its potential harms.

As a result of the pharmacokinetic properties of cannabis, it has been challenging to conduct research studies to establish its safety as a medicinal agent. Some of these properties include rapid and extensive metabolism, low analyte concentrations, and physiochemical characteristics which hinder compound separation. During pharmacological studies, therefore, the multiple surfaces adsorb the compounds of interests, resulting in low drug recovery. Marijuana is efficiently absorbed into the circulatory system, and this has been proved by studies where it has been established that the primary psychoactive compound in marijuana tetrahydrocannabinol (THC) is immediately absorbed into the blood after the first smoke. The rate of absorption after oral administration is however erratic and slow but has nevertheless been shown to have long-lasting effects, hence indicating that the pharmacokinetics of cannabis depends on the route of administration (Wilkinson et al., 2016). These mixed pharmacokinetic properties have resulted in the lack of well-designed randomized control trials that can sufficiently confirm the benefits and the harms of marijuana.

The available evidence regarding the use of cannabis as a potent medicinal agent is mixed, and one of the most significant concerns regarding this agent is the fact that marijuana cannot be regulated like other single molecule pharmaceutical drugs(Wilkinson et al.,2016). This is because the pharmacological effect of cannabis is due to a combination of the impact from approximately 500 individual cannabis compounds including flavonoids, cannabinoids, and terpenoids. The anti-cancer properties of cannabinoids such as cannabidiol (CBD) and THC have been well established, as well as its ability to reduce the adverse effects associated with cancer treatment. Cannabis has also been used to manage chronic pain, and diseases such as multiple sclerosis, Chron’s disease, and Alzheimer’s diseases (Whiting et al., 2015). There are various modes of administration for medicinal cannabis, with one of the most preferred methods being vaporization. Other methods of administration include inhalation, edible products ingestion or smoking. The most common method of administration is smoking, although vaporization has been gaining popularity due to its safety advantage. Vaporization eliminates the risk of combustible byproducts associated with smoking thereby decreasing the risk of adverse respiratory symptoms and carcinogens.

The use of medical marijuana has been associated with positive health outcomes. According to an article by Grinspoon(2018), those who consume medical cannabis have recorded clinically meaningful health outcomes, when compared to those who do not consume the product. This is especially so for epilepsy patients, who relate their health improvements to the consumption of cannabis. The article further outlines the positive health outcomes associated with the use of medical marijuana, some of which include improved quality of life, health satisfaction, reduced pain, reduced instances of depression and anxiety, better sleep, fewer sick days and reduced hospital visits. For epilepsy patients, the use of cannabis has been associated with better sleep, better health satisfaction, and less depression. It is, however, essential to note that despite the positive health outcomes related to the use of medical cannabis, patient safety remains at risk because there are no standards that exist which can guide people on how to use marijuana safely and therapeutically (Wilkinson et al., 2016). Moreover, a higher percentage of epilepsy patients who reported to use medical cannabis indicated that they did not solicit recommendations from healthcare professionals(Grinspoon, 2018).

Although various states in the United States have legalized the use of marijuana for medical purposes, studies exist which indicate that cannabis is associated with adverse health effects. A major health concern for the use of marijuana is its high risk of addiction. Evidence linking long-term use of marijuana to addiction exist as well as bona fide withdrawal systems. The regular use of marijuana has also been linked with an increased risk of mental illnesses, including psychosis, depression, and anxiety. Even though studies are not clear, the relationship between long-term use of marijuana and lung cancer has been established. Some of the established adverse effects of marijuana on the lungs include increased airways resistance, inflammation of the lung airways, and lung hyper-filtration. According to the National Institute on Drug Abuse (n.d), other non-airway conditions that have been linked to the use of marijuana include conditions such as nonseminomatous testicular germ cell tumor, which is an aggressive form of testicular cancer that mostly attacks young male adults who are regular marijuana users in their adolescent years

There are also limited studies describing the effects of marijuana on the circulatory system. Its rapid absorption into the blood results in increased blood pressure immediately after administration hence increasing the heart rate. The rise in blood pressure increases the susceptibility of individuals to heart attack, as well as orthostatic hypotension (dizziness or head rush on standing). Repeated exposure has also been shown to increase tolerance to some cardiovascular effects. Therefore, the use of medical marijuana for people with specific healthcare condition, more specifically in older adults is limited due to the age-related increased baseline vulnerability to cardiovascular risk factors(National Institute on Drug Abuse, n.d.).

Access to the medical use of marijuana is significantly affected by government policies, which consequently affect public health outcomes. Further complicating its ease of access is the perception of increased dependence of the drug, if at all adolescents are exposed to medical marijuana regularly. Although policies play a more significant role in limiting the access of marijuana, cultural and social perceptions as well as stigmatization affect its accessibility to particular groups of populations. For children and adolescents, for instance, access to medical marijuana can only be allowed if they have the required certification from their legal guardian and a licensed medical practitioner. It is important to note that according to an article by Grinspoon(2018)the only researched benefit of medical marijuana in teenagers and children is its ability to reduce nausea associated with chemotherapy. Treatment of other conditions in children using medical marijuana is scarcely studied. Also, most states allow access to marijuana only if a child has a “qualified medical condition.”

Although there is considerable evidence on the benefits of marijuana, there is still limited pediatric data. As a result, access to medical marijuana is insufficient for this specific population, and the limited access of marijuana to adolescents and children is due to the adverse cognitive effects, which are probably due to the active brain development in children and teenagers, which increases their vulnerability to cognitive adverse effects. Some of the adverse impacts that have established in children and adolescents include effects on problem-solving ability, attention, memory, and learning. This concern is essential mainly because a part of the brain known as the prefrontal cortex is underdeveloped during childhood and teenage years, and hence its development may be affected by the regular use of cannabis. Studies also indicate that children who access marijuana at a young age are more likely to become addicts in their later years of life. Other studies show the increased risk for psychotic disorders such as schizophrenia, for teenagers who regularly use cannabis (Grant & Bélanger, 2017). Given the physical and mental risks associated with the use of cannabis by children and adolescents, policymakers have the responsibility of ensuring continued limit to access of marijuana by this particular population(Grant & Bélanger, 2017).

Due to the mental and psychological effects of marijuana, people who use the drug are less likely to engage in health-promoting behaviors. This is according to a study by Palfai, Tahaney, & Winter (2015) which established that marijuana users are more likely to engage in risky health behaviors. Moreover, regular use of marijuana results in an increased risk of the use of other dangerous substances. It is also important to note that marijuana use affects cognitive function, which increases the risk of motor vehicle accidents, which has been attributed to the act that marijuana use lowers concentration. These adverse effects of legalizations of medical marijuana undermine the efforts of healthcare organizations and community health to promote health and wellbeing (Palfai et al., 2015). Because marijuana contains various complex compounds, its use is associated with long-term adverse health effects, that are irreversible.

One aspect that has been established with regards to the use of medical marijuana is the fact that policy has outpaced research in this particular area. This is especially so because even with the unavailability of sufficient research to determine the positive and the adverse effects of medical cannabis on the brain, 28 states have already fully legalized its use, with 17 others legalizing its use in specialized areas. Most research studies have focused on symptoms relief and treatment outcomes, with only a few studies focusing on its effects on the ability to perform cognitive tasks. Some of these few studies claim that the use of cannabis for medicinal purposes may also boost the cognitive functions including social functioning and quality of sleep. In addition to these positive effects, cannabis use may also cause fatigue, sleepiness, nausea, and dizziness. It is therefore evident that, for improved patient outcomes and patient safety, further research is required, since the available evidence is of low quality(Grant & Bélanger, 2017).

With the legal status of marijuana rapidly changing countrywide and considering its implications for public health, it is imperative for researchers to further their investigations, to enhance an understanding of the impact of marijuana use on public health (Clark, Capuzzi, & Fick, 2011).Moreover, marijuana is an unregulated drug, which means that its ingredients, purity, safety, and have not been checked. This is because as mentioned earlier, marijuana is a combination of more than 500 other compounds, all of which have individualized effects on the nervous system. This has made it difficult for researchers to characterize the exact impact of marijuana, especially in uncontrolled epidemiological studies. Further increasing the controversies surrounding the drug, is the classification of marijuana as a schedule I drug (with no medical use)which hinders researchers from conducting more specialized studies. Most importantly, shifting the drug from schedule I class of drugs will also require further research and investigation (Whiting et al., 2015).However, current preliminary research shows that the benefits of medical marijuana use outweigh its burdens.

References

Clark, P. A., Capuzzi, K., & Fick, C. (2011). Medical marijuana: Medical necessity versus political agenda. Medical Science Monitor, 17(12), RA249-RA261. doi:10.12659/msm.882116

Grant, C. N., & Bélanger, R. E. (2017). Cannabis and Canada’s children and youth. Paediatrics & Child Health, 22(2), 98-102. doi:10.1093/pch/pxx017

Grinspoon, P. (2018, January 9). Medical marijuana. Retrieved from https://www.health.harvard.edu/blog/medical-marijuana-2018011513085

National Institute on Drug Abuse. (n.d.). What are marijuana’s effects on other aspects of physical health? Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuana%E2%80%99s-effects-on-other-aspects-of-physical-health%3F

Palfai, T. P., Tahaney, K. D., & Winter, M. R. (2015). Is Marijuana Use Associated With Health Promotion Behaviors Among College Students? Health-Promoting and Health-Risk Behaviors Among Students Identified Through Screening in a University Student Health Services Center. Journal of Drug Issues, 46(1), 41-50. doi:10.1177/0022042615610619

Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A. V., … Kleijnen, J. (2015). Cannabinoids for Medical Use. JAMA, 313(24), 2456. doi:10.1001/jama.2015.6358

Wilkinson, S. T., Yarnell, S., Radhakrishnan, R., Ball, S. A., & D’Souza, D. C. (2016). Marijuana Legalization: Impact on Physicians and Public Health. Annual Review of Medicine, 67(1), 453-466. doi:10.1146/annurev-med-050214-013454

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