What the hemp?

By Dr. Jim Ferguson
Something is going on. Bank buildings, which dot virtually every street corner in Knoxville, are being challenged by CBD shops, which are springing up everywhere to sell the oil extracted from hemp plants. I have no problem with entrepreneurs who open businesses to meet public demand, but I also remember the observation of P.T. Barnum that “There’s a sucker born everyday.”

Cannabis sativa is a rapidly growing plant whose spun fibers have been used for thousands of years in paper, clothing, animal feed and most recently as biofuels. Though industrial hemp comes from the same genus as marijuana, it has low concentrations of THC (delta-9-tetrahydrocannabinol), the psychoactive cannabinoid (drug) in pot.

I’m no botanist, but I’m told that hemp species of Cannabis look just like the subspecies of plants with high concentrations of THC. Regulatory efforts are tough because field analysis of THC concentrations in Cannabis is difficult. And to make matters even murkier, different subspecies of Cannabis produce variable concentrations of THC. And genetic cloning and specialized farming of marijuana, have produced pot ten times as potent as available in the 1970s. Hence the dose of smoked or ingested pot is often much higher.

You may be surprised to learn that products bought at health food outlets are not subject to USP (U.S. Pharmacopeia) dosing standards. In other words, you can rely on the dosage of 325 mg aspirin tablets bought in a pharmacy with the USP stamp. However, there are no such regulatory standards for “supplements” purchased from health food outlets or pot purchased on street corners.

Cannabidiol or CBD“is one of some 113 identified cannabinoids in Cannabis plants.” CBD oil containing less than 0.3% THC is legal. I haven’t done a survey, but I assume CBD outlets are scrutinized to make sure they are in compliance with the law. I wonder. Furthermore, there are little scientific data substantiating benefits from CBD oil except for two rare seizure disorders. Even the mechanism of action of this substance is not known, though it is thought to bind to cannabinoid and neurotransmitter brain receptors.

Several years ago I wrote an essay entitled Rocky Mountain High after encountering scams to pedal medicinal marijuana while on a skiing trip in Telluride, Colorado. Many states now allow the use of marijuana for medical purposes. Examples are loss of appetite, weight loss or pain with cancer and muscle spasms in multiple sclerosis. Interestingly, a large, well done and long term study from Australia published last July showed no pain relief from cannabis; actually the study showed there was greater pain in the cannabis users.

Colorado, the District of Columbia and nine other states have now approved marijuana for recreational use. And with greater usage and pot with higher potency, medical problems are increasingly being recognized. In my previous essay I wrote about the dysmotivation syndrome where heavy marijuana users choose being stoned rather than getting on with their education, job and life. There is now a condition called cannabis use disorder where the drug is abused or associated with addiction. And in states like Colorado emergency room physicians are becoming experts in cannabis – induced psychosis. Psychosis is a syndrome where you lose touch with reality, often associated with delusions and hallucinations.

The hospital where I completed my internal medicine residency had an inpatient psychiatric ward. I was sometimes asked to see those patients confined for depression with suicide ideation, schizophrenia and severe manic depressive illness. I have never been a user of tobacco. (A friend took a picture of me smoking a cigar at a party when we graduated from our residency training, but beer evidently edited my memory of the cigar.) I do remember the perpetual cloud of cigarette smoke which hung like a fog in the psychiatric ward and quickly permeated my hospital coat and clothes. I later learned the reason that those patients all smoked. Nicotine is a very potent drug which stimulates various areas of the brain and produces both a calming effect as well as “putting you on your game.”

Though I am semi retired, I still read multiple medical journals and attend medical seminars to stay abreast of my field. And two other syndromes associated with marijuana use have recently caught my eye. The first is called cannabis hyperemesis syndrome. Dissecting the medical-ease, patients who are heavy users of cannabis can develop recurrent abdominal pain with severe nausea and vomiting which strangely seems to be relieved by taking hot showers. There are all sorts of speculation about this disorder, but everyone believes the ultimate treatment is to stop using pot.

The second disorder is more complicated. In Western civilization the lifetime risk of developing schizophrenia is 1%. This incurable serious mental disorder is associated with disturbances of thought and behavior including altered states of reality with delusions, apathy and hallucinations. (To partially understand what it’s like from the perspective of a paranoid schizophrenic watch the wonderful movie called A Beautiful Mind.) A disturbing trend is the increasing rate of schizophrenia associated with cannabis use. Furthermore, people with disorders such as schizophrenia make their conditions worse when they use alcohol or cannabis. A Swiss study showed a 4 fold increase in violence among young men with psychosis who use marijuana.

I am not a prude. When I was in medical school in the early 1970s, I attended a party and everyone was smoking pot. I was drinking beer. They talked me into trying marijuana, but after watching me try to smoke a reefer, my friends concluded that I looked ridiculous, swearing that smoke came out my ears as I tried to inhale. They took the reefer away for me, concluding that sharing with me was a “waste of good dope.”

Misuse of any medication or alcohol is problematic. However, it concerns me that the marijuana lobby and our hedonistic society have pushed our unsophisticated legislators to legalize a drug whose effects we don’t fully understand.

People will always be people and it is impossible to legislate morality or good behavior. Virtue is not a top down phenomenon. Virtue, like morality, is an inside out concept driven by the Spirit interacting with our essence, the non-anatomical site we call the soul. And I am required to “speak the truth in love” about cannabis, and avoid causing my brothers to stumble.

References for this essay:

Imprimas January, 2019

UpToDate

Wikipedia

My memory

 

 

 

 

 

 

 

 

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