Tag Archives: banning retail marijuana

Marijuana through the eyes of a doctor in Emergency Medicine

 Warnings from a Doctor

by Brad Roberts, MD:  I recently finished my residency in emergency medicine and began to practice in Pueblo, Colorado. I grew up there, and I was excited to return home. However, when I returned home, the Pueblo I once knew had drastically changed.  (Above photo is of people lining up at the opening of a pot dispensary in 2014.)

Where there were once hardware stores, animal feed shops, and homes along dotted farms, I now find marijuana shops—and lots of them. As of January 2016, there were 424 retail marijuana stores in Colorado compared with 202 McDonald’s restaurants.These stores are not selling the marijuana I had seen in high school.

Multiple different types of patients are coming into the emergency department with a variety of unexpected problems such as marijuana-induced psychosis, dependence, burn injuries, increased abuse of other drugs, increased homelessness and its associated problems, and self-medication with marijuana to treat their medical problems instead of seeking appropriate medical care.

I had expected to see more patients with cannabinoid hyperemesis syndrome (and I have), but they were the least of my concern. Our local homeless shelter reported seeing 5,486 (unique) people between January and July 2016, while for the entire year of 2013 (before recreational marijuana) that number had been 2,444 people.2

Most disturbing, we weren’t seeing just homeless adults but entire families. It is a relatively common occurrence to have patients who just moved here for the marijuana show up to the emergency department with multiple medical problems, without any of their medications, often with poor or nonexistent housing, and with no plan for medical care other than to use marijuana.

They have often left established medical care and support to move here for marijuana and show up to the emergency department, often with suitcase in hand.

Increasingly Potent & Dangerous Drug

This new commercialized marijuana is near 20 percent tetrahydrocannabinol (THC, the psychoactive component of cannabis), while the marijuana of the 1980s was less than 2 percent THC.

This tenfold increase in potency doesn’t include other formulations such as oils, “shatter” (highly concentrated solidified THC), or “dabbing” (heated shatter that is inhaled to get an even more potent form) that have up to 80 or 90 percent THC.3

The greatest concern that I have is the confusion between medical and recreational marijuana. Patients are being diagnosed and treated from the marijuana shops by those without any medical training. I have had patients bring in bottles with a recommended strain of cannabis and frequency of use for a stated medical problem given at the recommendation of a marijuana shop employee.

My colleagues report similar encounters, with one reporting seeing two separate patients with significantly altered sensorium and with bottles labeled 60 percent THC. They were taking this with opioids and benzodiazepines.

In some cases, places outside of medical clinics, like local marijuana shops, are being used to give screening examinations for medical marijuana cards.4 Reportedly, no records are available from these visits when requested by other medical providers. A large number of things treated with marijuana, often with no cited research at all or with severe misinterpretation of research, are advertised online.

These include statements that marijuana treats cancer (numerous types), cystic fibrosis, both diarrhea and constipation, hypoglycemia, nightmares, writer’s cramp, and numerous other conditions.5–7

Although there are likely some very effective ways to use the cannabinoid receptor (probably better termed the anandamide receptor), putting shops on every street corner and having nonmedical personnel giving medical advice is a very poor way to use this as a medicine.

Furthermore, to suggest that combustion (smoking) be the preferred route of medication delivery is harmful.3,8–10 I am also concerned that this is being widely distributed and utilized as a medicine prior to safety and efficacy studies having been completed; widely varying dosing regimens, concentrations, and formulations are being developed, sold, and utilized.

Patients are not being informed of the adverse effects associated with marijuana use, but instead, they are being told, “There are no adverse effects.” I am in favor of using the anandamide receptor for treatment purposes. However, we should do this safely and appropriately. What is occurring now is neither safe nor appropriate.

There are numerous adverse effects of marijuana that are significant. Marijuana use may lead to irreversible changes in the brain.3,9,11,12 Marijuana use correlates with adverse social outcomes.3

It is strongly associated with the development of schizophrenia.13–16 Dependence can lead to problem use.17,18 There are adverse effects on cardiovascular function, and smoking leads to poor respiratory outcomes.3,19,20 Traffic fatalities associated with marijuana have increased in Colorado.1

Pregnant women are using marijuana, which may lead to adverse effects on the fetus, and pediatric exposures are a much more common occurrence.21,22

This photo represents a few of the 270 Pueblo physicians who signed a petition last fall to opt out of marijuana for the city and county.

Different Approach Is Needed

We should approach mass marijuana production and distribution as we would any other large-scale public health problem. We should do what we can to limit exposure, and we should provide clear, unbiased education.

In the case of prevention efforts being unsuccessful, we need to provide immediate treatment and assistance in stopping use. If we are going to use this as a medication, then we should use it as we use other medications. It should have to undergo the same scrutiny, Food and Drug Administration approval, and regulation that any other medication does. Why are we allowing a pass on a medication that very likely would carry with it a black-box warning?

As emergency physicians, we are on the front lines. We treat affected patients; we need to be at the forefront of public policy recommendations at both state and national levels.

Originally published by ACEPNow,  a journal of Emergency Medicine.    We also published the testimony of another emergency doctor in Pueblo, Dr. Karen Randall.

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Pueblo West: The Right to Ban Retail Expansion

(Part 2 on the battle to keep retail marijuana out of communities.)  Colorado has become the butt of the jokes from late night talk show hosts.  Some have gone so as to call it the vacation destination of “stoners” across America.

In the past, Colorado had been known mainly for its sporting activities and natural beauty.  “I think that [health and wellness] is a better thing for us to promote. It seems a little hypocritical, regardless of what side of the argument you want to take. There’s a lot of evidence out there that this [marijuana] may not be the greatest thing for you,” Tim Haas told me as we discussed Colorado tourism.

Haas is struggling with the problem in Manitou Springs, as our last article detailed.  Isn’t growing up to be a healthy, high functioning human being the message worth promoting to young children of Colorado?    It’s time to let Colorado communities — rather than marijuana businesses that are expanding throughout the state — to decide what is best for their individual communities.

South to Pueblo West

An hour’s drive south of Manitou Springs,  the Pueblo West Metropolitan District is fighting a similar battle.  The community of Pueblo West has been struggling with the growing number of businesses selling, growing, cultivating, or producing marijuana-infused products. The metropolitan district is already credited to having 6 recreational dispensaries, with, what seems, a new rush of marijuana licenses on the way.

When medicinal and then recreational marijuana were legalized in Pueblo County, the county created a land use code that limited stores to property zoned for specific retail uses. The result was the zoning protected Pueblo City, with limited zoning, and Pueblo West, with far more retail zoning, became the place to open shop.

“The result is businesses looking for spaces found a lot more zoned in Pueblo West than a lot of other places in the county,” Commissioner Sal Pace said. “It was an unintended consequence.” Pueblo West doesn’t want the stores, but the community of about 35,000 is stuck with them.  That’s what the resolution ended with, that acknowledgement.

While unintended, it’s nonetheless a consequence.  In the minutes of a Pueblo West Metropolitan District meeting on July 8, 2014, Sheriff Kirk Taylor for Pueblo County is recorded as saying, that he “does not think the citizens of this community have weighed in on the issue. There have been over 100 municipalities and counties that have opted out [of marijuana retailers in their areas]. The community of Pueblo County never got an opportunity to opt out. Three commissioners decided it was good for us and they started giving out licenses, and in his opinion this is wrong.”   In other words Pueblo West doesn’t want the stores it has, but the city is stuck with them.

Buyers in Pueblo West, Colo., line up on Jan. 1, 2014 to legally buy marijuana after it was approved for recreational use. (Source: AP Photo/John Wark)
Buyers in Pueblo West, Colo., line up to legally buy marijuana on Jan. 1, 2014, the day the first  recreational marijuana stores opened. (Source: AP Photo/John Wark)

Pueblo for Positive Impact (PfPI) Founder and Leader, Paula McPheeters, has been working diligently to make sure someone is standing up and speaking out for the community.  “What we want is control of our own destiny for economic development and or the future.  And we know there is way more to Pueblo West than just the marijuana industry,” said McPheeters.

Later in July, the Pueblo West Metropolitan Board finally heard its constituents and voted in favor 5-0 of a new resolution asking that the county not permit any new licensing of any additional marijuana-related facilities or operations. The resolution was passed shortly after being edited to remove a moratorium on pot shops. So while the community would still like to see the shops go somewhere else, they are still protected by the local Metropolitan Board.

The County Commissioner’s Board is beginning to feel the heat, as well, now that the local Metropolitan Board is being called to accurately represent Pueblo West’s desire to end the addition of any more pot shops in its community.  Also putting on the pressure at the County Commissioner’s Board meetings are those representing the big business behind the marijuana industry, leaving many community members wondering who their local legislators are really listening to—the people who live in their communities and voted them in, or the profiteers looking to attract pot smokers.

These Coloradans aren’t arguing whether or not they think that pot should or should not be legal, it’s about community members deciding what’s best for them and their families.

Colorado used to be the state of the Olympic Committee, one of the healthiest populations in America, known for its hiking and skiing, and its beautiful landscapes. Communities that don’t want to be a part of the pot  community and this new stereotype have the right to do so.  Coloradans are now fighting for their right to not raise their children surrounded by pot shops and marijuana grows.

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