In November of 2018, Amendment 2 was passed in Missouri, beginning the process of allowing medical marijuana dispensaries and prescriptions to be given to those with qualifying medical conditions as per their health care providers. One month before this historical vote, a scientific paper by local professionals and a Missouri S&T student was released that discussed risks that marijuana poses, and to whom the most risk lies. In this two-part series we will take the scientific research done, condense and discuss it with commentary from local individuals and an author of the piece.

Two local professionals and a Missouri S&T student compiled an extensive list of research and citations to discuss potential negative implications for some users of marijuana in an article published by The Journal of the Missouri State Medical Association titled “Marijuana Use in the Era of Changing Cannabis Laws: What Are the Risks? Who is Most at Risk?.”

The authors, Dr. William V. Stoecker, an adjunct professor at Missouri S&T and doctor with the Dermatology Center of Rolla, Dr. Joseph M. Malters with the Dermatology Center of Rolla and Missouri S&T undergraduate Emily Rapp worked to create the piece that was published just one month before the general elections were set to take place. Ultimately, the elections ended with the success of two out of three referenda that would allow for different levels of access to medical marijuana.

The article focuses on the risks and problems that would arise as marijuana becomes more readily available in the U.S. Attention is highlighted for those who are the highest risk, the difference in risks between tetrahydrocannabinol (THC) and cannabidiol (CBD) and what exactly the risks presented are.

Stoecker, one of the authors, started the interview very clearly by stating that the research done and gathered was due to the fact that today’s marijuana is “not your grandfather’s weed.”

Stoecker explained that this statement came primarily from the research of Dr. Nora Volkow, the head of the National Institute on Drug Abuse, who was one of the leading individuals to show that more recent strains of marijuana contain a higher potency of THC, summarizing that information on marijuana use from older studies cannot be used due to the newer, higher potency.

“THC greater than 10 percent, you did not hear about that,” Stoecker said. “The passage of the marijuana referendum in November was more about making the weed available. When they wrote the law, they did not set a maximum THC content, like some countries like Uruguay did.”

The article cites multiple physical repercussions from frequent use of the drug, along with the potential for delayed symptoms that may surface later in life. One of these symptoms includes chronic bronchitis, which one study showed a correlation between frequent smoking use to chronic cough and phlegm production and bronchitis episodes. Another study reviewed anatomic brain changes in chronic marijuana users and found a substantial overlap between the location of changes in the brain with concentration of THC receptors.

“The greatest risk of harm from marijuana are for early users, daily users and those with a potential for psychosis, such as those with schizophrenic-causing genes. . . and males,” Stoecker said. “Why males? Females tend to develop their brains earlier, and females have more white matter (in their brains). . . and it is gray matter that shows more adverse effects from marijuana.”

The study details the parts of the brain that have been shown to be most affected by the use of marijuana, including the hippocampus, amygdala and the pre-frontal cortex. The hippocampus and cerebral cortex were stated to be “integral components of the brain reward, memory and executive attention-systems.”

“It should be alarming to users of any kind that many of the brain sites acted upon by marijuana and many of the features found in modern brain scans. . . many of the features overlap with findings in Alzheimer’s disease,” Stoecker said. “So, if you feel that users of marijuana have a defect in memory that reminds you of Alzheimer’s disease, there’s a reason for it.”

One of the biggest findings in the article is the link of marijuana usage to an increased risk of psychosis, or mental illness. The paper cites that The National Academy of Sciences review committee found multiple studies that had confirmed association between marijuana use and development of schizophrenia and other psychoses, such as manic-depressive disorder, hypomania, depression and suicide.

Following the publication of Stoecker, Malters and Rapp’s article, an additional paper was released by other researchers on the topic that correlated high concentrations of THC to psychosis.

“These (researchers) divided the category into low and high potency marijuana, low containing less than 10 percent THC and high potency containing greater than that,” Stoecker said. “The (research) was carefully done and showed a striking variation in psychotic disorders, and it does appear that the high potency marijuana is associated with psychosis.”

The article also cites that in the few states that maintain medical marijuana registries, of them Oregon and Colorado are often most used in obtaining information on the reports of patients with qualifying illnesses who use medical marijuana. Of them, 90 to 93 percent reported severe pain as a reason for use, with other reasonings being muscle spasms and multiple sclerosis (25 to 29 percent), nausea (12 to 13 percent), PTSD (8 percent), cancer (4 percent), seizures, nausea and others.

“We think that there is a lot of belief that marijuana has medical applications,” Stoecker said. “In a federal study in 2018 that we cited, those applications for which good evidence exists that marijuana does work are limited to three things: nausea and vomiting due to chemotherapy, chronic pain and relief from insomnia. All the other things, like glaucoma and seizures, we didn’t have increased evidence for, and that was a study done by the National Academy of Sciences.”

A quote cited in the article from the Colorado Medical Association states that “Other states facing legislative efforts to legalize marijuana should consider Colorado’s experience as a cautionary tale. Approving medical treatments by ballot initiatives sets a dangerous precedent for public health. This will be one of the great social experiments of the century.”

In the next part of the two-part series, we will discuss the study’s findings of THC versus CBD in marijuana, and how marijuana laws affects youth and schools.