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Medical marijuana: 4 experts on benefits vs. risks

Panelists and governor address health journalists at AHCJ conference in Colorado – and delegates visit a dispensary

When I landed in Denver to attend the Association of Healthcare Journalists (AHCJ) annual meeting, the pilot announced, "Welcome to the mile-high city — although lately the emphasis has been on high."

The humorous references to the state's recent legalization of recreational marijuana sales continued into the conference March 27 to 30, which was attended by about 700.

Governor John Hickenlooper opened his keynote speech by denying he was seeking" higher" office.

Marijuana from the Native Roots Apothecary in Denver, Colorado (Photo by Andrew Holtz)He gave a report on how Colorado has fared since January 1, when the state legalized recreational marijuana use for adults 21 and older and implemented ways to regulate, tax and distribute cannabis products. He noted that the state issued 136 licenses for recreational marijuana sales in December. (Although recreational marijuana only started January 1, medical marijuana has been legal in Colorado since 2000.)"The world has not fallen apart. Crime is not rampant. We are not having tons of automobile accidents from stoned drivers," Gov. Hickenlooper said. In the first month, he added, Colorado collected nearly $14 million in taxes from sales, mostly from Denver stores.

The governor said he was first offered marijuana in middle school: "Drugs are here whether there are laws or not. We have spent billions of dollars on the war on drugs in this country and it is not working." He said that since marijuana is around, it makes more sense to make it legal and educate the public about it.

He said his biggest concern was how the new law would affect children and young people. "We are spending a lot of money and effort to reach out to them." He noted that the state's state's marijuana website has a special section for parents to start a dialogue with their children and that his government is committed to working with state agencies and community partners over the coming months to develop a statewide public awareness campaign addressing the dangers of under-age marijuana use.

There were many questions from the audience of health journalists — including whether the governor had inhaled since the law took effect. His answer was no, but no one asked him whether he had consumed any products that contained marijuana, which are very popular in Colorado and can be found in every store selling it.

He said he wants to use the money raised by sales for education and research. He supports the proposal of Dr. Larry Wolk, executive director of the Colorado Department of Public Health and Environment, who is calling for the State Legislature to use tax revenues from marijuana sales to fund $10 million in human research trials.[divider]

Panelists speak from experience

Dr. Wolk took part in a panel discussion on the "Medical Ramifications of Legal  Marijuana," which drew a huge crowd. The panel was moderated by Michael Booth, Managing Editor of Health Elevations, a quarterly journal published by the Colorado Health Foundation. It included Dr. J. Michael Bostwick, a psychiatrist at the Mayo Clinic; Dr. Kari L. Franson, Associate Dean for Professional Education at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences; and Michael Elliot, Executive Director of the Marijuana Industry Group, which was founded in 2010 to protect and promote the Colorado medical marijuana regulatory framework, serve as a resource for policy makers, and protect the rights of medical marijuana patients. 

Dr. Kari Franson: Still much to learn – and be careful when eating it

Kari L. Franson, PharmD, PhD Dr. Franson said marijuana is difficult to study in the lab, and there is still a lot to learn about its effects on the body. "There is a reason people take one or two aspirins. We know that works for most people," she said. "We don't know that about marijuana."

She pointed out that unlike prescription drugs, people take marijuana in many different forms, and there is a wide variation in how tetrahydrocannabinol (THC) — the active ingredient of marijuana — affects individuals when taken in oral form. "One day a person might need one dose, and another day four or more in order to get the same effect."

Dr. Franson noted that patients can also get into trouble when they ingest marijuana products because it can take between one to five hours to feel its effects.

Many Patients prefer the convenience of the oral products, such as gummy bears and brownies, rather than smoking it. But they are used to inhaled weed which takes effect almost immediately. Edible products have to be digested. And consuming more edible products doesn't cause marijuana to get into the system faster. But it can lead to increased anxiety and altered perceptions once it becomes effective.

Pediatrician Larry Wolk: Reports of 'miracles' are overblown

Larry Wolk, MDDr. Wolk said that despite marijuana being around for years, we don't know that much about it: "It is almost impossible to get funding from the federal government for studies. I see this as an opportunity in public health to study the health effects, both short and long-term of marijuana."

When asked by a member of the audience whether he was prepared for the rush of parents of epileptic children moving to Colorado to get medical marijuana, Dr. Wolk, who is a pediatrician, said there hasn't been a rush. In fact, he said that  less than 300 of the 120,000 medical marijuana registrants were children. "Children with epilepsy and other seizure disorders have become the poster children for medical marijuana advocates, but the evidence is not there."

Dr. Wolk said the reports of the miracles for children who use a form of marijuana known as Charlotte's Web — named after Charlotte Figi, whose severe seizures were controlled by marijuana — have been overblown. "We only hear the success stories. It doesn't help everyone; in fact, we're not even sure if it helps the majority of children."

Dr. Wolk said he is very frustrated by the lack of response from doctors who treat patients: "I keep asking doctors to get me some data, show me your clinical notes or the EEGs and brain scans that show kids have responded clinically. Despite multiple requests, I've received no response."

Psychiatrist Michael Bostwick: One in 10 users meets medical criteria for addiction

J. Michael Bostwick, MDDr. Bostwick, who specializes in addiction psychiatry, said that unlike alcohol, whose responses are well known, there is a lot of variability in response to marijuana.

There have not been good randomized trials on the effects of marijuana. There is no funding for it, and politicians are against it. But we need to know more.

He said although it is almost impossible to overdose from marijuana, one in 10 marijuana users meet the medical criteria for addiction. "Although this is troubling given the vast amounts of people who use marijuana, it is still a low percentage compared to alcohol and nicotine."

He told the audience that his 20-year-old son needed treatment for marijuana use when he was 17. "It was absolute hell to figure out what was experimentation and what was going to destroy his life and his brain," Dr. Bostwick said. But his son's treatment worked. He has been substance-free for close to four years.

As a psychiatrist, Dr. Bostwick said he was disappointed that medical marijuana for PTSD is not among the eligible conditions approved by Colorado. "There is good evidence that for some patients with PTSD it is helpful," he said. (The eligible conditions include AIDS, HIV, cancer, glaucoma and any of the following symptoms that are caused by a chronic or debilitating disease or the treatment of such disease: cachexia (severe weight loss caused by a medical condition or its treatment), severe pain, severe nausea, seizures, or persistent muscle spasms.)

Advocate Michael Elliott: "We embrace regulation … and taxation"

Elliott, an attorney, said his trade association, the Marijuana Industry Group, takes an opposite approach to the tobacco companies:

We acknowledge safety concerns. We embrace regulation. They don't. We support taxation, they don't. The same is true for accountability, transparency and control. We want it because it makes the use of marijuana safer for both medical and recreational users.

Michael ElliottHe said his group supports using marijuana tax revenue to keep the substance away from children, deter driving while under the influence of marijuana and combat drug traffickers.

Elliott noted that laws in 20 states and the District of Columbia allow marijuana for medical use and that about a dozen other states are considering the legalization of marijuana in some form in the coming years.

My fellow attendees said they learned a lot from the panel discussion, and many expressed interest in seeing first-hand the stores that sold marijuana.

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Last year, Colorado and Washington because the first states to legalize the recreational use and sale of marijuana to people 21 and older. On January 1, the first licensed stores opened in Colorado. Regulations for these "adult use dispensaries" are posted on the state government's website. Here is a short FAQ.  

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Visiting a marijuana store

David Levine, the author of this story, visits the Native Roots Apothecary in Denver, Colorado. No photos were allowed inside to protect the confidentiality of patients who were there to buy medical marijuana.During the conference, several AHCJ members bought marijuana products and paraphernalia and showed it to a group of us sitting around the bar. It was an Alice in Wonderland atmosphere — not because anyone used it, but because no one had to look over their shoulder while showing it.

I went with a fellow attendee to visit one of the marijuana stores. It was right near the hotel, an easy 10-minute walk. To find it, all you had to do was Google "marijuana stores," and it was the first to come up.

The store is named the Native Roots Apothecary, and it bills itself as an alternative wellness center.  It is on the eight floor of an office building, and there are no signs on the street telling you to "buy marijuana here." 

It is very professionally run. All of the workers are licensed by the state and wear their IDs. When you take the elevator to the Apothecary, you can't just walk in. You are buzzed in, and the receptionist asks you if you are there as a recreational user or as a patient.  And you have to show the receptionist your driver's license, which is scanned (so you can't go from shop to shop) and looked at more closely than a TSA agent. You have to be 21 to buy any of the products.

If you are a resident of Colorado, you can buy one ounce of retail marijuana per transaction. If not, .25 ounces. You are allowed four transactions a day and can buy THC products such as THC lotion, topicals, elixirs and edibles (THC – tetrahydrocannabinol – is the active ingredient of marijuana), as well as the traditional "grass" you can smoke.

Recreational users don't need anything but a license. Medical patients need a state registration card, which they can only get from a doctor.

Once you go in, you wait. I was given a number, the kind you get in a bakery, and waited about half an hour. No cell phones or pictures are allowed because of patient confidentiality. This establishment has been operational for four and a half years, previously as a medical marijuana dispensary.

When we were called in, the people behind the desk looked at our driver's licenses again then showed us the products in the recreational section. (I asked to see the patient products but was not allowed).

Lip Buzz cannabis oil + mango butterThere were all kinds of products for sale. Marijuana varieties included Purple Flo, Tangerine Haze, Dark Dream and Lemon Sweet Skunk, with prices ranging from $30 to $35 for 1/8 of an ounce. Edibles included Love's Oven Magic Bars (150 mg of graham cracker, cannabis infused butter, coconut, sweetened condensed milk, semi-sweet chocolate, butterscotch and walnuts) for $14 each. You can see the full menu on the website. The person I went with bought marijuana chapstick, which she said didn't do anything.

The two people behind the counter were very knowledgeable and made recommendations to consumers based on whether they wanted to feel mellow or alert. But there was no joking around. They took their jobs seriously. And everyone there is certified by the State and has an ID issued by the state.

There was a photo of the staff with the rapper Snoop Dogg. There is a strain of marijuana named after him which is very popular.

You can't use marijuana in any public place. You can't even use it in the stores. (No one is sitting around getting stoned, if that was what you were wondering.)

And there is a lot of security, including guards and cameras. It is an all cash business. The federal government won't allow credit card transactions for marijuana, I was told, although Native Roots did allow debit card transactions.

I asked if they ever refused a sale. The clerk said, "If a person is impaired, either drunk or stoned, I have the power to refuse a sale." [divider]

Watch a video tour of the store

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You can also read the reviews on the website. The first one reads:

Awesome!

This was our first time in a dispensary. Overwhelming is an understatement but the staff was super nice and patient. Their suggestions were amazing and exactly what we were looking for. I will definitely be back soon.

As for store hours, it is open from 10 a.m. to 7 p.m. By law, all marijuana dispensaries must close by 7 p.m.[divider]

The Author

David Levine (@Dlloydlevine) is co-chairman of Science Writers in New York and a member the National Association of Science Writers (NASW) and the Association of Healthcare Journalists. He served as Director of Media Relations at the American Cancer Society and as Senior Director of Communications at the NYC Health and Hospitals Corp. He has written for Scientific American. The Los Angeles Times, Good Housekeeping, BioTechniques, Robotic Trends and Nautilus and was a contributing editor at Physician's Weekly for 10 years. He has a BA and MA from The Johns Hopkins University.



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