Not many people make a doctor’s appointment to talk about the pros and cons of smoking joints vs. vaping, the effects of the cannabis gummy bears they nibbled last weekend or whether it’s OK to mix Mary Jane with merlot. But maybe more of us should.
“There’s a perception that marijuana is like water and it has no harms associated with it, and it’s totally safe because it’s so common,” says Natasha Bhuyan, a One Medical doctor in Phoenix. “But that’s not true.”
Medical and recreational marijuana have become legal in a growing number of states, and use more than doubled between 2003 and 2013, according to researchers at Columbia University. One Medical providers are seeing all sorts of people using it: from college students and professionals in their 50s to recent immigrants and conservative-looking older folks.
“The most common scenario is your mid-30s software engineer who comes home from a long day at work and vapes as they’re eating takeout and watching TV or playing video games to relax,” says Mark Berman, a San Francisco lifestyle MD who counsels patients on weight loss and anxiety.
And more marijuana use means more marijuana problems — in fact, 30 percent of regular pot users have related health problems.
While using is an individual choice, we talked to some of our providers for the 411 on the possible pros and cons of marijuana and how to use it most safely.
Should I smoke it, eat it or vape it?
Visit a medical marijuana dispensary and you’ll find choices far beyond joints and brownies. There are vapor e-cigarettes, cannabis lotions and edibles like cannabis-laced watermelon lollipops, cheese puffs and chocolate chip cookies.
“I tell my patients I’d rather have them eat it because studies are clear (smoking) it does cause lung problems,” says Michelle Rhee, an MD in San Francisco, referring to coughs and asthma that some people develop.
And though there haven’t been long-term studies, vaping is easier on the lungs than smoking an old-school joint, and may be the safest way to get high. Vaporizers deliver the drug without the high temperature of smoke from a pipe or joint.
Since it’s hard to know the dose in a cookie or candy, it’s important to eat a tiny amount and wait at least an hour or two to see what the full effect will be. Otherwise, it’s easy to get a more potent dose of THC (tetrahydrocannabinol) than intended. “I’ve had people tell me they actually hallucinated on edibles,” Rhee says.
Is there anyone who shouldn’t use marijuana?
The most serious side effects are for adolescents and young adults, because their developing brains are more susceptible to the effects of marijuana, and pregnant women.
A Duke University study that tracked 1,000 subjects for 25 years linked marijuana use to a drop in IQ. But further research showed that the subjects with lower IQ also had other issues like unstable families, depression and behavioral problems. They also found that smoking cigarettes was a better predictor of lower IQ than marijuana. Researchers now theorize that having a low IQ may make it more likely that someone will experiment with marijuana at a young age. Other studies have shown that people who start using marijuana before age 15 have an increased risk of a psychosis later in life, and that the drug can be a trigger for people who already have a family history of schizophrenia.
A 2015 study in the British Medical Journal found that women who use marijuana before or during pregnancy have a higher risk of anemia and miscarriage. And when those women carried to full term, their babies were smaller and more likely to spend time in neonatal intensive care.
Why are people using marijuana?
Most patients say they’re enjoying pot recreationally. But others are seeking relief from conditions including anxiety, insomnia, glaucoma, chronic pain, nausea from chemotherapy, and epilepsy, says Rhee. Studies show marijuana can improve muscle control in people with multiple sclerosis, so those patients are curious about it.
But does it help?
It depends. Rhee says some people seem to benefit from it, but others don’t.
“I’m cautious … because it can make some people extremely anxious and paranoid,” says Rhee. Some stressed patients who tried marijuana had more anxiety while other patients who used it for insomnia became anxious after they stopped using it, as can happen with the sleep medication Ambien.
Staff at larger dispensaries and websites like High Times and 420 Magazine can help people figure out the strains to try to feel energized or mellow, and what formulations will achieve the desired effect.
Many people self-treat with marijuana, and Bhuyan points out that so-called “medical marijuana” isn’t FDA-approved so there’s a lot of guesswork involved. She encourages her patients to talk about what they’re trying so they can make sure it’s not causing any other issues.
What are some other side effects of using marijuana?
A 2013 study in the UK found that long-term users produce less dopamine, the brain chemical linked to motivation and reward. It explains the “slacker syndrome” often associated with chronic users. Researchers found that people who started using younger had the lowest levels of dopamine.
If you’ve seen Pineapple Express or Up in Smoke, you know short-term side effects include slow thinking, and difficulty with paying attention, learning and remembering.
And marijuana also gives people the munchies, though overall, regular marijuana users are likely to weigh less than nonusers, according to a study in the American Journal of Epidemiology.
“They’re not munching on carrot sticks and broccoli,” Berman says. “What they’re eating is pizza and fries and burgers and popcorn and basically foods they don’t need if they’re struggling with their weight.”
Berman says he generally discourages marijuana use, since it often seems to solve one problem while creating another. He says other medications and behavioral changes are better solutions.
“There are a lot of gaps in marijuana research,” says Bhuyan. “As providers, the best thing we can do for our patients is advocate for more research.”
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, Portland, the San Francisco Bay Area, Seattle, and Washington, DC.
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