When Dr. Margaret Gedde prescribes edible marijuana therapy for a patient, she usually starts with a cookie, cut into fours. She recommends her patients try a piece at a time and keep a daily log of the effects.
“The edibles in particular don’t take effect for a while, like a solid hour,” said Gedde, of Vibrant Health Clinic in Colorado Springs. “So for people who are new to it, we start low and go up slowly.”
Close monitoring — by doctor and patient — is key to getting treatment right and keeping it safe.
Though Gedde stressed that no deaths have been attributed directly to marijuana use, “there is a toxic level and there can be a danger there. That’s the biggest drawback — managing the psychoactive effects.”
Unwanted psychoactive effects can include feelings of being “too high,” or out of control, with confusion and a sense of unreality, she said. “That’s when people will end up in the emergency room, thinking they are having a panic attack,” Gedde said. “It can be very upsetting.”
Though still outlawed at the federal level, medical marijuana has been legal for registered card holders in Colorado since 2000. The passage of Amendment 64 in November made it legal for adults in the state to possess up to an ounce of the substance, which could be available for purchase through licensed establishments as early as 2014.
Vocal advocates for medical marijuana, such as Dr. Bruce Reimers, are less enthusiastic about the prospect of expanded availability.
In the years he has prescribed it at his practice, Reimers has seen marijuana work wonders for many who have failed to respond well to pharmaceutical therapies.
“Its medical effects are fantastic,” said Reimers, a Colorado Springs urologist. “It decreases the pressure in the eye and works for glaucoma. We know it simulates appetite, significantly reduces pain and spasms ... and of its effects in seizure control and multiple sclerosis. It may even impede the growth of cancer cells.”
His unabashed praise for marijuana does have limits, however.
“I’m not a proponent of letting everybody smoke,” said Reimers, who counsels his patients to dial back dosages as soon as they start to feel a “high.” “I’m firmly about medical use.”
While he concedes there might be medical benefits to marijuana in some scenarios, they don’t outweigh the downsides, especially among younger users, said Dr. Alex Kudisch, chief medical officer at Origins Recovery Center in South Padre Island, Texas.
“Cannabis seems to be something used at a very early age in people at the crux of brain development, and we think that there’s significant harm to that development,” said Kudisch, a fellow of the American Psychiatric Association. “We tend to see more issues with emotional disorders in children who are exposed to cannabis during fetal development.”
Children whose parents smoke marijuana can develop attachment disorders, which can lead to depression, Kudisch added.
“Adolescents who are under the influence tend to be apathetic and withdrawn and tend to want to stay at home and get high,” he said. “That doesn’t allow them to prepare to develop emotionally for the world as an adult.”
Physiological problems in children and adults can range from lung damage to a greater risk of virus and disease transmission among people who share marijuana cigarettes or smoking implements, Kudisch said.
And with legalization, “there will be more access to cannabis than where there is no legalization,” he said. “Higher access will create higher incidence.”
What’s certain to be strict regulation of the strength and labeling of any commercially available marijuana products will go a long way toward ensuring the safety of the adults who chose to indulge, said KC Stark, founder of the Medical Marijuana Business Academy of Colorado.
“Right now, you’re buying your marijuana at dispensaries, which are highly regulated, very controlled environments,” he said. “If you’re buying it off the streets, which is illegal, you have no idea what you’re getting. That hasn’t changed.”
With medical marijuana, Stark said, every plant is labeled and tagged from seed to sale and can be traced back to its source should any quality or health issues arise.
“Under (Amendment 64), things are probably going to be even more controlled, to protect the tourists that come here,” he said.
The best risk-aversion tactic when it comes to marijuana — or anything, really — remains vigilance and common sense, he pointed out. “There’s always danger with any substance — whether it’s potato chips, pizza or pot,” he said. “Abuse is abuse.”