Can too much weed kill you?

 

The idea for this post came from a Facebook friend who indicated they were concerned about the US’s recent push to legalize marijuana, particularly in light of the chances of death from an overdose. Myself and another ED colleague had never heard of a death resulting from THC. So off to research I went.

Scouring the search engines I could find no credible evidence to say overdosing on marijuana has, in fact, been attributed to a death. Having too much marijuana can cause a number of unwanted conditions within the body which can make you VERY uncomfortable:

  • Temporary feelings of paranoia, fear and anxiety
  • Shortness of breath
  • Pupil dilation
  • Vomiting and/or nausea
  • Fast heart rate
  • Shaking that is hard to control, feeling cold
  • Disorientation or hallucinations
  • Hangover

But these symptoms are also common with other illicit and legal drugs, such as alcohol. Studies have shown that a person would have to receive a massive amount of THC, the active high-producing ingredient in marijuana, to die from it- this would equate to pounds being used at a time. Very unlikely.

So marijuana is harmless?

Not so fast! The question is whether you can die from a single overdose of marijuana. But just like other chemicals that humans used for pleasure marijuana can have serious effects which could indirectly lead to death. It is these items I think many are talking about when they discuss the dangers of marijuana consumption.

A report from Colorado USA where marijuana is legal has found that traffic fatalities with drivers showing marijuana in their system at the time of the accident rose by 154%! Hospital presentations were also mentioned as increasing due to marijuana consumption, however the evidence was not clear that marijuana definitely had an impact. School suspensions from marijuana use were also mentioned.

Marijuana also has shown long-term health affects in terms of memory and brain function. There can also be secondary effects from smoking the drug and there are associated birth defects when women who are pregnant use marijuana.

The bottom line…

The actual THC in marijuana can kill you if consumed in large enough quantities. However, obtaining and using those quantities will either land you in jail for a very long time or be practically impossible. There are no known attributed cases to anyone dying from consumption of marijuana.

However, there are dangers in misuse of marijuana. As with all other chemicals consumed by individuals to obtain a euphoric state marijuana can alter a person’s functioning and cause health concerns. Therefore, any use of this or any other substance must be done so with full knowledge of the effects. And there it goes without saying a careful review of current laws on consumption in your area.

Should it be legal?

The eternal debate in modern society. Like other legal substances marijuana has very negative side-effects both short and long term, however that has not stopped tobacco and alcohol from remaining legal. Some would argue that it is a ‘gateway’ drug and could lead to greater abuse. However we do not know the numbers of individuals who use marijuana and never progress to harder drugs, so how can we really know? Like alcohol marijuana can impair a person’s driving and other complex and fine motor skills. So policies and laws would need to be put in place outlining legal limits on consumption and operation.

There is growing credible evidence that marijuana is beneficial to relieving pain and other neurological symptoms. Therefore, I think it’s use as a medical alternative to stronger and harsher medications is welcomed. Especially if those with severe and chronic pain can be helped. These individuals are often struggling, and if allowing this avenue can bring relief then I am all for it.

As for the rest of us, I still don’t know. I will state for the record I have never used marijuana. I can see both sides of the debate, and I guess as I have gotten older my views have become more complex. While once very much against the idea now I am leaning toward society’s choice. There are some distinct advantages to legalizing marijuana.

  • Once legal safe limits on consumption can be placed.
  • Regulations on growing, processing, and distribution can be instated and ensure a safe product.
  • There will be a decreased demand from law enforcement agents in going after marijuana users and dealers.
  • Marijuana use can be taxed leading to revenue.
  • Legalization may also spark increased interest in investigating other medicinal properties.

So I guess I am on the legalizing side of the debate. I also can see the arguments with those who wish to uphold the laws against marijuana use. However, I do feel that they will be fighting a loosing battle in years to come.

References

Herb.com: Marijuana Deaths: How Many Are There?

Huff post: Here’s How Many People Fatally Overdosed On Marijuana Last Year

New Health Guide: Can You Overdose On Marijuana?

Family Council: Number of Deaths Caused by Marijuana Much More than 0

National Institute on Drug Abuse: What is marijuana?

 

 

 

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Healthy one day, sick the next- the issue of Diagnosis Creep

 

An article by Hugo Wilcken in the Medical Journal of Australia InSight page turned me onto the discussion over ‘Diagnosis Creep’. Essentially this is coined as a negative term for the change in definitions of diseases which causes an increase in those diagnosed with that disease which prior to the change would be otherwise considered as not having it. An example would be osteoporosis where in 2008 a new definition was adopted and instantly changed the affected population of women from 21% to 72%! Similarly changes to definitions have created ‘pre-‘ conditions in the diseases of diabetes and hypertension. Wilcken contends that what makes these changes diagnosis creep is that they do not offer health benefits as the treatments do not successfully aid to overall health or well-being.

Some factors have been forwarded to explain diagnosis creep. One such idea is that of the ‘pre’ classification of diseases. Therefore, you may not clinically have the disease, but you are at risk of contracting it. Another theory is that the expert panels who decide on what clinical factors are needed to lead to a diagnosis are made up of clinicians who specialize in their field. These experts, in order to be able to treat effectively, tend to be more inclusive than exclusive when re-examining factors and therefore lessen the threshold for diseases.

Then there is the nasty side of diagnosis creep. There seems to be a pervasive concern that pharmaceutical companies have a wayward hand in expanding the population with certain diseases in order to increase sales of medications for that disease. The MJA InSight article discusses this as ‘Big Phrama’ and contends that some ‘expert panel’ members are sponsored by pharmaceutical companies- leading to potential conflicts of interest. A similar argument was made in an article in The Conversation in 2016.

No matter what the reasons diseases are being re-defined to include more patients an article in the Australian Prescriber magazine sums up the reason for this post:

Health professionals should be more aware, and patients and the public better informed, about the controversy surrounding many contemporary definitions of disease. Diagnostic criteria are not set in stone – they are regularly changed, often with the best of intentions, but are also often rigorously challenged because of the potential for unintended harms.

In Australia the issue has been seen as serious enough that the NPS group has developed an entire campaign entitled “Choose Wisely” to inform and attempt to tackle the need for certain tests, treatments and procedures. Readers of this blog can also follow the Choose Wisely campaign on Twitter at @ChooseWiselyAU.

Before the MJA article I had not known about diagnosis creep, nor the controversy surrounding it. However, the issue does make sense. All healthcare professionals should be conscious of how and why patients are being diagnosed with diseases and what treatments are being given. While I do recognize the need for disease management and appropriate medications I also recognize that we can easily over-medicate and the elimination of any unneeded treatment would be valuable, particularly in the elderly. I applaud the works of Wilcken and the NPS at serving as a checks-and-balance system in this most important area.

References

MJA InSight: Diagnosis creep: the new problem in medicine

The Conversation: Resisting expanding disease empires: why we shouldn’t label healthy people as sick

Australian Prescriber: Caution! Diagnosis creep

NPS Medwise: Choosing Wisely Australia

Australian drug names to get an overall in keeping with international standards

According to an article published on the GIZMODO website by Rae Johnston the Therapeutic Goods Administration (TGA) is planning to change the name of approximately 200 medications in Australia over a seven year period to better align with the international community. According to the article the TGA determines the approved names for medications, however in some cases the names may deviate from the internationally known name as identified by the World Health Organization. During the transition period the TGA will insist that labels show both the old and new medication names.

There is a website setup by the TGA acknowledging the name changes and listing some of the medications names which will be changed. Most will stay relatively the same with only minor variations due to the differences of spelling. Interestingly enough the TGA website was published in November, 2016 and the article in GIZMODO published yesterday. I wonder if there is a delay in the name-change process?

References

GIZMODO: 200 Australian Medications Are Getting A Name Change

Theraputic Goods Administration: Updating medicine ingredient names – list of affected ingredients