Cannabis: Social, Legal, and Research Issues
These are interesting times for cannabis. Cannabis is still a federally listed drug, but many states have decriminalized or legalized the use of cannabis for medical or recreational purposes. For example, Colorado and, more recently, California. Cannabis is available for consumption in the form of the traditional dried plant, referred to as buds, but can also come in the form of hashish, hash oil, cannabis tinctures, vaporizers, and in edible form such as candy or cookies (National Institute on Drug Abuse 2016c).
Additionally, there are many synthetic cannabinoids that are not detectable in the common toxicology screening but may cause patients to experience increased psychosis and lead to increased healthcare utilization. Certainly, cannabinoids maybe helpful for several diagnostic entities and are already available and FDA approved (such as dronabinol) in some formulations.
There are some studies lending credence that cannabis may be beneficial for patients with wasting syndromes and certain types of spasticity associated with multiple sclerosis and certain epileptic disorders (Carter and Weydt 2002; Friedman and Devinsky 2015). However, the American Academy of Addiction Psychiatry (AAAP) rejects the concept of medical marijuana as currently constituted; there are simply not enough studies about the efficacy of cannabis for many conditions. There are issues with addiction and secondary gain, and Nora Volkow, of the National Institute on Drug Abuse (NIDA), warns of certain deleterious syndromes associated with cannabis consumption, especially with developing adolescent brains (Volkow et al. 2014). The emergency psychiatrist is in a position to answer many questions from both patients and staff about cannabis. For the most part, cannabis is still seen by a majority of the medical community as an addictive and potentially dangerous substance.