Health Adviceby Dr. Weiss Jul 11, 2016 A proposed constitutional amendment to allow medical use of marijuana in Florida will be back on the ballot in November. A similar measure narrowly failed in 2014. With that in mind, I thought it would be instructive to look at Colorado’s experience with marijuana. Physicians, as sources of credible public health information, have a responsibility to share both potential risks and unexpected consequences of legalization of marijuana. Marijuana has had a complex effect on the health of the citizens of Colorado, according to a recent article in the Journal of the American Medical Association. Colorado’s state constitution was amended in 2000 to allow the use of medical marijuana by patients with “chronic debilitating medical conditions.” Federal law in place at the same time prohibited the possession or distribution of marijuana until 2009. With the liberalization of the Federal laws and the lucrative financial incentives associated with medical marijuana, the number of licensed sellers increased from under 5,000 in 2008 to more than 115,000 in 2014. In November 2012, Colorado’s state constitution allowed for the use of medical marijuana and opened a floodgate of activity. Two classes of sellers were created—medical and retail. Medical sellers have no minimum age for consumers and are restricted to residents of Colorado. Retail sellers can sell to anyone from anywhere over the age of 21. In November 2014, there were 497 medical marijuana dispensaries and 292 retail outlets in Colorado. The easy access to marijuana has led to exacerbations of chronic health conditions, particularly mental health disease. It is difficult to fully quantify the worsening of psychosis, anxiety, depression and other mental health diseases, but easy access to marijuana and other narcotics makes a bad condition worse. Without question, the combination of marijuana plus alcohol increases the risk of motor vehicle accidents more than either substance used alone. Emergency room treatment for marijuana intoxication was rare in Colorado until the laws changed. Now patients appear in emergency departments with anxiety, panic attacks, public intoxication, vomiting, and other symptoms of marijuana use. Safer medications are already on the market for all medical uses for marijuana. Ameliorating the side effects of cancer and chemotherapy can be accomplished without medical marijuana. The same is true for glaucoma and seizure disorders. But the financial rewards for marijuana purveyors are astounding, which I’m sure contributes to their tenacity. The unforeseen harm with the increased production and distribution of marijuana includes burns, cyclic vomiting syndrome, and potential overdoses by ingesting marijuana in edible forms. The extraction of the active ingredient THC in marijuana (tetrahydrocannabinol) uses butane as a solvent, and many purveyors have experienced significant flash burns. Cyclic vomiting syndrome—which presents with severe abdominal pain, vomiting and unusual sweating—is now also more prevalent. Smoked marijuana reaches a peak between 30 and 90 minutes, whereas the edible form peaks at 3 hours. This delayed effect from the oral form can seduce a user into ingesting additional amounts due to the delayed reaction—and thus can lead to an overdose. One of the worst unforseen negative outcomes is children inadvertently ingesting edible THC in the form of cookies, candy (gummy bears) or baked goods. Overdosing, widespread distribution, impairment of cognitive function, addictive potential, loss of self-control, and worsening of mental illness are all negative influences of marijuana. The only reason that I see that medical or recreational marijuana is being pushed by a small group is for financial gain, which can be huge for the producers, sellers, and distributors. Let’s stay informed as the election approaches and as we consider the welfare of our entire community.