Cannabis, the controversy updated. Guillermo Caletti

It is interesting reading the great number of publications related to the use of Cannabis as a medicinal and recreational product and the worldwide controversy for the authorization, and regulation for its medicinal and recreational use.

The history of Cannabis in Mexico is at least 5 centuries old, beginning with the introduction of hemp upon the arrival of Spaniards in the 16th century. Since then, hemp has had a continuous presence in Mexican society, economy, and national culture, either in the form of hemp products, as medicine for traditional use, and/or as a psychoactive substance. However, hemp had not been considered an unhealthy product until the 20th century, particularly during the ‘80s, when, due to pressure from the United States, the Mexican government was forced to start a fight against the Cannabis business, along with the illegal trade of cocaine from Colombia, increasing the levels of corruption within the government institutions, as well as the rise of organized crime and violence, linked to these unlawful businesses.

Nevertheless, this national reaction had nothing to do with local problems of diseases related to the use of Cannabis, but rather to the Cannabis’ illegal trade in the United States and the flight of capital that this market represents. It should be noted that, according to the 2011 Annual Report of the United Nations Office on Drugs and Crime (UNODC), the United States has the highest annual consumption of marijuana (13.7%), while in Mexico, the consumption is barely 1%, only higher than in Ecuador (0.7%) and the Dominican Republic (0.3%). So, whose problem it is?

From a health perspective, is marijuana a harmful substance? When a person learns that a relative or friend is consuming any type of drug, one of the major concerns is the risk of a fatal overdose. However, it has been discussed that marijuana overdose may not be possible because of all the factors involved for it to be experienced and still be fatal.

The scientists have demonstrated that, in order to enter a state of overdose, an individual requires at least 750 kg of marijuana. And there is more, that amount must be present in the body for 15 minutes. So, is it possible to smoke that amount of drug in such a short time?

To prove this risk, scientists decided to overdose animals. They provided an amount equivalent to 40,000 marijuana cigars; still, none of the animals died. Therefore, the risk of death for marijuana overdose is marginal. Now, a consumer may never experience an overdose, however, there are long-term effects that would compromise his/her health if marijuana is consumed for a prolonged period and in high doses.

RESPIRATORY PROBLEMS

Lungs are damaged when a person smokes, therefore, if this activity is done regularly for a long period, the potential risk of pulmonary irritation due to marijuana smoke is to be considered since the consumer would suffer the same consequences as those who smoke tobacco. Chronic cough and some of the most common lung diseases, such as Chronic Obstructive Pulmonary Disease (COPD) and the increased risk of infections are the most frequent conditions suffered from users. However, there is no evidence of lung cancer in Cannabis consumers.

ACCELERATED HEART RATE

Cannabis consumption accelerates the heartbeat, increasing the workload of the cardiac muscle. At least, four hours must pass for the heart rate to normalize after smoking marijuana. This is a feared effect since it can provoke a heart attack under specific conditions of physical or mental stress, hence, marijuana could be a secondary cause of death.

AGGRESSIVENESS DUE TO CANNABIS CONSUMPTION

There is no scientific evidence proving that Cannabis consumption increases aggressiveness in people. Many of us already knew it. It is as simple as attending a reunion with friends who consume Cannabis. They may have laughing attacks, reciting deep reflections that they may never do being sober, then got hungry or lethargic due to the Cannabis secondary effects, but we will never see them in an aggressive posture. Recently, for the most skeptical, this was scientifically proved.

Using a validated test of aggression behavior in response to provocation, subjective aggression increased significantly after drinking alcohol and decreased after ingesting Cannabis. The study performed at the Maastricht University, The Netherlands, included heavy alcohol users (n = 20), Cannabis regular consumers (n = 21), and controls (n = 20). Alcohol and Cannabis users received single doses of alcohol and placebo, or Cannabis and placebo, respectively. Then, the grade of aggressiveness was measured and tested.

Aggressive feelings increased significantly after provocation in all arms while being sober. Alcohol consumption increased subjective aggression while Cannabis decreased it post-provocation. Aggressive responses during PSAP (point-subtraction aggression paradigm) increased after alcohol consumption and decreased after consuming Cannabis compared to placebo. The authors concluded that “alcohol stimulates aggressive feelings while Cannabis decreases them in heavy alcohol users and regular Cannabis consumers, respectively”.

So, if Cannabis causes neither health, physical nor mental issues, why its legalization is taking so long?

The main discussion of the drug legalization promoters in Mexico, including Cannabis lies in the assumption of a decreased violence, not explaining the issue of increased consumption though, especially among young people under 18 years old, who would be trapped in the black-market mafias that provide the consumer groups that exist with or without legalization.

What should we do to solve the issue without failing in the radicalization of stances?

The answer, as for many controversial topics, is researching.

The good news is that on January 12, 2021, the Official Federation Journal published the “Ministry of Health Regulation in terms of the sanitary control for the production, research and medicinal use of Cannabis and its pharmacological derivatives”, allowing the legal cultivation of Cannabis to provide material for the relevant research programs, but not for commercial purposes. Only physicians would be able to prescribe Cannabis drug products through a unique recipe book with code bars. Also, only pharmacies will be able to market these products, provided they have the relevant COFEPRIS authorization.

This is a huge advancement in the recognition of the use of Cannabis in Mexico that will benefit from the outcome of the researches, as well as from the legally available Cannabis products in the international market.

Guillermo Caletti, MD, PhD.

Chief of Clinical Operations at Boehringer Ingelheim for Mexico and Central America.