Washington state grows marijuana crops almost as prolific as it grows moss, particularly since legalization of recreational weed last year.  Retail marijuana outlets now are a common sight on our commute to work, complete with their warm glowing lighting, inviting interiors, plush furniture and fancy display cases.  These are not fringy scruffy deadhead establishments but surprisingly upscale.

It has become a brave new retail world for a drug with side effects as varied as the bodies and brains ingesting it.

As a physician working daily with adolescents and young adults in a college health center, there is no question in the last few months retail marijuana is now the cannabis equivalent to the  growing market for artisan beers and local microbreweries.  There are distinct brands and strengths to attract users of all types and needs.  Yet one thing hasn’t changed with legalization: marijuana is not for everyone, and particularly not for young developing brains.  That caution is given lip service in state laws, though little attention has been paid to the effects on underage users until now.

The American Academy of Pediatrics has developed a statement about the health effects of changes in marijuana legality and made recommendations about enforcement policies here.  Seattle pediatrician Dr. Wendy Sue Swanson offers an excellent summary of the concerns over marijuana safety in youth here.

My daily clinical work in a university health center confirms my belief that marijuana is a far more complicated drug than a society desiring legalization chooses to believe.

Cannabis use has become normalized (thanks to NORML) to the point of some parents smoking or ingesting THC with their adolescent and adult children as part of holiday gatherings, special family events (Super – Bowl, anyone?) and evenings-at-home  “wind-down” routines.  It is a challenge for a clinician to question the judgment of a parent who sees no problem in their 18 year old using marijuana to help sleep or reduce their stress level, especially since that is exactly what the parent is doing themselves.  After all, some parents reason, it is safer than alcohol and has never “killed” anyone in an overdose, right?

I guess it depends on the definition of “safer” when comparing two very different mood-altering drugs, both of which have been shown in studies to cause significant potentially long-lasting damaging effects in developing brains.  True, alcohol poisoning carries imminent risk of death and injury while heavy marijuana use may simply cause acute and chronic physical and mental health disorders.

Marijuana often exhibits paradoxical effects and is unpredictable even in experienced users.  It is a common factor in the history of adolescents and young adults with anxiety disorders, paranoia, recurring dissociative episodes and increasingly persistent depressive symptoms.  Beyond the mental health impacts,  I’m seeing puzzling morning nausea and abdominal discomfort in some regular users, sometimes to the point of vomiting, which prompts the user ingest even more marijuana to “help improve appetite”.  This appears to me to be a mild version of cannabinoid hyperemesis syndrome as GI workups, antiemetics and other meds fail to help until marijuana use is discontinued completely.  Many regular users remain unconvinced about the connection —  anecdotally I’m convinced we are seeing a pseudo-withdrawal syndrome from routine use of high THC concentration marijuana.

Other states considering legalization of recreational marijuana will learn a great deal from the Colorado and Washington experiment of growing, regulating, and taxing retail recreational marijuana.  I hope they will look carefully at the effects such laws have on the attitude and habits of youth who are now adopting life-long use patterns and are too often harmed by regular use of powerful chemicals that “older and wiser”  society members have deemed “safe” without sufficient data to back those claims.

Maybe we in Washington state should simply stick to growing moss.