marijuana headaches

[Acebecker]

 No it's not. That study suggests heavy marijuana use might increase the likeliness of developing lung cancer but to say it's conclusive that it's more dangerous than smoking tobacco is simply not true.

 

Reference the number of lifetime uses of MJ that the study uses as it's criteria for "heavy."  It is 50.  50 lifetime uses of MJ increases your risk ratio of developing lung cancer significantly.  How many of our patients get 50 tobacco cigarettes in a week?  In a month?  Many, many.  However, 50 lifetime uses of MJ increases your risk.  This indicates that per use MJ is more dangerous than cigarettes. 

 

I realize that the study was not weighted nor designed to look at that, but you can read the numbers as well as I can. 

[BruceBanner]

Are you sure? Look closer.

 

 

 

Based on non-anonymous self-reported information at conscription....

 

That means they are basing their results on a singular questionnaire containing self-reported data from 40 years ago re: MJ use. They also only measured baseline tobacco use, and nowhere in the available reading did they mention a control for the next 40 years of lifestyle behavior in these men. 

 

So in other words, If we take a cohort of 49,000 men, look at what they self-reported regarding MJ and tobacco use 40 years ago (only accounting for use up to age 18-20), and then look at national death and inpatient registries we see a *small* increase in the incidence of lung CA in the MJ cohort, not accounting for 40 freaking years of subsequent lifestyle, environmental exposure, familial factors, etc. I've published work before and this appears to be nothing more than a retrospective cohort study controlling only for baseline conditions. They used Cox regression modelling, which assumes that the effects of the predictor variables upon survival are constant over time and are additive in one scale.

 

Garbage.

 

Advising people not to smoke anything is good, but don't cite some BS low-level data like this to support it.

[Acebecker]

To call this BS low level data is incorrect.  Nearly 50,000 participants gives the data strength.  Rarely do you find cohorts that big or with metrics like this. 

 

I will not argue over whether this is the best study in the whole world as every study has flaws, but it's more applicable than you are giving it credit for. 

 

Look at the rest of the studies that the national cancer institute cites for it's recommendations regarding MJ and cancer.  I think you'll note a lot of crummy articles (case series, unblinded or non-controlled trials, n of 60 or fewer, etc).  It sounds like you might be looking for double-blind, placebo controlled trials on the subject.  I don't believe there are any.  And there weren't for cigarettes, either. 

 

Edit to add:

I have encountered people (mostly laypersons) ferociously defending the practice of smoking marijuana.  What is that all about?  Why are so many people in favor of this?  Maybe I'm missing something... 

[RealityCheck]

http://www.health.harvard.edu/mind-and-mood/medical-marijuana-and-the-mind

 

We can debate and scorn but we all need to do research and present information to patients AND place responsibility on the patient to educate and make decisions.

 

After all, we cannot go home with them at night and tell them to put down the oreos or the bong.

 

Whether or not you condone marijuana for anyone including yourself - people have to have personal responsibility.

 

I will stay the course that marijuana is not legal federally and I will not Rx it. I will not Rx hydrocodone or other controls or CNS drugs with use of marijuana due to interactions and compounded effects.

 

If my patients say they use it - I will ask them to do research about its effects and be mindful of their children and the message as well as second hand smoke.

 

I have personally chosen not to smoke anything (grew up with asthma) and have addictive properties in my genetics that make drugs and alcohol wholeheartedly unappealing. I don't see the draw and still strive for that "everything in moderation" thing.

 

So, do right by your patient -- always

[rev ronin]

One of the things I stress to my patients is that because of the federal ban, there are no research dollars allocated to marijuana safety, even in states where MJ is medicinally or recreationally legal.  I stress that I'm trained to advise them on the basis of evidence-based medicine, explain what that is, and explain why we don't truly know whether some things are better or worse (MJ vs. tobacco for lung cancer, MJ vs. alcohol for driving impairment) than what's been extensively studied.

[jdenning]

Agree with Rev Ronin above. I tell patients we don't have enough studies or data to tell them whether to take it or not take it. I generally don't have a problem with patients who have medically intractable epilepsy using it, but for the most part they aren't driving and lung cancer is pretty far down their list of worries.

 

Where it gets murky though is that a lot of that particular epilepsy population live in state run group homes and they need written orders for everything. In those cases I try to make sure it's the MD who is doing the ordering and not me.

 

When it comes to MJ and driving I tell patients who are known users not to drive if they are under the influence. And I document that in their chart.

[Sam I Am]

Thanks for the read guys - interesting to see what others think. Back to the original concern of the OP, having worked in a nursing home, the doc and I never took orders from outside docs. Unless it was a specialist dealing with a complex patient/issue, we assume primary care when a patient is admitted into the facility. Everyone else can go kick rocks. So, you can punt that concern to that patient's nursing home doc.

[RealityCheck]

Not that it is a medical journal….. But National Geographic just did a cover story on cannabis and I learned a lot from that article from a broad perspective - I have never used pot and am fairly naive about drugs personally without personal exposure, etc.

 

The article is interesting and informative by describing the various types of cannabis and the minimal knowledge of what actually makes it up. 

 

Thought it might interest some.