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In response to Cooper's letter to the CMAJ regarding the Canadian Medical Association supporting a medical access stream for cannabis.1 I would like to provide some points to consider in rebuttal regarding medical marijuana.
Distinguishing between chronic pain and concomitant substance abuse and substance dependence alone is very difficult clinically. Substance dependence before, during and after medical marijuana treatment is common. In one study, the odds of marijuana abuse/dependence were 1.81 times higher (95% CI: 1.22, 2.67; p=0.0040) among residents of states that had legalized medical marijuana.2 Future studies are also needed on the consequences of increased marijuana use, such as accidents, aggression, school drop out, psychosis, HIV and sexually transmitted disease rates.3, 4, 5
Cannabis use disorder (CUD) is continued problematic use despite negative consequences that causes significant distress or impairment in functioning. 25%-50% of individuals who use cannabis daily are reported to develop CUD, with cannabis use during adolescence being associated with increased likelihood of CUD. Adolescents also appear to be more vulnerable to brain-based negative effects.6
In conclusion, medical marijuana leads to a higher incidence of substance dependence in a medical marijuana treated patient population that are already much of the time narcotic dependent at the presentation for medical marijuana consultation. CUD is a long term consequence of...
Show MoreCompeting Interests: Rohit Kumar is a Disability Adjudicator with the Ministry of Community and Social Services of Ontario