With the Canadian government changing its stance on recreational marijuana, it only makes sense that we’d want to know the more biological and scientific aspects of it on the body. That’s what this conversation is all about. At our recent Let’s Talk: Marijuana event, local family physician, Dr. Lucinda McQuarrie, humbly took to the stage to give a ridiculous amount of information on the physical effects of marijuana. After her 15-minute presentation, we play back two questions from our Q & A period at the same event, talking about the possibility of not getting high when using marijuana, and the merits of marijuana.
Who Are Our Guests?
Dr. Lucinda McQuarrie is a Family Physician who lives and works in Langley, BC. Work life includes work at the Fort Family Practice Clinic, Langley Maternity Clinic, and inpatient medical care at Langley Memorial Hospital. Home life includes a marriage of 16 years with 2 children aged 7 and 9. She is a member of The Salvation Army Willows Church in Langley, where she is involved in discipleship leadership. She has lived in 8 cities across Canada, enjoys outdoor activities, and spends most summer weekends camping outside of Gibsons, where she met her husband more than half a lifetime ago.
Dr. John Neufeld joined Back to the Bible Canada after 30 years of serving in pastoral ministry, both as church planter and senior pastor. He is known both nationally and internationally for excellence in expositional Bible teaching. Prior to joining Back to the Bible Canada, Dr. Neufeld lead one of the largest churches in Canada as Senior Pastor for 15 years. He has spoken widely at churches, conferences and seminars throughout North America, and internationally.
Dr. Mark Ward received his PhD in New Testament Interpretation from Bob Jones University in 2012. He now serves the church as a Logos Pro, writing weekly on Bible study for the Logos Talk Blog and training users in the use of Logos Bible Software.
You can watch the entire Let’s Talk: Marijuana event here.
Alright, so as a general family physician, I’m definitely not an expert in marijuana. I didn’t learn anything about it in medical school, but every day I encounter people who use or have questions about using. I want to encourage them, and I want to encourage us to have some critical thinking in our informed choices. To do so tonight, I’m just going to go through some of the background information about marijuana and our bodies, and ultimately, I just want God to get the glory for what we do as Christ’s followers.
In preparing for tonight, I asked a colleague of mine who works in youth mental health for some feedback and some insight. He felt that essentially all the facts that he’d read that I had got together would not change anybody’s opinions walking into that event. However, I want to challenge you in that, let’s open our minds. He did want for us to question and examine, what are our motives, our reasons for the use? Is it peer acceptance? Is it pain? Are there emotional issues? Is it just for enjoyment or relaxation?
As I was reflecting on that, I in my mind, kind of continued, as Christians, where should we find the answers to those needs, and what should be our coping mechanisms? However, tonight my job is to talk about the medical and biological properties, so bear with me, there’s a lot.
Marijuana is not a simple, one-chemical drug like most pharmaceuticals out there, it’s a crude drug. This means that it’s unrefined, there are lots of constituents in it, kind of the same way you get crude oil, and then later refine it for use.
The plant itself has up to 500 different compounds. Depending on which particular strain, there are 60 to 100 different cannabinoids. Cannabinoids are the single molecules that give marijuana its effects. They interact in our bodies with a system called the endocannabinoid system, and this system kind of branches out and interacts with all the other systems in our body.
An interesting fact that I learned is that the endocannabinoid system is actually responsible for our placebo effect. These molecules, the cannabinoids, they get metabolized through your liver. The liver is a major area where most negative drug interactions happen, and there’s lots possible with cannabis. Interactions for medical or recreational use of benzodiazepines and opioids, muscle relaxants, even antihistamines, alcohol, antidepressants, antacids, antibiotics, antifungals, antivirals, and special heart medicines. So, what are you mixing it with?
Tonight, we’re talking about recreational marijuana use, which is different from medical marijuana use. Medical marijuana is already legal through proper channels. The Delta-9-THC is the most psychoactive cannabinoid. In average street pot, it ranges about 10%, but can be as high as 30% of the compound, whereas it’s much lower in medicinal marijuana.
Then there is the cannabidiol, which is probably the one that gives most of the beneficial effects, and the proportion of these various chemicals, these are the two main ones, and remember, there’s 60 to 100 of them, the proportions of them are kind of what gives us the effect. Once marijuana is publicly legal for recreational use, the difference between those is still going to be the same. You are not using medical marijuana, okay, so this is a difference.
What is the drug effect? Psychologic effects of euphoria are kind of that happy, relaxed feeling, intense sensory experiences, time distortion, dis-inhibition. You’ve probably all seen that stereotypical laughter when people are high. However, it’s followed by a depressant period, and like with any medication on the market, there are some users who experience the opposite. They get dysphoric, they have heightened anxiety, they have psychotic symptoms. There is a very narrow window of desired drug effect with adverse effects surrounding it.
What happens if you smoke a joint? Within 15 minutes of smoking it, this euphoric effect can be experienced. Of course, the intensity of that depends on how deep you inhaled, how long you held the puff. I did have a patient end up his first time using marijuana, thought it would be a great experiment, ended up in emergency, because he just maximized deep breaths, and holding, and ended up toxically ill.
A joint has three times the tar, five times the carbon monoxide, 20 times the ammonia, and three to five times the nitrous oxide and cyanide compared with a typical cigarette. One can’t use a filter to smoke this, because the cannabinoids get caught in the filter. If you are going to use vaporizing, it is a much safer choice. There’s a lower temperature, and a lot of those other chemicals of organic burning don’t get inhaled.
Vaporized marijuana, for example, through a bong, has much more efficient THC extraction, and faster absorption. You get peak levels in your blood within about three minutes, and a maximum high definitely by the 60-minute mark. That delay is because your brain is trying to keep these drugs out. There’s a blood-brain barrier, and it kind of takes the drugs to be there frequently to pass into your brain.
To my understanding, edibles are going to remain illegal. There’s a lot of risk with these, because they need to go through your digestion, and we all digest differently. Time to onset, time to peak, can be very unpredictable, and the recommendation is to wait 30 minutes between each bite of an edible. Likewise, I’ve had a patient, middle-aged woman, should have known better, ended up in emergency because she just ate too much.
Just this February, the BC Medical Journal reported a small case study on April 20th, doing an analysis, and most of the poison control center calls had actually consumed edibles. Likewise, after legalization in Colorado, there was a 34% increase of calls to the poison control center, and 81 visits to the emerg. So you know, the risk gets experienced.
Synthetic cannabinoids are hitting the news. They have some trendy names, K2 and Spice. They mimic THC, it is not THC, but they can have severe outcomes, seizures, agitation and death. So, you know, be on your guard.
Big question, brain development. It is happening until we’re 25. The last things that kind of develop in our brain are some of those clinical reasoning and impulse control periods, and with marijuana onboard during that time, there are a lot of risks that increase in terms of how our brains develop. There is a two to three times increase risk of schizophrenia. There is three times increase risk of bipolar disorder. General depression, kind of comes and goes both ways, in terms of cause and effect with marijuana use, but essentially 62% increase risk of developing depression with heavy users, okay?
So how does it affect us in our abilities to function in everyday life? Attention, concentration, executive function, are all effected. A study of those aged 18 to 30 did show that even after stopping use, there was persisting cognitive deficits with verbal memory.
Pilots, there was a study of pilots in a flight simulator, and only one out of nine of them was actually aware of the effects that marijuana had had on their performance. At 50% of your peak high, so people just randomly say, “I’m at 50% high,” their motor skills are about the equivalent of somebody with a blood alcohol level of .05, which in British Columbia, that’s where your license gets taken away for a short time.
Driving within one hour of use increases motor vehicle accidents by two to seven times. Driving is recommended four hours after use. With edibles, they say eight hours after use. So, effects outside of our brain, you’re inhaling particulates. Quite surprising to me, there’s been no studies. There was one, but in general, it’s not thought to increase risks of emphysema or lung cancer, okay? However, people can experience more cough and phlegm.
It does lower our defense against respiratory molds and bacteria. Heart rate goes up, blood pressure goes down, heart attack risk increases about three times within an hour after use. Changes to the brain with chronic use, increase risk of stroke, digestive system effects. Dry mouth, increased appetite are kind of common, but with chronic use, pancreatitis, progression of liver disease.
Cyclical vomiting syndrome, is a real thing. I have had a patient experience this, despite what Facebook says. Also, effects on your reproductive system. Reduced sperm health, suppressed ovulation, effects to fertilization, transportation, implantation, fetal development, and placental development. Postpartum. Babies who are exposed through breast milk have been shown to have reduced motor skill development.
The only cancer found to have an increase risk is testicular cancer, of a 2.6-time effect, okay? So just like other drugs, the principles of tolerance, and dependence, and withdrawal apply. Withdrawal symptoms can include anger, anxiety, restlessness, irritability, depressed mood, disturbed sleep, strange dreams, reduced appetite, weight loss, chills, stomach pain, shaking, and sweating. I did have a patient who had to travel out of country, return with intense abdominal pain, which resolved itself, and my only diagnosis was marijuana withdrawal.
Psychologic dependence is there. In those who use marijuana during adolescence, it’s as high as one in six, in terms of addiction rates. Cannabis Use Disorder is a psychiatric diagnosis where there’s cognitive impairment, poor performance, giving up prior enjoyed activities, and about one in eight regular users develop this.
Regular use may, depending on why you’re using it, be a dysfunctional coping mechanism instead of processing and dealing with whatever the initial distress was. The emotional coping mechanisms that are healthy can become stunted. In essence, our stress tolerance is lowered, and instead of using other helpful coping mechanisms, physical activities, music, and art, meaningful relationships, instead people do run that risk of self-medicating, and probably to the outcome of harm.
If you are somebody who has thought about self-medicating, my suggestion is “Please talk to your doctor.” Talk about those reasons why you feel compelled to use. Talk about what your symptoms are. I hope you have a good doctor. If not, keep looking. You know, make an informed choice about why and what you’re going to use.
If you’re considering recreational use, consider not only the medical information, but your motive. Is recreational use a true benefit? I think marijuana’s one of those areas of multiples where what is legal is not necessarily the best ethical or moral choice, and where do we draw the line?
That was Dr. Lucinda McQuarrie giving her 15-minute presentation at our recent Let’s Talk: Marijuana event. Let’s now here two questions and answers that happened at this same event. The first on the idea of smoking marijuana without getting high, and the second on the good aspects, the merits of marijuana. Here we go:
If you don’t get high, is it wrong to smoke pot?
Here’s an interesting question. Let me refer to cigarettes, and then maybe we’ll answer the high question. I would not have a difficulty if someone had a cigarette once a week. Why wouldn’t I have a difficulty with that? I don’t think that there would be a medical problem with having a cigarette once a week. I just don’t know of anyone that has a cigarette once a week.
I’m going to say in terms of marijuana, I don’t know … I mean, I grew up in the ’60s and the ’70s, and I grew up with a lot of stoners. I mean, you talked about that, and I just never knew anyone who didn’t get high, so that’s the question that I’d like to ask. I don’t know the answer to that part of the question.
Mark, I’m going to put you on the spot here, because I read in your book, and it was really interesting in your book right here, I don’t know the page number, but you did say that the National Highway Traffic Administration were trying to find …
You know what I’m talking about?
Yes, I do. Yeah, so I’m leaning heavily on other people’s research here, but the National Traffic Safety Administration in the U.S. did a study that they concluded that it was … that you achieved a high between one and three puffs. So actually, you can’t know that you’re not going to get high. There’s a huge chance that you are, and I read repeatedly in other studies, basically the same thing, that no one does this to avoid getting high, whereas … that’s the most profound thing you’re going to hear all night.
Whereas the reason Dr. John and I were talking about this earlier today, and you brought it up in your talk, the reason that a Christian, biblical theologian cannot outlaw alcohol completely, even if he or she wishes to, is that God has made it so that you can ingest some alcohol and have this effect that God says you’ll have, “Your heart will be gladdened.” That’s righteous, that’s a gift from God. I haven’t done it for various reasons we could discuss, but that doesn’t appear to be the case with marijuana.
Yeah, and I touched a little bit on it in terms of that therapeutic window, how do you know if you’re going to get too much or too little? It’s interesting, because there’s not actually an alcohol or a marijuana blood level that has a specific predicted outcome, because it affects everybody differently. Unlike alcohol, where if you’re at a certain percentage, you get a certain outcome, it is variable for marijuana. Even for somebody to know would they get high or not, I would get high on a different amount than you would, right?
Yeah, that’s interesting.
But we’re not going to find that out here.
Having several family members whose lives have been transformed by cannabis, which is … I don’t know exactly what that means exactly, but it is disheartening to hear a doctor to talk about cannabis, and then only recite negative effects of its use. How do you expect other doctors to safely guide their patients when there’s little to no training about its merits?
There’s little to no training about the merits, because there’s little evidence about the merits. So yeah, I have patients who have told me they have had benefits, but I’ve only had short-term relationships with them to see how it’s affecting them. I already question the benefits.
I’m not saying that medicine has an answer to everything. I don’t know, I’m just reflecting now on issues of suffering, and where is God when we suffer? What is our response to the suffering in terms of the reasons why people use it medically? Certainly, you know what? If you think you have a medical reason to use marijuana, find somebody to talk about the concern with. Please don’t self-medicate.
Could I add, I am not that kind of doctor, and so don’t have that authority, but I try to therefore humble myself and listen to the people who do. What I have thought a lot about it epistemology, how can we justify our knowledge? Almost, I mean, any individual is going to be, by definition, be guilty of insufficient sampling.
Our experience in this area cannot be broad enough to draw the kinds of conclusion that a country can really rely on. We need the tools of empirical science, the double-blind peer reviewed studies spread out over different populations, controlling for different factors, and existing health, and the age of the patient, and other drugs that they’re taking. That’s very expensive and difficult to do and requires a lot of training.
The National Academy of Sciences in the U.S. did a review of reviews of studies. They got together about 24,000 different papers, narrowed it down to the ones that looked like they were going to provide some facts, and they basically found that, yes, there are some therapeutic advantages.
“In adults with chemotherapy induced nausea and vomiting, oral cannabinoids are effective antiemetics to keep you from vomiting. In adults with chronic pain, patients who were treated with cannabis are more likely to experience a clinically significant reduction in pain symptoms. It also helped short-term with multiple-sclerosis.” Then this is what they said. These are not Christians, they’re not being secretly paid by Back to the Bible Canada to say what will please Evangelicals, as far as I know. Their conclusion was…We’re going to pass the plate after this. For these conditions that I’ve just named, “the effects of cannabinoids are modest. For all other conditions evaluated, there is inadequate information to assess their effects.” I never want to be cruel to someone and say, “You’re lying, your relative really wasn’t helped by cannabis.” I don’t know that.
Maybe they were greatly helped, and I’m glad God gives such good gifts. Even when we’re twisting them, He’s still good to us. He causes his rain to fall on the just and the unjust. When I listen to the most responsible people, degrees from Harvard and all the most elevated, accredited places in American society, this is what they’re telling me, “Those positive effects are modest, and anything else you hear someone claim, there’s inadequate evidence for it right now.”
Yeah, and I agree. Yes, two days ago, I pulled out of my mailbox the new Canadian Medical Association Journal. Right on the front cover, marijuana. Basically, different people doing a different meta-analysis, but it was the same findings. Yeah, very interesting. An area for much more research.