As marijuana legalization sweeps through our country, use of the substance has been on the rise, and the public's attitude might be shifting. Many people believe that "weed" is a safe recreational drug, and carries health benefits that outweigh its risks. Those assumptions were challenged in an article published in the Canadian Journal of Cardiology that examined the story of a patient who developed crushing chest pain and myocardial ischemia (heart attack) after consuming most of a marijuana lollipop.
Cannabis can be very useful in medicine for patients who are experiencing nausea from chemotherapy or extreme pain from either a cancer or a pain medical diagnosis. However, marijuana does carry many risk factors that have not been appropriately addressed in patient populations or have healthcare providers been educated on this drug. Some of the “risk” comes from inappropriate dosing and oral consumption.
The case review reported was a 70-year old man with stable coronary artery disease, who took his cardiac medications appropriately ate most of a 90 mg THC infused lollipop to relieve his pain and as an aid for sleep. This dose and route caused him to experience a potentially very serious heart attack that could have killed him. His heart rate increased to dangerous levels, his blood pressure went up and his heart had to pump much harder to keep up with the stress response he was under. Massive stress hormones were released we call catecholamines and all of this was coupled with extreme anxiety and fearful psychotropic hallucinations caused by the unusually large amount of THC he ingested all causing an unfortunate strain on his heart and body.
This patient consumed a much larger dose than the 7 mg that is typically ingested by smoking a single joint or taking the 2.5 mg starting dose of Marinol, a synthetic THC marketed for nausea in cancer patients. This patient has not smoked marijuana since his youth. He was also not familiar with the time-delay and extended effect of oral THC dosing. This is not an isolated case and a number of cases are now being reported along with epidemiological studies that are describing the association between worrisome cannabis use with cardiovascular disease that may or may not be diagnosed.
It is critical to realize that most of the marijuana induced myocardial ischemia research focused mostly on younger patients and did NOT focus on different formulations and potencies. Legislators jumped on this public health out-cry and now we have both patients and healthcare not up-to-speed with potential risks, dose, route, route of administration or degree of tolerance.
The legalization of cannabis has large public support but it also raises a real public health concern. Some people may benefit greatly but others could be harmed or even killed, especially in the most vulnerable older populations with heart disease.
Dr. Carly Willeford
1 in 25 adults has a serious mental illness in a given year. That adds up to 10.4 million people, or 4.2% of U.S. adults 18 or older.