Risky Business

Risk/Benefit Analysis
Every time your doctor writes you a prescription, they weigh the benefits of that particular medication against the risks. The thought process goes something like this: Effective for your pain? Then a large weight on the yes side of the scale. High risk of causing a bleeding ulcer in someone like you? A much bigger weight on the no side. In that scenario, the risk of the medication is judged to outweigh the benefit.

All medications carry some degree of risk, ranging from a theoretical one that is almost never seen to a risk so high the drug is only used in an act of desperation. Conversely, medications also produce benefits that range from barely noticeable to fantastically good. When and how to use them is matter of putting the weights, which are different for each person, on the benefit and risk sides of the scales and seeing which way it tilts. Sometimes it’s obvious. Sometimes it's pretty close.

Medical cannabis is a medication. It has certain possible benefits and of course it carries its own set of risks. We will be talking much about the possible benefits of medical cannabis. First let's take a look at the risk side of the scale.

The Risks of Medical Cannabis
The most dire risk in the use of medications is death. Almost all medications carry the risk of poisoning. There has never been a death due to an overdose of cannabis and the best scientific guess is that it is impossible for a user to overdose. That takes a lot of weight off the scale on risk side of medical cannabis compared to all other medications.

People with certain psychological problems must be very cautious when considering the use of medical cannabis. Like any drug that affects the brain’s chemistry, cannabis can affect the symptoms of psychological disorders. Sometimes for better, sometimes for worse. If you are being treated with medications for a psychiatric or psychological problem, the best course is to closely consult with your doctor before trying medical cannabis. We want to avoid making things worse.

The Difference between Dependence and Addiction
The question of addiction with cannabis is a bit more murky. Up to half of chronic cannabis users will develop what doctors call dependence. That means with sudden stopping of cannabis use, symptoms such as problems with sleep, nausea, headaches and irritability occur. Dependence is a normal response to chronic cannabis use. The brain will naturally decrease the amount of the amount of cannabinoids it naturally makes since the cannabis is supplying them. It takes time for the brain to get back up to making the normal levels of cannabinoids when the cannabis is stopped and the shortage during that time causes the symptoms of dependence.

Addiction is a psychological disorder which happens when a person can’t stop using a drug when it is interfering with their normal life, finances, work and personal relationships. There is a risk of developing addiction to cannabis. It seems to be small but useful information is lacking. Dependence looks like it occurs in almost half of chronic users, but symptoms are relatively mild. There are other concerns frequently brought up about negative psychological effects of medical marijuana. Cannabis use is associated with depression and/or anxiety. Of course, many people use cannabis to treat their depression and/or anxiety... Looks like more studies are needed to sort that chicken and egg problem.

Tipping the Scales
Most of the other risks related to the side effects of cannabis depend on the particular strain used, how it was consumed, dosage, interaction with other drugs, etc. We will be talking about those side effects and ways to deal with them in other blogs.

Using any medication is risky business. To make a good choice, you must pull out the risk/benefit scale and weigh your options. Is the chance of relief of your symptoms worth the possibility of a bad result. In the end, it is your body and your decision. Make it a good one.

Brian Nichol MD
Cannabis Expert