It’s 420…Blaze It or Not? One Doctor’s Biased Opinion

Yes, it’s April 20th, but “420” also means Pot, MaryJane, MJ, Weed, cannabis…whatever you choose to call marijuana. Legend has it that the nickname “420” originated in my birthplace, San Rafael, CA, from way back in the early 1970s, when a group of high school students used to meet at 4:20pm after classes to either smoke weed or search for it. Regardless, today is often celebrated in the cannabis-partaking world as Weed Day, so let’s talk about pot.

As a family physician who has also worked in urgent care on a large college campus, I recognize my bias from treating all the negative outcomes of pot. I understand that many responsible adults use cannabis legally and appreciate the arguments regarding the safety of pot vs. alcohol. However, I’d like to share a few thoughts that I discuss with my college student patients, in the spirit of nonjudgmental education. (For an extended discussion, please see “Ch.10 Smoking, Vaping and What You Might  Not  Know about Pot” in The Ultimate College Student Health Handbook: Your Guide for Everything from Hangovers to Homesickness.)

  1. Smoking pot is common in college students, but perhaps not as common as you think! Studies show that about 5% smoke weed daily, and around 40% report using pot at least once in the past year. Let’s reverse that and note that 60% have not even tried pot.
  2. If pot is legal in your state, please purchase it legally, because otherwise my mantra is this: “If you didn’t grow it, you don’t know what’s in it.” Nope, I’m not advocating growing your own. However, quite honestly, this is the worst thing that I see- people who believe they “only” smoked pot, but I’m seeing them because they’ve had a very bad experience/ “bad trip” (they are super agitated, physically ill or hallucinating) and when we do their urine drug screen, we find another drug like LSD or fentanyl. Turns out that drug dealers add other substances to their pot- whether it’s something physically heavy like sand or glass particles (pot is sold by weight) or just a pinch of formaldehyde, acid, or another chemical to enhance the potency of the hallucinogens (“stronger” weed sells better.)
  3. This is NOT your parents’ pot! THC (tetrahydro cannabidiol) is the chemical in pot that gives you the “high”, and while the THC concentration in the 1960’s-1970’s averaged 2-4%, today’s market routinely offers 20% and higher (up to 30%).
  4. Regular pot use impairs short-term memory, judgment, motivation, and learning. In the college setting, frequent pot-users skip more classes, have lower GPAs, and ultimately have lower lifetime earning potential. Ouch.
  5. Not everyone can just “try” pot or smoke “socially”. One in six teens (17%) and one in eleven adults (9%) will become dependent on marijuana. So yes, the 5 out of 6 people you know that casually smoke CAN get away with it, but we don’t know ahead of time which one you will be. The continual growth and reshaping of white matter in brains younger than 25 years make them more susceptible to all types of addiction, including pot.
  6. Although many states have legalized pot, federal law still states that “recreational and medical use of marijuana is illegal.” I will let the lawyers hash this out, but recognize what you thought was a legal act today could potentially be held against you later within a national or governmental job setting. Also please note that it’s a felony for anyone to give, share or sell pot to anyone under the age of 21, and even in states where pot is legal, you must be 21 to legally partake.
  7. “But doctor, I smoke because pot relieves my anxiety.” Try saying this phrase to any psychiatrist, primary care physician, counselor or any mental health professional that treats college students, and I can almost guarantee an eye-roll and a grimace. So yes, smoking pot CAN produce a comforting euphoria that provides short-term relaxation, I acknowledge this. However, smoking any given joint can also exacerbate anxiety, add in paranoia, or precipitate a full-on panic attack…and that’s WITHOUT any “additives” sprinkled in as mentioned above. Regularly smoking pot (or drinking alcohol for that matter) to escape anxiety with a mind-altering substance rather than learning and using healthy coping skills at best stunts your psychological maturation and creates unhealthy habits that are awfully tough to break.
  8. Drug testing for internships and jobs. A nonsmoker who tries pot and smokes a joint may have a positive urine drug screen for a few days. Someone who smokes “casually” on weekends typically tests positive for about a week, while someone with daily use can remain positive for a month. (Details depend on how much and often you smoke, as well as your body fat percentage, because marijuana is stored in fat.) Hair sample testing, however, can remain positive for pot for up to three months. Let me say here that many college students find quitting their pot habit is far more difficult than they thought it would be, particularly with the added stress (and parties) around graduation.
  9. Cannabinoid Hyperemesis Syndrome (CHS). You’ve no doubt heard of “marijuana munchies” and, indeed, medical marijuana can be used to stimulate appetite or suppress nausea. However, CHS is a syndrome we are seeing more and more in people who use pot regularly- meaning more than 20 days per month, often daily or multiple times per day. Symptoms are miserable, with recurrent episodes of often intense vomiting that are oddly only transiently relieved with hot baths or showers. Upper or mid-abdominal pain may also be present. Completely stopping cannabis use will eliminate the problem, but obviously since this occurs in people  who smoke quite often, this can be challenging. Anecdotally, I had deleted this section for brevity, but added it back in because I immediately had several ER doctor friends message me that they are seeing this with regular and increasing frequency, so I should be sure to let people know. Patients experiencing CHS often require hospitalization for IV hydration and  other medical interventions to relieve their symptoms, and very rarely, cases can be fatal. How common is this? We do not yet have accurate numbers, but a 2018 study done in a large, urban ER in New York  demonstrated that up to a third of their patients with heavy (daily) marijuana use experience some level of nausea and vomiting relieved with hot baths or showers. Patients that I have treated have often been particularly frustrated because they were self-treating their nausea by smoking MORE, which only perpetuated the problem and ultimately made it harder for them to quit.

BOTTOM LINE: It’s HIGH time that everyone, especially college students, be aware of these pot-related risks so they can make an informed decision before…well…420.


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