Editor’s note: This commentary is by Dr. Karen Randall, FAAEM, a practicing emergency medicine physician and vice president of case management at Southern Colorado Emergency Medicine Associates in Pueblo, Colorado. She spent 18 years at Henry Ford in Detroit as a teaching physician in emergency medicine.
[I]t is my understanding that Vermont’s Legislature has passed S.22 that legalizes possession of marijuana for personal use and personal plant grows. I understand that Vermont has established a commission that is directed to study and move toward introduction of legislation in 2018 to have what is called a “regulated system.” It seems that many who have encouraged this legislation feel that it is a first step toward full legalization and commercialization that will lead to the establishment of retail stores. May I please offer to you my experience where that has been done.
I am sure that many wonderful things have been promised to the communities of Vermont. The marijuana industry is happy to banter about all the tax money generated by selling their product. I have been living that promise for the last four years. I am a practicing emergency medicine physician and I have been very active in the community with regards to homeless outreach, local clinic outreach and the like. Colorado passed Amendment 64 several years ago. I worked in Pueblo, Colorado before and after that change. How has my community changed since that time?
• In a short period of time, our homeless population has tripled (our metro area population has increased a little but has not even doubled).
• Over the last few years, we have increased visits to the emergency department for marijuana related issues (hyperemesis, accidental ingestions, pediatric ingestions, acute psychosis — a small sample of what we have seen).
• Our community, Pueblo County, once billed itself at the “Napa Valley of Pot.” We have encouraged a tidal wave of people moving to the area with the intent of smoking marijuana in a legal setting. Unfortunately, many of the people that moved here have significant chronic medical and psychiatric issues (including substance abuse issues). The medical community here is having a very difficult time keeping up with the influx of patients. Many community physicians are leaving the area, and the local clinics/hospitals and office practices are having a very difficult time recruiting new physicians to the area. The local population of Pueblo County is about 160,000; the Medicaid population is 115,000 (based on late 2015 numbers). Medical costs (ED visits, psychiatric care, medical care, etc.) are not ever factored into the cost of marijuana to the community. An example for the reader: I saw two young people who were making butane oil hash in a shed in the backyard. Their shed blew up. Both sustained significant and disfiguring burns. They were flown to a burn center for extended care for extensive burns. I would imagine that the cost of their care will exceed a million dollars.
• The marijuana community promised jobs. They state that they have provided 1,300 jobs to the area. An aside and personal observation: every employee that I have seen that identifies themselves as a marijuana industry employee has been on Medicaid. So, does it really benefit a community to provide more extremely low-income jobs to an area? I am sure there are a very limited number of people who are profiting excessively from the marijuana industry, but the majority of workers are not making enough money that they can live and thrive without government assistance (Medicaid, food stamps, etc).
• The marijuana community promised growth economic benefits to the area. We now have more retail stores for marijuana than we have Starbucks and McDonald’s combined (this is statewide and holds true for Pueblo County). There are limited retail malls here (we do not even have an Old Navy here).
• The marijuana community promised our community that youth would benefit and they would be safe from the effects of marijuana. Unfortunately, the use of marijuana has rapidly become normalized in public and by some parents, and there is a marked increase in youth usage. I have followed hospital emergency department urine drug screens, and youth (younger than age 21) testing positive has increased dramatically. Unfortunately, at the same time, the number of youth testing positive for marijuana plus methamphetamine and/or heroin has also increased. I specifically use “youth,” as marijuana is not legal for sale to those under the age of 21.
Please understand that there are reasons that the majority of medical, legal and educational professionals in the community oppose marijuana as a recreational substance in the area.
• The environmental costs of a marijuana grow are huge. Each plant uses roughly six gallons of water/day. In our arid environment, this is an enormous consumption of water. Ranchers living in the area of grows are having tremendous/costly problems getting enough water for their livestock. Please take the time to read about the carbon footprint that one marijuana grow leaves on our environment. We continue to claim awareness of global warming, but the carbon footprint from one grow is astounding. We have worked hard to get tobacco smoke out of public places, restaurants, malls, etc., but there is currently a push to allow marijuana to be smoked in some public places (personally, I am not sure I understand the difference; for each, the smoke carries carcinogens).
• Colorado high school students take The Healthy Kids survey every other year. For 2015, 65 percent of our high school children indicated that it was easy or very easy to get marijuana. The number of children under the age of 13 who have tried marijuana in Pueblo is 15.8 percent. The marijuana proponents argue that this is not a significant number; I would say that it is. Almost one child in five under the age of 13 has tried or used marijuana.
• The industry has been irresponsible in ramping up the concentration of THC (the psychoactive portion of marijuana) in all products. The literature is clear that growing and developing brains are adversely affected by marijuana (and these studies were done with low potency marijuana). The medical community has no idea what high dose dabs, shatter, etc. will actually do to a developing brain. I have seen numerous elderly patients in the ED with acute psychosis, acute nausea and vomiting, and accidental overdose secondary to the high dose edibles. I have seen a tremendous increase in emergency room visits for nausea and vomiting associated with cannabis. The marijuana industry has claims that it will cure everything from Parkinson’s to insomnia, to pregnancy-induced vomiting (and more, you simply have to do a Google search to see what marijuana “cures or treats”). None of those claims have been supported with peer-reviewed research. The medical community has no idea what the long-term benefits or consequences from marijuana will be. Studies are ongoing, but it is anyone’s guess at this time. Most likely, most of the medical benefits will come from CBD (the non-psychoactive portion of marijuana) rather than THC. I have a friend who runs a large substance abuse program at the state hospital. She tells us that her methamphetamine addicts won’t use the marijuana here because it is too strong.
• The marijuana industry promised safety to the community. Our jail is full, even overcrowded. Petty crime is up. There are vagrants everywhere here begging for money. The number of illegal grows has never been higher. All this takes police force time and personnel.
• Our current homeless outreach center (Posada) has had to close due to marked increase in demand for services and increased safety issues for those working there. Our soup kitchen has tripled the number of meals they provide. The soup kitchen has had a marked increase in the number of violent episodes there.
• Finally, please know that I do not profit from the marijuana industry and I will not profit from the lack of marijuana. I am simply trying to paint a picture of how our community has changed. I am one of the many who provide emergency care. One year ago 257 of 300 community physicians signed an open petition in the paper in support of reversing the marijuana stance in our county. Many physicians did not publish their names for fear of retribution and threats (yes, that has happened). But please understand that there are reasons that the majority of medical, legal and educational professionals in the community oppose marijuana as a recreational substance in the area. Ask your local professionals how they feel before you vote.
