Question: Use of medical marijuana has become more common. What are the problems with the use of cannabis that people worry about? — Rhonda, of Lima

Yes, Rhonda, medical marijuana use has become more common. It is a big topic. We will deal with only some areas here.

Some states have legalized the medical use of marijuana. The approved conditions differ state to state. Only state-approved dispensaries can dispense medical marijuana. Only doctors who are licensed to prescribe medical marijuana can prescribe it.

It seems more people are using the drug than are prescribed.

Dronabinol (Marinol, the synthetic THC) was approved by the U.S. Food and Drug Administration for oral administration in the treatment of anorexia. In this disease there is loss of appetite associated with weight loss as well as in patients with AIDS. It is also approved for nausea and vomiting associated with cancer chemotherapy in those patients who have failed to respond adequately to conventional treatments for nausea. There are many other conditions that are treated by medical marijuana. This is not the place to discuss them all.

There are some contraindications to use of medical marijuana. Based on known adverse effects of recreational cannabis use, it seems prudent to avoid recommending medical cannabis to individuals with a history of schizophrenia. It is contraindicated if there is a history a recent acute myocardial infarction. It should not be used if a person has irregular heartbeats. It is best not to use for people who must drive or operate heavy machinery. It may lead to accidents.

THC is not entirely safe. THC has potential drug to drug interactions with some other medications.

THC has a sedative effect. It is a central nervous system depressant; THC increases the sedative effects of other central nervous system depressants such as alcohol and tranquilizers like benzodiazepines. It not advisable to combine use of alcohol and sedatives with THC or cannabis. This additive interaction is especially relevant when driving or operating heavy machinery.

Cannabis has become one of the most used illegal psychoactive substance, used by an estimated 192 million individuals worldwide. It is not right. Public education is needed to stem the tide.

Rates of cannabis use in the United States are higher in young adult men with low incomes and no college education than among other population groups. Approximately one in eight current regular cannabis users develops a cannabis use disorder.

Cannabis use before age 17 years is strongly associated with lower educational attainment and increased use of other drugs.

Individuals with cannabis use or cannabis use disorder often use other psychoactive substances, especially alcohol and tobacco. They are all harmful.

Cannabis acutely impairs attention, concentration, episodic memory, associative learning and motor coordination in a dose-dependent manner. Long-term cannabis use is associated with impairment of verbal memory and cognitive processing speed. But there is hope because it resolves after at least a month of abstinence.

Substantial evidence suggests that chronic cannabis use, especially during adolescence, is associated with later development of schizophrenia.

Cannabis use is associated with injury and death from motor vehicle accidents.

Cannabis smoking is associated with acute, transient respiratory symptoms.

Cannabis smoking acutely increases sympathetic activity and myocardial oxygen demand and is associated with a small increased risk of myocardial infarction and stroke.

Cannabis use is also associated with periodontal disease and a lower sperm count.

Some obstetricians are reporting that many pregnant women are using cannabis. They should not.

Many folks who use cannabis have other chronic diseases. They delay coming to the hospital when they need to and end up with more serious problems.

Let us hope people can be more careful by better education.

Dr. Suman Kumar Mishr at his office in Cridersville. Craig J. Orosz | The Lima News

Suman Kumar Mishr MD, Fellow of American College of Endocrinology. Cridersville, Ohio