Time and again, people in my circle have assured me that dope is "harmless." I wish I had a nickel for every time someone told me that "pot never killed anyone." Past expositions on this include Smoking Linked to Chronic Pain (December 2014); New Testing for Marijuana (April 2016); Marijuana Statute in Florida (March 2019); Edible but Stomach Churning (October 2023); Edibles and Illness (November 2023); Harmless (January 2024); and Dope and Heart Disease (March 2024).
In the end, I remain curious about the health impacts of weed. Nonetheless, I am unconvinced it is as harmless as so many argue it is. I am also continuously reminded of the battle cry that dope is "legal." more on that in a future post.
NBC News recently reported on the results of a study published in the Journal of the American Medical Association (JAMA). The field of Otolaryngology concludes that "regular heavy marijuana use may increase a person’s risk of developing some head and neck cancers." But, you all said dope is harmless?
Whatever the causative factor, these scientists concluded that "heavy cannabis users were between 3.5 and 5 times more likely to develop head and neck cancers than those who didn’t use the drug regularly." That is potentially chilling. If you told me that paying in quarters would make me 5 times more likely to win the lottery, I would certainly buy all of my "retirement" tickets with quarters.
The conclusion is that there is a beginning of "a somewhat muddy body of evidence" to support that marijuana may impact health. Certainly, there are readers that paused here to face-palm. Others perhaps paused for a "wait . . . what?" Some will say "But they told us weed can't hurt you," while others will say "inhaling smoke seems like a bad idea no matter what is burning." In short, the debate will persevere.
The report turns to a discussion of why grass may be a contributing factor in some cancer diagnoses. Some argue that “The cannabinoids themselves could be carcinogenic." That is, that it matters "what" you smoke. Others are focused on the carcinogenic effect of "the smoke itself." That is, it only matters "that" you smoke. Cause and effect are foundations of scientific thought and method.
There is some intriguing background in the analysis. The team researched these potential implications using a database of over 4 million patients. Some were diagnosed with this, and others with that. Among those with a cancer diagnosis, their history was examined for drug use. This is a critical point because there was no science (positive drug test, measure of frequency or intensity of use). The evidence of drug use was "self-reported use of the drug." The patients said they did, and described how much/often.
Is it possible that some patients underreported their use? Might some patients have falsely denied blowing dope? The causation analysis might be impacted by such obfuscation. The described cohort study compared the cancer diagnosis rate between those who admitted dope use and those who denied it. It is dependent on the reporting. There is always room for caution when foundational facts are dependent alone on self-reporting.
So, if half of those folks who said they smoked dope were lying, then the results may be skewed. And if half of the folks who said they did not use dope were lying, the result is as likely skewed. The only distinction is in which direction the data would be misleading. Is it more likely a dope smoker would deny being an addict or that non-use would falsely state they are an addict? This is an important point to ponder. Maybe some falsely claim addiction to be part of the "cool crowd? Well, in fairness, some did in high school.
Let's pause here for a moment of pure conjecture regarding dope. As a controlled substance, utterly and completely illegal, perhaps some was grown in less than ideal conditions? Is it possible that chemicals were used for fertilizer, insecticide, or otherwise? What was the origin, history, and provenance of that "dime bag" or "loose joint" that the patient consumed? It is perhaps possible that something in the process, beyond the weed itself, might play a role. In the "self-reported" paradigm that will be impractical to determine at best.
Nonetheless, the "people with cannabis use disorder" were all free of any "history of head and neck cancer before the study began." The link between the dope and the cancer is based on the conclusion that "The cannabis users in the study were more likely to develop all types of head and neck cancer except hypopharyngeal cancer." Thus, in a spectrum of disease and diagnosis, a commonality was "use disorder" or "addiction" if you prefer.
What is "use disorder?" Why is this study focused on "disorder" rather than "use?" Yale Medicine defines "use disorder" as an addiction. This is therefore seemingly a distinction as regards frequency and intensity of use. Mary Margret is unlikely to have an enhanced risk of these cancers because she took a single toke behind the gym while the coach was distracted. Nonetheless, I saw her do so.
The "disorder" modifier is signaling that these marijuana smokers were regular or persistent users of the so-called "harmless" weed. One potential flaw in the conclusions is that the team found it difficult to quantify the frequency and intensity of use. There are inherent limitations to self-reporting. The benchmark they settled on is self-reporting of at least "one joint per day." For the sake of the "straights" in the crowd, "joint" is not a universal term of measure. Joints come in all sizes. Joint is not a measure of volume.
The good folks at Yale seem to hold contrary opinions to the "harmless" crowd. That website suggests that dope smoking may "increase the risk for schizophrenia," "harm the lungs," and may be "associated with deficits such as memory and attention problems." Either some folks have a different definition of "harmless" or these medical experts disagree with that label. I am neither a doctor nor a weed user, so I defer to the two opposing camps to sort this out.
The impact of this study will not be an immediate U-turn on the "let's all smoke more harmless dope" train. As a colleague once assured me "The pot Jeannie is out of the bottle." I have never doubted it. People are drawn to a variety of "mother's little helper(s)," (Rolling Stones, RCA 1965). Whether it is a "little yellow pill," or a nice California Sensimilla, there are people who seek an outlet, an escape, a release. They are willing to assume any risk to tomorrow for a little relief from today. And, too often, they find addiction, illness, and even death.
This has been true with a variety of substances and behaviors over the course of human history. That will not change. Nonetheless, there is a habitual cost/benefit analysis that may be worthy of attention. Before consuming a product, there is a benefit in knowing what the potential risks are. In the world of weed, it seems immediately clear that it is not "harmless," and never was. Saying that marijuana never killed anyone is perhaps as accurate as saying that smoking never killed anyone.
Maybe there is room for investigation and contemplation? Or maybe the solution is to rip off the bandaid and see what happens? Honestly, how bad could it possibly be?
