UNANTICIPATED CONSEQUENCES OF MARIJUANA LEGALIZATION

Abstract

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: A nineteen year old male, never a tobacco smoker, with no significant history, presented to clinic after three episodes of spontaneous pneumothorax in two months. CASE PRESENTATION: After presenting to clinic, he denied smoking, substance use, and environmental exposures. Physical exam was unremarkable. Between his first and second events, CT scans revealed apical bullae. His three episodes required thorascopy, left apical bullectomy, and pleurectomy. Pathology showed respiratory bronchiolitis and inflammation with abundant eosinophils, raising suspicion for undisclosed smoking habits. The patient retroactively admitted to smoking marijuana and inhaling heated oils daily for “medical purposes,” due to chronic back pain, and had obtained a “medical card” to purchase marijuana. DISCUSSION: This case of respiratory bronchiolitis and bullae due to marijuana and heated oil inhalation exemplifies unintended consequences of marijuana legalization, and delineates a perception that marijuana use is largely harmless. It suggests that there is confusion regarding the distinction between recreational and medical marijuana, among users and medical providers. Moreover, it outlines a perceived probability that obtaining a license for marijuana use permits recreational procurement, by way of claiming to be affected by a condition which may not have entirely objective diagnostic criteria. CONCLUSIONS: Marijuana is one of the most commonly used substances, and has been used extensively in medicine. Chronic pain is the most common reason for use of medical marijuana, which is legalized and approved for specific uses. Despite known complications, marijuana use remains prevalent and may become the first Schedule I substance to traverse the gap between substance use and medical therapy. Amid constituent compounds, cannabidiol is believed to correlate with analgesia, and whether it can be administered without exposing lung parenchyma to inflammatory states is worth exploring. Describing the risks and benefits of marijuana can bolster public knowledge as its legal status continues to broaden. Reference #1: Peacock A, Leung J, Larney S, et al. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018:113(10):1905-1926. Reference #2: Aggarwal SK, Carter GT, Sullivan MD, et al. Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions. J Opioid Manag. 2009;5:153–168. Reference #3: Wilkinson S, Yarnell S, Radhakrishnan R, Ball S, D’Souza D. Marijuana Legalization: Impact on Physicians and Public Health. Annu Rev Med. 2016;67:253-466. DISCLOSURES: No relevant relationships by Humberto Choi, source=Web Response No relevant relationships by Charlie Lin, source=Web Response