The big news in this month's election is not the contested presidential race. It's not undecided Senate seats. The big news is that New Jersey voted to legalize recreational marijuana use! Is this a recreational activity that is good, or even safe, for those with heart disease or risks for heart disease?
Marijuana is a greenish mixture of leaves, stems, and flowers derived from Cannabis plants. It contains many different chemicals, called cannabinoids. The two major, active chemicals are delta 9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the most psychoactive chemical, producing the euphoric effects of marijuana. CBD is anti-inflammatory. There are also synthetic cannabinoids which are used for medical purposes in the treatment of epilepsy and to relieve severe nausea and vomiting in cancer chemotherapy patients. Cannabinoids are either smoked or eaten, with 77% of users reporting inhalation as their method of choice. There has been a dramatic increase in marijuana use over the last ten years. In 2017, more than 39 million Americans reported using marijuana at least once. Marijuana consumption is not just for the young. In the older population, marijuana is used to treat chronic illnesses. Marijuana consumption increased by 4.5 times in people over age 55 between 2002 and 2014.
Paralleling the increase in consumption is an increase in the legalization of marijuana at the state level. The medical use of cannabis is legal (with a doctor’s prescription) in 35 states. New Jersey legalized medical marijuana in 2010. The law allowed marijuana to be acquired at state licensed treatment centers. As of 2017, there were six centers in the state, with about 12,000 patients enrolled in the program. On November 3 2020, New Jersey voted, by a 66% to 33% margin, to legalize the recreational use of marijuana, joining 14 other states. The law will take effect on January 1 2021, potentially opening a huge market (estimated at $2 billion) as New Jersey is the most populous state on the East Coast to legalize marijuana.
The general public opinion is that marijuana use is safe, maybe even healthy. How true is that assumption? What are the physiologic effects of marijuana? Is marijuana consumption safe for heart patients? Smoking marijuana causes an immediate increase in heart rate and blood pressure as well as an increase in the work of the heart. In addition, it activates the body’s release of adrenaline. Marijuana impairs the blood’s oxygen carrying capacity, resulting in less oxygen to the heart muscle. Marijuana can cause inflammation and blood clots within the heart arteries. None of these effects are beneficial for heart patients. Multiple case reports have linked marijuana with heart attacks and strokes. The victims are usually young (average age 45), males, and without cardiac risk factors. The risk of a heart attack rises 5 fold within one hour of smoking marijuana. Angina, chest pain, also occurs frequently after smoking marijuana due to the decrease in oxygen to the heart. Cardiac rhythm problems may also occur with marijuana smoking, due to the stimulation by adrenaline. The most common rhythm disturbances are atrial fibrillation (an irregular rhythm from the upper chambers of the heart) and ventricular fibrillation (cardiac arrest). The average age of patients suffering from marijuana-associated arrhythmias is only 24 years old. About 3% of marijuana users experience an arrhythmia. On the other end of the spectrum, at higher doses of THC, slow heart rates can occur, sometimes necessitating a pacemaker. Most of the effects described are with inhalation of marijuana. However edible forms are not safer and may be more dangerous. Oral marijuana gets into the blood stream slower than inhaled marijuana. Since the favorable psychogenic effects take longer, more is consumed, leading to higher concentration of chemicals and a higher rate of complications. Lastly, marijuana interacts with many cardiac medications including antiarrhythmic agents, calcium channel blockers, beta-blockers, statins and warfarin.
While there is evidence linking marijuana to adverse cardiac events, the studies are not robust. Given the increasing use of marijuana in the general population as well as the population with heart disease or heart risks, high quality studies are needed. However, the adverse effects of marijuana seem to be as bad as cigarette smoke. It can be concluded that inhaling particulate matter of any kind is harmful to the heart and blood vessels. That’s food for your head before you go to the head shop in January 2021.