John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

Specialties: Ophthalmology

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New Cannabis Article from NORTH Magazine July/Aug 2014

Jul 20, 2014 - 12 comments


At one time asbestos used in school construction, doctors recommending cigarettes to soothe sore throats and putting cocaine in soft drinks seemed like good ideas. Now we can only wonder, “What were they thinking?”  Perhaps we can forgive our forebears because scientific evidence of the cancer causing properties of asbestos and tobacco and the addicting and health destroying nature of cocaine was not in existence at the time. That is not the case with marijuana.
Its unlikely future generations will absolve us of responsibility if the recreational and medical use of marijuana becomes national. The number of states permitting medical marijuana (23) and recreational cannabis for adults (Washington and Colorado) continues to increase. Short summary—bad idea!  As research physicians we present the known adverse health implications of marijuana use.
While generally mellow, marijuana users only seem to become angry and agitated when any suggestion is made that their pot use might have adverse consequences. When we wrote on this subject in the Kansas City Star, they had to shut down The Star website discussion because of all the abusive and vulgar postings. It’s obvious that stoners would rather get mad than carefully consider any contrary evidence to their mental construct that chronic marijuana use is harmless fun.
The high growing cannabis plant has been used commercially in the United States since colonial times when it was imported from Caribbean countries. It was refined or spun into cloth, ropes, wax, resins, paper, fuel, pulp and other useful products.  The Caribbean natives were aware of the psychoactive effects of smoked hemp which they called “ganja”. Presently smoked cannabis plant is also known by many monikers most commonly:  pot, weed, Mary Jane, reefers, roach, buds, joint, green, and back to its original roots—hemp and rope.  
The potency of present day marijuana is from 5 to 20 times stronger that the hippie “grass” used in the 1960’s. That increases the habituating and addicting properties of tetrahydrocannabinol (THC) the major cannabis psychoactive ingredient. This accounts for the rising annual number of emergency room visits (400,000+) for panic attacks, acute psychosis and toxicity.  A review of medical and mental damaging effects of marijuana can be found in Missouri Medicine 2012. Suffice here to say that THC is especially dangerous to children under age 15 and increases the incidence of mental health problems, in some cases the risk of Schizophrenia is increased 10 fold compared to the general population. Ambition and drive is blunted, memory impaired and IQ may be reduced permanently by as much as 8 points. Driving and working while using marijuana dramatically increases the chance of accidents and injuries.
The rapidly expanding commercial marijuana industry e.g. the profitable California based Medbox Corporation, has already produced cannabis food (marijuana laced brownies to be sold in vending machines) and candy like cannabis concoctions with names like “Pot Tarts” and “Kif Kat Bars” that  appeal to youngsters.  Deaths have occurred in children who overdosed on ‘cannabis candy.”
As we reported in Missouri Medicine, “Proponents of cannabis use argue that smoking cannabis provides relaxation and pleasure, enhances the sense of well-being, contributes to stress relief, and helps to deal with hard reality. Of course any enhancement of well-being in a mentally healthy person through use of a psychoactive substance is in some sense an oxymoron. Furthermore, cannabis use alters cortical dopamine, which plays a major role in higher cognitive functions, working memory, executive function, etc. Hence, the “relaxed” feeling most cannabis users report as a desirable acute effect, in all likelihood reflects cognitive dulling (non- or a-motivated syndrome) caused by altered cortical dopamine balance. In other words the weight of evidence indicates that cannabis creates cognitive dulling rather than reduction in anxiety, indifference rather than relaxation, and amotivation rather than inner peace, all closer to psychopathology than well-being.”
Numerous medical studies have shown that chronic marijuana use can permanently impair memory, intelligence, coordination, driving ability, impulse control, damage the heart, lungs, immune system, liver and increase the risk of certain types of cancers. The younger the user and the more frequent the use of marijuana the more potential for serious health problems.  Australian psychiatrist David Castle, MD filled a 252 page text (Marijuana and Madness, 2nd Ed, Cambridge Press) with carefully referenced studies on physical and mental disease caused by marijuana. There were 49 respected contributing scientists from all over the world.
Already over 400 chemicals have been identified in marijuana including carbon monoxide, hydrogen cyanide and ammonia. “Hey man, you want a drag of cyanide and ammonia?” might not find as many takers among the tokers when the roach makes the rounds at parties.
The FDA and physicians rightfully consider cannabis a drug and subject to federally stipulated rigorous study protocols. The legislative route being used to introduce medical and recreational marijuana illegally and dangerously circumvents this FDA drug testing process. Federal law also mandates that marijuana use and possession is illegal but Presidents and the Justice Department have chosen to ignore the laws they swore to defend.
Legitimate FDA type research has been done on purified cannabis and useful products for cancer chemotherapy such as Marinol® and Cesamet® are available. These drugs do not produce psychoactive effects. The use of marijuana products such as “Charlotte’s Web” for childhood seizures and other illnesses is unproven, anecdotal and potentially harmful. Cannabis use for glaucoma treatment is never needed. Medical marijuana “cards” are widely abused. Searching on Google “How to fake needing a medical marijuana card” offers 871,000 helpful suggestions. The most frank and succinct being, “Like man you tell them you got pain. Every dude has pain. Pain work every time!”  
Although dependence and addiction to alcohol and nicotine are among Missouri’s biggest social and health problems, the legal use of booze and cigarettes are cited by marijuana activists as reasons to legalize pot. Less than 8% of Americans smoke marijuana while 52% use alcohol and 27% smoke nicotine cigarettes. Missouri has over 10,000 tobacco related deaths per year. Addiction and abuse of legal medications are more of a problem than illegal drugs.  Deaths from legal drug overdose exceed the number of deaths from automobile accidents and surpass all types of illegal drug deaths combined.  It is catastrophically illogical to introduce another public health problem and source of habituation and addiction to our already overwhelmed health and social welfare systems.
How should one account for nanny-state social planners and big city politicians demonizing sugar, banning trans-fats and large size soft drinks while giving marijuana a pass? Why does the bent-out-of-shape crowd  rail at ‘Big Tobacco, Big Food and Big Pharma” while ignoring “Big Weed” (e.g. CannabisInvestments.com) gearing up to make stores peddling smoked and eaten marijuana as ubiquitous as Starbucks and Subways?  Revenue from taxing marijuana has failed to achieve projections.
As physicians we regard recreational and sham-medical marijuana as a looming public health problem with adverse consequences that could eventually rival those of tobacco use and alcohol addiction.
Washington and Colorado are now conducting de facto social and scientific experiments on the problems of   widely available medical and recreational marijuana. Let’s wait at least five years to assess their results. Let’s stay off the “high” way.
Svrakic DM, Lustman PJ et al. Legalization, Decriminalization & Medicinal Use of Cannabis: A Scientific and Public Health Perspective. Missouri Medicine 2012; 109(2)90-98

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Avatar universal
by SippyStix, Aug 09, 2014

Avatar universal
by Lexicon311, Aug 21, 2014
Rhetorically well written...and I smoke pot. I completely agree, and have often told my doctors, that it doesn't reduce pain; rather, it makes you just not care enough to focus on it. It definitely makes people lethargic and unproductive. Students blow their potential trying to retain valuable information, while learning and toking. Valid arguments with minimal bias. Kudos.

Lexicon, thank you for your opinion and the civil tone in which rendered. Most responses are removed by webmasters due to profanity and threatening language.


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by real_jimmy, Sep 03, 2014
I just want to say that i wish people get clear from Cannabis and start getting strong without any stuff support and get immune towards what led them start/continue with it, as ultimately one can never justify the wrong, be it herb or anything.. Rise up people and choose the better path... Good Luck

Avatar universal
by weaver71, Sep 03, 2014
I am not a cannabis user, though I have been and know many who are. I have a couple of criticisms to this article, though it is one of the better ones I have read of yours. Please do not take offense, I am actually trying to help you with your cause. Using the word stoner alienates many, making you a preacher to the choir. Like black friends calling each other, "my *****," or heroin addicts calling each other, "dope heads," those terms are reserved for those within those groups. As an anti-marijuana advocate, your use of the term stoner is derogatory and judgmental. It screams bias and turns many people you are trying to reach away. If your goal is preaching to the choir, this is a great way to make sure they are the only ones who listen to you.

Second, I am fairly educated on mental illness. Cannabis can trigger pre-existing conditions, but there has been no solid proof of it causing schizophrenia, bipolar, or BPD, attention deficit and OCD maybe, but those symptoms pass after coming down. Most "stoners" know that, so quoting inductive research is likely hurting your cause, rather than helping it.

I too would rather people be satisfied with life off all mood altering chemicals, including many pharmaceuticals passed by the FDA, but laws have never stopped addiction in all of history. Prohibition of alcohol actually increased the dangers related to alcohol. Education has been far more effective in making changes. If you truly want to reach pro-cannabis advocates, I suggest you change your use of the word "stoner," which I have seen you use in every article I have read of yours. I would also stick to solid, irrefutable science in your defense of your position. If I went on the addiction forum and called opiate users, "dope heads," do you think I would be helping them to choose sobriety? If I went on the bipolar forum and said my condition was caused by cannabis, I would be told I am not bipolar or else the drug simply activated it. Just a few things to think about.

Being the nation of the highest crime, drug addiction, and violence in the Western world, I truly hope some real changes take place soon. Cannabis has ruined our relegate market here in NorCal, the greedy growers of cannabis are taking over our communities. I am fine with moderate use of alcohol, cannabis, or tobacco, but that is not what is happening. This is a real issue and I hope you can make effective change. Good luck.

Colorado Legal Marijuana Creates Health Problems:


Free JAMA (Journal of the American Medical Association) medical journal article.


Avatar universal
by smilliorn, Mar 11, 2015
I saw you followed a similar post about this. My  5yr old daughter  started talking about seeing "sparkles" a few months ago. I feel like pedi doc not taking this very seriously. We did get a referral to a pediatric ophthalmologist and saw him yesterday. He saw vision fine both distance (20/25). He did a muscle strength test which was fine. He dilated her eyes and did several exams with that. Said eyes were healthy and to "wait and see". I have a grandmother who started out seeing sparkles and progressively got worse as she aged and then in her adulthood found out she was having seizures. Her sparkles came and went though (with the seizure activity).

My daughter says she sees them all the time, whether eyes are open or shut. She says they are normally centered in her line of sight but if she moves her eyes very fast from side to side she can get the sparkles to track off to the side so she can see clearly what is in front of her. Her account of these sparkles has not changed in the past 3 months, so we do not feel like she is pretending or make believing. I did ask her about double vision bc I have very bad astigmatism and that's the first thing I noticed as a kid. She thought that was cool and for a while started saying she saw double of things but we could tell she was just pretending. She gets frustrated bc she says they are distracting and make it hard for her to practice writing skills as well as interrupts her play.

I just don't know how hard to push her pedi doc for a possible neuro consult or EKG to check for seizure activity. or just wait and see if things change. She doesn't complain of headaches at all. I do get migraines with visual auras though.

Thank you for your time!

Well its very difficult to know how far to push a work up for unusual or bizarre symptoms in kids. Very frequently they are a result of over active imagination or seeking attention.  Obviously your GM having seizures is relevant but no treatment available to prevent them from developing. I think you will need to continue to rely on advice of your pediatrician and the peds ophthalmologist.  If something else develops that could change the calculus of their recommendations

Avatar universal
by Momof3_1withspecial, May 11, 2016
Can you address the use of Marinol to reduce nausea and increase appetite for a young patient who desperately needs to be able to eat and gain weight?

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by JohnHaganMD, Dec 16, 2016
A new study in JAMA Ophthalmology  http://jamanetwork.com/journals/jamaophthalmology/fullarticle/2589167 has demonstrated that regular use of cannabis can damage the ganglion cells of the retina. These cells are critical to vision and carry sight from the retina to the brain. They are the cells that glaucoma also kills.  Moreover these cells are brain cells (the retina is part of the brain not the eye per se. Thus this study also suggests that regular cannabis use can damage or destroy other vital cells in the brain.

Avatar universal
by judithmhol, Aug 24, 2018
So does alcohol,destroy vital cells in the brain. Alcohol has led to so much heartache, health related problems, vehicular homicide on and on. In our life time and that of our grandchildren’s world alcohol will be available at every corner store.  I have never ever heard of any medicinal value from drinking, yet so many people find relief from anxiety, ptsd, a host of medical conditions from the use of marijuana.  The really exciting aspect of the way it is grown now is that for someone like myself, who doesn’t want a high concentration of THC, there any many blends of very mellow weed that Can help with a host of ailments.  Which also gives many of us hope that we won’t always be tied to the pharmaceutical way of life. As we all know they are far too many side effects, deaths and general mistrust with “too much of a good thing”. (ie: Prescription meds)
I think it is high time (no pun intended) that we listen to a different way.  Not necessarily instead of traditional medicine, but perhaps along side one another?

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by JohnHaganMD, Aug 24, 2018
Alcohol or tobacco is not the issue.

1. No published studies show MJ relieves pain. Yet pain is the most common reason for medical MJ  “prescriptions” also if you google “how do I obtain a medical marijuana card even though I don’t need it?” the most common answer is “tell them you have pain”
2. Glaucoma treatment gets worse in states/localities with medical/recreational MJ (patients stop using drops, stop going to ophthalmologists)  chronic MJ use causes damage to the retina similar to glaucoma (loss of ganglion cells)  these cells are CNS cells and a proxy for what happens in the brain. Loss of neural cells may be reason for permanent loss of IQ points in pot using youths, loss of memory, slow reflex/apathy/loss of motivation, etc.
3. The possible use of PURE DRUG based on cannabis has been addressed with FDA approved but they have serious side effects (but likely less than street based cannabis non/drug formulations) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC34325/
4. The possible use of PURE DRUG based cannabis for childhood seizures has been addressed with FDA approved produce: https://www.ucsf.edu/news/2018/06/410996/fda-approves-landmark-marijuana-derived-drug-first-tested-ucsf
5. Statement of the Colorado Medical Society that did not mobilize to fight recreational cannabis in their state:
http://www.cms.org/articles/marijuana-legalization This is the concluding statement “Other states facing legislative efforts to legalize marijuana should consider Colorado’s experience as a cautionary tale. Approving medical treatments by ballot initiatives sets a dangerous precedent for public health. This will be one of the great social experiments of the century”

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