Laced Cannabis Concerns follow Rise in Marijuana Use


Marijuana use is up as is concern over laced cannabis. Dr. Litvin shares her account of a patient self-medicating with a non-medical grade marijuana leading to negative outcomes.

There are a myriad of taboos surrounding the use of marijuana. Despite the notorious reputation that precedes the drug, several clinical uses have been identified legalizing its use in several states. Rheumatism is an umbrella under which chronic pain flourishes. Hence, some patients have turned to using cannabinoid as a form of treatment for their ailments.

A recent study published in The Lancet Psychiatryfinds that more adults in the U.S. are using marijuana. Apparently, they feel marijuana is a safer alternative to other drugs, even though it has become more potent in the last decade.

The Lancet Psychiatry study analyzed data from the U.S. National Survey on Drug Use and Health (NSDUH), which is based on a random sample of households selected from across the United States. It does not include the homeless, those living in shelters and those who are incarcerated.

Inner city rheumatologists serve this underrepresented population which I find can have a strong predilection towards the use of marijuana. For example, consider Patient X:  a 36-year-old male with a history of rheumatoid arthritis and is on biologic therapy.  He presented with a worsening ecchymosis, circumscribed, palpable and painful rash on his buttocks, ears, nasal tip and lip.

A biopsy taken from a buttock lesion revealed leukocytoclastic vasculitis. The patient admitted using street-grade marijuana and the particular batch that landed him in the hospital was laced with K2, a synthetic cannabinoid. His use of marijuana was for alleviating chronic joint pain - which persisted despite receiving biologics (he expressed a hesitancy for further treatment).

Most of the common conditions that rheumatologists see daily include chronic aches and fatigue as unifying symptoms. Treating these subjective components with pain medications can be a slippery slope. Physicians are often asked for a more “natural or holistic” approach that can absolve symptoms, citing available internet sources as references for use of marijuana.

Many patients are not aware of the dangers that lurk behind these street drugs, which they feel can cure their ailments. However, current events have depicted significant adverse events, including death that can occur with the use of marijuana - especially today and the prominent addition of additives that can make it a more treacherous diversion. 

Marijuana use has become much more rampant on the streets and as such, it is seen much more often in hospital emergency rooms.

Writing in The Lancet Psychiatry, Wilson M. Compton, M.D., and colleagues, urge the need for improved education and prevention messages regarding the risks of marijuana, which I can attest is true. Its use continues to be a subject we need to broach with our patients as they become immersed in a drug culture dotted with possible new norms.

Irina Litvin, D.O., is a physician and rheumatology fellow at SUNY Downstate in Brooklyn, N.Y.



Irina Litvin, D.O., is a physician and rheumatology fellow at SUNY Downstate in Brooklyn, N.Y.


Wilson M Compton, MD, Beth Han, MD, et al. "Marijuana use and use disorders in adults in the USA, 2002–14: analysis of annual cross-sectional surveys," The Lancet Psychiatry. Aug. 31, 2016. DOI:


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