Jake Deutsch, M.D., is a veteran ER doctor and a contributor to The Daily Details. Send your health questions to Ask@Details.com. We'll publish the answers here every week.
In the ER, treating strokes is an unfortunate part of my daily routine. The story usually goes something like this: A patient experiences a sudden onset of weakness, typically predominant on one side of the body. He might also have difficulty speaking, a facial droop, or alteration of consciousness. My medical training has shown such neurologic emergencies stem from either a clot in the blood vessels in the brain or from bleeding into the white matter as a consequence of uncontrolled blood pressure. Most often, these patients are middle-aged or older and have other medical problems, like diabetes. So when a 35-year-old comes into the ER with an acute stroke, reeking of weed and clutching a bong in his nonparalyzed hand, it's anything but routine.You don't have to go to medical school to know that smoking marijuana impairs cognitive function—watch Fast Times at Ridgemont High if you need a refresher. Even the term pot head was chosen because the drug's adverse effects primarily target the brain. Doctors have known for years that the toxicity of toking up interferes with neural functions critical to thinking and memory. In the long term, THC permanently damages perception, coordination, and memory, and chronic use of "chronic" can cause psychiatric illness. In young adults, heavy marijuana use has even shown a two-fold increase in schizophrenia.
Given marijuana's brain-damaging potential, it makes sense that the ultimate cerebral injury—a stroke—may also ensue. In fact, a recent study of stroke patients came to a surprising conclusion: 16 percent regularly smoked pot. Research determined that THC derails the part of our nervous system that moderates blood pressure, causing it to run abnormally high. The result? The brain arteries harden and intracranial pressure increases like it does during an acute stroke. And while only 10 percent of all strokes occur in people under 45, those related to marijuana use are fives times more likely to happen to men than to women.
The emergence of synthetic weed raises more cause for alarm. Recently, a teenager almost died from experimenting with designer pot. After the young patient was put into a medically induced coma, scans showed what looked like the brain of a 70-year-old who had suffered multiple strokes. Nicknamed K2 and Moonrock, synthetic marijuana previously sold as herbs in gas stations is now classified as a Schedule I controlled substance—the same as heroin and crack cocaine.
Research that indicates a link between marijuana and strokes is still in the early stages, but one hypothesis questions the methods of marijuana ingestion. For example, if inhaling forcefully from a bong increases the pressure on the brain, does that therefore compound the drug's injurious effects? Other data shows that most documented cases of marijuana-related stroke occur with in a half-hour of smoking weed, and if 4:20 really is the preferred time of day to toke up, doctors like me should be ready for a wave of strokes in young people around 5 P.M.
—Dr. Jake Deutsch is an New York City-based ER doctor. Follow him @DrJakeDeutsch.