In a follow-up study in 2014, the whole blood of donors who had consumed cannabis had diminished platelet aggregation. The conclusion was drawn that endocannabinoid receptor agonists reduce platelet activation as well as aggregation, and as such might have potential in antithrombotic therapies. This anticoagulatory effect could counteract the surgeon’s attempts to create hemostasis within the operative field and thus limit visualization. Yet Zakrzeska also concluded that marijuana use may put certain individuals at risk for thromboembolism, a second issue of surgical concern. Even though an intravenous injection of cannabis has been shown to cause a significant drop in the platelet count which seems in line with the belief of anticoagulation, it is the marijuana components that cause a release of ADP from erythrocyte, leading to platelet aggregation. This aggregation is the reason behind the reduction in platelet count.The theory of marijuana use leading to platelet aggregation leads toward substantiating the conclusion Desbois et al. made in regards to an increased predilection for myocardial infarctions and arterial disease. Reports of cases similar lead to Deusch et al.’s in vitro study. The cannabinoid receptors CB1 and CB2 were found on the cell membrane of the human platelet via western blot. Delta-9- tetrahydrocannabinol, which is the ingredient within cannabis drying racks responsible for the psychological effects, demonstrated the ability to significantly increase the expression of glycoprotein IIb-IIIa as well as P-selectin thus increasing the activation of the human platelet. This findings lead to the conclusion that THC, through its effects on the cannabinoid receptors on platelets, may create a prothrombotic setting favoring the development of cardiovascular events.
As surgical technique and field advance, more complicated and potentially painful procedures are becoming more common practice. Surveying patients indicated that over 80% experience postoperative pain that was rated as either moderate or severe. This pain can set off a series of physiologic changes that may harm various systems ranging from cardiovascular to the central nervous system, and has been shown to lengthen hospital stays and time to first ambulation, impede postoperative nursing and physiotherapy, increase healthcare costs, and reduce the patient’s satisfaction with the outcome. However, multiple reviews of the available literature have concluded that appropriate and adequate postoperative analgesia improves recovery, including improving cardiac function and decreasing mortality and morbidity related to pulmonary function, decreases thrombosis risk, diminishes the possibility of chronic pain syndrome, and improves overall outcome. Marijuana plays a role now in medicine as an analgesic. Prescribed for a number of diagnoses, medical marijuana has been shown in over 18 randomized trials to be both effective and safe in the treatment of chronic pain, with the best evidence being for neuropathic pain. Investigating the role marijuana plays as an analgesic, Russo found that due to cannabis’s role in multiple pathways, safety, and potential side effects and benefits shown in the clinical trials, marijuana may play a more important role in pain management when combined with opioids. However, the appropriate management of marijuana users with opioids postoperatively is more complicated than these trials suggest. In chronic marijuana users, the perioperative narcotic requirements to gain appropriate analgesia were significantly increased. Yet despite this increase, patients were more likely to subjectively experience less pain than those of their non-marijuana using counterparts.
Clinically, this increase materialized in the form of a narcotic requirement twice that of the average patient of the same height and weight each day over the course of two postoperative days, demonstrating a potential interaction between marijuana and opioids which must be taken into account when considering the potential postoperative complications that may arise from the increased doses of opioids. In a literature review published in the Journal of Obesity Surgery, Rummel et al. posed the question of whether or not marijuana use should be a contraindication to bariatric surgery. In their investigation, the authors determined that there was a lack of a generalized screening protocol for marijuana use amongst providers and thus there is no account of a known effect on procedures due to confounders. Yet, due to the many effects marijuana has on the cardiovascular, pulmonary, immunologic, and central nervous system, the conclusion was drawn that it is fair to hypothesize that cannabis use has the potential to worsen adverse outcomes in the postoperative period. These potential risks and lack of screening resulted in the recommendation that practitioners of bariatric surgery should be devoted to assessing controlled and problematic levels of preoperative substance use and take the time to discuss the potential postoperative risks with patients. However, the American Association of Clinical Endocrinologists, the Obesity Society, and the American Society for Metabolic and Bariatric Surgery took the recommendations one step further by stating that current drug use, including marijuana, should be treated as exclusionary criterion in the case of bariatric surgery. These recommendations for an elective procedure should potentially be considered in the case of all elective surgical procedures.Marijuana is the most frequently used illegal drug in the United States.In August 2013, the U.S. Department of Justice announced an updated marijuana enforcement policy, making clear that marijuana remains illegal federally.In recent years, however, the public health policy regarding marijuana legalization has been swiftly changing in the United States.
As of April 2018, nine states – Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Vermont, and Washington – and the District of Columbia have enacted laws to authorize the production, distribution, and possession of marijuana. A total of 29 states and DC have allowed medical use of marijuana for patients with approved health conditions. States with medical marijuana laws have an evident form of patient registry, and they provide protection against arrest for possession up to a limited amount of marijuana for medical use.In the U.S., marijuana legalization may be one of the most controversial issues including legal, policy, health, and economic considerations. For example, marijuana legalization has been a highly contested public health issue between state and federal drug laws.Also, the essential question may be whether marijuana has medical value. The national controversy over marijuana legalization has included discussion of both the benefits and risks of nonmedical marijuana use.Additionally, it is important to consider economic effects of marijuana legalization.Communication researchers have examined how the news media can influence public perceptions or attitudes toward certain issues by using the notion of framing.According to Gamson and Modigliani,a frame refers to a key organizing theme or idea that provides meaning to issues or events reported in a news story. A frame is an idea organizer that packages an issue in a specific way, telling what the issue is about.Media frames suggest how the public can interpret an issue or event, and framing involves selection and salience.Thus, news framing can influence the public’s perceptions about public health policy including marijuana legalization.Drugs have been described mainly as objects of government enforcement and negative connotations of use in the mainstream news outlets.In the issue of marijuana legalization, a variety of organizing themes can be presented.
For example, a marijuana legalization story can be framed as a legislation issue,in which news stories primarily emphasize the legislative proceedings regarding marijuana use and marijuana legalization. Previous studies have explored how American news media frame the marijuana policy, including medical use of marijuana and recreational use of marijuana.Analyzing newspaper articles between June 2008 and June 2009,Vickovic and Fradella found that U.S. newspapers mainly discussed medical marijuana as legal and regulatory issues and passage of medical marijuana news. Although it is very prominently discussed in terms of public health, legal, policy, and economic perspectives, researchers had paid little attention to how the media presented this issue. In order to reduce the gap in the literature, we make an attempt to comprehensively investigate media frames about marijuana legalization. First, we examine the organizing theme of marijuana legalization stories.More specifically, this study investigates how U.S. newspapers present the issue of marijuana legalization from 1995 to 2014. Also, we look at whether the frequency of organizing themes remains steady or not over time. As a recent survey shows, public opinion on legalizing marijuana has dramatically changed.This study aims to answer the question of how U.S. newspapers have presented the issue of marijuana legalization between 1995 and 2014.Taken together, our findings are consistent with previous studies that have revealed that marijuana has been mainly discussed as a legal and policy issue.Framing can affect the way the readers evaluate a certain issue, influencing their judgment.Thus, it can be argued that Americans are more likely to evaluate marijuana legalization as a public policy issue, rather than a public health issue.There can be several explanations for these findings. First, marijuana legalization is essentially the theme about the legislative acts. A number of legislative measures that allow for recreational use of marijuana have been passed since 2012. Second, marijuana stories often involved conflicts between federal and state governments, between enforcement agencies and citizens, and between governors and congresses.
The conflict perspective is a popular frame because conflict is a recognized news value.Thus, this conflict may influence journalists to report cannabis grow tray stories as a law enforcement theme.Third, a medical effect theme and a patients theme might appear less often because we examined stories related to recreational use as well as medical use. Nonetheless, criticism of newspapers’ tendency to define marijuana stories as legislation or law enforcement stories may be justified. Because these themes were clearly dominant, the issues surrounding medical marijuana were not commonly highlighted in the news. Although the issue of marijuana is important in terms of public health approach,our findings indicated that journalists paid little attention to the medical effect theme when covering marijuana stories. Our findings also revealed that organizing themes appeared differently according to the presidential periods. First, newspapers frequently described marijuana stories with a legislation theme during the Obama administration period. Since Colorado and Washington initially allowed for recreational use of marijuana in 2012, other seven more states have followed. As Griffin et al. pointed out, the passage of marijuana laws significantly increased news stories. During this period,frequent legislative activities caused media attention. Second, an economy theme more frequently appeared since 2009. Block also found that marijuana legalization was discussed mainly as a business issue in 2014. In particular, many news stories reported the expected and actual economic effects of legalization during those years. Third, a youth drug use theme peaked during the first Clinton administration period, and then it has decreased. Interestingly, according to Monitoring the Future survey,the actual use among youth was somewhat declined between 1995 and 2008. Thus, newspapers probably reflected this trend. Although more than half articles described the issue of marijuana with a neutral tone, positive stories were published more frequently than negative stories.These findings can be explained by two-sided framed stories, which often result in a neutral tone. As Sniderman and Theriault indicate, the public should make choices between several competing values in real politics. In a two-sided frame, a story presents both frames of an issue.For example, the media may present reasons to both support and oppose marijuana legalization in the same story.
Over the past decade, the political discourse around marijuana legalization has been dominated by competing frames over the legal, law enforcement, economic, and public health consequences of proposed state and federal government policies.These two-sided or non-framed articles likely present the issue with a neutral tone. Our findings have several limitations. First, we examined only newspapers. If marijuana stories were retrieved from other sources for 20 years, 1995 to 2014, it could be very hard to manage the sample. Thus, one of the major reasons to analyze only newspapers was to obtain a manageable sample size. Also, newspapers still provide a useful channel to deliver information, as they can play a key role in setting the agenda for other news media.In addition, many mainstream newspapers have provided their online versions through their own webpages and social media. Thus, news stories from these newspapers can be widely exposed to Americans. Future research should include other news sources. Second, the selection of newspapers has limitations. Because some newspapers were not available through online search engines, we examined less representative newspapers, which can cause concerns regarding the generalizability of the findings. Thus, it is necessary for future research to include more representative newspapers as much as possible. Third, it can be pointed out that the categories of themes were inductively determined because there have been only a few previous studies on the topic of marijuana legalization.