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Support for legalizing the recreational use of marijuana has been steadily climbing. While there has been a decline in marijuana-related convictions and increase in state revenues, the impact on public health and safety is not clear. The nephrology community must be aware of the complications of chronic marijuana use, such as recurrent acute kidney injury secondary to hyperemesis.
Marijuana is the most widely used illicit drug in the United States and in the world. About 44% of the US population aged 12 years and above have admitted to lifetime use of marijuana.1 The pro-marijuana legalization arguments include decriminalization of young people, higher arrest rate of ethnic minorities, difficulty in enforcing marijuana laws, apparent safety profile, and less addictive potential compared to alcohol and tobacco. State revenue generation is appealing, and tight regulation has been created to ensure that minors don’t get access to marijuana. The anti-marijuana legalization arguments include an increase in marijuana use among young adults, high potential for abuse, the potential rise in marijuana-related road traffic accidents, and use of marijuana as a “gateway drug” for more dangerous substances.
Recently, four additional states (California, Massachusetts, Maine, and Nevada) have voted to legalize the recreational use of marijuana, bringing the total to eight states and the District of Columbia. Oregon, Washington, Alaska, and Colorado have previously legalized recreational use of marijuana. Three of these states have given their first report on the impact of marijuana legalization.
Marijuana use and kidney transplantation
Marijuana use is not considered to be a contraindication for organ donation or transplantation, but it is regarded as a risk factor for medical complications, due to physical and behavioral components, albeit there is little evidence for this. 9 Areas of concern include susceptibility to fungal infections, possible interaction with the metabolism of immunosuppressants and co-existing behavioral disturbances. Previously, marijuana users were commonly denied kidney transplants, but physician attitudes towards this have been changing. Now experts have begun emphasizing behavioral assessment of these patients to rule out any negative influence of smoking marijuana on their socio-economic conditions. Seven states have disallowed physicians from rejecting potential transplant recipients solely on the basis of the use of medical marijuana. Transplant centers usually ask kidney donors to stop smoking tobacco and marijuana for 6-12 weeks prior to organ donation.