Marijuana

Young people are very susceptible to myths and inaccurate information, so guidance with regard to drugs and evidence-based information is critical.  Youth who begin using substances are often unaware of the short and long term potential impact on their daily lives.  Optimally, adults need to reach out and connect with youth well before they are exposed to substances that could negatively impact their lives.   There is much debate regarding marijuana, otherwise known as cannabis. In order to make an educated decision regarding marijuana use, it is important to utilize reliable sources of information.  It is also important to take the “legal or illegal” piece out.  Perceptions of risk decrease with legality. Some of the claims made for or against marijuana are scientifically well-grounded and some are not. There is much biased information since there is a potential for monetary gain. As individuals, we need to look at reliable information in formulating our viewpoints and decisions.

The following statement is from the National Academies of Sciences, Engineering, and Medicine (NASEM) report: The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.

Despite the extensive changes in policy at the state level and the rapid rise in the use of cannabis both for medical purposes and for recreational use, conclusive evidence regarding the short- and long-term health effects (harms and benefits) of cannabis use remains elusive. A lack of scientific research has resulted in a lack of information on the health implications of cannabis use, which is a significant public health concern for vulnerable populations such as pregnant women and adolescents. Unlike other substances whose use may confer risk, such as alcohol or tobacco, no accepted standards exist to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.

Although we do not have a broad base of research regarding marijuana at this time in comparison with other substances, what we do know can be very helpful in guiding youth with their decision making.

What is marijuana?

Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant. The plant contains the mind-altering chemical THC and other similar compounds. Extracts can also be made from the cannabis plant.

Cannabis is a broad term. It describes the different products that come from the Cannabis sativa plant, including marijuana and cannabinoids. Cannabinoids are a group of active chemical compounds found in cannabis, such as tetrahydrocannabinol (THC) that get users “high.”

How does marijuana affect the brain?

 

Image by NIDA

Short-Term Effects

When a person smokes marijuana, THC quickly passes from the lungs into the bloodstream. The blood carries the chemical to the brain and other organs throughout the body. The body absorbs THC more slowly when the person eats or drinks it. In that case, they generally feel the effects after 30 minutes to 1 hour.

THC acts on specific brain cell receptors that ordinarily react to natural THC-like chemicals. These natural chemicals play a role in normal brain development and function.

Marijuana overactivates parts of the brain that contain the highest number of these receptors. This causes the “high” that people feel. Other effects include:

• altered senses (for example, seeing brighter colors)
• altered sense of time
• changes in mood
• impaired body movement
• difficulty with thinking and problem-solving
• impaired memory
• hallucinations (when taken in high doses)
• delusions (when taken in high doses)
• psychosis (when taken in high doses)

Long-Term Effects

Marijuana also affects brain development. When people begin using marijuana as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. Researchers are still studying how long marijuana’s effects last and whether some changes may be permanent.

For example, a study from New Zealand conducted in part by researchers at Duke University showed that people who started smoking marijuana heavily in their teens and had an ongoing marijuana use disorder lost an average of 8 IQ points between ages 13 and 38. The lost mental abilities didn’t fully return in those who quit marijuana as adults. Those who started smoking marijuana as adults didn’t show notable IQ declines.

A Rise in Marijuana’s THC Levels – Increased Potency

The amount of THC in marijuana has been increasing steadily over the past few decades. For a person who’s new to marijuana use, this may mean exposure to higher THC levels with a greater chance of a harmful reaction. Higher THC levels may explain the rise in emergency room visits involving marijuana use.

Marijuana potency, as detected in confiscated samples, has steadily increased over the past few decades. In the early 1990s, the average THC content in confiscated marijuana samples was roughly 3.8 percent. In 2014, it was 12.2 percent. The average marijuana extract contains more than 50 percent THC, with some samples exceeding 80 percent. These trends raise concerns that the consequences of marijuana use could be worse than in the past, particularly among those who are new to marijuana use or in young people, whose brains are still developing.

Researchers do not yet know the full extent of the consequences when the body and brain (especially the developing brain) are exposed to high concentrations of THC or whether the recent increases in emergency department visits by people testing positive for marijuana are related to rising potency. The extent to which people adjust for increased potency by using less or by smoking it differently is also unknown. Recent studies suggest that experienced people may adjust the amount they smoke and how much they inhale based on the believed strength of the marijuana they are using, but they are not able to fully compensate for variations in potency.

The popularity of edibles also increases the chance of harmful reactions. Edibles take longer to digest and produce a high. Therefore, people may consume more to feel the effects faster, leading to dangerous results. Higher THC levels may also mean a greater risk for addiction if people are regularly exposing themselves to high doses.

Marijuana Extracts

Smoking THC-rich resins extracted from the marijuana plant is on the rise. People call this practice dabbing. These extracts come in various forms, such as:

• hash oil or honey oil—a gooey liquid
• wax or budder&mdsh; a soft solid with a texture like lip balm
• shatter—a hard, amber-colored solid

These extracts can deliver extremely large amounts of THC to the body, and their use has sent some people to the emergency room. Another danger is in preparing these extracts, which usually involves butane (lighter fluid). A number of people have caused fires and explosions and have been seriously burned from using butane to make extracts at home.

What are the other health effects of marijuana?

Marijuana use may have a wide range of effects, both physical and mental.

Physical Effects

• Breathing problems. Marijuana smoke irritates the lungs, and people who smoke marijuana frequently can have the same breathing problems as those who smoke tobacco. These problems include daily cough and phlegm, more frequent lung illness, and a higher risk of lung infections. Researchers so far haven’t found a higher risk for lung cancer in people who smoke marijuana.
• Increased heart rate. Marijuana raises heart rate for up to 3 hours after smoking. This effect may increase the chance of heart attack. Older people and those with heart problems may be at higher risk.
• Problems with child development during and after pregnancy. One study found that about 20% of pregnant women 24-years-old and younger screened positive for marijuana. However, this study also found that women were about twice as likely to screen positive for marijuana use via a drug test than they state in self-reported measures. This suggests that self-reported rates of marijuana use in pregnant females is not an accurate measure of marijuana use and may be underreporting their use. This concerns medical experts because marijuana use during pregnancy is linked to lower birth weight and increased risk of both brain and behavioral problems in babies. If a pregnant woman uses marijuana, the drug may affect certain developing parts of the fetus’s brain. Children exposed to marijuana in the womb have an increased risk of problems with attention, memory, and problem-solving compared to unexposed children. Some research also suggests that moderate amounts of THC are excreted into the breast milk of nursing mothers. With regular use, THC can reach amounts in breast milk that could affect the baby’s developing brain. More research is needed.
• Intense Nausea and Vomiting. Regular, long-term marijuana use can lead to some people to develop Cannabinoid Hyperemesis Syndrome. This causes users to experience regular cycles of severe nausea, vomiting, and dehydration, sometimes requiring emergency medical attention.

Mental Effects

Long-term marijuana use has been linked to mental illness in some people, such as:

• temporary hallucinations
• temporary paranoia
• worsening symptoms in patients with schizophrenia—a severe mental disorder with symptoms such as hallucinations, paranoia, and disorganized thinking

Marijuana use has also been linked to other mental health problems, such as depression, anxiety, and suicidal thoughts among teens. However, study findings have been mixed.

Other Health Effects?

Can secondhand marijuana smoke affect nonsmokers, including children?

Secondhand marijuana smoke contains tetrahydrocannabinol (THC), the chemical responsible for most of marijuana’s psychological effects, and many of the same toxic chemicals in smoked tobacco. Smoked marijuana has many of the same cancer-causing substances as smoked tobacco, but there are still a lot of unanswered questions around secondhand marijuana smoke exposure and its impact on chronic diseases such as heart disease, cancer, and lung diseases.

How Does Marijuana Affect a Person’s Life?

Compared to those who don’t use marijuana, those who frequently use large amounts report the following:

• lower life satisfaction
• poorer mental health
• poorer physical health
• more relationship problems

People also report less academic and career success. For example, marijuana use is linked to a higher likelihood of dropping out of school. It’s also linked to more job absences, accidents, and injuries.

Does marijuana use affect driving?

Marijuana significantly impairs judgment, motor coordination, and reaction time, and studies have found a direct relationship between blood THC concentration and impaired driving ability.

Marijuana is the illicit drug most frequently found in the blood of drivers who have been involved in vehicle crashes, including fatal ones. Two large European studies found that drivers with THC in their blood were roughly twice as likely to be responsible for a fatal crash than drivers who had not used drugs or alcohol. However, the role played by marijuana in crashes is often unclear because it can be detected in body fluids for days or even weeks after intoxication and because people frequently combine it with alcohol. Those involved in vehicle crashes with THC in their blood, particularly higher levels, are three to seven times more likely to be responsible for the incident than drivers who had not used drugs or alcohol. The risk associated with marijuana in combination with alcohol appears to be greater than that for either drug by itself.

Several meta-analyses of multiple studies found that the risk of being involved in a crash significantly increased after marijuana use—in a few cases, the risk doubled or more than doubled. However, a large case-control study conducted by the National Highway Traffic Safety Administration found no significant increased crash risk attributable to cannabis after controlling for drivers’ age, gender, race, and presence of alcohol.

Can a person overdose on marijuana?

An overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death. There are no reports of teens or adults dying from marijuana alone. However, some people who use marijuana can feel some very uncomfortable side effects, especially when using marijuana products with high THC levels. People have reported symptoms such as anxiety and paranoia, and in rare cases, an extreme psychotic reaction (which can include delusions and hallucinations) that can lead them to seek treatment in an emergency room.

While a psychotic reaction can occur following any method of use, emergency room responders have seen an increasing number of cases involving marijuana edibles. Some people (especially preteens and teens) who know very little about edibles don’t realize that it takes longer for the body to feel marijuana’s effects when eaten rather than smoked. So they consume more of the edible, trying to get high faster or thinking they haven’t taken enough. In addition, some babies and toddlers have been seriously ill after ingesting marijuana or marijuana edibles left around the house.

Is marijuana addictive?

Marijuana use can lead to the development of a substance use disorder or marijuana use disorder, a medical illness in which the person is unable to stop using even though it’s causing health and social problems in their life. Severe substance use disorders are also known as addiction. Research suggests that between 9 and 30 percent of those who use marijuana may develop some degree of marijuana use disorder. People who begin using marijuana before age 18 are four to seven times more likely than adults to develop a marijuana use disorder.

Marijuana use disorders can be associated with dependence—in which a person feels withdrawal symptoms when not taking the drug. Marijuana dependence occurs when the brain adapts to large amounts of the drug by reducing production of and sensitivity to its own endocannabinoid neurotransmitters.

Many people who use marijuana long term and are trying to quit report mild withdrawal symptoms that make quitting difficult. These include:

• grouchiness
• sleeplessness
• decreased appetite
• anxiety
• cravings

How do I know if I am addicted to marijuana?

Some of the signs that someone might be addicted to marijuana include:

• Trying but failing to quit using marijuana.
• Giving up important activities with friends and family in favor of using marijuana.
• Using marijuana even when it is known that it causes problems at home, school, or work.

Compared to marijuana users who are not addicted, people who are addicted to marijuana are at a higher risk of the negative consequences of using the drug, such as problems with attention, memory, and learning.

What is Medical Marijuana?

The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions. The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine. However, scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form. Continued research may lead to more medications. Because the marijuana plant contains chemicals that may help treat a range of illnesses and symptoms, many people argue that it should be legal for medical purposes. In fact, a growing number of states have legalized marijuana for medical use.

Why isn’t the marijuana plant an FDA-approved medicine?

The FDA requires carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication. So far, researchers haven’t conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it’s meant to treat.

What are cannabinoids?

Cannabinoids are chemicals related to delta-9-tetrahydrocannabinol (THC), marijuana’s main mind-altering ingredient that makes people “high.” The marijuana plant contains more than 100 cannabinoids. Scientists as well as illegal manufacturers have produced many cannabinoids in the lab. Some of these cannabinoids are extremely powerful and have led to serious health effects when misused.

How might cannabinoids be useful as medicine?

Currently, the two main cannabinoids from the marijuana plant that are of medical interest are THC and CBD.  THC can increase appetite and reduce nausea. THC may also decrease pain, inflammation (swelling and redness), and muscle control problems. Unlike THC, CBD is a cannabinoid that doesn’t make people “high.” It may be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly even treating mental illness and addictions.

Many researchers, including those funded by the National Institutes of Health (NIH), are continuing to explore the possible uses of THC, CBD, and other cannabinoids for medical treatment. For instance, recent animal studies have shown that marijuana extracts may help kill certain cancer cells and reduce the size of others. Scientists are also conducting preclinical and clinical trials with marijuana and its extracts to treat symptoms of illness and other conditions, such as diseases that affect the immune system, including: HIV/AIDS, multiple sclerosis (MS), inflammation, pain, seizures, substance use disorders and mental disorders.

Should I Try CBD Products for Myself or a Child?

It would be wise to use extreme caution if considering trying CBD products, especially with children.  CBD products are currently unregulated without any safety or quality standards.  Testing on some of the CBD products that are available for sale revealed there were sometimes other substances in the product, such as the mind altering component, THC.  More research is needed.

Points to Remember

• The term medical marijuana refers to treating symptoms of illness and other conditions with the whole, unprocessed marijuana plant or its basic extracts.
• The FDA has not recognized or approved the marijuana plant as medicine.
• However, scientific study of the chemicals in marijuana called cannabinoids has led to two FDA-approved medications in pill form, dronabinol and nabilone, used to treat nausea and boost appetite.
• Cannabinoids are chemicals related to delta-9-tetrahydrocannabinol (THC), marijuana’s main mind-altering ingredient.
• The body also produces its own cannabinoid chemicals.
• Scientists are conducting preclinical and clinical trials with marijuana and its extracts to treat symptoms of illness and other conditions.

Recreational Marijuana – The discussion with regard to recreational legalization is a very different conversation in comparison with legalization for medical reasons.  Taking on some health risks in order to gain some benefit with regard to a health issue may certainly be worth considering in some cases.  Taking on health risks for recreational purposes is a different consideration.  In many cases, a push toward legality is made for monetary reasons.  People want to make money and selling a potentially addictive substance is very lucrative. The number of young people who believe regular marijuana use is risky is decreasing, likely due to increasing legality. Another important factor to assess, of course, is the potential for side effects, whether they be cognitive, physiological, temporary, or permanent.

Treatments for Marijuana Use Disorders

Marijuana use disorders appear to be very similar to other substance use disorders, although the long-term clinical outcomes may be less severe. On average, adults seeking treatment for marijuana use disorders have used marijuana nearly every day for more than 10 years and have attempted to quit more than six times. People with marijuana use disorders, especially adolescents, often also suffer from other psychiatric disorders (comorbidity). They may also use or be addicted to other substances, such as cocaine or alcohol. Available studies indicate that effectively treating the mental health disorder with standard treatments involving medications and behavioral therapies may help reduce marijuana use, particularly among those involved with heavy use and those with more chronic mental disorders. The following behavioral treatments have shown promise: cognitive-behavioral therapy, contingency management, and motivational enhancement therapy.

Currently, the FDA has not approved any medications for the treatment of marijuana use disorder, but research is active in this area. Because sleep problems feature prominently in marijuana withdrawal, some studies are examining the effectiveness of medications that aid in sleep and executive function.

Synthetic Marijuana

Synthetic cannabinoids are human-made mind-altering chemicals that are either sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense.

These chemicals are called cannabinoids because they are similar to chemicals found in the marijuana plant. Because of this similarity, synthetic cannabinoids are sometimes misleadingly called “synthetic marijuana” (or “fake weed”), and they are often marketed as safe, legal alternatives to that drug. In fact, they are not safe and may affect the brain much more powerfully than marijuana; their actual effects can be unpredictable and, in some cases, more dangerous or even life-threatening.

Synthetic cannabinoid products are often labeled “not for human consumption.” Labels also often claim that they contain “natural” material taken from a variety of plants. However, the only parts of these products that are natural are the dried plant materials. Chemical tests show that the active, mind-altering ingredients are cannabinoid compounds made in laboratories. Manufacturers sell these products in colorful foil packages and plastic bottles to attract consumers. They market these products under a wide variety of specific brand names. Hundreds of brands exist, including K2, Spice, Joker, Black Mamba, Kush, and Kronic.

How do synthetic cannabinoids affect the brain?

Synthetic cannabinoids act on the same brain cell receptors as THC (delta-9-tetrahydrocannabinol), the mind-altering ingredient in marijuana. So far, there have been few scientific studies of the effects of synthetic cannabinoids on the human brain, but researchers do know that some of them bind more strongly than marijuana to the cell receptors affected by THC, and can produce much stronger effects. The resulting health effects can be unpredictable and dangerous. Because the chemical composition of many synthetic cannabinoid products is unknown and may change from batch to batch, these products are likely to contain substances that cause dramatically different effects than the user might expect.

People who have used synthetic cannabinoids and have been taken to emergency rooms have shown severe effects including:

• rapid heart rate
• vomiting
• violent behavior
• suicidal thoughts

Synthetic cannabinoids can also raise blood pressure and cause reduced blood supply to the heart, as well as kidney damage and seizures. Use of these drugs is associated with a rising number of deaths.

Are synthetic cannabinoids addictive?

Yes, synthetic cannabinoids can be addictive. Regular users trying to quit may have withdrawal symptoms including headaches, anxiety, depression and irritability. Behavioral therapies and medications have not specifically been tested for treatment of addiction to these products.