All About Marijuana

All About Marijuana 

 

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 

​Marijuana is the most commonly used psychotropic drug in the United States, after alcohol.  Its use is widespread among young people. In 2018, more than 11.8 million young adults used marijuana in the past year. 

According to the Monitoring the Future survey, rates of past year marijuana use among middle and high school students have remained steady, but the number of teens in 8th and 10th grades who say they use it daily has increased. With the growing popularity of vaping devices, teens have started vaping THC (the ingredient in marijuana that produces the high), with nearly 4% of 12th graders saying they vape THC daily. In addition, the number of young people who believe regular marijuana use is risky is decreasing.

Legalization of marijuana for medical use or adult recreational use in a growing number of states may affect these views.

How do people use marijuana?

People can mix marijuana in food (edibles), such as brownies, cookies, or candy, or brew it as a tea. A  popular method of use is smoking or eating different forms of THC-rich resins.   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 butter
  • 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.

Effects of Marijuana on the Body     

Marijuana has both short-and long-term effects on the brain.

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

  • altered senses  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 (risk is highest with regular use of high potency marijuana)

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.  A New Zealand study conducted 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. ​

A Rise in Marijuana’s THC Levels

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.  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.

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. 
  • 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 –  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 breastmilk of nursing mothers.   With regular use, THC can reach amounts in breast milk that could affect the baby’s developing brain.
  • 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.

Reports of Deaths Related to Vaping

The Food and Drug Administration has alerted the public to hundreds of reports of serious lung illnesses associated with vaping, including several deaths. They are working with the Centers for Disease Control and Prevention (CDC) to investigate the cause of these illnesses. Many of the suspect products tested by the states or federal health officials have been identified as vaping products containing THC, the main psychotropic ingredient in marijuana. Some of the patients reported a mixture of THC and nicotine; and some reported vaping nicotine alone. No one substance has been identified in all of the samples tested, and it is unclear if the illnesses are related to one single compound. Until more details are known, FDA officials have warned people not to use any vaping products bought on the street, and they warn against modifying any products purchased in stores. They are also asking people and health professionals to report any adverse effects. The CDC has posted an information page for consumers.

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.

Marijuana Use Disorder

  • Cannabis is often taken in larger amounts or over a longer period than intended
  • There is a persistent desire or unsuccessful efforts to cut down or control cannabis use
  • A great deal of time is spent in activities necessary to obtain cannabis, use cannabis or recover from its effects
  • Craving or a strong desire to use cannabis
  • Recurrent cannabis use results in failure to fulfill role obligations at work, school or home
  • Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis
  • Important social, occupational or recreational activities are given up or reduced because of cannabis use
  • Recurrent cannabis use in situations in which it is physically hazardous
  • Cannabis use continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.
  • Tolerance, as defined by either: (1) a need for markedly increased cannabis to achieve intoxication or desired effect or (2) a markedly diminished effect with continued use of the same amount of the substance.
  • Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms.

CUD is defined as either mild (two to three symptoms present), moderate (four to five symptoms present) or severe (six or more symptoms present). 

Cannabis Intoxication        

  1. Recent use of cannabis        
  2. Clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use        
  3. At least two of the following signs, developing within 2 hours of cannabis use: conjunctival injection, increased appetite, dry mouth, tachycardia.        
  4. Symptoms not due to a general medical condition and not better accounted for by another mental disorder.
  5. Specify if perceptual disturbances are present: hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of delirium.   

Cannabis Withdrawal         

  1. Cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months). Three or more of the following signs and symptoms develop within approximately 1 week after cessation of heavy, prolonged use:            
    1. Irritability, anger or aggression           
    2. Nervousness or anxiety , agitation           
    3. Sleep difficulty (i.e., insomnia, disturbing dreams)            
    4. Decreased appetite or weight loss            
    5. Restlessness            
    6. Depressed mood, mood changes
    7.   Chills, sweating
    8. Fatigue
    9. Headaches
    10.   Cravings    
  2. At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or a headache.        
  3. The signs or symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.        
  4. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

It should be noted that evidence suggests that withdrawal only occurs in a subset of patients. Symptoms usually begin within the first 24 hours, peak by day 3, and can last for up to 2 weeks. Increased use and more recent use can predict the severity of withdrawal     

Cannabis Intoxication Delirium

This diagnosis relies on the definition of delirium and is appropriate when the following two symptoms predominate in someone who has taken cannabis:            

  1. Disturbance in attention (i.e., reduced ability to direct focus, sustain, and shift attention) and awareness (reduced orientation to the environment)
  2. An additional disturbance in cognition (i.e., memory deficit, disorientation, language, visual-spatial ability, or perception).

Cannabis-Induced Psychotic Disorder            

  1. Presence of delusions or hallucinations.            
  2. Evidence from the history, physical examination, or laboratory findings of either one of the following:           
    1. The symptoms in the first criterion developed during or soon after cannabis intoxication or withdrawal.            
    2. The disturbance is not accounted for by a psychotic disorder that is not substance induced.
    3. Evidence that the symptoms are accounted for by a psychotic disorder that is not substance induced might include the following:            
      1. The symptoms precede the onset of substance use (or medication use).      
      2. The symptoms persist for a substantial period (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially more than what would be expected, given the type or amount of the substance used or the duration of use.      
      3. Other evidence suggests the existence of an independent non–substance–induced psychotic disorder (e.g., a history of recurrent non–substance–related episodes).      
      4. The disturbance does not occur exclusively during delirium.    
      5. The disturbance causes clinically significant distress or impairment in social, occupational, or other areas of functioning. 

Cannabis-Induced Anxiety Disorder            

  1. Panic attacks or anxiety predominate in the clinical picture.            
  2. Evidence from the history, physical examination, or laboratory findings of either of the following:                
    1. The symptoms in the first criterion developed during or soon after substance intoxication or withdrawal.                
    2. The disturbance is not better accounted for by an anxiety disorder that is not substance induced. Evidence that the symptoms are better accounted for by an anxiety disorder that is not substance induced might include the following:                    
    3. The symptoms precede the onset of substance use.                    
    4. The symptoms persist for a substantial period (e.g., about a month) after cessation of acute withdrawal or severe intoxication or are substantially more than expected given the type or amount of the substance used or the duration of use.                    
    5. Other evidence suggests the existence of an independent non–substance–induced anxiety disorder (e.g., a history of recurrent non–substance–related episodes).                
    6. The disturbance does not occur exclusively during delirium.               
    7. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.      

Cannabis-Induced Sleep Disorder            

  1. A prominent and severe disturbance in sleep.            
  2. There is evidence from the history, physical examination, or laboratory findings of both of the following:            
    1. The symptoms in the first criterion developed during or soon after cannabis intoxication or after withdrawal from or exposure to it.          
    2. The disturbance is not better explained by a sleep disorder that is not substance/medication induced. Such evidence of an independent sleep disorder could include that:               
    3. The symptoms precede the onset of cannabis use.          
    4. The symptoms persist for a substantial period (i.e., about a month) after the cessation of acute withdrawal or severe intoxication.         
    5. There is other evidence suggesting the existence of an independent non-substance/medication-induced sleep disorder (i.e., a history of recurrent non-substance/medication-related episodes).           
    6. The disturbance does not occur exclusively during delirium.                
    7. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Treatment for Cannabis Use Disorder

According to NIDA, CUD is similar to other substance abuse disorders in that people with the disorder often suffer from other psychiatric disorders or substance abuse problems. For that reason, treating underlying mental health concerns may help treat the marijuana use disorder. Behavioral health treatments include:

  • Cognitive-behavioral therapy, which teaches people strategies to identify and correct behaviors that lead to substance abuse
  • Contingency management, which monitors target behaviors and rewards positive behavior changes
  • Motivational enhancement therapy, which is designed to mobilize a person’s internal motivations for change

             Is Any Amount of Marijuana OK?  

 Cannabis has long had the reputation of being non-addictive, unlike other “harder” drugs. Scientists, however, disagree–particularly in today’s environment that produces stronger strains. Simply stated, this isn’t your parents’ weak weed.

Deborah Hasin,Ph.D., professor of epidemiology at Columbia University, in New York City has grave concerns.   “The potency of cannabis products used to be much weaker, perhaps contributing to the impression that marijuana is not addictive.  However, potency has increased greatly over the last few decades. Updated figures show that 20 to 30 percent of cannabis users develop CUD, so the risk for addiction is real.”  I think the very idea that there is a ‘healthy’ amount of any psychoactive substance is problematic.  Some people can use marijuana without harm, just as some people can drink without harm, especially if use is infrequent, but others run the risk of adverse consequences, including CUD, impaired social or operational functioning, respiratory problems, motor vehicle crashes and cannabis reactions requiring visits to the emergency room.”

 

 

https://www.ncbi.nlm.nih.gov/books/NBK538131/

https://www.drugabuse.gov/publications/drugfacts/marijuana