Marijuana

Botanical name: Cannabis sativa

Other common names: pot, herb, bud, dope, spliff, reefer, grass, weed, ganja, 420, schwag, smoke, Mary Jane, gangster, boom, skunk. There are over 200 street names for marijuana.

What is Marijuana?

Marijuana is a green, brown or gray mixture of dried, shredded leaves, stems, seeds and flowers of the hemp plant Cannabis sativa. Marijuana is used as a psychoactive (i.e. mind altering) recreational drug, for certain medical ailments and for religious and spiritual purposes. Sinsemilla, hash/hashish (resinous form) and hash oil (sticky black liquid) are stronger forms of marijuana.

How does Marijuana work?

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). It is a psychoactive ingredient. Thew highest concentrations of THC are founbd in the leaves and flowers. When marijuana smoke is inhaled, THC rapidly passes from the lungs into the bloodstream and is carried to the brain and other organs throughout the body. THC from the marijuana acts on specific receptors in the brain, called cannabinoid receptors, starting off a chain of cellular reactions that finally lead to the euphoria, or "high" that users experience.

Certain areas in the brain, such as the hippocampus, the cerebellum, the basal ganglia and the cerebral cortex, have a higher concentration of cannabinoid receptors. These areas influence memory, concentration, pleasure, coordination and, sensory and time perception.¹ Therefore these functions are most adversely affected by marijuana use.

Marijuana's strength is correlated to the amount of THC it contains and the effects on the user depend on the strength or potency of the THC it contains. The THC content in marijuana has been increasing since the 1970s. For the year 2007, estimates from confiscated marijuana indicated that it contains almost 10 percent THC on average. There are many other chemicals found in marijuana, many of which may adversely affect health.² Marijuana contains over 60 different cannabinoid compounds related to THC, including cannabidiol, cannabinol, and β-caryophyllene.

Marijuana is usually smoked as a cigarette (called a joint or a nail) or in a pipe or bong. In recent years, it has appeared in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug, such as crack. The “blunts” retain tobacco leaf used to wrap the cigar and therefore it combines marijuana's active ingredients with nicotine and other harmful chemicals. Some users also mix marijuana into food or use it to brew tea.

Medicinal use of THC

In the United States, the Controlled Substances Act (CSA) of 1990 classifies marijuana as a Schedule I substance, which has no approved medical use and has high potential for abuse. However, many US states have legalized the use of medical marijuana. Prescription medicines containing synthetic cannabinoids (THC) are already available.

• Marinol (dronabinol) - Classified as Schedule III
• Cesamet (nabilone) - Classified as Schedule II

Both medications are used to treat chemotherapy patients who have nausea, vomiting and loss of appetite. However, Marinol is also approved to treat HIV patients with cachexia (weight loss, muscle atrophy, fatigue and loss of appetite).

Studies have also been done which show that THC and cannabidiol (CBD) provide therapeutic benefit for Multiple Sclerosis (MS) spasticity symptoms.³ In Canada, Europe, and several other countries, Sativex, an oral sublingual spray is available for adjunctive use in MS neuropathic pain and cancer-related pain. Sativex® is composed of plant-derived extracts of THC and cannabidiol, not synthetic cannabinoids. In 2011, Sativex was in Phase III clinical trials for US approval for use in cancer pain, and has the adopted generic name of nabiximols. Dronabinol has also been used in Europe for treatment of MS-related pain.

• Sativex (nabiximols)

Marijuana has also been used for glaucoma to lower intraocular pressure (IOP), but research does not show that marijuana has a better effect than currently approved glaucoma medications. Studies have shown that smoked, oral or IV use may have an effect on lowering IOP, but topically applied marijuana derivatives to the eye did not have an effect. Marijuana is not FDA approval for use in glaucoma, and may lead to other adverse effects such as increased heart rate and lowered blood pressure. ⁴ However, in some US states, marijuana is used for glaucoma under medical marijuana programs.

Extent of Marijuana Use

In 2010, marijuana was noted by the United Nations as being the most widely used illicit substance in the world. Globally, between 129 and 191 million people aged 15 to 64 used marijuana at least one time in 2008, or 2.9 to 3.4 percent of the world's population. In North America, 29.5 million people used marijuana at least once in 2008.⁵

Data indicate that in 2008 marijuana was responsible for about 17 percent (322,000) of all admissions to treatment facilities in the United States. Only opiates has a higher admission rate among abused substances. Marijuana admissions were primarily male (74 percent), white (49 percent), and young (30 percent were in the 12–17 age range). Starting marijuana by age 14 was a common factor among 56 percent of those admitted for treatment.¹

According to the 2010 National Survey on Drug Use and Health, 2.4 million Americans aged 12 or older used marijuana for the first time in the 12 months prior to being surveyed (roughly 6,600 new users per day), which is similar to the 2008-2009 rate. Close to 59 percent of the 2.4 million recent marijuana users were younger than age 18 when they first used. The 2010 first-time rate is higher than the rate estimates from 2002-2007. Approximately 6,000 people a day used marijuana for the first time in 2007 - 2.1 million Americans. Of these, 62.2 percent were under the age of 18.⁶

The 2010 Monitoring the Future survey indicates that marijuana use among 8th-, 10th-, and 12th-graders, which has shown a consistent rise over the past two years, continues this trend with 13.7 percent of 8th-graders, 27.5 percent of 10th-graders, and 34.8 percent of 12th-graders reporting past-year use. Heightening the concern over this rise is the finding that the proportion of 8th-graders who perceived smoking marijuana as harmful and the proportion who disapprove of the drug’s use have decreased. Particularly noteworthy, daily marijuana use increased significantly in all three grades in 2010, 1.2%, 3.3.% and 6.1% in grades 8, 10 and 12. This computes to roughly one out of every 16 high school seniors who smoke marijuana daily.⁷

Effects during Pregnancy and Lactation

Any drug of abuse can affect a mother's health. THC can cross the placenta so there is potential for problems in the fetus. THC can depress the fetal heart rates and change fetal brain wave electrical patterns. Studies have found that babies born to mothers who used marijuana during pregnancy were smaller than those born to mothers who did not use the drug. In general, smaller babies are more likely to develop health problems. Tests given to children at 48 months of age whose mothers used marijuana during pregnancy have shown lower verbal and memory scores compared to children whose mother did not use marijuana. [8] Babies born to adolescents who used marijuana during pregnancy have also shown adverse effects on the neurological behavior of the newborns in the first 24 to 78 hours after delivery.⁹

A nursing mother who uses marijuana passes some of the THC to the baby in her breast milk.⁸ Research indicates that use by a mother during the first month of breast-feeding can impair the infant's motor development. Pregnant and nursing women should avoid marijuana use.

Marijuana side effects

What are the short-term side effects of Marijuana use?

Side effects of marijuana use will be variable from person to person, depending upon strength and amount of marijuana used and if the user is occasionally or chronically exposed to THC. The short-term effects of marijuana use include problems with memory and learning; distorted perception (sights, sounds, time, touch); difficulty in thinking and problem solving; loss of coordination and motor skills; increased heart rate, anxiety, bloodshot eyes, dry mouth. Reaction time may be impaired while driving. Panic attacks, paranoia and psychosis may occur acutely and be more common in psychiatric patients.¹⁰. For chronic users, the impact on memory and learning can last for days or weeks after its acute effects wear off.¹ Marijuana may be cut on the street with more dangerous substances that may lead to more serious side effects.

THC in marijuana is strongly absorbed by fatty tissues in various organs. Generally, traces of THC can be detected by standard urine testing methods several days after a smoking session. In heavy chronic users, traces can sometimes be detected for weeks after they have stopped using marijuana.

What are the long-term side effects of Marijuana use?

People who smoke marijuana often have the same respiratory problems as cigarette smokers. These individuals may have daily cough and phlegm, symptoms of chronic bronchitis, and more frequent chest colds. They are also at greater risk of getting lung infections like pneumonia. Marijuana contains some of the same, and sometimes even more, of the cancer-causing chemicals found in cigarette smoke. A study from 2009 suggests that regular and long-term use of marijuana may increase the risk for testicular cancer.

When people smoke marijuana for years they can suffer negative consequences. For example, because marijuana affects brain function, the ability to do complex tasks could be compromised, as well as the pursuit of academic, athletic, or other life goals that require you to be 100 percent focused and alert. Long-term abuse of marijuana may lead to addiction.

Marijuana also may affect mental health. Studies show that early use may increase the risk of developing psychosis (a severe mental disorder in which there is a loss of contact with reality) including false ideas about what is happening (delusions) and seeing or hearing things that aren’t there (hallucinations), particularly if you carry a genetic vulnerability to the disease. Also, rates of marijuana use are often higher in people with symptoms of depression or anxiety.²

Effects of Marijuana On Other Organs

Effects on the Heart

Shortly after smoking marijuana the heart rate increases drastically and may remain elevated for up to 3 hours. This effect may be enhanced if other drugs are taken with marijuana. One study has suggested that the risk of heart attack may increase by up to 4.8-fold in the first hour after smoking marijuana.¹¹ The effect may be due to the increased heart rate, as well as altered heart rhythms. The risk of heart attack may be greater in those with specific risk factors such as patients with high blood pressure, heart arrhythmia, or other cariac disease.

Effects on the Lungs

After smoking marijuana, the bronchial passage relaxes and becomes enlarged, and the blood vessels in the eyes expand making the eyes look red. Studies have shown that marijuana smoke contains 50–70 percent more carcinogenic hydrocarbons than tobacco smoke, and is an irritant to the lungs. Marijuana users tend to inhale more deeply and hold their breath longer than tobacco smokers do, which further increase the lungs' exposure to carcinogenic smoke. Marijuana smokers can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections.[1] A case-controlled study from 2006 found no links between marijuana use and lung cancer, but no evidence-based consensus has been definitively made on the absolute risk of lung cancer with marijuana use.¹²

Effects of Heavy Marijuana Use on Social Behavior

Heavy marijuana abuse may show low achievement in important life measures including mental and physical health, and career. Marijuana affects memory, judgment and perception. Learning and attention skills are impaired among people who use it heavily. Longitudinal research on marijuana use among young people below college age indicates those who use marijuana have lower achievement than the non-users, more acceptance of deviant behavior, more delinquent behavior and aggression, greater rebelliousness, poorer relationships with parents, and more associations with delinquent and drug-using friends.

Smoking marijuana can make driving dangerous. The cerebellum is the section of our brain that controls balance and coordination. When THC affects the cerebellum’s function it can cause disaster on the road. Research shows that drivers have slower reaction times, impaired judgment, and problems responding to signals and sounds if driving while under the influence of THC.²

Addictive Potential

A drug is addicting if it causes compulsive, uncontrollable drug craving, seeking, and use, even in the face of negative health and social consequences. Research suggests that roughly 9 percent of users become addicted to marijuana, with higher rates if the user starts at a young age (17 percent) and in those who use marijuana daily (25-50 percent). While not everyone who uses marijuana becomes addicted, when a user begins to seek out and take the drug compulsively, that person is said to be dependent or addicted to the drug.

Long-term users who try to quit could experience withdrawal symptoms such as sleeplessness, irritability, anxiety, decreased appetite and drug craving. Withdrawal symptoms usually begin about a day after the person stops using marijuana, peaks in 2 to 3 days and may take about 1 to 2 weeks to subside.

Some heavy users develop a tolerance to marijuana; meaning that the user needs larger doses to get the same desired results that he or she used to get from smaller amounts.¹

Medical Marijuana

As of September 2011, 16 states and the District of Columbia legally allow marijuana for personal medical use. Rules surrounding the use of medical marijuana vary by state. The first state in the union to legalize the medial use of marijuana for medical purposes was California in 1996. Other states that allow medical marijuana include Alaska, Arizona, Colorado, Delaware, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Washington, and the District of Columbia.

In May 2011, Delaware became the 16th state to approve medical marijuana. According to the Delaware laws, medical marijuana can be used for treatment of debilitating medical conditions, such as cancer, HIV/AIDS, decompensated cirrhosis, amyotrophic lateral sclerosis, Alzheimer's disease, post-traumatic stress disorder, wasting syndrome, severe debilitating pain that has not responded to other treatments for more than three months or for which other treatments produced serious side effects, severe nausea, seizures, or severe and persistent muscle spasms. The amount of marijuana for medical use that can be possessed by the individual patient and primary caregiver varies by state, but may include dried marijuana and live plants. The use of marijuana for medical reasons is controversial. The American Medical Association (AMA), in it’s 2009 AMA Policy: Medical Marijuana states that marijuana’s status as a federal schedule I controlled substance should be reviewed "with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines, and alternate delivery methods. This should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product."

However, many political leaders, US government officials, health care providers and medical organizations take differing views of the benefits and risks of medical marijuana. Proponents state that marijuana has valid medical uses and further research should be pursued, while opponents list concerns about health risks, and the "gateway" effect of marijuana that can lead to more dangerous drug abuse, among other issues. Nonetheless, legalization of medical marijuana continues to be pursued at the state level, with pending legislation in 6 states as of September 2011.¹³

References:

1. National Institute on Drug Abuse (NIDA). NIH. NIDA Info Facts. 11/10. http://www.nida.nih.gov/infofacts/marijuana.html Accessed 9/22/2011.
2. National Institute on Drug Abuse (NIDA) for Teens. NIH. Marijuana. http://teens.drugabuse.gov/facts/facts_mj2.php Accessed 9/22/2011
3. Lakhan SE, Rowland M. Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review. BMC Neurology 2009:9;59
4. National Eye Institute (NEI). NEI Statement. Glaucoma and Marijuana Use. National Institute of Health. May 13, 2009. http://www.nei.nih.gov/news/statements/marij.asp Accessed 9/22/2011.
5. UNODC. World Drug Report 2010. United Nations Publication, 2.4 Cannabis. p. 194. http://www.unodc.org/documents/wdr/WDR_2010/2.4_Cannabis.pdf Retrieved September 22. 2011.
6. U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Office of Applied Studies. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm Accessed September 19, 2011
7. Monitoring the Future. National Results on Adolescent Drug Use. Overview of Key Findings 2010. http://monitoringthefuture.org/pubs/monographs/mtf-overview2010.pdf Accessed September 19, 2011
8. Coustan DR, Mochizuki TK. Handbook of Prescribing Medications During Pregnancy. Third Edition. Third Edition. Lipincott-Raven Publishers 1998.
9. de Moraes Barros MC, Guinsburg R, de Araújo Peres C, et al. Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period. J Pediatr. 2006;149:781-7.
10. Jacob L Heller, MD, MHA. Marijuana Intoxication. Medline Plus. NLM/NIH. 1/5/2011.
11. http://www.nlm.nih.gov/medlineplus/ency/article/000952.htm. Accessed 9/22/2011.
12. Mittleman MA, Lewis RA, Maclure M, et al. Triggering myocardial infarction by marijuana. Circulation 2001;103(23):2805-9. Hashibe M, Morgenstern H, Cui Y, et al. Marijuana use and the risk of lung and upper aerodigestive tract cancers: Results of a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2006;15(10):1829-34.
13. ProCon.org. Medical Marijuana. http://medicalmarijuana.procon.org/ Accessed 9/22/2011.