Marijuana is a psychoactive drug. Reefer. Mary Jane. Weed. Pot. Ganja. Grass. It has many names. Marijuana's history is long and controversial. For thousands of years, cultures worldwide have used cannabis medically and recreationally. Now, marijuana finds itself thrust center-stage into a modern debate. All eyes turn its way. Current evidence appears split - with medical marijuana promises on one hand, yet marijuana addiction risks on the other. Where does the balance lie? The answer is far more complicated than one might presume. Today, passionate voices clamor to loosen laws, arguing marijuana could help many. Others cry caution, warning its use comes at a cost. So who speaks the truth? The truth likely rests somewhere in between. In this article, I will explore marijuana's science, weigh potential benefits against harms, and seek to find solutions for my patients. So let us begin.
A Brief History of Marijuana Use
The unassuming cannabis plant boasts a storied past spanning thousands of years. This humble herb traces its roots to ancient Central Asia, where it grew wild. Early humans - curious and resourceful as we are - recognized its properties. Seeds journeyed along Silk Road trade routes where the plant took hold and flourished. Ancient Chinese folk medicine hailed cannabis as a cure-all, treating illnesses from malaria to constipation. Shamans prized the plant's spiritual psychedelic powers. In India's Vedic Scriptures, cannabis stood amongst five sacred plants of enlightenment. As knowledge spread, so too did cannabis. Its mystical and medicinal fame rippled across the Middle East and Africa. For over 5,000 years, diverse cultures have cultivated cannabis. Yet today, this once-hallowed plant sparks impassioned debate. How perspectives change with the ages! The cannabis plant's long and winding story reminds us traditions can evolve in unexpected ways.
Cannabis' winding path through Western medicine proves equally fascinating. An Irish physician, William B. O'Shaughnessy, observed Indian cannabis customs firsthand in the 1800s. He immediately noticed the plant's potential. He brought seeds with him to the British Isles. Soon cannabis emerged throughout European and American pharmacies. Doctors prescribed marijuana as a treatment for severe pain, anticonvulsant for seizures, and more. At the turn of the 20th century, you could find cannabis treatment everywhere. But things began to change, as they often do. Regulations squeezed cannabis from pharmacies.
Why Did Marijuana Become Illegal?
As aspirin and morphine appeared on the scene, medical attitudes turned against cannabis use. By the early 1900s, cannabis - once a prominent therapy - saw its place in Western medicine vanish away. There were several reasons behind this change. Some claim that cannabis was associated with Mexican immigrants - who called it marihuana - which increased prejudice against the drug. There were also exaggerated media stories linking marijuana to crime and violence. In the 1930s, the anti-marijuana campaign intensified. The federal Marihuana Tax Act essentially banned it nationwide in the US. A key argument was that marijuana caused insanity and was unsafe. But the evidence was largely anecdotal. Later, a stronger motivation arose - the war on drugs. Marijuana was linked to heroin and demonized. In 1970 it was classified as a Schedule I illegal drug with no medical value. But by then the public didn't distinguish marijuana from truly dangerous drugs. The stage was set for decades of prohibition. Marijuana use became weaponized. In the US, millions of citizens were arrested and jailed for possession and use.
Why Did Cannabis Become Legal?
A chill wind of change swirled amid the hazy marijuana debate. For decades, stern laws crippled countless lives. Over 25 million Americans have been arrested on cannabis charges since 1937. Disproportionately impacting minorities and the poor. Jails overflowed while the ruthless War on Drugs raged on. Yet prohibition failed to stomp out use. And public perception evolved. So the people pushed back. Compassionate voices drowned out demonizing rhetoric. Slowly, laws eased. States legalized medical then recreational marijuana. Public health approaches replaced punishment. A growing acceptance of marijuana use occurred in the 1990s. The USA moved away from treating cannabis users as criminals. Now, there is a growing wave of people advocating for the recreational use of marijuana laws. But deep wounds remain among those jailed for minor marijuana offenses. And the unfinished quest for fairness, justice, and opportunity for all.
What Makes Marijuana Psychoactive?
To the naked eye, marijuana seems like an ordinary plant. But peek inside at a molecular level and a fascinating world appears. The cannabis plant produces over 100 distinct compounds called cannabinoids - as unique as human fingerprints. Each affects the body in its own way. Among them, one is the most important - delta-9-tetrahydrocannabinol, or THC. THC packs a psychoactive punch by impersonating natural brain chemicals called endocannabinoids. Like a clever imposter, it slips into brain receptors meant for our own neurotransmitters. A cascade of effects follows. Dopamine surges, launching sensations of euphoria and relaxation. No wonder THC is the stuff of legends! Now here's the crazy part: today's new strains can contain up to 30% THC - that's nearly 10 times the levels of the mellower marijuana of yesteryear. So in essence, today's marijuana is the Ferrari of the cannabis world. What benefits and problems can this stronger version cause?
How is Marijuana Used?
There are a few different ways that people use marijuana:
Smoking - Marijuana is most commonly smoked in hand-rolled cigarettes called joints or in pipes, bongs, or bowls. When marijuana is smoked, THC enters the bloodstream quickly from the lungs and reaches the brain rapidly. Smoking produces an almost immediate high.
Vaporizing - Vaporizers heat marijuana to a temperature below combustion, releasing vapor containing THC that is inhaled. Vaporizing is thought to reduce the harm of smoking.
Edibles - Foods and drinks can be infused with marijuana. Edibles take longer to have an effect because THC is absorbed through the digestive system. However, the high from edibles may be more intense and last longer.
Tinctures/Oils - THC and other cannabinoids can be extracted into oils and tinctures, which are absorbed under the tongue. Tinctures allow for precise dosing of THC.
Topicals - Topical products like gels, creams, and balms are applied to the skin. They may provide localized pain relief but do not cause a high.
Medical Use of Marijuana
People use marijuana to treat many different things:
Chronic pain - Marijuana may reduce certain types of chronic pain through its effects on the endocannabinoid system. Both THC and CBD seem to help with pain. Marijuana looks like it helps especially with nerve pain, but it might not be as effective for other types of pain.
Nausea and vomiting - THC is an effective anti-nausea drug and is FDA-approved for treating nausea and vomiting caused by chemotherapy. CBD may also help reduce nausea and vomiting.
Appetite stimulation - Marijuana increases appetite by binding to cannabinoid receptors in the brain. Both THC and CBD can be used to stimulate appetite in conditions like HIV/AIDS, cancer, and anorexia.
Multiple sclerosis - Marijuana may help relieve spasticity and pain in multiple sclerosis patients. Oral cannabinoids like dronabinol and nabiximols can reduce self-reported spasticity scores in MS.
Epilepsy - CBD has shown promise in treating some drug-resistant epilepsy syndromes like Dravet and Lennox-Gastaut syndrome. Epidiolex, which contains purified CBD, is FDA-approved to treat these forms of epilepsy.
Anxiety disorders - Low doses of marijuana may reduce symptoms of PTSD and social anxiety. However, higher doses may increase anxiety or cause panic attacks.
Parkinson's disease - Marijuana may help treat tremors, pain, sleep problems, and poor mood associated with Parkinson's disease. However, more studies are needed.
Alzheimer's disease - Early research suggests marijuana may slow the progression of Alzheimer's disease. THC was found to slow the formation of amyloid plaques in the brain, a hallmark of Alzheimer's.
A lot of the healing benefits of marijuana come from how it works with our body's endocannabinoid system. We still need to learn more to fully grasp the pros and cons of using it for medical reasons.
Is Marijuana Addictive?
Just like some other drugs that play with our brain's reward center and stimulate dopamine release, marijuana can be addictive. But, the effects of marijuana addiction seem to be less severe compared to some other substances.
According to the 2020 National Survey on Drug Use and Health, about 30% of marijuana users have marijuana use disorder. This means they meet clinical criteria for dependence and experience impaired control over use. Other addiction statistics:
Around 1 in 10 people who ever use marijuana will become addicted. This rate increases to 1 in 6 among people who start using marijuana as teenagers.
About 4 million Americans met criteria for marijuana addiction in 2019.
Those hooked tend to use it daily or near daily.
Up to half of such frequent users end up addicted.
Half report withdrawal symptoms when trying to quit. These include anxiety, insomnia, appetite loss.
Addiction risks seem higher for men than women.
So while marijuana may not be as addictive as other drugs, addiction is still a very real risk, especially with regular, heavy use.
Signs of Marijuana Addiction
How can you tell if your marijuana use has become an addiction? Here are some signs of marijuana addiction:
Using more marijuana than intended or using it for longer than planned
Spending a lot of time getting, using, and recovering from the effects of marijuana
Strong urges or cravings to use marijuana
Failure to fulfill major obligations due to marijuana use
Continuing to use marijuana despite negative consequences
Giving up social, occupational or recreational activities due to marijuana
Using marijuana in physically hazardous situations
Building up a tolerance and needing more marijuana to get the same effect
Experiencing withdrawal symptoms when trying to quit
If you recognize several of these signs in yourself or a loved one, it may indicate marijuana addiction or dependence. An evaluation by a doctor or substance abuse specialist can provide an official diagnosis.
What Causes Marijuana Addiction?
Why do some people who use marijuana become addicted, yet others don't? Multiple factors likely contribute:
Genetics - Certain genes impact how cannabis affects each person's brain. This may predispose some to addiction.
Brain chemistry - Chronic marijuana use changes the brain's reward system and these changes promote continued drug use.
Potency - High potency marijuana with very high THC amplifies the addictiveness of the drug.
Use at a young age - Using marijuana before the age of 18 increases the risk of addiction. The adolescent brain is still developing and more vulnerable to addiction.
Co-occurring mental health issues - Conditions like anxiety, depression, and schizophrenia may increase addiction risk. Marijuana addiction is very common among people with bipolar disorder.
Childhood trauma and stress - Traumatic experiences and high stress levels seem to increase the risk of abusing marijuana and other drugs.
So both nature (genetics) and nurture (environment/experiences) interact to determine if someone will develop an addiction. And the younger marijuana use starts, the higher the chances of addiction.
What are Marijuana Withdrawal Symptoms?
Addiction to marijuana is real. When someone who is addicted stops using marijuana, they may experience unpleasant withdrawal symptoms. Marijuana withdrawal usually sets in 1-3 days after last use. Common marijuana withdrawal symptoms include:
Irritability
Anxiety
Depressed mood
Sleep difficulties like insomnia and strange dreams
Decreased appetite
Physical discomfort like stomach pain, shakiness, sweating
Restlessness
Strong cravings for marijuana
Marijuana withdrawal tends to peak within the first week and most symptoms resolve within 1-2 weeks. But irritability, anxiety, sleep problems, and cravings may linger for several weeks. Withdrawal makes it more difficult for people addicted to marijuana to quit.
Dangers of Long-Term Marijuana Use
While a lot of folks enjoy marijuana casually without any issues, using it for a long time can have some health downsides, especially if started when young. Here are a few concerns about using marijuana for a long time:
Mental health issues - Chronic marijuana use, especially in teenagers, is associated with increased risk for psychosis, schizophrenia, anxiety, and depression later in life. Marijuana may trigger serious mental illness in those predisposed. Frequent use starting in the teen years may impair brain development.
Impaired learning and memory - Marijuana negatively affects working memory, processing speed, attention, decision-making and problem-solving skills. These cognitive impairments may persist and become permanent with heavy use.
Respiratory problems - Marijuana smoke is an irritant and can cause chronic cough, increased mucus, and bronchitis. It may increase the risk of lung infections. However, it has not been conclusively linked to lung cancer.
Cardiovascular issues - Marijuana raises the heart rate and increases the risk of heart attack in the hour after use. It may contribute to or trigger heart attacks in those with heart disease.
Lower educational outcomes - Teenagers who use marijuana frequently tend to get lower grades and are more likely to drop out of high school.
Motor vehicle crashes- Marijuana use impairs driving ability and significantly increases the risk of crashes. Mixing marijuana and alcohol is even riskier.
Future drug abuse - Early marijuana use is associated with an increased risk of abusing other drugs like alcohol, tobacco, and opioids later in life.
These potential health effects underscore why it's risky to use marijuana frequently or over the long term, especially for teenagers and young adults.
Is Marijuana Harmful for Youth?
The developing adolescent brain is especially vulnerable to the negative effects of THC. That's why health experts caution against using marijuana before the age of 18. Here's what the research shows on how marijuana affects teens:
The brain keeps developing until around age 25. Marijuana use during teen years may impair brain maturation.
Teenage marijuana use is linked to abnormalities in the areas of the brain that control memory, learning, and impulse control.
Adolescents who use heavily have shown loss of IQ points and decreased cognitive function into adulthood, even after quitting.
Marijuana poses real risks, especially for teen minds still under construction.
Daily teen users face up to an 8-fold rise in depression or suicidal thoughts.
Early pot use heightens psychosis and schizophrenia risks later in life.
Teens using marijuana tend to engage in risky behaviors - like unsafe sex or crime.
They drop out more and achieve less in school.
In the teen brain, THC may permanently alter signaling in the reward system. This could set the stage for addiction.
The takeaway is that recreational marijuana use comes with real risks for teenagers. It's safest to avoid marijuana until reaching adulthood.
Can You Become Addicted to Marijuana?
Absolutely. Despite common perceptions that marijuana is harmless, it can be addictive. About 1 in 10 people who use marijuana will develop dependence and an addiction. The rate is higher when use starts in adolescence.
People who are addicted to marijuana meet the clinical criteria for a substance use disorder. Key signs include:
Loss of control - taking more than intended, unsuccessful attempts to cut down
Spending a lot of time getting, using, and recovering from marijuana
Powerful cravings and urges to use
Missing work/school due to use
Continuing to use despite physical or mental health problems
Giving up social, work, or recreational activities to use
Use in physically hazardous situations like driving
Marijuana abuse has real risks and negative consequences. It can take over someone's life and be very difficult to overcome without treatment and social support.
What are the Long-Term Effects of Marijuana on the Brain?
Chronic marijuana exposure can cause lasting changes in the brain that lead to problems with mood, learning, and behavior control. Here are some of marijuana's long-term effects on the brain:
Shrinks key brain regions - Long-term use shrinks the hippocampus and amygdala, areas involved in memory and emotions. This can impair learning and processing emotions.
Alters brain chemistry - THC alters brain cell signaling. Chronic users have decreased dopamine which can contribute to apathy, depression, and poorer executive function.
Increases brain activity - Imaging studies show abnormally high brain activity in marijuana users. Their brains may have to work harder to complete challenging tasks.
Damages white matter - Changes to myelin in nerve cells slow signaling between brain regions. This affects cognitive coordination and efficiency.
Blunts brain's reward system - Regular exposure blunts the dopamine-based reward system. This dampens motivation, enjoyment, and goal-directed behavior.
Many of these brain changes are dose-dependent and worsen with early use, higher doses, and sustained consumption extending into adulthood. Some brain alterations from marijuana may be permanent. However, the risks don't stop there. Those who struggle with marijuana addiction also face risks to their lives.
Can Marijuana Cause Head and Neck Cancers?
Head and neck cancers affect areas like the mouth, throat, voice box, sinuses, and salivary glands. These cancers are strongly linked to tobacco, alcohol, and HPV infection. But could marijuana use also increase risk? Here's what researchers have found:
Marijuana smoke contains carcinogens like benzopyrene and toxins that irritate and damage mucus membranes of the head and neck area over time.
However, most large studies have not found a statistically significant link between marijuana smoking and head and neck cancers. The association is much weaker than for tobacco.
One study found an increased risk of head and neck cancers in marijuana users versus non-users. And the risk increased with the intensity of marijuana use.
Laboratory studies show that cannabinoids like THC can impair the body's anti-tumor immune response and increase the proliferation of cancer cells. This suggests a potential cancer-promoting effect.
For people with HPV infection, marijuana use may amplify the risk of HPV-related head and neck cancers. More research is needed.
Combined marijuana and tobacco use likely has synergistic cancer-causing effects over the long term.
Overall, the evidence that marijuana smoking increases head and neck cancer risk is inconsistent and inconclusive at this time. More long-term studies that account for tobacco use are needed.
What are the Cognitive Side Effects of Regular Marijuana Use?
Using marijuana impacts cognitive processes like memory, learning, attention, decision-making, and problem-solving. Here are some of the cognitive deficits linked to ongoing marijuana use:
Impaired short-term and working memory - Marijuana makes it harder to learn and retain new information. Regular users tend to struggle with remembering things like new tasks or events.
Reduced ability to focus and concentrate - Frequent marijuana administration leads to problems ignoring irrelevant information and sustaining attention. Chronic users are easily distracted.
Slower information processing speed - Studies show regular cannabis users have diminished speed of information processing. It takes longer to execute complex mental tasks.
Decline in verbal fluency - Heavy users experience a shrinkage in vocabulary size and have trouble rapidly producing speech. They tend to use shorter, simpler sentence structures.
Compromised decision-making - Marijuana disrupts the parts of the brain needed for sound judgment and anticipation of consequences. Users make riskier, more impulsive choices.
Lack of motivation - Long-term use has been associated with a syndrome called a motivational disorder. Chronic users often lack drive and ambition.
These effects can persist and even worsen over years of regular use. Quitting may allow partial recovery but cognitive deficits could be long-lasting.
Recreational vs. Medical Marijuana Debate
The legalization of marijuana for medical purposes has fueled debate about recreational legalization. Here are some key considerations about recreational vs. medical marijuana:
Medical marijuana has documented therapeutic benefits like reducing chronic pain
Recreational marijuana is used for pleasure and has no medical value
Medical marijuana can be precisely dosed under a doctor's supervision
Recreational use involves smoking unstandardized strains of varying potency
Many medical marijuana products contain CBD which has medical benefits without the high THC
Recreational users seek the high from potent, THC-dominant strains
Legal medical marijuana may reduce risky recreational use by teens
Recreational legalization normalizes marijuana use and could increase rates of use
Medical marijuana laws have not led to increased teen use
But recreational legalization may make marijuana more accessible to adolescents
Revenue from taxing recreational marijuana could benefit state budgets
Both medical and recreational marijuana carry health risks with long-term use
Many health organizations oppose recreational legalization but support medical use
There are good-faith arguments on both sides of this issue. More research is needed to define the pros and cons of both forms of legalization. However medical marijuana appears to have solid therapeutic value for many people. Recreational legalization is still an open debate.
What are Marijuana Addiction Treatment Options?
Marijuana addiction is beatable but no magic pill exists, proven options offer hope:
Psychotherapy like cognitive behavioral therapy helps patients change perspectives and develop healthy coping strategies.
Support groups provide an understanding community and peer inspiration to stay strong.
Motivational enhancement therapy guides patients towards internal motivation and commitment to sobriety.
Contingency management uses rewards to reinforce positive behaviors like abstinence.
Medications can ease withdrawal and curb cravings in the early stages when relapse risk is high.
Combining therapy, social support, lifestyle changes and at times medicines work best long-term.
There is no one-size-fits-all approach. Each person's journey of recovery is unique. But lives once broken by addiction can be rebuilt. Healing happens when care for the person comes first, not judgment of their past choices. A brighter future always lies ahead.
Key Takeaways
Marijuana has been used medically for thousands of years but was banned in the 20th century.
Marijuana is the most commonly used illegal drug in the US.
THC causes psychoactive effects by interacting with cannabinoid receptors in the brain.
Marijuana can be smoked, vaped, eaten, or applied topically. Smoking is the most common recreational use.
Marijuana may help treat chronic pain, nausea, MS symptoms, and certain forms of epilepsy.
Marijuana addiction and abuse is real.
Marijuana dependence affects around 30% of users, causing cravings, withdrawal, and problems quitting.
Frequent marijuana smoking can increase risks of respiratory issues, mental illness, cognitive deficits, and driving accidents.
Marijuana use during adolescence can impair brain development and cognition and increase psychosis risks.
Marijuana addiction changes the brain's reward circuits and has been linked to lower motivation.
Head and neck cancer links are inconclusive but more research is needed on marijuana's cancer-causing effects.
Medical marijuana has proven benefits but more research is needed on the risks of long-term recreational use.
Frequently Asked Questions
What are the most common forms of marijuana?
The most common forms of marijuana are the dried flowers and leaves that can be smoked or vaporized. Marijuana can also be concentrated into oils, edibles like baked goods and gummies, tinctures, capsules, and topical products.
What makes you high from marijuana?
The main psychoactive ingredient in marijuana that causes the high is THC (tetrahydrocannabinol). THC binds to cannabinoid receptors in the brain and disrupts normal neurotransmission, leading to the intoxicating effects.
Can marijuana kill you or cause brain damage?
There are no reported cases of lethal overdose from using marijuana alone. However, very high doses can cause respiratory depression and arrhythmias. Marijuana does not directly cause brain cell death but long-term use can change brain cell function and structure.
Is smoking marijuana bad for your lungs?
Yes, regularly smoking marijuana long-term carries risks like chronic cough, increased phlegm, inflammation of the airways, and lung infections. However, conclusive evidence linking marijuana smoking to lung cancer is lacking. Tobacco smoking causes far more lung damage.
Can you get addicted to marijuana?
Yes, about 1 in 10 marijuana users will develop an addiction. This rate rises to 1 in 6 among those who start using in adolescence. Recognizing the signs of marijuana addiction and seeking help early leads to better recovery outcomes.
What are the signs of being addicted to marijuana?
Marijuana can cause addiction symptoms. Signs of marijuana addiction include strong cravings, using more than intended, spending more time using/recovering from use, repeated failed attempts to quit or cut back, tolerance, withdrawal symptoms, and continued use despite major negative consequences.
How long does marijuana addiction last?
For heavy users, marijuana addiction can last for years or decades if left untreated. The effects on the brain's neural pathways tend to strengthen addiction over time through reinforcement of maladaptive learned behaviors. Seeking treatment and making lifestyle changes can help overcome cannabis dependence.
Can you treat marijuana addiction?
Yes, marijuana addiction treatment is through a combination of behavioral therapies, peer support, lifestyle changes, and sometimes certain medications. Cognitive-behavioral therapy is often used to modify behaviors and cope with cravings and relapse triggers. Complete abstinence provides the best addiction recovery results.
What are the withdrawal symptoms from marijuana?
Common marijuana withdrawal symptoms include anxiety, irritability, depressed mood, cravings, difficulty sleeping, restlessness, decreased appetite, stomach pain, sweating, tremors, and headaches. Withdrawal symptoms tend to peak within the first week of abstinence.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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