Marijuana and Medical Marijuana
Marijuana is the most commonly used illicit drug in the United States. Its use is widespread among young people and according to a yearly survey of middle and high school students, rates of marijuana use have steadied in the past few years after several years of increase. However, the number of young people who believe marijuana use is risky is decreasing. This is probably because society has evolved to a more permissive and liberal attitude regarding marijuana and many think it should be legalized for medical and adult recreational use; consequently, as our attitude changes it opens the door to a philosophy shift that will result in increased use especially by our youth. Generally, when society accepts a substance as a norm the use trends to increase.
People smoke marijuana in hand-rolled cigarettes (joints) or in pipes or water pipes (bongs). They also smoke it in blunts—emptied cigars that have been partly or completely refilled with marijuana. To avoid inhaling smoke, more people are using vaporizers. These devices pull the active ingredients (including THC) from the marijuana and collect their vapor in a storage unit. A person then inhales the vapor, not the smoke. Marijuana can also be mixed in food (edibles), such as brownies, cookies, or candy, or brew it as a tea.
Smoking THC-rich resins extracted from the marijuana plant is on the rise. Users call this practice dabbing. People are using various forms of these extracts, such as:
- Hash oil or honey oil—a gooey liquid;
- Wax—a soft solid with a texture like lip balm;
- Shatter—a hard, amber-colored solid.
These extracts can deliver large amounts of THC to users, and their use has sent some people to the emergency room. Another danger is in preparing these extracts, which usually involves butane. Obviously, butane is a fire hazard and has caused fires and explosions.
EFFECTS OF MARIJUANA
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, the user generally feels the effects after 30 minutes to 1 hour. THC acts on specific brain cell receptors that ordinarily react to natural THC-like chemicals in the brain. 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 users feel. The short term effects include:
- Altered senses (for example, seeing brighter colors);
- Altered sense of time;
- Mood changes;
- Impaired motor functions (higher risk of accident when operating an auto);
- Cognitive/thinking is altered and the ability to solve complex problems is impaired;
- Impaired memory.
Marijuana also affects brain development. When marijuana users begin using as teenagers, the drug may reduce cognitive ability, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. Marijuana’s effects on these abilities may last a long time or even be permanent. For example, a study showed that people who started smoking marijuana heavily in their teens and had an ongoing cannabis use disorder lost an average of eight IQ points between ages 13 and 38. The lost mental abilities did not fully return in those who quit marijuana as adults. Those who started using as adults did not experience notable decline in mental capabilities (no sustained loss).
The potency of marijuana has been increasing steadily over the past few decades. For a new user, 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 users having 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. Dabbing is yet another growing trend. More people are using marijuana extracts that provide stronger doses, and therefore stronger effects. The higher THC levels may mean a greater risk for addiction if users are regularly exposing themselves to high doses. Marijuana use may also have a wide range of physical and mental effect. One of the more common physical effects is difficulty in breathing. Marijuana smoke irritates the lungs, and frequent marijuana smokers can have the same breathing problems that tobacco smokers have. These problems include daily cough and phlegm, more frequent lung illness, and a higher risk of lung infections. Researchers still do not know whether marijuana smokers have a higher risk for lung cancer. Marijuana users often experience an increase in heart rate for up to 3 hours after using. This phenome places seniors and those with heart problems at higher risk for heart attack. Marijuana use during and after pregnancy has been linked to problems with child development and may lead to increased risk of both brain and behavioral problems in babies. If a pregnant woman is a moderate to heavy uses of marijuana, the drug may affect certain developing parts of the fetus’s brain; consequently, the child may have developmental problems (benchmarks such as talking and walking may be slower than normal). Additionally, some research suggests that moderate amounts of THC is excreted into the breast milk of nursing mothers. The effects on a baby’s developing brain are still unknown.
Marijuana use can interfere with performance at home, work or school and may be physically hazardous in situations such as driving a car. Legal problems may occur as a consequence of arrests for marijuana possession. There may be arguments with spouses or parents over the possession of marijuana in the home or its use especially in the presence of children. The essential features of marijuana intoxication is the presence of clinically significant maladaptive behavioral or psychological changes that develop during or shortly after marijuana use. Intoxication typically starts with a “high” feeling followed by symptoms that include euphoria with inappropriate laughter and grandiosity, sedation, lethargy, impairment in short term memory, difficulty in carrying out complex mental processes, impaired judgement, distorted sensory perceptions, impaired motor performance and the sensation that time is passing slowly. Occasionally, anxiety (which can be severe), dysphoria or social withdrawal occurs. These psychoactive effects are accompanied by two or more of the following signs, developing within two hours of marijuana use: conjunctival Injection, increased appetite, dry mouth and tachycardia.
The long term effects of chronic marijuana use has been linked to mental illness in some users. Examples of observed effects are:
- Temporary hallucinations—sensations and images that seem real though they are not;
- Temporary paranoia—extreme and unreasonable distrust of others;
- 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, suicidal thought (especially among teens).
Contrary to common belief, marijuana can be addictive. Research suggests that about 1 in 11 users becomes addicted to marijuana. This number increases among those who start as teens (to about 17 percent, or 1 in 6) and among people who use marijuana daily (to 25-50 percent). Compared to nonusers, heavy marijuana users more often report the following:
- Unsettled life style/unhappy;
- Increased mental health issues (reduced ability to solve complex problems);
- Increased physical health problems;
- More difficulty relating to others;
- Problems in the home, at work and in the community.
Researchers also report that heavy marijuana users have less academic and career success. The heavy users are s also linked to a higher likelihood of dropping out of school and increased job absences, accidents, and injuries.
Long-term marijuana users trying to quit report withdrawal symptoms that make quitting difficult. These include:
- Decreased appetite;
Behavioral support has been effective in treating marijuana addiction. Examples include therapy and motivational incentives (providing rewards to patients who remain substance free). No medications are currently available to treat marijuana addiction. However, continuing research may lead to new medications that help ease withdrawal symptoms, block the effects of marijuana, and prevent relapse.
Marijuana addiction appears 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 quits several times. People with marijuana use disorders, especially adolescents, often also suffer from other psychiatric disorders. They may also abuse 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 heavy users and those with more chronic mental disorders. The following behavioral treatments have shown promise:
- Cognitive-behavioral therapy: A form of psychotherapy that teaches people strategies to identify and correct problematic behaviors in order to enhance self-control, stop drug use, and address a range of other problems that often co-occur with them.
- Contingency management: A therapeutic management approach based on frequent monitoring of the target behavior and the provision (or removal) of tangible, positive rewards when the target behavior occurs (or does not).
- Motivational enhancement therapy: A systematic form of intervention designed to produce rapid, internally motivated change; the therapy does not attempt to treat the person, but rather mobilize their own internal resources for change and engagement in treatment.
- Support groups and family involvement.
Currently, no medications are indicated 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. Medications that have shown promise in early studies or small clinical trials include the sleep aid zolpidem (Ambien®), an anti-anxiety/anti-stress medication called buspirone (BuSpar®), and an anti-epileptic drug called gabapentin (Horizant®, Neurontin®) that may improve sleep and, possibly, executive function. Other agents being studied include the nutritional supplement N-acetylcysteine and chemicals called FAAH inhibitors, which may reduce withdrawal by inhibiting the breakdown of the body’s own cannabinoids. Future directions include the study of substances called allosteric modulators that interact with cannabinoid receptors to inhibit THC’s rewarding effects.
- Regular marijuana refers to the processed leaves, flowers, stems, and seeds from the hemp plant, Cannabis sativa;
- The plant contains the mind-altering chemical delta-9-tetrahydrocannabinol (THC) and other related compounds;
- The amount of THC in marijuana has been increasing steadily, creating more harmful effects for users.
- Marijuana may be either smoked, eaten, drank , and/or inhaled;
- Smoking THC-rich extracts from the marijuana plant (a practice called dabbing) is on the rise;
- THC over activates certain brain cell receptors, resulting in effects such as: altered senses;
- Changes in mood and impairs motor functions;
- Impaired memory and learning and difficulty with thinking and complex problem-solving;
- Impaired memory and learning;
- Marijuana use may have a wide range of effects, both physical and mental, which include: breathing illnesses, possible harm to a fetus’s brain in pregnant users and hallucinations and paranoia;
- Marijuana can be addictive.
Treatment for marijuana addiction includes forms of behavioral therapy. No medications currently exist for treatment.
The term medical marijuana generally refers to using the whole unprocessed marijuana plant or its basic extracts to treat a disease or symptom. 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 or symptoms, many people argue that it should be legal for medical purposes. In fact, thirty-three states and DC have legalized marijuana for medical use and others continue to add this to ballots.
Medical marijuana is legal in 33 U.S. states and the District of Columbia:
- District of Columbia
- Mississippi (Novemer 2020 ballot)
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Dakota
- Rhode Island
- South Dakota (November 2020 ballot)
- West Virginia
The marijuana plant is not FDA approved for medical purposes because the FDA requires carefully conducted clinical trials in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication. As of yet, researchers have not 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 is meant to treat. That may be said for a number of medicines currently approved and on the market.
Cannabinoids are chemicals related to delta-9-tetrahydrocannabinol (THC), marijuana’s main mind-altering ingredient. Other than THC, the marijuana plant contains more than 100 other 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 abused.
The body also produces its own cannabinoid chemicals. They play a role in regulating pleasure, memory, thinking, concentration, body movement, awareness of time, appetite, pain, and the senses (taste, touch, smell, hearing, and sight).
There is growing interest in the marijuana chemical cannabidiol (CBD) to treat certain conditions such as childhood epilepsy, a disorder that causes a child to have violent seizures. Therefore, scientists have been specially breeding marijuana plants and making CBD in oil form for treatment purposes. These drugs may be less desirable to recreational users because they are not intoxicating.
Currently, the two main cannabinoids from the marijuana plant that are of medical interest are THC and CBD. THC generally increases appetite and reduces nausea. The FDA-approved THC-based medications are used for these purposes. THC may also decrease pain, inflammation (swelling and redness), and muscle control problems. CBD is a cannabinoid that does not affect the mind or behavior. It may be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly even treating mental illness and addictions.
Researchers 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. Evidence from one cell culture study suggests that purified extracts from whole-plant marijuana can slow the growth of cancer cells from one of the most serious types of brain tumors. Research in mice showed that treatment with purified extracts of THC and CBD, when used with radiation, increased the cancer-killing effects of the radiation. Scientists are also conducting preclinical and clinical trials with marijuana and its extracts to treat numerous diseases and conditions, such as the following:
- Autoimmune diseases that weaken the immune system such as HIV/AIDS
- Multiple sclerosis (MS), which causes gradual loss of muscle control
- Alzheimer’s disease, which causes loss of brain function, affecting memory, thinking, and behavior
- Inflammation; pain; seizures
- Substance use and abuse disorders
- Mental disorders
- People with Health- and Age-Related Problems
Regular medicinal use of marijuana is a fairly new practice. For that reason, its effects on people who are weakened because of age or illness are still relatively unknown. Older people and those suffering from diseases such as cancer or AIDS could be more vulnerable to the drug’s harmful effects. Scientists need to conduct more research to determine if this is the case.
MEDICATIONS WITH CANNABINOIDS
Two FDA-approved drugs, dronabinol and nabilone, contain THC. They treat nausea caused by chemotherapy and increase appetite in patients with extreme weight loss. The United Kingdom, Canada, and several European countries have approved nabiximols (Sativex®), a mouth spray containing THC and CBD. It treats muscle control problems caused by MS. The United States is conducting clinical trials for its safe use in treating cancer pain. Although it has not yet undergone clinical trials, scientists have recently created Epidiolex, a CBD-based liquid drug to treat certain forms of childhood epilepsy.
- As stated previously, the term medical marijuana refers to treating a disease or symptom 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.
- Cannabinoids are chemicals related to delta-9-tetrahydrocannabinol (THC), marijuana’s main mind-altering ingredient. The body also produces its own cannabinoid chemicals. Currently, the two main cannabinoids from the marijuana plant that are of interest for medical treatment are THC and cannabidiol (CBD).
- Scientists are conducting preclinical and clinical trials with marijuana and its extracts to treat numerous diseases and conditions. Two FDA-approved marijuana drugs are dronabinol and nabilone, both used to treat nausea and boost appetite.
Medical marijuana is in its infancy and may prove beneficial for certain medical applications once the FDA has conducted sufficient clinical trials to prove it is safe. A primary concern in the recovery industry is that the some will wager the medical applications for justification to legalize marijuana for recreational use by the general public.
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