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Friday, October 21, 2011

Is Marijuana Safe?

(updated April 13, 2012)
   Our news media’s stories on marijuana tend to be poorly done. So-called "pop-stars" like Miley Cyrus and Justin Bieber promote various drugs to teens, including marijuana, making drug use seem like it's a liberating event that shouldn't be denied.

    There’s not enough reporting on the big-picture about marijuana. That’s what this post is about and the obvious conclusion is that marijuana does much more harm than good for the typical user. This is a message that the media should be sharing with the public, but instead, they focus only on the legislative battles about medical marijuana and public opinion about legalization.

Panic attacks, "de-realization" and "de-personalization"
are more common experiences for teens who smoke marijuana
probably due to the substantial increase in the potency of the drug.
Marijuana: Amount used by frequency of use – where’s the low risk zone?
Amount / frequency of use
Several times a day
Once daily
Once or more a week
1-2 times a   month or less
Not safe
Not safe
Not safe
Low risk use*
Not safe
Not safe
Not safe
Not safe
Not safe
Not safe
Not safe
Not safe
Not safe
Not safe
Not safe
Not safe
*This grid is based on the conclusion that marijuana use does more harm than good for the typical user of any age. The point of this grid is to share two important ideas:
 1) There is no “safe” amount of marijuana use, and
2) If you use marijuana, the safest amount you can use is the least amount, infrequently.

There are three issues with marijuana that make even light monthly use a problem:
(1) Marijuana is an addictive drug because it has strong reinforcement properties (users like the way it feels which creates subsequent impulses to “get high” which many individuals might not be able to control) (marijuana's potency has substantially increased so the risk for reinforcement is much greater);
(2) Marijuana is fat soluble, so reverse tolerance occurs along with increased tolerance and withdrawal symptoms; and
(3) Since marijuana does not affect your brain-stem, it is not lethal, however, tolerance can peak to the point where a user develops cravings for stronger drugs in order to satisfy the urges and manage withdrawal symptoms; the other drugs are much more addictive, such as heroin (and Oxycontin), Xanax, or other opiate-based pain killers, sedatives, cocaine, or Adderall.

This grid outlines the degrees of scientific research which support the predictability of positive and negatives effects of marijuana use for users.

Potential Help
Potential Harm
(short term)
Potential Harm [i]
(potential long-term)
Fairly Predictable Consequence (good number of well-designed studies)
1)       Refractory nausea and vomiting caused by anti neoplastic drugs which are used to treat cancer
2)       For appetite loss in patients with severe weight loss
3)       Cachexia of patients with HIV
4)       Anti-emetic uses for adults
1)       Euphoria [ii]
2)       Dysphoria
3)       Severe anxiety [iii]
4)       Panic attack
5)       Paranoia
6)       Drowsiness / sleepiness [iv]
7)       Loss of coordination
8)       Impairment of reaction time, hand-eye coordination, physical strength.
9)       Increased speed of thought
10)    Flight of ideas that may feel very profound or unique
11)    Confusion
12)    Mixing of perceptions
13)    Out-of-control thinking
14)    Fragmented thinking
15)    Mental confusion
16)    Short-term memory loss
17)    Act of violence (less common)
18)    Derealization experience
19)    Depersonalization experience
20)    Feelings of loss of control

21)    Fear of dying

Delusions of grandiosity
22)    Delusions of control
23)    Auditory hallucinations
24)    Blunted affect

1)       Flashbacks of experiences when intoxicated (usually of dysphoric reactions) (Sometimes can be severe like PTSD).
2)       Impaired cognitive performance in memory and executive functioning.
3)       Impairment of short-term visual and verbal memory (may be worse with lower IQ).
4)       Small drop in IQ.
5)       Memory deficits.
6)       Depression.
7)       Marijuana Dependence.
8)       Panic Disorder.

Possible Consequence
(fair amount of research, some good studies)
1)       Spasticity from spinal cord injury
3)       Chronic pain
4)       Tourette’s
5)       Asthma
6)       Glaucoma
7)       Patients with cancer or AIDS who suffer from various complications or symptoms
8)       Less aggression
9)       Increase sociability

25)    Tachycardia with peripheral vasodilation
26)    Aggravate per-existing heart disease.
27)    Marijuana Abstinence Syndrome
28)    Amotivational syndrome
1)       May cause tumors or promote tumors
2)       Airflow obstruction and hyperinflation of the lungs
3)       Galactorrhea in women
4)       Gynecomastia in men
1)       Onset of Schizophrenia or Bipolar Disorder for teenagers as they reach maturity.
2)       Suppress sexual maturation in teens.
3)       Bronchitis
4)       Emphysema
5)       Squamous metaplasia (pre-cancerous cell changes)
6)       Possible risk of serious infection from Aspergillus and Salmonella (of special concern to those with immunity issues)
7)       Impaired pulmonary defense against infection.
8)       Heroin use/addiction or other drug use/addiction
9)       Anti-social behavior.
10)    Academic failure, drop out.
11)    Unemployment.

Not enough research to know if it will cause any of these problems or benefits for the typical user.
1)       May help protect nerve cells from damage for individuals 65 and older.
2)       May improve autoimmune diseases
3)       Possible anti neoplastic activity on malignant gliomas and skin tumors
4)       May inhibit angiogenesis of malignant gliomas
5)       May improve hypertension
6)       May improve cardiovascular disease 
7)    May help with cigarette withdrawal in the short-term.
1)      Thus far, no improvement in dementia related behavior problems.
2)     No evidence for          improvement for Tourette's or OCD related symptoms.
3)    No evidence of alleviating symptoms of rheumatoid arthritis and side-effects were much worse than placebo.
4)   No evidence of alleviating symptoms of  Schizophrenia.
5)   No evidence of alleviation of symptoms from Multiple Sclerosis.

1)       Possible low birth weight of babies born to mothers who use marijuana (hypoxia).
2)       Impairment of ability to learn.

1)       Impairment of social skill development.
2)       Impairment of stress coping skills.
3)       Increased risk for teen pregnancy.
4)       Increased risk for STDs.

Teens and some adults often defend their marijuana use or minimize the use by their spouse or kids. These are some of the common arguments for marijuana use followed by the reality:

(1)   “It's natural.”  Arsenic is natural, so is Radon; of course those things won’t get you “high.” Marijuana may be “natural” but it’s addictive and addiction leads to other very serious problems. Milk is natural, but it’s not addictive. Drinking Milk will not eventually lead to abusing other drugs, land you in jail, bleed your wallet dry, or cause you to have memory and concentration problems, or potentially cause you to develop panic disorder or schizophrenia. Simply put, what’s “natural” is not always healthy, and what is synthetic isn’t always bad.

(2)   “Everybody is doing it.” This is called, Appeal to Popularity. No one should ever fall for this defense. To begin with, it’s completely false. Everybody is not doing it. However, let’s pretend for a minute that everyone is doing it that still does not mean that it’s okay or good for you to do, too. The “everybody-is-doing-it-so-I-should-to” is non-sense anytime it’s used. Lots of kids don’t want to smoke marijuana, so they need a good reason not to. Parents can prevent marijuana use by threatening to “come down very hard” on the kids. A huge mistake with parenting and criminal justice is to use “first time offender” as a mitigating factor. It seems to make sense, however, as far as parenting goes, you’re better off warning your kids of harsh consequences for the first time offense, including random drug testing, room searches, loss of important privileges, increased monitoring, and even loss of friends; this will give kids a solid excuse to say “no” and comfortably face peer pressure.

(3)   “It has medicinal properties.” Chemicals are not either good or bad, they tend to have both good and bad consequences. The important question is, does the benefits outweigh the harm, and with marijuana, the answer for the average person is no. Marijuana does have medicinal properties, but these are limited and may not be much more effective than existing treatments. But let’s be real, if you’re smoking marijuana, you’re smoking it because it feels good or because you want to feel like you fit in to the group, neither reason is good.

(4)    “It doesn’t cause cancer.” The marijuana advocacy group, NORML likes to make this claim, but it’s actually quite false – a lie in fact. Marijuana is known to cause pre-cursors to cancer. It has a large amount of tar, full of all the same carcinogens found in cigarettes (except for the radioactive stuff like polonium and lead 210 which are found in cigarette smoke). It also has some mutagenic properties.

(5)    “50% of Americans think it should be legal” – Well, not exactly. In a recent poll, 50% of participants said, “Yes” it should be legal. But why are these 50% of Americans saying it should be legal? Is it because they keep hearing something over and over again so they think it must be true? People tend to believe things when they are repeated ad infinitum which has been the case with marijuana. People could have all sorts of other thoughts about marijuana that no one asked. Maybe they equate legalization with decriminalization. Maybe they think it should be by prescription only. Appealing to popularity gets us nowhere and means very little when it comes to medical science (I doubt many of those surveyed are fully educated on the issue).

(6)   “It’s been around for centuries.” Yes it has, but so has all kinds of things, good or bad. This is a worthless defense; it has no substance to it.

(7)   “Your brain has cannabinoid receptors, so, that must mean that your brain was meant to have Cannabis.” The nerve cells where Cannabis attaches itself to are called Cannabinoid receptors; however, there are dozens of types of Cannabinoids. Marijuana consists of Delta-9-Tetrahydrocannibinol (THC) and about 63 others (Cannabicyclol). THC does not normally float around your blood stream. It’s similar enough to other Cannabinoids so that it sticks to the G-Protein of some nerves which then inhibits the release of other neurotransmitters down-stream. This is hardly normal. Your brain also has opiate receptors but that doesn’t mean that we should all use heroin (Oxycontin). Just because something sticks to a nerve cell doesn’t mean it was meant to be there or that it should be put there.

(8)   It’s only illegal because the Rockefeller family wanted to nix the competition for nylon rope by making hemp rope inaccessible. This is another popular argument by NORML. It may be true that the Rockefeller family influenced legislation, but even so, in the early 1920’s it’s clear from primary historical sources that marijuana was looked down upon by the general public as “evil,” or a “menace.” This idea of marijuana grew so that by 1940, from increased influence from other sources or not, people considered marijuana to be associated with heroin addiction and violent crimes. Perhaps the Rockefellers did influence marijuana laws, but there was an existing disdain for marijuana prior, and there probably was some truth to the anecdotes; indeed, research today somewhat supports marijuana being a gateway drug for heroin (or Oxycontin).

(9)  Marijuana is not addictive. This is not true. Years ago, it was was thought that marijuana was not physically addictive because users did not have intense withdrawal symptoms. Today, we know that marijuana is addictive, psychologically and physically. A psychological addiction is a physcial addiction in the brain (what is psychological is physical). Physical addiction is evidenced by the increased tolerance and withdrawal symptoms as well as the decline in a person's ability to function; users "feel like" they are functioning well or better when "high;" however, to others around them, they social, academic, or occupational functioning has actually declined.

There are arguments for decriminalization of marijuana but that is not the same as legalization. These are very complicated and controversial issues. A primary point of the decriminalization argument is that criminal laws do not deter marijuana use. I agree with this argument, but my response to it is to implement quicker and harsher punishments for first time offenders. Punishment does not deter use when they are administered gradually and in small doses (e.g., a ticket for marijuana possession). Repeat offenders should not be subject to futher criminilization but ordered into treatment, and families should be provided education for how to support treatment goals.
I don’t support legalization at all. Another popular argument for legalization is that it will reduce crimes; however, if anything it will just lead to the promotion of other more serious drugs to take the place of marijuana. For example, if marijuana were made legal, not only would we probably have millions of more Cannabis addicts, drug dealers would fill the vacuum either with extremely potent marijuana or other drugs like Oxycontin and meth. The best way to combat illegal drug trade is to reduce unemployment with higher minimum wage jobs combined with increased drug education at a younger age.

Epidemiology of Cannabis:
About 7% of Americans use illegal drugs each year. That’s about 20 million people. Of that number, about 14.6 million of them used marijuana recently. Of that 14. 6 million users, nearly 11 million used marijuana regularly, and nearly 4 million of them met the criteria for Cannabis Dependence (see below for definition).
About 10% of people who try marijuana will become daily users which suggests that marijuana has strong reinforcement properties which are why so many users become dependent on it.
About half of those who smoke marijuana more than monthly suffer from behavioral or emotional difficulties. Since 1990, marijuana use has doubled and emergency room visits have increased 139% for problems of chronic addiction, cannabis psychosis, and cannabis-related schizophrenia. The percent of treatment admissions for marijuana is now equal to treatment admissions for cocaine and heroin. However, for teens, 61% of treatment admissions were for marijuana.

Marijuana dependence has probably increased since marijuana has become more potent. "In the days of John Lennon—who referred to marijuana as a "harmless giggle"—its potency was approximately 2% (THC). Today, it is between 10% and 30%. It is a very different drug, a potent drug, but the potency of any given "batch" is not known to the consumer," (Dr. Herbert Kleber, addiction psychiatrist). Joints laced with hashish oil can have 300mg of THC. The dramatic increase in dosage may lead in substantial reinforcement and addiction from heightened feelings of euphoria. It may also lead to increased psychosis and anxiety.

Cannabis Dependence is when the user cannot control, or has substantial difficulty controlling the impulse to use marijuana. Functional impairments from dependency, such as, academic performance problems, occupational problems, decline in social functioning, self-care or legal problems and spending large amounts of money on marijuana especially while neglecting other financial responsibilities, are also present. Psychological dependence is usually present, where the user feels or believes they need marijuana in order to get through the day; they may be pre-occupied with acquiring and using marijuana and report withdrawal affects which may be observable, such as restlessness, irritability, and physical complaints. They may also complain about problems with memory or concentration as well as psychosis, or others may observe these problems.

UPDATE: Marijuana appears to cause anatomical changes in brain of teenagers who use it just once a week or more.

UPDATE: Marijuana may cause acute coronary syndromes, like stroke and heart attack.

[i]  The possibility that some of these affects are permanent is not yet known. There is not enough scientific research on long-term affects over 2 years.
   There are many variables for all of these consequences of marijuana use. For example, the age of the user, the individual’s sensitivity to Cannabis, the amount of marijuana used, the route of absorption, the quality of the drug and whether or not it was mixed with adulterants, the use of other drugs, the home environment of the user, the expectations the user has of marijuana, and the presence of other illnesses.

[ii]  Euphoria may be a desirable consequence of marijuana use however, it can contribute to problematic behaviors such as unprotected sex, using other drugs, reckless driving, and it contributes to addiction.
[iii]  Some users who experience anxiety may end up developing Panic Disorder.
[iv]  Drowsiness can become a serious side effect in work environments or while driving. Some research indicates that marijuana users are likely to cause car accidents with a greater incidence of fatalities.

Mental Health Advice Disclaimer

The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

1 comment:

  1. maggie.danhakl@healthline.comSaturday, October 11, 2014 7:10:00 AM


    I hope all is well with you. Healthline just published an infographic detailing how marijuana affects the body. This is an interactive chart allowing the reader to pick the side effect they want to learn more about.

    You can see the overview of the report here:

    Our users have found our guide very useful and I thought it would be a great resource for your page:

    I would appreciate it if you could review our request and consider adding this visual representation of the effects of marijuana to your site or sharing it on your social media feeds.

    Please let me know if you have any questions.

    All the best,
    Maggie Danhakl • Assistant Marketing Manager

    Healthline • The Power of Intelligent Health
    660 Third Street, San Francisco, CA 94107 | @Healthline | @HealthlineCorp

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