Cannabis is a generic term used to denote the several psychoactive preparations of the plant Cannabis sativa. The major psychoactive constituent in cannabis is ∆-9 tetrahydrocannabinol (THC). Compounds which are structurally similar to THC are referred to as cannabinoids.
In addition, a number of recently identified compounds that differ structurally from cannabinoids nevertheless share many of their pharmacological properties. The Mexican term 'marijuana' is frequently used in referring to cannabis leaves or other crude plant material in many countries. The unpollinated female plants are called hashish.
Cannabis oil (hashish oil) is a concentrate of cannabinoids obtained by solvent extraction of the crude plant material or of the resin.
Cannabis is by far the most widely cultivated, trafficked and abused illicit drug. Half of all drug seizures worldwide are cannabis seizures. The geographical spread of those seizures is also global, covering practically every country of the world. About 147 million people, 2.5% of the world population, consume cannabis (annual prevalence) compared with 0.2% consuming cocaine and 0.
2% consuming opiates. In the present decade, cannabis abuse has grown more rapidly than cocaine and opiate abuse. The most rapid growth in cannabis abuse since the 1960s has been in developed countries in North America, Western Europe and Australia. Cannabis has become more closely linked to youth culture and the age of initiation is usually lower than for other drugs.
An analysis of cannabis markets shows that low prices coincide with high levels of abuse, and vice versa. Cannabis appears to be price-inelastic in the short term, but fairly elastic over the longer term.
Though the number of cannabis consumers is greater than opiate and cocaine consumers, the lower prices of cannabis mean that, in economic terms, the cannabis market is much smaller than the opiate or cocaine market.
Acute health effects of cannabis use
The acute effects of cannabis use has been recognized for many years, and recent studies have confirmed and extended earlier findings. These may be summarized as follows:
- Cannabis impairs cognitive development (capabilities of learning), including associative processes; free recall of previously learned items is often impaired when cannabis is used both during learning and recall periods;
- Cannabis impairs psychomotor performance in a wide variety of tasks, such as motor coordination, divided attention, and operative tasks of many types; human performance on complex machinery can be impaired for as long as 24 hours after smoking as little as 20 mg of THC in cannabis; there is an increased risk of motor vehicle accidents among persons who drive when intoxicated by cannabis.
Chronic health effects of cannabis use
- selective impairment of cognitive functioning which include the organization and integration of complex information involving various mechanisms of attention and memory processes;
- prolonged use may lead to greater impairment, which may not recover with cessation of use, and which could affect daily life functions;
- development of a cannabis dependence syndrome characterized by a loss of control over cannabis use is ly in chronic users;
- cannabis use can exacerbate schizophrenia in affected individuals;
- epithelial injury of the trachea and major bronchi is caused by long-term cannabis smoking;
- airway injury, lung inflammation, and impaired pulmonary defence against infection from persistent cannabis consumption over prolonged periods;
- heavy cannabis consumption is associated with a higher prevalence of symptoms of chronic bronchitis and a higher incidence of acute bronchitis than in the non-smoking cohort;
- cannabis used during pregnancy is associated with impairment in fetal development leading to a reduction in birth weight;
- cannabis use during pregnancy may lead to postnatal risk of rare forms of cancer although more research is needed in this area.
The health consequences of cannabis use in developing countries are largely unknown because of limited and non-systematic research, but there is no reason a priori to expect that biological effects on individuals in these populations would be substantially different to what has been observed in developed countries. However, other consequences might be different given the cultural and social differences between countries.
Therapeutic uses of cannabinoids
Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS. Dronabinol (tetrahydrocannabinol) has been available by prescription for more than a decade in the USA.
Other therapeutic uses of cannabinoids are being demonstrated by controlled studies, including treatment of asthma and glaucoma, as an antidepressant, appetite stimulant, anticonvulsant and anti-spasmodic, research in this area should continue.
For example, more basic research on the central and peripheral mechanisms of the effects of cannabinoids on gastrointestinal function may improve the ability to alleviate nausea and emesis.
More research is needed on the basic neuropharmacology of THC and other cannabinoids so that better therapeutic agents can be found.
Cannabis is globally the most commonly used psychoactive substance under international control. In 2013, an estimated 181.8 million people aged 15-64 years used cannabis for nonmedical purposes globally (uncertainty estimates 128.5–232.1 million) (UNODC, 2015).
There is an increasing demand of treatment for cannabis use disorders and associated health conditions in high- and middle-income countries, and there has been increased attention to the public health aspects of cannabis use and related disorders in international drug policy dialogues.
This publication builds on contributions from a broad range of experts and researchers from different parts of the world. It aims to present the current knowledge on the impact of nonmedical cannabis use on health.
This report provides a review and summary of current knowledge about cannabis use and health effects, and is ly to be relevant for policy makers, public health officials, educators and other individuals concerned with health promotion.
Cannabis Use Disorder (Marijuana Addiction): Know The Signs
As of April 2021, cannabis, or marijuana, is legal for recreational use in 16 states and the District of Columbia (medical marijuana is legal in 36 states), with several others attempting to follow suit.
1 Despite its prevalence and increasing legalization, however, marijuana remains classified by the U.S. Drug Enforcement Administration as a Schedule I drug, along with heroin and LSD, due to its high potential for abuse and the absence of currently accepted medical use.
As such, marijuana is still federally illegal and, according to research on substance abuse disorders, potentially dangerous.
“Cannabis use disorders are often associated with dependence—in which a person feels withdrawal symptoms when not taking the drug.
People who use marijuana often report irritability, mood and sleep difficulties, decreased appetite, cravings, restlessness, and/or various forms of physical discomfort that peak within the first week after quitting and last up to two weeks,” explains Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA).
“When dependence and other factors escalate to cannabis use disorder, a person cannot stop using the drug even though it interferes with many aspects of his or her life,” Dr. Volkow continues. “Some studies suggest that nine percent of people who use marijuana will become dependent on it, with higher rates in those who start using in their teens.” Other studies show even higher rates.
What Is Cannabis Use Disorder?
Among other substance abuse disorders, cannabis use disorder (CUD) is classified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) using a series of criteria that determine a user’s patterns of behavior. These criteria include:
- 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 ly 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). According to NIDA, in 2015 roughly 4 million people in the United States met the criteria for cannabis use disorder.
Treatments 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, un other “harder” drugs. Scientists, however, disagree–particularly in today’s environment that produces stronger strains. Simply stated, this isn’t your parents’ weak weed.
“The potency of cannabis products used to be much weaker, perhaps contributing to the impression that marijuana is not addictive,” explains Deborah Hasin, Ph.D., professor of epidemiology at Columbia University, in New York City.
“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.” It is for that reason that Dr.
Hasin feels that marijuana consumption of any amount can be cause for concern.
“I think the very idea that there is a ‘healthy’ amount of any psychoactive substance is problematic,” says Dr. Hasin.
“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.”
Although somewhat controversial, cannabis use has also been linked to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorder.