Dr. Jeff's and Dr. Tanya's Blog

Facts every parent needs to know about Marijuana

• A Letter to Parents
• What is marijuana? Aren't there different kinds?
• What are the current slang terms for marijuana?
• How is marijuana used?
• How many people smoke marijuana? At what age do children generally start?
• How can I tell if my child has been using marijuana?
• Why do young people use marijuana?
• Does using marijuana lead to other drugs?
• What are the effects of marijuana?
• What happens after a person smokes marijuana?
• How long does marijuana stay in the user's body?
• Can a user have a bad reaction?
• How is marijuana harmful?
• How does marijuana affect driving?
• What are the long-term effects of marijuana?
• What about pregnancy? Will smoking marijuana hurt the baby?
• What happens if a nursing mother uses marijuana?
• How does marijuana affect the brain?
• Can the drug cause mental illness?
• Do marijuana users lose their motivation?
• Can a person become addicted to marijuana?
• What is "tolerance" for marijuana?
• Are there treatments to help marijuana users?
• Can marijuana be used as medicine?
• How can I prevent my child from getting involved with marijuana?
• Talking to your children about marijuana
• Resources

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Tips for Parents

• Be a good listener
• Give clear no-use messages about drugs and alcohol
• Help your child deal with peer pressure to use drugs
• Get to know your child’s friends and parents
• Monitor your child’s whereabouts
• Supervise teen activities
• Maintain an open and honest dialogue with your child

Fact: Marijuana is the most frequently used illegal drug in the United States.

Fact: 42.3 percent of 12th-graders have tried marijuana at least once.

Fact: Marijuana smoking affects the brain and leads to impaired short-term memory, perception, judgment, and motor skills.

Source: National Institute of Drug Abuse

Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com

Factsheet on the abuse of Marijuana

Marijuana is the most commonly abused illicit drug in the United States. It is a dry, shredded green and brown mix of flowers, stems, seeds, and leaves derived from the hemp plant Cannabis sativa. The main active chemical in marijuana is delta-9-tetrahydrocannabinol; THC for short.

How is Marijuana Abused?

Marijuana is usually smoked as a cigarette (joint) or in a pipe. It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana. Since the blunt retains the tobacco leaf used to wrap the cigar, this mode of delivery combines marijuana's active ingredients with nicotine and other harmful chemicals. Marijuana can also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish, and as a sticky black liquid, hash oil.* Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.

How Does Marijuana Affect the Brain?

Scientists have learned a great deal about how THC acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs throughout the body.

THC acts upon specific sites in the brain, called cannabinoid receptors, kicking off a series of cellular reactions that ultimately lead to the “high” that users experience when they smoke marijuana. Some brain areas have many cannabinoid receptors; others have few or none. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thoughts, concentration, sensory and time perception, and coordinated movement.¹

Not surprisingly, marijuana intoxication can cause distorted perceptions, impaired coordination, difficulty in thinking and problem solving, and problems with learning and memory. Research has shown that marijuana’s adverse impact on learning and memory can last for days or weeks after the acute effects of the drug wear off.² As a result, someone who smokes marijuana every day may be functioning at a suboptimal intellectual level all of the time.

Research on the long-term effects of marijuana abuse indicates some changes in the brain similar to those seen after long-term abuse of other major drugs. For example, cannabinoid withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system³ and changes in the activity of nerve cells containing dopamine.⁴ Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.

Addictive Potential
Long-term marijuana abuse can lead to addiction; that is, compulsive drug seeking and abuse despite its known harmful effects upon social functioning in the context of family, school, work, and recreational activities. Long-term marijuana abusers trying to quit report irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which make it difficult to quit. These withdrawal symptoms begin within about 1 day following abstinence, peak at 2–3 days, and subside within 1 or 2 weeks following drug cessation.⁵

Marijuana and Mental Health
A number of studies have shown an association between chronic marijuana use and increased rates of anxiety, depression, suicidal ideation, and schizophrenia. Some of these studies have shown age at first use to be a factor, where early use is a marker of vulnerability to later problems. However, at this time, it not clear whether marijuana use causes mental problems, exacerbates them, or is used in attempt to self-medicate symptoms already in existence. Chronic marijuana use, especially in a very young person, may also be a marker of risk for mental illnesses, including addiction, stemming from genetic or environmental vulnerabilities, such as early exposure to stress or violence. At the present time, the strongest evidence links marijuana use and schizophrenia and/or related disorders⁶. High doses of marijuana can produce an acute psychotic reaction, and research suggests that in vulnerable individuals, marijuana use may be a factor that increases risk for the disease.

What Other Adverse Effect Does Marijuana Have on Health?

Effects on the Heart
One study found that an abuser’s risk of heart attack more than quadruples in the first hour after smoking marijuana.⁷ The researchers suggest that such an outcome might occur from marijuana’s effects on blood pressure and heart rate (it increases both) and reduced oxygen-carrying capacity of blood.

Effects on the Lungs
Numerous studies have shown marijuana smoke to contain carcinogens and to be an irritant to the lungs. In fact, marijuana smoke contains 50 to 70 percent more carcinogenic hydrocarbons than tobacco smoke. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which further increases the lungs’ exposure to carcinogenic smoke. Marijuana smokers show dysregulated growth of epithelial cells in their lung tissue, which could lead to cancer;⁸ however, a recent case-controlled study found no positive associations between marijuana use and lung, upper respiratory, or upper digestive tract cancers.⁹ Thus, the link between marijuana smoking and these cancers remains unsubstantiated at this time.

Nonetheless, 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, a heightened risk of lung infections, and a greater tendency toward obstructed airways. A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers.¹⁰ Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.

Effects on Daily Life
Research clearly demonstrates that marijuana has the potential to cause problems in daily life or make a person’s existing problems worse. In one study, heavy marijuana abusers reported that the drug impaired several important measures of life achievement including physical and mental health, cognitive abilities, social life, and career status.¹¹ Several studies associate workers’ marijuana smoking with increased absences, tardiness, accidents, workers’ compensation claims, and job turnover.

What Treatment Options Exist?

Behavioral interventions, including cognitive behavioral therapy and motivational incentives (i.e., providing vouchers for goods or services to patients who remain abstinent) have shown efficacy in treating marijuana dependence. Although no medications are currently available, recent discoveries about the workings of the cannabinoid system offer promise for the development of medications to ease withdrawal, block the intoxicating effects of marijuana, and prevent relapse.

The latest treatment data indicate that in 2006 marijuana was the most common illicit drug of abuse and was responsible for about 16 percent (289,988) of all admissions to treatment facilities in the United States. Marijuana admissions were primarily male (73.8 percent), White (51.5 percent), and young (36.1 percent were in the 15–19 age range). Those in treatment for primary marijuana abuse had begun use at an early age: 56.2 percent had abused it by age 14 and 92.5 percent had abused it by age 18.**

How Widespread is Marijuana Abuse?

According to the National Survey on Drug Use and Health, in 2006, 14.8 million Americans age 12 or older used marijuana at least once in the month prior to being surveyed, which is similar to the 2005 rate. About 6,000 people a day in 2006 used marijuana for the first time—2.2 million Americans. Of these, 63.3 percent were under age 18.***

Monitoring the Future Survey
According to the 2007 Monitoring the Future survey—a national survey of 8th, 10th, and 12th graders, marijuana use has been declining since the late 1990s. Between 2000 and 2007, past-year use decreased more than 20 percent in all three grades combined. Nevertheless, marijuana use remains at unacceptably high levels, with more than 40 percent of high school seniors reporting use at least once in their lifetimes. ****

Percentage of 8th-Graders Who Have Used Marijuana:
Monitoring the Future Study, 2007

1994 1995 1996 1997 1998 1999 2000 Lifetime 16.7% 19.9% 23.1% 22.6% 22.2% 22.0% 20.3% Past Year 13.0 15.8 18.3 17.7 16.9 16.5 15.6 Past Month 7.8 9.1 11.3 10.2 9.7 9.7 9.1 Daily 0.7 0.8 1.5 1.1 1.1 1.4 1.3

2001 2002 2003 2004 2005 2006 2007 Lifetime 20.4% 19.2% 17.5% 16.3% 16.5% 15.7 14.2 Past Year 15.4 14.6 12.8 11.8 12.2 11.7 10.3 Past Month 9.2 8.3 7.5 6.4 6.6 6.5 5.7 Daily 1.3 1.2 1.0 0.8 1.0 1.0 0.8

Percentage of 10th-Graders Who Have Used Marijuana:
Monitoring the Future Study, 2007

1994 1995 1996 1997 1998 1999 2000 Lifetime 30.4% 34.1% 39.8% 42.3% 39.6% 40.9% 40.3% Past Year 25.2 28.7 33.6 34.8 31.1 32.1 32.2 Past Month 15.8 17.2 20.4 20.5 18.7 19.4 19.7 Daily 2.2 2.8 3.5 3.7 3.6 3.8 3.8

2001 2002 2003 2004 2005 2006 2007 Lifetime 40.1% 38.7% 36.4% 35.1% 34.1% 31.8% 31.0% Past Year 32.7 30.3 28.2 27.5 26.6 25.2 24.6 Past Month 19.8 17.8 17.0 15.9 15.2 14.2 14.2 Daily 4.5 3.9 3.6 3.2 3.1 2.8 2.8

Percentage of 12th-Graders Who Have Used Marijuana
Monitoring the Future Study, 2007

1994 1995 1996 1997 1998 1999 2000 Lifetime 38.2% 41.7% 44.9% 49.6% 49.1% 49.7% 48.8% Past Year 30.7 34.7 35.8 38.5 37.5 37.8 36.5 Past Month 19.0 21.2 21.9 23.7 22.8 23.1 21.6 Daily 3.6 4.6 4.9 5.8 5.6 6.0 6.0

2001 2002 2003 2004 2005 2006 2007 Lifetime 49.0% 47.8% 46.1% 45.7% 44.8% 42.3% 41.8% Past Year 37.0 36.2 34.9 34.3 33.6 31.5 31.7 Past Month 22.4 21.5 21.2 19.9 19.8 18.3 18.8 Daily 5.8 6.0 6.0 5.6 5.0 5.0 5.1

“Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

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* For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit: http://www.whitehousedrugpolicy.gov/streetterms/default.asp.

** These data are from the Treatment Episode Data Set (TEDS) Highlights – 2006: National Admissions to Substance Abuse Treatment Services (Office of Applied Studies, DASIS Series: S-40, DHHS Publication No. SMA 08-4313, Rockville, MD, 2008), funded by the Substance Abuse and Mental Health Services Administration. The latest data are available at 800-729-6686 or online at www.samhsa.gov.

*** Results from the 2006 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H–32, DHHS Publication No. SMA 07-4293 Rockville, MD, 2007). NSDUH is an annual survey conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information at 800-729-6686.

**** These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th graders’ illicit drug use and related attitudes since 1975; in 1991, 8th and 10th graders were added to the study. The latest data are online at www.drugabuse.gov.

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1 Herkenham M, Lynn A, Little MD, et al. Cannabinoid receptor localization in the brain. Proc Natl Acad Sci, USA 87(5):1932–1936, 1990.

2 Pope HG, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 58(10):909–915, 2001.

3 Rodríguez de Fonseca F, Carrera MRA, Navarro M, Koob GF, Weiss F. Activation of corticotropin-releasing factor in the limbic system during cannabinoid withdrawal. Science 276(5321):2050–2054, 1997.

4 Diana M, Melis M, Muntoni AL, Gessa GL. Mesolimbic dopaminergic decline after cannabinoid withdrawal. Proc Natl Acad Sci, USA 95(17):10269–10273, 1998.

5 Budney AJ, Vandrey RG, Hughes JR, Thostenson JD, Bursac Z. Comparison of cannabis and tobacco withdrawal: Severity and contribution to relapse. J Subst Abuse Treat, e-publication ahead of print, March 12, 2008.

6 Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet 370 (9584):319–328, 2007.

7 Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 103(23):2805–2809, 2001.

8 Tashkin DP. Smoked marijuana as a cause of lung injury. Monaldi Arch Chest Dis 63(2):92–100, 2005.

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 15(10):1829–1834, 2006.

10 Polen MR, Sidney S, Tekawa IS, Sadler M, Friedman GD. Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med 158(6):596–601, 1993.

11Gruber AJ, Pope HG, Hudson JI, Yurgelun-Todd D. Attributes of long-term heavy cannabis users: A case control study. Psychological Med 33(8):1415–1422, 2003.

Source: National Institute of Drug Abuse

Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com

Adolescents, marijuana use, and withdrawal

Dr. W. B. Apple writing in the Journal of Orgonomy states, “Over the past twenty-five years, the proportion of pupils age fourteen to fifteen who knew someone using marijuana more than quadrupled from 15% to 65%, and the proportion who had been offered drugs increased nine--fold from 5% to 45% by 1994. Both of these proportions more than doubled over the past five years (3). Alarmingly, age of initial use has consistently decreased over time to younger students (4). In one sample of adolescents in treatment for substance abuse, the average age of onset of marijuana use was 12.75 years for outpatients and 11.75 years for inpatients (5). Current estimates suggest that among high school students, 12% of all twelve to seventeen year olds are regular users of marijuana. This increases to 22% for eighteen to twenty-five year olds (6). These estimates are applicable to all strata of society: in a recent survey at a private preparatory school, over 20% of the students characterized themselves as either moderate or heavy users of marijuana. Eleven percent preferred marijuana over alcohol, the most predominant drug among teenagers (7). These facts all probably underestimate actual levels of use because of well-documented inaccuracies in such epidemiological data due to under-reporting or complete denial (8). It appears that use of marijuana has become so much a part of everyday adolescent culture that adolescents and even their parents have been desensitized to its presence and are accepting of its use as a normal part of ‘adolescent experimentation.’ "
Again, we quote Dr. Apple, “research has demonstrated that heavy users are more likely to experience psychopathological consequences, including personal problems of identity diffusion, low self-esteem, an "amotivational syndrome," interpersonal problems with peers and parents, and difficulty with the law. Over time, these problems were likely to be severe, chronic, and progressive.” Dr. John Ratey in a personal communication with Dr. Apple states, “Smoking marijuana is probably the worst possible thing someone diagnosed with ADD can do for their symptoms.”

A new study in Drug and Alcohol Dependence (2008;92:48-54) has now shed some light on the problem of kicking the marijuana habit, particularly for heavy users of marijuana. Amazingly, it appears that marijuana withdrawal can be just as bad as tobacco withdrawal. During the marijuana withdrawal phase of the study, the study participants experienced a wide range of withdrawal symptoms including: irritability, anxiousness, sleep problems, decrease in appetite, disturbing dreams, and decrease concentration which was very similar to the withdrawal symptoms experienced by the study participants who were withdrawing from tobacco. Another important point but certainly surprising point about the study is that about fifty percent of the study participants who withdrew from tobacco and marijuana simultaneously were better able to tolerate that withdraw symptoms than whose who withdrew from just one substance alone.

The Bottom Line: A new study indicate that adolescents who are heavy marijuana users can have a particulary difficult time withdrawing from marijuana and/or tobacco.

Sources: See blogposts in Addictions: Marijuana

Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates
of New England
www.psychopharmassociates.com