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A Necessary Conversation About Marijuana

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buds of weed - Marijuana use

Is marijuana a new wellness drug? Legislation and news headlines seem to say yes. In 38 states and Washington D.C., cannabis is legal for medical use. In 18 states and D.C., it’s legal for recreational use. But look beneath those headlines at the research, and you will find that marijuana usage, whether for recreation or health, should be a cause for concern.

Considering that more than half (4.1 million) of the 7.1 million people diagnosed with an illegal* drug use disorder in 2017 were diagnosed with cannabis use disorder, it’s apparent that we need to clearly understand its effects on mental and physical health. It is the most used illegal drug in the United States, with nearly 18%, or 49.6 million people, having used it at least once in 2020, as reported by the Substance Abuse and Mental Health Services Administration (SAMHSA).

What’s the Problem?

Problems plural. And the first is potency. In the 1980s, the key ingredient that causes the high, THC, was around 4%. Since then levels have been going up, so that today, it can be as high as 30% and, more rarely, as high as 80%. People who buy marijuana medicinally or for recreation need to know what they are buying. As with alcohol, which clearly states the percentage of alcohol by volume on each container, it should be clear to consumers exactly what it is they are consuming.  

Studies are also finding that cannabis can have long-term negative effects on the brain. For example, a Canadian study published in January 2022, based on more than 43,000 people, found that cannabis can cause impairment in decision making, learning, remembering, and time needed to complete mental tasks. For young adults, this is particularly critical, since their brains continue to develop until they reach their mid-20s, noted the researchers. It also impacts adults in areas like work performance and safe driving.

A New Zealand study found a permanent reduction in IQ of 6 percentage points in people who had used marijuana regularly over a period of years in their teens and young adulthood. They found that those who used cannabis the most showed an average decline in IQ scores of five to six points, between the ages of 13 and 38. Users showed declines in executive functions, memory, processing speed, perceptual reasoning, and verbal comprehension and those declines caused impairment in everyday functioning. Of particular concern was the finding that those who began using marijuana in their teens showed a larger decline, an average of eight IQ points, than those who began using in adulthood.

Dr. Adam D. Scioli, medical director and head of psychiatry at Caron Treatment Centers, said the study confirmed what Caron has found through psychometric testing of adult and young adult patients. “We see moderate to severe impairment in executive functioning that is consistent with the cognitive impairment documented in this study. Oftentimes with cessation, we observe gradual improvement in cognitive function. But that’s not always the case. The best approach is not to use cannabis or seek help if you’re using and struggling to stop on your own.”

Heavy use of cannabis products by teens and young adults with mood disorders — such as depression and bipolar disorder — is also linked to an increased risk of self-harm, suicide attempts, and death, according to a 2021 study in JAMA Pediatrics. Marijuana use may also lead to mental health issues in young adults who did not previously show signs of them. In a 2019 study, researchers found that pre-teens and teens who used marijuana were at risk of developing depression and suicidality as young adults. A 2021 study of pre-teens, teens, and young adults with cannabis use disorder noted that it is associated with an “elevated risk of self-harm, overall mortality, and death by unintentional overdose and homicide.”

When cannabis is prescribed or dispensed to relieve pain or alleviate the symptoms of anxiety, depression, and other mental health issues, users may not realize that it could also put them at risk for more serious mental health disorders. There is an established link between cannabis use and schizophrenia with daily marijuana use doubling the chances of developing psychotic symptoms. Although it is not clear if cannabis triggers the psychosis, studies are beginning to show that cannabis is the driver, noted Dr. Scioli in his column on the Caron website.

There are also dangers due to additives that can make marijuana even more harmful and possibly deadly. Recent news articles, for example, have noted increasing amounts of cannabis laced with fentanyl, a synthetic opioid up to 100 times more potent than heroin that can lead to overdose and death. A November 2021 New York Times article about fentanyl noted that it is found in many illicit products, including marijuana.

What Should We Do?

More research is needed to understand marijuana’s impact on the brain, particularly the developing brain. What causes people to become addicted to marijuana? How addictive is it? What effects does it have on mental health? Physical health? How does cannabis affect mental health disorders, from anxiety and depression to schizophrenia and psychosis. What are the connections?

We also need to have better guidelines on how effective cannabis is in alleviating symptoms in physical illnesses and mental health disorders so that appropriate research-based dosage and usage limits can be set. As Dr. Scioli explained in his column, “there are hundreds if not thousands of chemical compounds in cannabis, and some of those may indeed be medically useful, but without evidence-based guidance we are left to rely on anecdotal reports from people who say it has helped them. We need peer-reviewed, double-blind clinical studies to confirm this.”

Give this public health issue a platform. National and local agencies should educate young and old alike about the dangers and misconceptions about cannabis use and increase access to treatment. Surgeon General Vivek Murthy noted in a February 2022 statement that “we need to be responsible in how we teach our kids about marijuana. I think how we talk to families about marijuana use, and I think health care providers also need to be empowered to have these conversations early on as well as teachers.”

There ought to be universal support for making marijuana use legal only for adults over the age of 21, or possibly older. Brain development continues through the age of 25. It is critical to give adolescent and young adult brains the time to mature, to prevent irreversible damage to the brain. Marijuana use at an early age is an important predictor of development of a substance use disorder later.

The bottom line is that what research is telling us about marijuana usage is cause not only for concern, but for action. We should take steps to better understand both the dangers involved in marijuana use as well as the medicinal value it may have. We must set reasonable limits on use that protects our young people’s cognitive and mental health. Last, education and awareness is needed in order to inform people about the realities of marijuana use.

*Note: Legal drugs are prescription drugs, alcohol, and tobacco. Drugs like opioids, cocaine, and marijuana, among others, are illegal. Marijuana’s legality can be confusing because it is legal in most states for medicinal use and in some states for recreational use as well. However, it is still considered an illegal drug by the federal government.

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