Marijuana Use and Misuse

By Jim Shackelford, PhD LCP CADC

The controversy continues about who should have access to marijuana for “medicinal” or for “recreational” purposes and about the decriminalization of marijuana use in general. Some want the right to use marijuana as they choose without the risk of arrest. Others feel that it’s unfair for states to choose who can and cannot legally use marijuana. Others believe that the risks of using marijuana are so great that it requires legislation, supervision, and restriction. I’ve based this overview about marijuana on information from trustworthy sources (see the list at the end of this article), and I offer my own reflections on this debate.

What is marijuana?

Marijuana refers to the dried leaves, flowers, stems, and seeds from the hemp plant, Cannabis sativa. It contains the mind-altering chemical tetrahydrocannabinol (THC). It is the most commonly used illicit drug in the United States, especially among young people, who tend to believe that its use isn’t risky. It is estimated that over 9.5% of the adult population in the United States use marijuana. Legalization of marijuana for medical use or adult recreational use in some states has contributed to the increase in the number of users during the last two years. Currently, 23 states have legalized medicinal or compassionate use of marijuana.

How do people use marijuana?

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, some people use vaporizers (“vaping”). These devices pull the active ingredients (including THC) from the marijuana and collect the vapor in a storage unit. A person then inhales the vapor, not the smoke. Some mix marijuana in food (edibles), such as brownies, cookies, or candy, and some brew it as a tea. A newly popular method of use, “dabbing,” is when a person smokes or eats different forms of THC-rich resins (hash honey oil, wax, budder, or shatter—a hard, amber-colored solid). These extracts can deliver extremely large amounts of THC to users, and their use has sent some people to the emergency room. Another danger can occur during the preparation of these extracts, which usually involves using butane (lighter fluid). A number of people who have used butane to make extracts at home have caused fires and explosions and have been seriously burned.

In Illinois, who can purchase marijuana for medicinal use?

According to the National Organization for the Reform of Marijuana Laws (NORML), medical conditions that qualify a person living in Illinois for the medicinal or compassionate use of marijuana are serious or debilitating or require treatment that creates debilitating effects (for example, Alzheimer’s disease, amyotrophic lateral sclerosis [ALS], cancer, Crohn’s disease, fibromyalgia, glaucoma, hepatitis C, HIV/AIDS, lupus, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, spinal cord disease, traumatic brain injury, and postconcussion syndrome).

What are the medicinal effects of marijuana?

Research results have shown that ingesting THC by smoking, eating, or dabbing can reduce many of the symptoms associated with these diseases and disorders. For example, it can reduce nausea caused by medications taken for cancer treatment or HIV/AIDS, and it can reduce nerve pain and general pain related to cancer, headaches, arthritis, back injuries, and other diseases. It helps control muscle spasms and stiffness. It improves poor appetite and can help people at risk for severe weight loss. It helps reduce eye pressure in people with glaucoma. It can decrease anxiety.

Some disorders have not yet been approved for marijuana use. Examples include posttraumatic stress disorder (PTSD) and attention deficit and hyperactivity disorder (ADHD). Marijuana could help relieve the symptoms of these disorders, but some policymakers believe that current research results do not support its approval. For example, some believe that marijuana could help patients with ADHD cope with the rebound effects of stimulant medications that wear off quickly, and some say that marijuana could help people with PTSD cope with reactivity and hypervigilance.

Why do people who don’t have medical conditions use marijuana?

Some people say that using marijuana just makes them “feel good” or “mellow.” Other people, however, say that using it makes them feel spacy and out of touch with reality.

In a blog post, one marijuana user described the positive effects by noting that it made him feel euphoric, high, and without body aches or pain. It enhanced his sensations, particularly taste, sight, and hearing. Food became highly pleasurable. Colors were brighter and more intense. Music was richer. Time slowed down, increasing his perception of things around him. It sometimes caused mild hallucinations and visions, which he found enjoyable. It created short-term memory loss, which he thought was funny or helpful if recent events had been painful. It let him fall asleep.

What less positive effects are recognized?

This same blogger also recognized less positive effects, such as when “the munchies,” or increased appetite, caused binge eating and weight gain. Smoking marijuana could create trouble with his concentration, his ability to stay focused, and his motivation to solve problems, do projects, or complete homework. His memory was impaired, and he couldn’t remember what happened while under the influence. On rare occasions, he could have a “bad trip,” during which he experienced paranoia, nausea, and just felt rotten. He noted that using marijuana reduced his desire to be social, because it took too much effort to converse and concentrate on what was going on. As a result, he tended to isolate himself.

Research investigators have shown that using marijuana has long-term effects on the brain and brain development. Using marijuana may reduce thinking, memory, and learning functions and may affect how the brain builds connections between the areas necessary for these functions. This is especially a problem when use begins during the teenage years. The effects may last a long time or become permanent. The results of one study showed an average loss of 8 IQ points in people who started using marijuana as teens.

The strength of THC found in joints, edibles, and dabbing has been increasing, and as a result, people have experienced harmful reactions that have contributed to a rise in emergency room visits. Higher THC levels may equate to a greater risk for addiction if users are regularly exposing themselves to high doses.

Marijuana smoke irritates the lungs, and people who frequently smoke marijuana can have the same breathing problems that tobacco smokers have. These problems include daily cough and phlegm, more frequent lung illness, and a having a high risk of developing lung infections.

Marijuana use raises a person’s heart rate for up to 3 hours after smoking. This effect may increase the chance of heart attack. Older people and those with heart problems may have an even higher risk.

Investigators have linked marijuana use during pregnancy with an increased risk of both brain and behavioral problems in babies. If a pregnant woman uses marijuana, the drug may affect developing parts of the fetus’s brain. Resulting challenges for the child may include problems with attention, memory, and problem solving. Additionally, some investigators have suggested that moderate amounts of THC are excreted into the breast milk of nursing mothers, and the effects on a baby’s developing brain are unknown.

Temporary hallucinations and paranoia can occur. Patients with thought disorders such as schizophrenia may find that their symptoms become worse with marijuana use. In addition, their thinking can become more disorganized. Marijuana use also has been linked to other mental health problems, such as depression, anxiety, and suicidal thoughts among teens.

How does marijuana affect a user’s life?

Compared with nonusers, heavy marijuana users more often report lower life satisfaction, poorer mental and physical health, more problems with relationships, and fewer academic and career successes. Marijuana smokers may not complete college and are more likely to be unemployed. If they do work, they make less money than people who do not use marijuana.

Is marijuana addictive?

Yes, marijuana can be addictive. Research results suggest that 30 percent of users develop some degree of problem use, which can lead to dependence and addiction. People who begin using marijuana before age 18 are more likely to develop problem use than other adults. The new diagnostic manual of the American Psychiatric Association, the DSM-5, describes “Cannabis Use Disorders” as being mild, moderate, or severe, depending on how many symptoms or problems the use creates. Symptoms can be physical, psychological, or consequential.

Is marijuana a gateway drug?

Some research results suggest that marijuana use is likely to precede the use of other drugs and that marijuana use is associated with being addicted to other substances. Thus, marijuana use becomes a “gateway” to other drug use. The investigators of one study showed that marijuana use makes other drugs more pleasurable to the brain and enhances their effects. Although these findings support the idea that marijuana is a gateway drug, the majority of people who use marijuana do not go on to use other “harder” drugs.

Will stopping marijuana use bring on withdrawal symptoms?

Long-term marijuana users who have tried to quit have reported experiencing withdrawal symptoms that make quitting difficult.

So, should we worry about people who use marijuana?

I think it depends. Using marijuana to help relieve symptoms related to debilitating medical conditions or the effects of the treatment for these conditions seems reasonable. Current research results confirm the positive effects of using marijuana to alleviate many serious medical conditions. The clinics that dispense marijuana for medicinal purposes follow strict regulations and provide patient education about appropriate use.

Worrying about people who use it for recreational reasons also depends. For teens and children, marijuana use is detrimental to brain development and brain function, and it is associated with many negative consequences. Parents, schools, and communities all need to be concerned about and aware of the risks for youth. Although using marijuana might “feel good,” regular use can set teens on a path that leads to fewer successes, more physical and mental health problems, and potential addiction and negative consequences.

For adults, marijuana use may contribute to difficulties related to their health, relationships, and work. However, adults make choices, sometimes wise and sometimes not. For the 30 percent of users who develop significant problems, continued marijuana use is not a wise choice. Getting a buzz or high or being stoned and totally out it may appear to be the fun, social thing to do, not the risky thing to do. The truth is, there are consequences for that 30 percent of people, and for some, marijuana use can be very risky. People in 12-step recovery programs repeat the Serenity Prayer, which includes the line, “God grant me… the wisdom to know the difference.” My hope is that adults will make wise choices.

Finally, should marijuana use be decriminalized?

The number of marijuana users who develop a serious problem represents approximately 3 percent of the population. The other 6.5 percent of the population who use marijuana don’t become problem users. So the question of criminalization is complex. Users who cause problems for themselves and others by their behavior probably should have consequences. Users who deal marijuana and promote marijuana use among teenagers probably should face legal consequences. Some states have set up diversion courts to send problem users into treatment programs rather than to jail, and some have set thresholds for “how much is too much.” This strategy has reduced the number of people who have been arrested. Others continue to believe that any marijuana use is bad and should be punished. Personally, I prefer the diversion court model and the recognition that arrests use public resources that could be used for treatment and public education.

For more information, check out some of these online resources that were used to compile this article:

www.drugabuse.gov/publications/drugfacts/marijuana. National Institute on Drug Abuse website. See information on medicinal effects of marijuana and “Marijuana: Facts Parents Need to Know.”

www.drugfree.org. Partnership for Drug-Free Kids website. Resources for parents.

www.ncjrs.gov/ondcppubs/publications/pdf/marijuana_myths_facts.pdf. National Criminal Justice Reference Service website. “Marijuana: Myths and Facts—The Truth Behind 10 Popular Misperceptions.” Office of National Drug Control Policy.

www.norml.org/aboutmarijuana is the website for the National Organization for the Reform of Marijuana Laws. It has reliable information.

www.Rosecrance.org. Rosecrance treatment centers website. See “Resources for Parents.”

www.safeaccessnow.org. Americans for Safe Access: Advancing Legal Medical Marijuana Therapeutics and Research. Good information.

www.SAMHSA.gov. Substance Abuse and Mental Health Services Administration website. Offers a variety of research papers on prevalence and risks. See “Tips for Teens: The Truth About Marijuana”(http://store.samhsa.gov/product/Tips-for-Teens-The-Truth-About-Marijuana/PHD641) and “Keeping Your Teens Drug-Free: A Family Guide” (http://store.samhsa.gov/product/Keeping-Your-Teens-Drug-Free-A-Family-Guide/PHD1114).

https://www.whitehouse.gov/ondcp/state-laws-related-to-marijuana. Office of National Drug Control Policy website. Marijuana Resource Center: State Laws Related to Marijuana. and http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. National Conference for State Legislatures website. State medical marijuana laws.