Marijuana is one of the most widely used substances of abuse today. Debates about its legalization, effects, and use have become part of the conversation in nearly every circle, as its presence touches public health, criminal justice reform, the economy, and individual rights.
The terms “marijuana” and “cannabis” have become mostly interchangeable, but the difference between the two terms speaks to the controversial history of marijuana regulation in the United States. On a scientific level, there are two distinct subspecies of the cannabis plant, and the difference is important.
Cannabis sativa, which is the marijuana of popular culture and debate, has psychoactive properties because of its main chemical compound, tetrahydrocannabinol. The other plant is Cannabis sativa L., which is a non-psychoactive form of cannabis known as “hemp.” Cannabis sativa L. is used in the production of oil, fuel, and cloth. There are other subspecies of the cannabis plant (some psychoactive, some not), but these are relatively uncommon.
Cannabis plants evolved in Central Asia, specifically in the modern-day regions of Mongolia and Siberia. Cannabis arrived in the United States in the first decade of the 20th century, brought by Mexican immigrants fleeing the violence of the Mexican Revolution.
Barney Warf, a professor of geography at the University of Kansas, told Live Science that despite the popular reputation cannabis had around the world, it was used to demonize the refugees who sought safety in America. The decision to refer to cannabis as “marijuana” was a way of driving a racial wedge between the Hispanic immigrant refugees and the majority white Americans.
Such was the hysteria, that no distinction was made between the two strains of the cannabis plant. In 1915, Utah became the first state to ban its use, production, and sale. By 1931, 28 other states followed suit. At the end of the decade, the Federal Bureau of Narcotics was successful in making marijuana legal in all 48 states in the country. The Marijuana Tax Act placed the regulation of cannabis under the Drug Enforcement Agency, making it illegal to own any strain of the plant.
Today, even though a number of individual states have taken steps toward decriminalization and legalization, marijuana is still a Schedule I controlled substance, and it is still subject to the highest levels of restriction at the federal level.
A century or so later, marijuana is thought of very differently in the United States. In the runup to the 2016 elections, popular support for cannabis legalization reached an all-time high. In 2015, the General Social Survey, which The Washington Post says conducts the “gold standard of public opinion research, found that 57 percent of Americans felt that the personal ownership and use of marijuana should not be a crime or penalized as such.
However, there is no uniform regulation or enforcement of cannabis, and the drug’s criminalization at the federal level has led to a lot of confusion and scorn. This has contributed to “outdated pot laws” that prevent legal cannabis businesses from opening bank accounts, or that threaten the jobs and careers of people who have legitimate medical reasons for using marijuana that are not recognized in other states or for federal jobs. Even families have been broken up by child protective service agencies if one parent has a marijuana plant in their possession.
Cannabis is big business, but doctors and public health advocates have long sounded the alarm over what unleashing the drug could do to vulnerable citizens. Many studies have documented the adverse health effects of smoking too much marijuana or what happens when young people smoke marijuana. In February 2016, for example, the PLOS One journal published the results of a study that found that chronic cannabis users struggled to identify “deeper levels of emotions,” and that people who smoked a lot had difficulty empathizing with others who were experiencing such deep emotions.
The following month, Nature magazine published a paper that showed that as a single hit of marijuana increases the production of the dopamine neurotransmitter, long-term marijuana use can dull the reward centers of the brain. The more a person takes marijuana, the harder it becomes to feel pleasure or to become excited about being pleased.
Both PLOS One and Nature identified tetrahydrocannabinol (THC) as the culprit. As the main psychoactive ingredient in cannabis, THC is what starts the dopamine release process. Continued exposure to THC forces unnatural levels of dopamine production, meaning that the neurons that normally do all the hard work eventually lose the ability to do so.
In and of itself, THC is not bad. THC is similar to neurotransmitters that the body naturally produces on its own, called endocannabinoids. As part of the endocannabinoid system, they work on a cellular level to regulate the brain, endocrine, and immune responses; they reduce inflammation, heal damaged tissue, control metabolism and appetite, and work as muscle relaxants.
Simply put, the human body is built to receive molecules that activate cannabinoid receptors, whether they are endocannabinoids or THC. This puts marijuana in a class of its own because when a person uses cannabis, there are natural physiological events that result. Alcohol, on the other hand, is physiologically treated like a poison; even mild drunkenness is, in medical terms, a low dose of alcohol poisoning. But where THC is different from endocannabinoids is how it can modulate neurotransmitters in the parts of the brain that regulate movement, feelings, pain, pleasure, and memory.
Despite marijuana enjoying more popularity than it has ever had in the past, the cannabis of today is notably different than the drug of a few decades ago. In the 1970s, the concentration of THC in cannabis was no more than 2 percent; today, cannabis-based products have an average of 13 percent THC, if not higher.
Products include “edibles,” like cookies, brownies, and cakes that are baked with THC. When taken as food, THC becomes four times more psychoactive than if it were inhaled, which has led to a rise of hospitalizations because people are unaware of how much they are flooding their endocannabinoid systems with potent THC.
Upon consumption, the brain is the primary part of the body that is impacted. Blood flow to the brain surges and the marijuana molecules attach to the cannabinoid receptors, including some receptors that aren’t typically activated by endocannabinoids. This kicks off a number of different cognitive effects. Sensations are enhanced and users undergo perceptual changes, like lingering on a thought, word, or action more than normal.
While most people feel relaxed and pleasured by the release of dopamine, others react negatively to the 112 other chemicals that are in cannabis. THC is one of the main ones. The other is cannabidiol (CBD), and the ratio of one to the other, depending on the individual strain obtained, and the user’s own physiology and mental health balance, determine the effects. THC is the psychoactive compound, so if it is higher in volume than the CBD, users will likely experience anxiety and paranoia. CBD has a more calming effect.
One of the brain regions most affected by marijuana is the hippocampus, which regulates short-term memory. Exposure to certain amounts of cannabis, or exposure to cannabis at a young age, can change how the hippocampus functions; users might not be able to remember things or learn new tasks.
The cerebellum of the brain, which controls coordination, is also impacted. This is why people who take marijuana feel that time slows down when they are high, and it’s why driving while high is so dangerous. However, as many as 70 percent of Americans are under the impression that driving while smoking is not a serious problem, even though 60 different studies have found that consuming marijuana affects “all the cognitive abilities needed for safe driving,” such as tracking, divided attention, visual function, short-term memory, and motor coordination.
Beyond the brain, the mouth has to work overtime to compensate for the smoke, tar, and other chemicals in cannabis. People who cough when they smoke marijuana are demonstrating a reflexive protective mechanism to protect their body from the toxins in the drug, which are then passed on to the esophagus, the larynx, and the lungs.
Unlike cigarettes, marijuana joints are unfiltered, so the airways can be more damaged through smoking marijuana than by smoking a cigarette. The American Lung Association writes that marijuana smokers tend to inhale deeply and hold their breath for longer as they consume, which exposes the lungs to more tar. Given time, this can lead to chronic bronchitis, coughing fits, and excessive production of phlegm.
People who have heart conditions might exacerbate those problems by consuming marijuana. Exposure to cannabis can increase heart rate by as much as 30 percent.
Cannabinoids have complex effects on the cardiovascular system, according to Harvard Medical School. Dilation of blood vessels makes the heart pump harder. Other research has suggested that the possibility of a heart attack is much higher in the 60 minutes following marijuana consumption than it would be without that consumption.
According to the European Journal of Immunology, cannabis appears to suppress immune functions, increasing the risk of infections. Most cells in the system are protective, to fight infections and cancers, but myeloid-derived cells are suppressants. They suppress the immune system and restrict its responses. This exposes users to a greater risk of infectious diseases and theoretically to even developing certain types of cancer.
Speaking to Live Science, the study’s author pointed out that the cannabinoids in marijuana are both a blessing and a curse. They can cause an increased susceptibility to cancer, but they also present opportunities to treat disorders where a restricted immune system would actually be helpful, such as arthritis, hepatitis, multiple sclerosis, and lupus.
Chronic marijuana use can also affect sexual functioning and performance in men. Some research has shown that too much cannabis use can make it more difficult for a man to get or keep an erection because of decreased levels of testosterone. The inhibition of the nervous system can cause premature or delayed ejaculation.
Further studies have found that male marijuana smokers were twice as likely as nonsmokers to have abnormally shaped and sized sperm. The lead author noted that if male cannabis users intended on starting a family, they would do well to stop using the drug. Another study from the University of Copenhagen found that men who smoked marijuana at least once a week had a 33 percent reduction in their sperm count than men who didn’t smoke.
Female smokers are also at risk. The Epidemiology journal found a connection between marijuana use (and use of other drugs) and abnormalities in the ovaries, which leads to a “slightly elevated risk of infertility.” Researchers wrote that the risk was highest for women who had taken cannabis within a year of trying to become pregnant.
There are many controversies surrounding the legal use of marijuana, but the application of cannabis for legitimate medical purposes tends to be more favorable. Since cannabidiol has little to no intoxicating properties, patients who have received it report few, if any, intoxicating effects.
Harvard Medical School writes that what they do receive are many health benefits. It relieves insomnia, anxiety, and the effect that marijuana has on pain makes it widely used for medicinal purposes in the United States. Cannabis cannot help in the management of severe pain, but people who have struggled with chronic pain have benefitted from its use. One reason behind its popularity is that it is being used as a safe alternative to opiates, and it can be used in place of other drugs if patients cannot take those medications because of other health concerns.
Marijuana’s medical applications are the result of the two primary active ingredients in cannabis: THC and CBD. THC targets a cannabinoid receptor that is located in the brain, nervous system, liver, kidneys, and lungs. When activated (either by THC or the body’s natural endocannabinoids), the receptor dampens the response to pain or toxins.
The “munchies,” the well-known side effect of intense hunger that follows marijuana consumption, can be used to stimulate appetite in patients who have a condition, like HIV/AIDS, or are undergoing treatment like chemotherapy, that suppresses appetite.
Similarly, medical marijuana is also touted for its use as a muscle relaxant, which can lessen the tremors caused by Parkinson’s disease. Harvard Health writes of how medical marijuana has been used successfully to help patients who have fibromyalgia, endometriosis, and a number of other conditions linked by the symptom of chronic pain.
Marijuana is also medically used for its properties of managing weight loss and nausea, which are both symptoms of many other conditions, including stress. This has made medical cannabis a promising prospect for the treatment of post-traumatic stress disorder in military veterans. Many advocacy groups for recovering veterans and associated therapists and doctors have reported significant improvement in the treatment of PTSD symptoms when marijuana is used, to a greater and drastically safer degree than opioids and other pharmaceuticals.
Cannabis is still a Schedule I controlled substance in the United States, so federal funding cannot be allocated toward research and clinical trials on its effectiveness. However, preliminary studies have suggested that it can be used in the treatment of pain and wasting syndrome associated with HIV/AIDS, in addition to Crohn’s disease and irritable bowel syndrome.
There is a common belief that it is not possible to be addicted to marijuana, but this is a misconception. Many public health and scientific bodies have clarified that cannabis use disorder or addiction is very possible, especially if a given user has a family history of substance abuse, if the person has a mental health condition that increases the possibility of developing a substance use disorder, and if there are certain factors in the person’s environment and lifestyle that can make the development of an addiction likely.
What constitutes marijuana abuse or addiction, and how can it be spotted? In order for a person to meet the medical criteria for such a problem, a person must have at least two of 11 agreed-upon symptoms, within a 12-month period of time. A few of these symptoms are outlined below.
The Medical criteria for a Marijuana Addiction
The signs of marijuana abuse and addiction demonstrate that there is both a physical and a behavioral component to unhealthy use of the drug. The symptoms will get progressively worse as a user transitions from infrequent and casual use to obsessive and dependent use. As the mental unbalance caused by the abuse grows, the person may not even realize that their use has crossed a line. Additionally, the person may not be able to stop using even while recognizing that there is a problem.
Knowing that a problem exists can happen when the user’s quality of life and overall wellbeing decline as a direct result of cannabis use. Being told by trusted friends and family members that the marijuana use has gotten out of hand is another way that a user can be made aware of their issues.
Treating marijuana addiction entails the user gradually weaning off their current rate of consumption; the pace of this should be decided by a doctor. Attempting to cut down by too much or stopping entirely might induce withdrawal symptoms that deter reduction. A steady progression gives the user a better chance of controlling the urge to go back to using.
A supervising doctor may prescribe medication to keep withdrawal discomfort at bay. Anti-anxiety medication, for example, will help the person overcome agitation associated with breaking away from the constant activation of their cannabinoid receptors.
The length of this process of detoxification depends on how long the individual has been using marijuana, the strain and type of marijuana, as well as the presence of other drugs, pre-existing mental health and medical conditions, and the person’s unique physiology and family history. A complete intake and evaluation at a treatment center will yield the most accurate information, which will help a doctor determine the best course of therapy and rehabilitation.
When the person is better able to control their physical need for marijuana, they can start working with a therapist to address the mental health effects of the abuse. This might entail uncovering the underlying problems that spurred the abuse, as well as participating in group and/or family therapy sessions. Therapists use different methods to help clients confront and overcome their psychological dependence on marijuana and related coping mechanisms, showing them how they can refocus their needs on more productive expressions.
In Addictive Behaviors, researchers wrote that integrated cognitive-behavioral therapy has been very effective in treating patients who have developed a psychological dependence on marijuana. This has proven especially useful for patients who have major anxiety issues, which might have compelled the move to unhealthy coping mechanisms.
Lastly, individuals should engage with peer-led aftercare support networks. These groups are usually led by other people who have overcome the effects of marijuana abuse. They are often based on the 12-step approach for accountability, support, and welcoming others who have struggled with the addictive potential of cannabis.
If you or a loved one has been using marijuana and you’re worried that you may have developed a substance use disorder, there is help available. Call the drug addiction treatment specialists at Delphi Behavioral Health Group at 844-899-5777 to learn more about how marijuana addiction can be treated and the therapies that are available to you.
Bloomfield, Michael A., Ashok, Abhishek H. “The Effects Of Δ9-Tetrahydrocannabinol on the Dopamine System.” (November 2016). Nature. from https://www.nature.com/articles/nature20153
Ghose, Tia. “Driving With a Marijuana High: How Dangerous Is It?” (July 2015). Live Science. from https://www.livescience.com/51450-driving-on-marijuana-alcohol-dangerous.html
“How Marijuana Suppresses the Immune System.” (November 2010). Live Science. from https://www.livescience.com/9008-marijuana-suppresses-immune-system.html
Grinspoon, Peter, MD. “Medical Marijuana.” (January 2018). Harvard Medical School. from https://www.health.harvard.edu/blog/medical-marijuana-2018011513085
Rubin, Eugene, M.D., Pd.D. “A New England Journal of Medicine Article About Marijuana.” (August 2014). Psychology Today. from https://www.psychologytoday.com/us/blog/demystifying-psychiatry/201408/new-england-journal-medicine-article-about-marijuana
“Drug Addiction (Substance Use Disorder).” (October 2017). Mayo Clinic. from https://www.mayoclinic.org/diseases-conditions/drug-addiction/diagnosis-treatment/drc-20365113