In this latest in the series of articles presented by Chayeinu, a new organization dedicated to providing education and guidance to our community regarding substance use disorder, I would like to talk about marijuana. Marijuana is the most commonly used illicit drug in the United States. In 2018, over a third of high school seniors reported using marijuana in the past month, with 6% using it daily. A substantial number of eighth graders are also using the drug. Marijuana remains quite popular among adults as well. Approximately 15 to 20% report using the drug each year, with higher rates of use in states that have legalized recreational or medical use of the drug. While we hope that these statistics are not as high in our Jewish community, we would be naïve to think that we are untouched.
What Is Marijuana?
Marijuana usually refers to the leaves that come from the cannabis plant. The main psychoactive compound in marijuana is THC, and it appears that levels of THC in marijuana are rising. Smoking THC-rich resins or extracts from cannabis, which are called by names like hash, wax, or shatter, is also increasing in popularity. There is incredible diversity among marijuana extracts, one more potent than the other. The point is that this is not the same marijuana smoked by Bill Clinton or Barack Obama.
Marijuana can be purchased relatively cheaply. In Maryland, where marijuana for recreational use remains illegal, marijuana is purchased on the street in different amounts. An ounce costs somewhere between $250 and $350, while a gram can be purchased for as little as $12 to $20. Synthetic forms of cannabis, such as K2 and Spice, which are considerably more powerful and unpredictable than marijuana – and are sometimes called “parole-weed” because they do not show up on routine urinalysis testing – seem to be somewhat less popular at this time.
How Is Marijuana Used?
Marijuana is usually smoked in joints, pipes, or bongs, and sometimes in little cigars, called blunts. It can also be smoked in electronic cigarettes (i.e., Juuls), making it hard to detect. An increasingly popular method of consumption is mixing it with food, known as edibles. Edible products include brownies, muffins, and candies, even lollypops. It has even become popular in certain circles to infuse challah with marijuana, though it is not clear who provides the hashgacha for this type of product.
What Are the Short-Term Effects?
Marijuana is absorbed quickly in the bloodstream and moves to the brain, causing a “high,” along with an altered sense of time and a feeling of relaxation. It also tends to impair thinking, judgment, and coordination, and ordinary things often seem much funnier. Marijuana is also notorious for increasing appetite. You can tell that someone is consuming marijuana if he or she is giggling for no apparent reason and searching for potato chips. High doses of marijuana can be quite problematic, at times inducing delusions or other psychotic thinking or behavior.
Is Experimenting with Marijuana a Problem?
A consequence of efforts to legalize marijuana appears to be that teenagers express less concern about its negative side effects. But there seems to be plenty to worry about. Parents might consider these problems when speaking to their children about drug use.
The first problem is the possibility of developing a cannabis-use disorder. About 10 to 30% of teenagers who use marijuana report symptoms of cannabis-use disorder. The drug often interferes with everyday functioning, like doing homework or pursuing extracurricular activities. Many kids report symptoms that occur when trying to stop using the drug, such as anxiety, depression, and sleep disturbance. Among adults, about 30% of those who use marijuana report having a disorder. As we have noted in previous articles, people with risk-factors for addiction, like a family history of addiction, cigarette smoking, untreated ADHD or mental illness, or trauma, are most prone to developing a disorder.
Second, marijuana impacts brain regions involved in executive functioning, and can lead to deficits across many cognitive domains, such as memory, problem-solving, and planning. These deficits become worse and more permanent with chronic use. There is a strong association between cannabis use and poor academic achievement. As we have noted before, doing poorly in school and feeling alienated from school culture, often has long-term negative consequences.
Third, marijuana users often use more of the drug than intended. Those who consume edibles, for example, are often unaware of the quantity being consumed. Because the digestion process delays the onset of the drug’s effects, people may use more marijuana than they intended. Higher doses of the drug lead to greater physical and cognitive impairment, which includes more risky decision making.
Fourth, because marijuana affects coordination, reaction time, and judgment, people smoking marijuana are more likely to get into traffic accidents. About 20% of teenagers admit that they have driven while under the influence of marijuana.
Fifth, the social nature of marijuana use increases involvement with teenagers who are using other classes of drugs. Although marijuana is unlikely a “gateway drug,” it provides an obvious pathway to experimentation with other drugs of abuse.
And finally, marijuana use frequently co-occurs with mental health problems. Marijuana seems to worsen psychiatric symptoms like depression and anxiety and reduces the effectiveness of prescribed medications. In fact, people who smoke marijuana are much less happy and satisfied than those who do not smoke.
Therapeutic Effects
There are currently 33 states (including Maryland) that have legalized the use of marijuana for medical purposes, while 10 states have legalized recreational use for adults 21 years or older. Although medical marijuana laws vary from state to state, each state requires the user to have medical authorization. Research evaluating the therapeutic value of chemicals from the cannabis plant focus largely on two compounds, THC and CBD. THC seems to show potential for reducing nausea and increasing appetite, and may be helpful for reducing some types of pain. CBD, which, unlike THC, does not induce intoxication, is known to help with severe forms of epilepsy and may have other therapeutic uses, including reduction in anxiety and improving sleep. A considerable amount of research is evaluating these hypotheses.
Conclusion
The success of efforts to legalize marijuana is somewhat surprising since there is absolutely no scientific consensus supporting the safety of the drug – though, of course, there is much profit to be made. Marijuana is already the most popular illicit drug in the U.S., and legalization may further increase rates of use among teenagers and adults. The good news is that most teenagers and adults who use marijuana will not develop serious problems because of it. But many people do develop problems, especially those at higher risk for addiction. And there are other worrying developments – higher drug potency, new ways to use the drug, fewer concerns about negative effects – that bode poorly for the future. It will not be long before more states legalize the recreational use of marijuana. We need to educate our children.
Dr. Kidorf is Associate Director of Addiction Treatment Services and Associate Professor, Psychiatry and Behavioral Sciences, at Johns Hopkins University School of Medicine.
