Marijuana Addiction

Marijuana Addiction

Marijuana Addiction

Marijuana AddictionEverything about marijuana is caught up in controversy today.

The United States government classifies marijuana as a Schedule I Controlled Substance, which means it is highly addictive and has no medical uses whatsoever.

Yet sixteen states have passed laws legalizing marijuana for medical purposes.

Anyone caught dealing in marijuana is subject to the most severe penalties for drug offenses under federal law. Even trafficking in just 100 kilograms of marijuana gets you five to 40 years in prison for a first offense and ten years to life for a second offense. And yet every month over 15 million Americans risk arrest to use marijuana, and 80% of Americans believe it should be legal to do so.

Some doctors believe that marijuana is no more addictive or harmful than cigarettes or coffee, and yet the American Psychiatric Association lists “cannabis dependence” as a mental disorder.

Former U.S. Surgeon General Dr. Joycelyn Elders called marijuana “a remarkably safe” drug that should be legalized. Others like Dr. Richard N. Rosenthal, chairman of psychiatry at St. Luke’s-Roosevelt Hospital in Manhattan and professor of clinical psychiatry at Columbia University, believe that legalizing marijuana would be “unleashing a Pandora’s Box … (because) the people who become chronic users don’t have the same lives and the same achievements as people who don’t use chronically.”

To complicate matters even more, research into marijuana is ongoing and producing results that fortify both sides of the debate.

What Is Marijuana?

Marijuana is a plant once widely grown in the American colonies for paper, clothing, and rope. Even George Washington grew it on his plantation. After the cotton gin was invented, marijuana crops became unpopular. Until about 1900, marijuana was used in the form of a syrup for medicinal reasons.

Around 1920, marijuana caught on as a drug to smoke for relaxation. By 1930, New York city alone had over 500 “tea pods” or public places where you could smoke it. In 1937, Congress passed the Marijuana Tax Act, making the drug illegal, and it remains illegal on the federal level today. Since federal laws trump state laws, you can go to jail for mailing or distributing marijuana even in a state that allows the use of the drug for medical reasons. However, the federal government has not cracked down on these endeavors so far.

Marijuana grows in nearly every tropic or temperate climate, but the majority consumed in the U.S. comes from Canada or Mexico, with its distribution controlled by African-American, Asian and Hispanic street gangs. There are over 200 street names for marijuana, including pot, weed, Mary Jane, dope, hydro, reefers, hash, skunk, herb, and ganja.

The stems and leaves of the plant are dried and then rolled into cigarettes. Some users empty cigars and refill them with a combination of marijuana and tobacco. Marijuana can also be consumed as a tea or an ingredient in food.

Marijuana contains over 4000 chemicals, some of which have never been identified. Its main active ingredient is tetrahydrocannabinol or THC, a chemical that attaches itself to cannabinoid receptors in nerve cells in the brain. These receptor cells are particularly abundant in the cerebellum, hippocampus, and cerebral cortex, which are areas of the brain involved in pleasure, memory, thinking, concentration, perception of time, and coordinated movement. THC is fat soluble and remains in the bloodstream up to 30 days, accumulating in the liver, lungs and testes.

Why Do People Take It?

People take marijuana to relax and for its psychoactive effects, which last one to three hours. Colors seem brighter, the sense of time is altered, and the person may feel relaxed, silly, and “high.” Individual biology and genetics, the strength of the marijuana, whether it is smoked or eaten, whether it is used with alcohol and other drugs, and the person’s expectation and previous experience with the drug all influence its effects. Eating or drinking marijuana provides two or three times more drug potency than smoking it.

Marijuana increases the heart rate and blood pressure, and one study found that you are four times more likely have a heart attack within an hour of smoking the drug. It also increases the rate of breathing and the appetite even as it slows down reaction times. Red eyes and dry mouth are other usual side effects. Psychological effects can be short-term memory loss, anxiety, depression, paranoia, and magical thinking. At high doses people have experienced panic attacks or psychosis.

Light or first-time users of marijuana will test negative on urine tests after a week has passed since using it; however, it can take up to a month of abstinence for heavy users to test negative.

Physicians do not prescribe smoking marijuana for medical reasons because it is illegal to do so and because smoking is linked to cancer and other lung diseases. As University of Southern California professor Joel Hay put it, “Marijuana will never be approved by the FDA.”

However, the active ingredient in marijuana has been isolated and used in medicines. Dronabinol (brand name: Marinol), Cesamet, and Sativex are all drugs derived from THC and used to treat nausea in cancer, loss of appetite in AIDS patients, chronic pain, and multiple sclerosis.

Although proponents of legalizing marijuana argue that the terminally ill and patients with AIDS, multiple sclerosis and glaucoma need to smoke it, the medical establishment does not agree. So far, smoking marijuana has not been shown to be useful in the treatment of weight loss in cancer, Huntington’s disease or schizophrenia, and probably not useful for treating glaucoma, epilepsy, insomnia or eczema. Although some terminally ill people smoke it, the American Medical Association and the American Cancer Society do not endorse this use. An Institute of Medicine Report of March 1999 vetoed marijuana for use by HIV/AIDS patients, because there is some possibility that the drug interferes with the immune system. The National Eye Institute issued a statement in 2009 that marijuana is not as effective as other drugs on the market for glaucoma.

The vast majority of people who use marijuana are doing so for recreational purposes.

Why Do People Abuse Marijuana?

Experts in the United States have been debating for a long time whether marijuana is addictive. The most current research indicates that it is, and that people abuse marijuana because they are addicted to it. About 9% of people who use marijuana become serious addicts, compared to 17% of those who use cocaine and 23% of those who use heroin, according to research from the Institute Of Medicine of the National Academies. In other words, marijuana is addictive, but not among the most highly addictive substances. Factors that help determine whether you will become addicted to marijuana are your genetics, the age at which you experiment with it, whether you use other drugs, and the quality of your relationships with others.

Physicians currently recognize two kinds of marijuana addictions as mental disorders: Cannabis Abuse and Cannabis Dependence. This will probably change when the new edition of The Statistical and Diagnostic Manual of Mental Disorders (DSM) comes out in 2013. The committee currently revising the DSM has noted that research and “compelling arguments clearly support that Cannabis Withdrawal and Cannabis Dependence” should be included in DSM-V.

It is hard to study marijuana addiction because most users also consume alcohol and other drugs along with it. Marijuana was a factor for 740,800 new patients or 83% of all new admissions to treatment centers in 2008, the latest year for statistics. About 17% of admissions, representing 322,000 patients, were primarily for marijuana, which was second only to opiate addictions.

Over 60% of those in treatment for marijuana are under age 15 years old, and 56% are ages 15 to 19 years old. One meta-analysis of 48 previous studies found that marijuana addicts tend to be males with low educational attainment who earn less than $30,000 a year. People who use marijuana daily tend to be unemployed, of low educational attainment, suffer from other mental illnesses, and use multiple drugs. Most adults seeking treatment for marijuana had used the drug once a day for more than ten years and tried to quit six times on their own.

What Are the Signs That You Are Addicted To Marijuana?

You may be addicted to marijuana if you can answer yes to any of the following questions.

  • Does your marijuana use result in problems such as absenteeism and failure to achieve at work or school?
  • Does marijuana interfere with your family relationships?
  • Have you driven an automobile under the influence of marijuana or in any other way put yourself into a hazardous situation because of this drug?
  • Have you had problems with the law, or do you worry about being arrested for marijuana possession?
  • Do you keep needing more marijuana to achieve the high that you want from it?
  • Are you smoking marijuana more often or using it in greater amounts than you want to or than you did in the past?
  • Do you worry that you’re spending too much time obtaining and smoking marijuana?
  • Are you giving up friendships and certain activities that you used to like because of your marijuana use?
  • Do you become depressed and irritable when you try to quit marijuana?
  • Have you tried to give up marijuana and been unsuccessful?
  • Does your self-esteem suffer because you use marijuana?

Dangers And Risks Of Using Marijuana

The National Organization for the Reform of Marijuana Laws (NORML), the main group lobbying for legalization, considers the greatest danger of marijuana is putting its users at an increased risk for automobile accidents. Between 16% and 19% of automobile crash victims test positive for marijuana. Marijuana is involved in over 375,000 visits to emergency rooms every year.

Marijuana smoke has about 6,000 of the same chemicals as in tobacco smoke. In fact, the main difference between the two cigarettes is whether the main ingredient is THC or nicotine. Marijuana smokers, like tobacco smokers, suffer more frequently from colds, bronchitis, and other upper respiratory problems. There have been no long-term studies of marijuana and lung cancer. A February 2009 study linked heavy marijuana use to a 70% increase in a particularly dangerous testicular cancer in men ages 20 to 30 years old.

Marijuana use is also associated with serious mental health problems, but no one is sure whether marijuana causes or worsens mental illness, or if people that already have such illnesses use marijuana to self-medicate. One 2005 study found that four out of five people with schizophrenia used marijuana regularly as teenagers. An Australian study of long-term users of marijuana found structural changes in the hippocampus and amygdala areas of their brains. It may increase the risk for anxiety, depression, suicide, and psychosis as well as schizophrenia.

Marijuana seems to alter the information-processing mechanism in the hippocampus region of the brain, resulting in damage to memory and the ability to learn. One study of students who did well on tests as fourth graders found they scored lower as 12th graders if they were heavy users of marijuana. A study of 129 college students found that heavy marijuana users had impairment in attention, memory and learning.

Long-term users of marijuana have told researchers that they are disappointed in their achievements and relationships, and blame their drug use for their problems. There is some indication that heavy marijuana use takes away motivation.

A study of 450 employees found that people who use marijuana tend to be absent more –usually because of upper respiratory problems, and they are tardy more often and have more accidents than non-drug users.

Since the human brain continues to develop until age 25 years old, marijuana may have a more detrimental effect on young people. Some experts believe it may cause certain changes in the brain’s reward system, making young people more susceptible to drug addiction. It also puts them in contact with street dealers who push them to buy more dangerous drugs.

A University of Mississippi study done in 2009 involved an analysis of 65,000 samples of marijuana seized in all 50 states between 1975 and 2008. The research team found that the amount of THC increased every year, and street marijuana had become twice as strong in 2008 as it was 25 years ago. This could explain why the number of people addicted to marijuana keeps going up, while the number of users remain stable. As Dr. Nora Volkow, director of the National Institute on Drug Abuse, said, “It is like drinking beer versus whiskey. If you only have access to whiskey, your risk is higher for addiction. People now have access to very high potency marijuana.”

Marijuana And Drug Interactions

Marijuana interacts with central nervous system depressants, barbiturates, certain antidepressants such as Prozac. It also interacts with Coumadin and other blood thinners, drugs for asthma such as Theophylline, and disulfiram, a drug used for alcoholism.

People with diabetes should not take marijuana because it affects blood sugar. People with high blood pressure, liver diseases, and immune diseases should not use marijuana. It interferes with hormones and should not be used by women taking estrogen. Because it is addictive, people with histories of drug abuse or alcoholism should not experiment with marijuana.

Marijuana Withdrawal Syndrome

The timeline for withdrawal is about the same as that of tobacco withdrawal. Symptoms of withdrawal will begin one day after quitting marijuana, peak two or three days later and subside within a week or two. The severity of the withdrawal symptoms predicts whether a person will still be dependent on marijuana one year later.

Typical symptoms are anger, aggression, irritability, anxiety, nervousness, difficulty sleeping, weight loss, decreased appetite, and restlessness. There is less support in the research for symptoms such as depression, fatigue, trouble in concentration, craving, sweating, and chills.

Marijuana withdrawal is not as difficult as withdrawing from benzodiazepines, barbiturates, heroin and other opiates, cocaine, and nicotine. However, some heavy and chronic marijuana users have found the experience extremely difficult, experiencing symptoms for months that may include dislike of food, nightmares, and depression, even weepiness. These kinds of difficulties can indicate underlying psychological problems.

Marijuana Addiction Treatment And Recovery

There are very few drugs available to help people who are withdrawing or recovering from marijuana addictions. Among the drugs that have been tested and proven mostly ineffective are Buproprion, Nafazodone, Lithium, and cannabinoid antagonists. Taking THC orally and reducing the amounts gradually also had no effect on cravings. Lofexidine seemed to help recovering addicts sleep.

One challenge in recovering from marijuana addiction is that the drug takes away motivation, even the motivation to stop using drugs. Motivational interviewing and motivational incentives, which involve specialized therapy and/or offering people money for goods and services if they remain abstinent, are two techniques that have been shown to improve motivation and outcomes.

The vast majority of people with severe addictions to marijuana have comorbidities such as severe mental disorders like schizophrenia and bipolar disorder, or other underlying psychiatric problems such as childhood trauma, anxiety, depression, and so forth. These issues need to be addressed separately from their addiction, and sometimes certain medications are helpful. Cognitive behavioral therapy, learning relaxation techniques, setting goals with the help of a trained therapist, nutritional therapy, and attending support meetings such as Marijuana Anonymous can be helpful.

Sources:

Marijuana Penalties, The Department of Justice, Drug Enforcement Agency, see http://www.justice.gov/dea/agency/penalties.htm

National Institute of Drug Abuse, “Marijuana: Research Report Series” (pamphlet), see http://www.drugabuse.gov/sites/default/files/rrmarijuana.pdf

Gottfried, Ted. “Marijuana.”  New York: Benchmark Books, 2010, page 6.

“Cannabis,” The American Psychiatric Association, Criteria and Rational for the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, see

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=454

Kershaw, Sarah and Rebecca Cathcart. “Marijuana is a Gateway Drug,” The New York Times, July 19, 2009.

Gottfried, Ted, op cit,  pages 7-12.

Ibid, pg, 22-25.

National Institute of Drug Abuse, “Infofacts: Marijuana,”  see http://www.drugabuse.gov/publications/infofacts/marijuana

National Institute of Drug Abuse, Marijuana: Research Report Series (pamphlet), see http://www.drugabuse.gov/sites/default/files/rrmarijuana.pdf

Ibid.

National Institute of Drug Abuse, Marijuana: Research Report Series (pamphlet), see http://www.drugabuse.gov/sites/default/files/rrmarijuana.pdf

Gottfried, op cit, pg. 30.

“Marijuana: Its Use and Its Effects,” WebMD, see http://www.webmd.com/mental-health/marijuana-use-and-its-effects

National Institute of Drug Abuse, Marijuana: Research Report Series (pamphlet), see http://www.drugabuse.gov/sites/default/files/rrmarijuana.pdf

Ibid.

Doheny, Kathleen. “Medical Marijuana Has Merit,” see http://www.webmd.com/pain-management/news/20100218/medical-marijuana-has-merit-research-shows?print=true#

National Institute of Drug Abuse, “Infofacts: Marijuana,”  see http://www.drugabuse.gov/publications/infofacts/marijuana

“Cannabis,” The Mayo Clinic, see http://www.mayoclinic.com/health/marijuana/NS_patient-marijuana/METHOD=print&DSECTION=all

“Cannabis,” The American Psychiatric Association, Criteria and Rational for the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, see

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=454

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