Marijuana Dependence

MARIJUANA

Marijuana is a dried mixture of the leaves and flowers of Cannabis sativa, or hemp plant. Slang words for marijuana include "pot," "weed," "grass," and "dope." The term "cannabis" refers to different psychoactive preparations of the plant, including marijuana, hashish, and hashish oil. Hashish is the resin produced by the flowering tops of the plants; hashish oil is a concentrated form of cannabis extracted from the plant or resin using a solvent. Unpollinated female plants are called sinsemilla (sen-suh-mee-ah) and the flowering tops of these plants produce potent "buds" that do not contain seeds.

The major psychoactive ingredient in cannabis is delta-9-tetrahydrocannabinol (THC), but there are more than sixty related chemicals in marijuana, which are called "cannabinoids." Cannabis also contains other unrelated compounds that have similar psychoactive effects. The World Health Organization reported in 1997 that THC content in marijuana ranges from 0.5 to 4 percent, while concentrations in cannabis oil, hashish, and sinsemilla generally range from 7 to 14 percent, but may be as high as 20 percent. THC concentration depends on the variety, sex, and growing conditions of the plant, and it has increased over the years due to hydroponic cultivation techniques and selective breeding.

Marijuana and other cannabis products are usually smoked as a cigarette (a "joint") or in pipes, but may also be ingested orally. In the 1990s, the use of "blunts" to smoke marijuana became more common. A blunt is made by removing the tobacco from a cigar wrapper and filling it with marijuana, or a mixture of marijuana and some other drug like cocaine.

PSYCHOACTIVE AND PHYSIOLOGICAL EFFECTS

THC is absorbed more quickly into the bloodstream when smoked than when eaten. Effects are felt almost immediately and peak within thirty minutes of smoking. The marijuana "high" results when the THC binds with cannabinoid receptors in the brain. This process slows down regular nerve transmission, interfering with normal function. The cannabinoid receptors are located in the areas of the brain involved in muscle control, sexual functioning, vision and hearing, reasoning, hormone release, and memory.

Short-term effects include a temporary increase in heart rate, blood pressure, and blood flow to parts of the brain. Users generally feel a sense of euphoria, relaxation, hilarity, and heightened sensory perception. Negative psychological reactions may include anxiety, hallucinations, and panic attacks. Many smokers report that they feel unmotivated when they are high. Cannabis intoxication alters perceptions of time and space and impairs reaction time—affecting the performance of psychomotor tasks such as driving, which increases the risk of motor vehicle accidents. Cannabis increases food intake, impairs learning capabilities, and affects short-term memory. Many cannabis effects are subjective and influenced by the social circumstances, but the extent of impairment mainly depends on the potency and dose of the drug, the individual's tolerance to and experience using cannabis, and the difficulty and complexity of the task at hand.

LONG-TERM HEALTH CONSEQUENCES

Many of the studies done on the health consequences of marijuana have been inconclusive, although a picture is emerging of some worrisome long-term health effects. Smoking marijuana affects the respiratory system in much the same way as cigarette smoking. Cannabis smoke contains many of the same toxic chemicals and carcinogens as tobacco, as well as cannabinoids, all of which are respiratory irritants. Frequent marijuana smokers often report laryngitis, hoarseness, and coughing, and they are more likely than infrequent or nonusers to get acute and chronic bronchitis.

In a comprehensive analysis of the health effects of cannabis, the World Health Organization reports that cannabis is known to have adverse effects on the immune system, reproductive system, adrenal hormones, growth hormone, and cognitive function, particularly related to attention and memory processes. The long-term consequences of these effects, however, are not fully known, and further research is warranted. Smoking marijuana during pregnancy reduces oxygen flow to the fetus, which may interfere with growth and result in low birth weight, premature birth, and deficits in verbal ability and memory during childhood.

Preliminary research has demonstrated some positive health benefits of marijuana, including control of nausea and vomiting in people suffering from advanced cancer and AIDS (acquired immunodeficiency syndrome), appetite stimulation for those with wasting diseases, treatment of glaucoma by reducing intraoculer pressure, and control of convulsions and muscle spasms. More research in these areas is needed.

TRENDS IN MARIJUANA USE

Marijuana use by young people in North America peaked at the end of the 1970s, then declined progressively until the early 1990s, when use began to rise again. In the United States, it appears that the rate of increase may have stabilized at the end of the 1990s, although this stabilization was not apparent in Canada. The Monitoring the Future Survey found that lifetime use of marijuana among U.S. high school seniors peaked in 1979 at 60.4 percent, declined to a low of 32.6 percent in 1992, then rose to 49.6 percent in 1997, where it appears to have leveled off. A 1998 Canadian study on marijuana use did not report use among twelfth graders, but did find that approximately 42 percent of tenth graders had used marijuana in the previous year, up from 25 percent in 1991. In comparison, in 1998 only 31.1 percent of tenth graders in U.S. high schools reported use.

Marijuana use across the entire U.S. population was examined in a household survey in 1992 by the National Institute on Drug Abuse, which reported that 33 percent of Americans age 12 years and over had tried marijuana, 9 percent had used it during the previous year, and approximately 4 percent were current users, though the rate of use varied with age. These figures changed little in the 1998 survey. The proportion of Americans who reported having used marijuana at some point in their life was 11 percent among those 12 to 17 years old, 59 percent among those 26 to 34 years old, and 25 percent among people 35 years old and older.

1n 1994, the Canada Alcohol and Other Drug Survey found that 28 percent of Canadians had used cannabis at least once, 7.4 percent used it in the past year, and 3.2 percent were current users. During the early to mid-1990s, the proportion of people in other countries who reported having tried marijuana was 34 percent in Australia, 43 percent in New Zealand, 37 percent in Denmark, 17 percent in Switzerland and 14 percent in the United Kingdom. In general, marijuana use is lower among European, African, Asian, and South American youth than among young people in North America.

Different subgroups in the North American population report different rates of use. In general, males and white youth report higher rates of marijuana use than females, black youth, or young people from other racial or ethnic backgrounds. Young people who have dropped out of school are more likely to use cannabis than those who are in school, and 84.5 percent of students who attended alternative high schools in 1998 said they had tried cannabis.

MARIJUANA AND SUBSTANCE ABUSE

Since the 1970s, research has consistently demonstrated that adolescents progress through a uniform sequence of drug use involvement that begins with alcohol, cigarettes, and marijuana and proceeds to the use of "hard" drugs like hallucinogens, benzodiazepenes, amphetamines, sedatives, cocaine, and heroin. For this reason, marijuana, alcohol, and tobacco have been called "gateway" drugs. Some studies have shown that use of marijuana is almost a necessary condition for cocaine use by youth. The more frequently and intensively that gateway drugs are used, the greater the likelihood of dependence on the drug and progression to a later stage in the sequence of substance use involvement. However, most young people who use marijuana do not progress to dependence, or use harder drugs. The majority of marijuana users do not use other illicit drugs, although they are more likely to smoke cigarettes and drink alcohol than nonusers. Heavy use of marijuana does, however, place users in contact with more diverse networks of drug users and sellers, thereby increasing their exposure to other drugs and to the influence of those who use them. Participation in street culture is related to marijuana use. Those young people who do progress to abuse other illicit drugs and who experience the most harmful consequences are more likely to be socially and economically disadvantaged.

PREVENTION

Most cannabis-use prevention programs are school based, and they tend to focus on illicit drugs in general, not just marijuana. The existence of a stable pattern of drug use suggests that prevention efforts should be directed not only at preventing the initiation of use, but also at curbing the transitions from experimental to regular use of any of the gateway drugs and the transition to other drugs. In reviewing what works in drug-use prevention, D. R. Gerstein and L. W. Green found that no prevention programs were reliably effective in all cases with all groups. However, a number of principles for effective prevention have been identified. The U.S. National Institute on Drug Abuse suggests that programs should be comprehensive and long-term, with reinforcement over several years; should target all forms of drug abuse; focus on the family, with a parent or caregiver component; include interactive methods, and be age-specific, developmentally appropriate, and culturally sensitive. School programs are best offered in the sixth through tenth grade, and should include components to develop interpersonal social skills, resistance skills, and self-efficacy, and to improve knowledge of health effects. The higher the level of risk in the specific population, the more intensive and targeted the program should be.

MARJORIE A. MACDONALD

(SEE ALSO: Addiction and Habituation; Behavior, Health-Related; Health Promotion and Education; School Health; Social Determinants; Substance Abuse, Definition of)

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