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Cannabis Compound Abuse

Marijuana was introduced to the Western Hemisphere in the early

1500s. African slaves brought marijuana plants with them to the Portuguese
colony of Brazil, while the Spaniards began growing it in Chile.
Cannabis was introduced to the Virginia colony of Jamestown in 1611
and to the Massachusetts Bay Colony in 1629. Although primarily used as a
source of fiber, cannabis occasionally was smoked. Cannabis began to be
used medicinally and was grown by many American planters.
In the United States, recreational abuse of marijuana became more
common in the early 20th century. Marijuana was enjoyed with bathtub gin in
the Prohibition Era (1920s). In the 1960s, marijuana use became associated
with the widespread cultural changes. As a result of the Comprehensive Drug
Abuse Prevention and Control Act of 1970, the penalties for marijuana use
became substantially less than the penalties for other drugs such as cocaine
or heroin. The medicinal use of cannabis currently is the subject of intense
legal and medical debate in the United States.
Pathophysiology: Cannabis contains several pharmacologically active
substances, of which, the most powerful psychoactive member is delta-ltetrahydrocannabinol (THC). Pyrolysis of marijuana releases more than 100
substances that are subsequently inhaled with the smoke.
Little is known about how marijuana exerts its psychological effects at
the CNS cellular level. Most of the hypothesized activities of marijuana are
based upon associative evidence. Because marijuana has sedative effects,

some studies have hypothesized activation of benzodiazepine (BZ) receptors

in the limbic system and cerebellum. Other studies have viewed the sedating
properties as potential evidence of GABA receptor activity.
THC binding sites are known to be distributed widely throughout the
brain. The density of these sites is highest in the basal ganglia and
cerebellum. They are moderately dense in the hippocampus and cortex.
These sites of action may partially account for the psychotoxic effects of the
drug.
Frequency:

In the US: Marijuana remains the most commonly used

illicit drug in the United States. According to data from the 1998
National Household Survey on Drug Abuse (NHSDA), more than 72
million Americans (33%) aged 12 years and older have tried marijuana
at least once in their lifetimes.

Internationally: Rates of abuse vary widely. The hypothesis

that cannabis is the most widely used illicit drug in most Western
countries is generally accepted.
Race: Marijuana is abused among all racial groups, with no propensity
for any one race.
Sex: Males consistently outnumber females in surveys of marijuana
users.
Age: Adolescents and young adults are the most common group to
abuse this substance; however, abuse may be observed relatively commonly
in most age groups.
People who use marijuana may present either with acute effects of

intoxication or with symptoms resulting from chronic use.

Onset of symptoms of marijuana intoxication occurs within a few minutes of
smoking or within half an hour of oral ingestion. The duration of action usually
is 6-12 hours; symptoms are most marked in the first 1-2 hours. The following
symptoms may be prominent in acute intoxication:
o

Euphoria

Relaxation

Subjective feelings of well-being or grandiosity

Perceptual changes (including visual distortions)

Drowsiness and sluggishness

Diminished coordination

Paradoxical hyperalertness

A subjective sense of slowing of the passage of time

Increased appetite (the "munchies")

Although commonly misperceived as universally resulting in a relaxed and

euphoric state, cannabis intoxication can produce a dysphoric reaction.
Carefully examine patients for evidence of suicidality and homicidality,
document presence or absence thereof, and manage as indicated.
Physical: Physical signs and symptoms reflect the effects of marijuana
on multiple organ systems and can be classified according to the system
involved.

Effects on central and peripheral nervous systems:

Cannabis-induced cerebral atrophy or neuropsychological impairment

remains a controversial diagnosis. Chronic effects of long-term

marijuana use may be related to marijuana's significant fat solubility

resulting in high blood levels of the drug after extended use. Marijuanainduced seizures have been described. Studies using simulated driving
and flying situations have shown that the use of cannabis has a
profound effect on estimations of time and distance and causes
impairment of attention and short-term memory. These effects are still
discernible 24-48 hours after use of the drug.

Effects on respiratory system: Cannabis smoke contains

carcinogens similar to those found in tobacco smoke, and chronic

heavy marijuana use may predispose people to chronic obstructive
lung disease. Some studies indicate that pulmonary neoplasms are
more common among habitual marijuana users; however, confounding
by cigarette smoking limits the interpretability of some of these reports.

Effects on cardiovascular system: Acute intoxication may

induce tachycardia and orthostatic hypotension.

Effects on reproductive system: Marijuana has been

linked to infertility. In vitro studies have reported abnormal cell division

and abnormal spermatogenesis resulting in decreased sperm counts;
however, the effects of marijuana on human fertility remain unclear. In
females, marijuana use may increase the number of anovulatory
cycles. In males, marijuana use may cause a decrease in folliclestimulating hormone, resulting in a decrease in testosterone production
and, possibly, testicular atrophy.

Effects on gastrointestinal tract: Marijuana has known

antinausea properties and the use of marijuana has been permitted for
the treatment of nausea in some US states for this reason.

Ocular effects: Injected conjunctivae may occur.

Lab Studies: Cannabinoids can be detected in the urine for as many

as 21 days after use in persons chronically using marijuana because these
lipid soluble metabolites are slowly released from fat cells into the blood;
however, 1-5 days is the normal urine-positive period. Blood samples may be
used to measure quantitative levels of cannabinoids.
Treatment
People who use marijuana and are suffering from biological, psychological,
or social impairment from marijuana use should be evaluated and, if
necessary, treated by a psychiatrist. The treatment of marijuana abuse
follows the general principals of substance abuse, with particular attention
paid to psychological and social aspects. Lifestyle changes, such as avoiding
drug-related situations, may be encouraged. Identify and address low selfesteem, mood disorders, family problems, and other stresses. One-to-one
therapy, group therapy, and even hospitalization may be necessary
components of the treatment plan. (Patients with uncomplicated marijuana
use in the absence of other psychiatric or medical problems are rarely
hospitalized.)
Short-term, low-dose BZ treatment for acute intoxication has been
used. Chronic psychosis associated with marijuana use may require
antipsychotic treatment. Drug therapies that diminish cravings for marijuana
or intoxicating effects from marijuana use currently are not available.
Treatment includes behavior therapy (aimed at reducing the chances of
reexposure and establishing coping mechanisms to resist further use); family,
group, and individual therapy; and periodic testing of urine to monitor
abstinence.

Adolescent drug programs usually focus on promoting communication skills

and age-appropriate behaviors.
School-based programs and peer-led groups may be useful in primary
prevention of marijuana abuse.
Complications:

Marijuana use may be complicated by comorbid substance

use and medical problems as outlined.

Marijuana abuse may result in infants with low birth weights.

THC is soluble in breast milk and can be passed to infants.

Prognosis:

As with other substance abuse conditions, relapse is

common, and treatment may be necessary for multiple episodes.

Picture 1. Cannabis sativa

Picture 2.
The

major

psychoactive

tetrahydrocannabinol (THC).

component

of

marijuana

is