Most users perceive marijuana as a healthy, natural plant. It's touted as a cure or treatment for pain, anxiety, seizures, and other various ailments. Yet, much of this is false. Dr. Roneet Lev, a board-certified emergency medicine physician and addiction specialist, tells us about what the pot industry prefers to keep to itself.
Cannabis, commonly known as marijuana, is legal for recreational or medical use in many states and is highly commercialized. In 2020, an estimated 57 million Americans used cannabis in the past year.
The marijuana plant has over 400 chemicals. The two most common chemicals are delta-9-tetrahydrocannabinol (THC), the main psychoactive component of cannabis, and cannabidiol (CBD), a non-psychoactive cannabinoid.
Most users perceive marijuana as a healthy, natural plant; it is touted as a cure or treatment for pain, anxiety, seizures, and other various ailments. At least, this is what the billion-dollar cannabis industry wants you to believe. Its masterful advertisement campaigns compete for sales with the alcohol industry while at the same time downplaying the many health hazards – something that few people are aware of.
In this paper, I have highlighted ten facts about marijuana. Cannabis users routinely end up in the emergency department, unaware of the science. As its use skyrockets during this time of deregulation, users of the drug must be made aware of the real risks.
Here are ten things smart consumers know about cannabis that the industry is not sharing:
- Potency and Product Integrity
- Addiction and Withdrawal
- Psychosis risk
- Pregnancy and Pediatric Exposures
- Drug Interactions with THC and CBD
- Cannabis Hyperemesis Syndrome
- Heart and Lung Health
- Cannabis and Pain
- Seizure risk
- Drugged Driving
1. Potency and Product Integrity
Cannabis products sold at dispensaries can contain a high percentage of THC, making the drug very potent. The plant products that are smoked may have THC levels as high as 17 – 40%. The concentrate products such as shatters, dabs, and oils can have concentrations near 90%. By comparison, the marijuana plant of 1995 averaged 4 % THC.
Many high-potency products were not on the market when the first states legalized marijuana. All research studies on cannabis were conducted on low potency products and do not apply to the new market products. The industry has been unregulated with regard to limiting potency, and it is these high levels of THC that are the driving force behind adverse health events.
The industry is also poorly regulated in terms of contaminants. In a study from UC Davis, 20 out of 20 legal dispensaries were found to have contaminants in their plant-based products. Fungal contamination of cannabis flower is well known. This prompted the CDC to warn against smoking cannabis for organ transplant recipients and those with other immunocompromising conditions. People who are immunocompromised should not be smoking or vaping cannabis products.
2. Addiction and Withdrawal
Cannabis use disorder or addiction is defined using the same DSM V 11-point criteria as alcohol use disorder or opioid use disorder. Cannabis use disorder (CUD) occurs in 9% of adults who use marijuana and up to 25-50% of daily users. Three out of 10 cannabis users developed CUD. Increased addiction is associated with younger age of onset and higher frequency of use.
We know that brain development continues into the mid 20’s, with final myelination occurring in the frontal cortex and pruning of neuronal pathways. The incomplete frontal lobe development results in poor executive functioning and several traits like impulsivity and sensation-seeking that are associated with the risk of developing a substance use disorder. Substance exposures to the growing brain are up to seven times more likely to result in addiction than for older adults. While the legal age for drinking alcohol or consuming cannabis may be 21, the scientific age for preventing addiction is 25 years or even older.
Cannabis withdrawal is reported in up to 30% of regular users and 50-90% of heavy users. Many cannabis users do not believe they suffer from withdrawal until they understand that the symptoms of cannabis withdrawal are different than alcohol or opioid withdrawal. The common symptoms of cannabis withdrawal are irritability, anxiety, insomnia, headache, and significant cravings for marijuana. Typically, these symptoms last for about two weeks after cessation.
3. Cannabis Induced Psychosis
Cannabis is known to cause neuropsychiatric symptoms; FDA drug labels for low concentration THC reflect this. The agency has researched and published adverse effects and warnings for pure THC when approving prescription THC called dronabinol (Marinol, THC). The FDA warning for dronabinol incudes neuropsychiatric adverse reactions, hemodynamic instability for patients with cardiac disorders, seizures, and paradoxical nausea, vomiting, and abdominal pain.
High potency THC has a greater association with psychosis. Large European studies associated high potency THC, defined at over 10% concentration in plant-based products, with a 5-fold increased odds ratio of developing a psychotic disorder. A study published in the Lancet of 10 studies including 7390 patients showed a dose-response between frequency of cannabis and risk of psychosis. Furthermore, states with liberal cannabis laws have increased psychosis associated with cannabis.
4. Pregnancy and Pediatric Exposures
The Surgeon General has issued a warning against using cannabis products while pregnant. The American College of Obstetrics and Gynecology similarly advises against using cannabis products during conception, pregnancy, and lactation.
The ABCD study of Adolescent Brain Cognitive Development is the largest long-term study of brain development and child health, reaching 11,878 children. The study showed an increased risk of children with psychosis when their mother used cannabis while pregnant. In another study, children aged 3 – 6 were more likely to have anxiety, aggression, and hyperactivity if mothers used cannabis while pregnant.
Marijuana-related hospital encounters in children under the age of 6 increased 13.3-fold in 2018 compared to 2004, with 15% requiring intensive care treatment. Pregnant women should not use cannabis products. Cannabis products should be locked away from children.
5. Drug Interactions
While drug prevention experts focus on youth, adults should also be aware of health risks, especially if they take other medications. Both THC and CBD are metabolized by the cytochrome P450 system and, therefore, may interact with many medications. Examples include Benadryl, Flexeril, Lexapro, Lyrica, Seroquel, Xanax, Zoloft, and Zyrtec. THC and CBD used in combination with blood thinners present a risk of spontaneous bleeding. It is recommended to use medication interaction checkers that include cannabis or cannabidiol (such as the one available for free at Drugs.com).
6. Cannabis Hyperemesis Syndrome
Cannabis Hyperemesis Syndrome (CHS) is associated with long-term cannabis use, typically of smoked product. The symptoms of CHS have been described as “scromiting,” screaming, and vomiting. There are reported deaths with CHS caused by electrolyte imbalance. This problem is based on the inundation of THC on the cannabinoid receptors over a long period causing the neurons to act irradicably. The cure for cannabis hyperemesis syndrome is the cessation of marijuana use, which is easier said than done since people with this disorder most likely have an addiction.
7. Heart and Lung Health
Patients with cardiovascular disease should be cautioned about cannabis use related to their individual medical diagnosis, per the American Heart Association. This follows as high potency THC behaves as a stimulant. There are associations with heart attack, stroke, and irregular heart rhythms. Smoking and vaping any product is detrimental to pulmonary health. Smoked cannabis products can contain similar toxins to tobacco products. In fact, vaping cannabis is worse for the lungs than tobacco. A marijuana joint produces 3.5 times as much secondhand smoke as a Marlboro cigarette.
8. Cannabis and Pain
Most people who use marijuana as medicine claim it helps with pain. However, cannabis is contraindicated in patients who have an opioid use disorder according to the American Society of Addiction Medicine. Concurrent marijuana and long-term opioid use does not improve pain. Cannabis use increased the risk of opioid use disorder in a study of 34,653 participants.
There is false and dangerous messaging that marijuana is good for seizures. In fact, it decreases the seizure threshold and increases the risk of seizures. CBD, cannabidiol, is available in prescription form as Epidiolex and is recommended for a select subset of babies with a rare seizure disorder called Dravet Syndrome or Lennox-Gastaut Syndrome. These babies are not smoking pot or using any type of THC product. CBD is pharmacologically distinct from THC.
10. Drugged Driving
Drugged driving is a public health issue that is growing. A study of 191 regular cannabis users measured a composite driving score after smoking delta-9-THC cigarettes. Driving scores diminished 30 minutes and 90 minutes after smoking THC. It took 4.5 hours to return to baseline. Overall, marijuana users were about 25% more likely to be involved in a crash than drivers with no evidence of marijuana use. The National Highway Traffic Safety Administration published information on Drug-Impaired Driving.
As is the case with alcohol, tobacco, and opioids, there are health risks associated with cannabis use. What makes marijuana unique today is that the public is unaware of the many risks. Consumers deserve to know the risk of cannabis, especially the new high potent THC products. An educated public makes informed decisions.