Cannabis, or marijuana, is a psychoactive herb that comes from the cannabis plant. Many states across the nation have either legalized marijuana, regulated its medical use, or have a low tetrahydrocannabinol (THC) program. (THC is the main active chemical in marijuana.)
Marijuana is a mixture of dried, shredded flowers, as well as leaves of the plant Cannabis sativa. Stronger forms of cannabis include sinsemilla, hashish or hash, and hash oil.
Marijuana is usually smoked and can be found in electronic cigarettes as well as in cigars that have been emptied of tobacco and refilled with marijuana, known as blunts. Marijuana cigarettes or blunts sometimes include crack cocaine, and some users mix marijuana in food or brew it in tea.
All forms of cannabis are mind-altering, psychoactive drugs, and all forms contain THC. Marijuana's effect on the user depends on the amount of THC in which the person is exposed. The potency of the drug is measured by the average amount of THC in test samples confiscated by law enforcement agencies; these samples show the following:
- Most ordinary marijuana contains, on average, 7 percent THC.
- Sinsemilla, from buds, contained 12 percent THC on average but ranged from less than 1 percent to 27 percent.
- Hashish, the sticky resin from female flowers, had an average of 10 percent THC but ranged from 1 percent to 26 percent.
The Monitoring the Future Survey, conducted yearly, includes students from middle through high school. A finding from a recent survey shows that marijuana vaping by adolescents has remained steady between 2019 and 2020. Daily or near-daily marijuana vaping has decreased overall among teens, with the highest decrease among 10th graders. However, daily marijuana use has remained nearly the same.
According to the CDC, 48.2 million people used marijuana at least once in 2019, and approximately 3 in 10 marijuana users have marijuana use disorder.
Signs and symptoms as cataloged by the DSM-5:
A problematic pattern of cannabis use leading to clinically significant impairment or dis­tress, as manifested by at least two of the following, occurring within a 12-month period:
- Cannabis is often taken in larger amounts or over a longer period than intended.
- There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
- A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.
- Craving or a strong desire or urge to use cannabis.
- Recurrent cannabis use resulting in a failure to fulfill major obligations at work, school, or home.
- Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
- Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
- Recurrent cannabis use in situations in which it is physically hazardous.
- Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.
Tolerance, as defined by either of the following:
- A need for markedly increased amounts of cannabis to achieve intoxication or desired effect.
- Markedly diminished effect with continued use of the same amount of cannabis.
- Withdrawal, as manifested by either of the following: The characteristic withdrawal syndrome for cannabis; cannabis is taken to relieve or avoid withdrawal symptoms.
Because some cannabis users are motivated to minimize their frequency of use, it is important to be aware of common signs and symptoms of cannabis use and intoxication so as to better assess the extent of use. As with other substances, experienced users of cannabis develop behavioral and pharmacological tolerance such that it can be difficult to detect when they are under the influence. Signs of acute and chronic use include red eyes (conjunctival injection), cannabis odor on clothing, yellowing of fingertips (from smoking joints), chronic cough, burning of incense (to hide the odor), and exaggerated craving and impulse for specific foods, sometimes at unusual times of the day or night.
With adolescent users, changes in mood stability, energy level, and eating patterns are commonly observed. These signs and symptoms are likely due to the direct effects of cannabis use (intoxication) and the subsequent effects following acute intoxication (coming down), as well as attempts to conceal use from others. School-related problems are commonly associated with cannabis use disorder in adolescents, particularly a dramatic drop in grades, truancy, and reduced interest in general school activities and outcomes.
Cannabis use disorder among adults typically involves well-established patterns of daily cannabis use that continue despite clear mental health or medical problems. Many adults have experienced repeated desire to stop or have failed at repeated cessation attempts. Milder adult cases may resemble the more common adolescent cases in that cannabis use is not as frequent or heavy but continues despite potential significant consequences of sustained use. Meanwhile, the rate of use among middle-aged and older adults appears to be increasing.
Early onset of cannabis use (prior to age 15 years) is a robust predictor of the development of cannabis use disorder and other types of substance use disorders and mental disorders during young adulthood. Such early onset is likely related to other externalizing problems, most notably conduct disorder. However, early onset is also a predictor of internalizing problems and probably reflects a general risk factor for the development of mental health disorders.
Is marijuana a gateway drug?
There is cross-sensitization between different substances—meaning that, after being exposed to one drug, there is heightened responsiveness to another drug. But according to the National Institute on Drug Abuse, most people who use marijuana do not progress to hard drugs, such as heroin or ecstasy. Another possibility, however, may be that individuals more at risk for hard substances find marijuana more readily available, and therefore start with marijuana.
Is there a link between marijuana and psychosis?
Research that appeared in The Lancet Psychiatry has found that people who smoke cannabis regularly, or those who smoke it with a high THC potency, are more at risk for first psychotic episodes. In one large-scale study, subjects who used high-potency cannabis daily were almost five times more likely to experience an episode of psychosis. Marijuana use can intensify the experience of psychotic symptoms for those who have schizophrenia.
Is there a link between schizophrenia and marijuana?
Yes. The use of cannabis can have both positive and negative impacts, due to the different cannabinoids in the drug. People who suffer from schizophrenia and who smoke marijuana regularly appear to develop the disease earlier than individuals with schizophrenia who do not use marijuana. The onset of symptoms is, on average, three years earlier for the marijuana users. The cannabinoid THC can trigger psychosis in individuals with and without schizophrenia.
However, many people with schizophrenia self-medicate with cannabis. This is because marijuana also contains cannabidiol (CBD), a cannabinoid that differs from THC and can have an antipsychotic effect. Because CBD can diminish symptoms of psychosis, it is currently under investigation as a treatment for schizophrenia.
Associated features, development, and course as cataloged by the DSM-5:
Individuals who regularly use cannabis often report that it is being used to cope with mood, sleep, pain, or other physiological or mental health problems, and those diagnosed with cannabis use disorder frequently do have other concurrent mental disorders. Careful assessment typically reveals reports of cannabis use contributing to exacerbation of these same symptoms, as well as other reasons for frequent use (to experience euphoria, to forget about problems, in response to anger, as an enjoyable social activity). Related to this issue, some individuals who use cannabis multiple times per day for the aforementioned reasons do not perceive themselves as (and thus do not report) spending an excessive amount of time under the influence or recovering from the effects of cannabis, despite being intoxicated on cannabis or coming down from its effects for the majority of most days. An important marker of a substance use disorder diagnosis, particularly in milder cases, is continued use despite a clear risk of negative consequences to other valued activities or relationships (school, work, sports activity, partner or parent relationship).
The onset of cannabis use disorder can occur at any time during or following adolescence, but onset is most commonly during adolescence or young adulthood. Although much less frequent, the onset of cannabis use disorder in the preteen years or in the late 20s or older can occur. Acceptance of the use and its availability may increase the rate of onset of cannabis use disorder among older adults.
Generally, cannabis use disorder develops over an extended period of time, although the progression appears to be more rapid in adolescents, particularly those with pervasive conduct problems. Most people who develop a cannabis use disorder typically establish a pattern of cannabis use that gradually increases in both frequency and amount. Cannabis, along with tobacco and alcohol, is traditionally the first substance that adolescents try. Many perceive cannabis use as less harmful than alcohol or tobacco use, and this perception likely contributes to increased use.
Cannabis use disorder among preteens, adolescents, and young adults is typically expressed as excessive use with peers that is a component of a pattern of other delinquent behaviors usually associated with conduct problems. Milder cases primarily reflect continued use despite clear problems related to the disapproval of use by other peers, school administration, or family, which also places the youth at risk for physical or behavioral consequences. In more severe cases, there is a progression to using alone or using throughout the day such that use interferes with daily functioning and takes the place of previously established prosocial activities.
How is cannabis intoxication different from alcohol intoxication?
Cannabis intoxication does not typically result in as severe behavioral and cognitive dysfunction as does significant alcohol intoxication, which may increase the probability of more frequent use in more diverse situations than with alcohol. These factors likely contribute to the potential rapid transition from cannabis use to cannabis use disorder among some adolescents and the common pattern of using throughout the day that is commonly observed among those with more severe problems.
Each individual is different, and treatment is tailored to a person's needs. First, individuals need to acknowledge whether they have a problem, which will make controlling their cravings easier. People in treatment can learn behavioral strategies to change habits. Sometimes, medications are part of the treatment regimen.
- Treatment should enable patients to reduce drug use.
- Improve the person's ability to function.
- Minimize complications for people with additional medical problems such as heart disease or others.
- Adopt healthier lifestyles.
Treatments for marijuana dependence can include:
- Behavioral therapies
- Support groups
Are there medications for marijuana dependence?
There are currently no medications for treating marijuana dependence. Drug treatment researchers are identifying which characteristics of users are predictors of treatment success and which approaches to treatment can be most helpful.