Marijuana Marijuana

Medical Friend or FoeMedical Friend or Foe

West Virginia University School of Medicine

Department of Behavioral Medicine and Psychiatry

Ehab Abdallah M.D.

Classifying MarijuanaClassifying Marijuana

Marijuana produces some excitatory effects but it is Marijuana produces some excitatory effects but it is not generally regarded as a stimulant. not generally regarded as a stimulant.

Marijuana produces sedative effects, but a person Marijuana produces sedative effects, but a person faces no risk of slipping into a coma or dying. faces no risk of slipping into a coma or dying.

Marijuana produces mild analgesic effects, but it is not Marijuana produces mild analgesic effects, but it is not related pharmacologically to opiates like drugs. related pharmacologically to opiates like drugs.

Marijuana produces hallucinations at high doses, but Marijuana produces hallucinations at high doses, but its structure does not resemble LSD or any other drug its structure does not resemble LSD or any other drug formally categorized as hallucinogen.formally categorized as hallucinogen.

So marijuana So marijuana is clearly a is clearly a hybrid drug hybrid drug in a league of in a league of its own.its own.

Basic TerminologyBasic Terminology

MarijuanaMarijuana is is frequently a frequently a synonym for synonym for cannabiscannabis but but technically the two technically the two terms are separate. terms are separate.

CannabisCannabis is the is the botanical term for botanical term for the hemp plant the hemp plant cannabis sativacannabis sativa. .

Cannabis sativa have been Cannabis sativa have been

commercially valuable for commercially valuable for thousands of years in the thousands of years in the manufacture of rope, shoes, manufacture of rope, shoes, sailcloth, and containers of all kinds. sailcloth, and containers of all kinds.

Pots made of hemp fiber discovered Pots made of hemp fiber discovered at archeological sites in China date at archeological sites in China date the origins of cannabis as far back the origins of cannabis as far back as the Stone Age.as the Stone Age.

Cannabis sativa is arguably the Cannabis sativa is arguably the oldest cultivated plant not used for oldest cultivated plant not used for food.food.

Brief History Brief History

Spaniards Spaniards brought brought cannabis to cannabis to the New World the New World in 1545. in 1545.

English settlers brought it to Jamestown, English settlers brought it to Jamestown, Virginia in 1611 as a major commercial Virginia in 1611 as a major commercial crop along with tobacco.crop along with tobacco.

In the eighteenth-century George In the eighteenth-century George Washington grew cannabis on his farm. Washington grew cannabis on his farm. Entries in his diary indicated that he Entries in his diary indicated that he maintained a keen interest in cultivating maintained a keen interest in cultivating better strains of cannabis, but there is no better strains of cannabis, but there is no reason to believe he was interested in reason to believe he was interested in anything more than a better quality of anything more than a better quality of rope. rope.

Marijuana – The PlantMarijuana – The Plant Marijuana is obtained from serrated Marijuana is obtained from serrated

leaves from the cannabis plant.leaves from the cannabis plant. The key psychoactive factor is The key psychoactive factor is

contained in a sticky substance, or contained in a sticky substance, or resin, that accumulates on these resin, that accumulates on these leaves. leaves.

Depending on the growing conditions, Depending on the growing conditions, cannabis will produce either a greater cannabis will produce either a greater amount of resin or greater amount of amount of resin or greater amount of fibers. fibers.

Marijuana – The Plant Marijuana – The Plant

In hot, dry climates such as North In hot, dry climates such as North Africa the fiber content is weak but Africa the fiber content is weak but so much resin is produced that the so much resin is produced that the plant looks as if it is covered with plant looks as if it is covered with dew. dew.

In cooler more humid climates In cooler more humid climates such as North America less resin is such as North America less resin is produced but the fiber is stronger produced but the fiber is stronger and more durable. and more durable.

DefinitionsDefinitions

CannabinoidsCannabinoids: Any of the several dozen : Any of the several dozen active substances in marijuana and other active substances in marijuana and other cannabis products. cannabis products.

Delta-9-tetrahydrocannainol (THC):Delta-9-tetrahydrocannainol (THC): The The active psychoactive ingredient in active psychoactive ingredient in marijuana and hashish.marijuana and hashish.

MarijuanaMarijuana: The most commonly available : The most commonly available psychoactive drug originated from the psychoactive drug originated from the cannabis plant. The THC concentration cannabis plant. The THC concentration ranges from approximately 1 to 4 ranges from approximately 1 to 4 percent. percent.

DefinitionsDefinitions

SinsemillaSinsemilla: A form of marijuana : A form of marijuana obtained from the un-pollinated or obtained from the un-pollinated or seedless portion of the cannabis seedless portion of the cannabis plant, it has a higher THC plant, it has a higher THC concentration than regular concentration than regular marijuana, as high as 6 percent.marijuana, as high as 6 percent.

HashishHashish: A drug containing the resin : A drug containing the resin of cannabis flowers, the THC of cannabis flowers, the THC concentration ranges from concentration ranges from approximately 8 to 14 percent. approximately 8 to 14 percent.

DefinitionsDefinitions

Hashish Oil:Hashish Oil: A drug produced by A drug produced by boiling hashish, leaving the potent boiling hashish, leaving the potent psychoactive residue, the THC psychoactive residue, the THC concentration ranges from concentration ranges from approximately 15 to 60 percent. approximately 15 to 60 percent.

Hashish oil crystals:Hashish oil crystals: Solid form of Solid form of hashish oil. hashish oil.

BhangBhang: A liquid form of marijuana, : A liquid form of marijuana, popular in India. popular in India.

The History of The History of Marijuana and Hashish Marijuana and Hashish The first direct reference to a cannabis The first direct reference to a cannabis

product as a psychoactive agent dates product as a psychoactive agent dates from 2737 B.C. in the writings of the from 2737 B.C. in the writings of the Chinese emperor Shen Nung. The focus Chinese emperor Shen Nung. The focus was on its powers as a medication for was on its powers as a medication for rheumatism, gout, malaria, and rheumatism, gout, malaria, and strangely enough absent- mindedness.strangely enough absent- mindedness.

In India the use was clearly recreational In India the use was clearly recreational as the most popular form is liquid made as the most popular form is liquid made from cannabis leaves called Bhang. from cannabis leaves called Bhang.

History History

The Muslim world also grew to appreciate The Muslim world also grew to appreciate the psychoactive potential of cannabis, the psychoactive potential of cannabis, encouraged by the fact that ,in contrast encouraged by the fact that ,in contrast to its stern prohibition of alcohol to its stern prohibition of alcohol consumption, The Koran did not consumption, The Koran did not specifically ban its use.specifically ban its use.

In Iran, because of the hot dry climate In Iran, because of the hot dry climate and high resin content of the cannabis, and high resin content of the cannabis, hashish was born and its popularity hashish was born and its popularity spread quickly during the twelfth century spread quickly during the twelfth century from the east to North Africa in the West. from the east to North Africa in the West.

Hashish in the Hashish in the Nineteenth CenturyNineteenth Century

Before the nineteenth century hashish was not Before the nineteenth century hashish was not known in Europe, Pope Innocent VIII in 1484 known in Europe, Pope Innocent VIII in 1484 condemned witchcraft and the use of hemp in condemned witchcraft and the use of hemp in the Black Mass . the Black Mass .

By 1800 marijuana was widely used for two By 1800 marijuana was widely used for two reasons: 1) French soldiers who had served in reasons: 1) French soldiers who had served in Napoleon’s campaigns in Egypt brought Napoleon’s campaigns in Egypt brought hashish back with them to their homes in hashish back with them to their homes in France. 2) The wave of romanticism that swept France. 2) The wave of romanticism that swept over Europe, including an increased interest in over Europe, including an increased interest in exotic stories of the East, such as exotic stories of the East, such as Arabian Arabian NightsNights and and The Tales of Marco PoloThe Tales of Marco Polo which which contained references to hashish. contained references to hashish.

Hashish in the Hashish in the Nineteenth CenturyNineteenth Century

In Paris during 1840’s a small group of In Paris during 1840’s a small group of prominent French artists, writers and prominent French artists, writers and intellectuals formed the intellectuals formed the Club des HachichinsClub des Hachichins (Club of Hashish-Eaters), members included (Club of Hashish-Eaters), members included Victor Hugo. Victor Hugo.

They gather “to take of literature, art and They gather “to take of literature, art and love” while consuming large quantities of love” while consuming large quantities of hashish. The mixture consisted of a hashish. The mixture consisted of a concentrated hemp paste, mixed with concentrated hemp paste, mixed with butter, sweeteners, and flavoring such as butter, sweeteners, and flavoring such as vanilla and cinnamon. vanilla and cinnamon.

Marijuana and Hashish Marijuana and Hashish in the Twentieth Centuryin the Twentieth Century

By 1890, cotton had replaced hemp as a By 1890, cotton had replaced hemp as a major cash crop in southern states although major cash crop in southern states although cannabis plant continued to grow wild along cannabis plant continued to grow wild along road sides and in the fields. road sides and in the fields.

It was not until the 1920’s that marijuana It was not until the 1920’s that marijuana began to be a noticeable phenomenon.began to be a noticeable phenomenon.

Some authors had related the appearance Some authors had related the appearance of marijuana as a recreational drug to social of marijuana as a recreational drug to social changes brought on by prohibition when it changes brought on by prohibition when it was difficult to obtain good quality liquor at was difficult to obtain good quality liquor at affordable prices. affordable prices.

At first its recreational use was restricted to At first its recreational use was restricted to Jazz musicians and people in show Jazz musicians and people in show business. business.

Marijuana and Hashish Marijuana and Hashish in the Twentieth Centuryin the Twentieth Century

Famous mainstream clarinetist and band Famous mainstream clarinetist and band leader Benny Goodman had his popular hit leader Benny Goodman had his popular hit “Sweet Marihuana Brown”.“Sweet Marihuana Brown”.

Marijuana by that time was tolerated by Marijuana by that time was tolerated by authorities because it was not illegal. authorities because it was not illegal.

Marijuana was not considered as a social Marijuana was not considered as a social threat. threat.

In late the 1920’s and the early 1930’s In late the 1920’s and the early 1930’s there was a large migration of Mexicans to there was a large migration of Mexicans to the United States, they entered the country the United States, they entered the country through towns along the Mexican border through towns along the Mexican border and along the Gulf Coast. and along the Gulf Coast.

MarijuanaMarijuana and Hashish and Hashish in the Twentieth Centuryin the Twentieth Century

In Mexican communities marijuana was, in In Mexican communities marijuana was, in the words of one historian “a casual the words of one historian “a casual adjunct to life … a relaxant, a remedy for adjunct to life … a relaxant, a remedy for headaches, a mild euphoric cheaply headaches, a mild euphoric cheaply obtained for two cigarettes for the dollar. obtained for two cigarettes for the dollar.

Rumors about the violent behavioral Rumors about the violent behavioral consequences of marijuana smoking consequences of marijuana smoking among Mexicans began to spread. The among Mexicans began to spread. The idea was unchallenged by objective data. idea was unchallenged by objective data.

Considering the hysteria against marijuana Considering the hysteria against marijuana smoking and cannabis use in general smoking and cannabis use in general Congress passed the Marijuana tax act of Congress passed the Marijuana tax act of 1937. 1937.

Marijuana and Hashish Marijuana and Hashish in the Twentieth Centuryin the Twentieth Century

The marijuana regulation was accomplished The marijuana regulation was accomplished indirectly as the act did not ban marijuana; it indirectly as the act did not ban marijuana; it merely required everyone connected with merely required everyone connected with marijuana, from growers to buyers to pay a tax. marijuana, from growers to buyers to pay a tax.

It was a simple procedure that, in effect, made it It was a simple procedure that, in effect, made it virtually impossible to comply with the law. virtually impossible to comply with the law.

In absence of compliance, a person was in In absence of compliance, a person was in violation of the act and therefore subject to arrest. violation of the act and therefore subject to arrest.

During the 1940’s and 1950’s the theory that During the 1940’s and 1950’s the theory that marijuana was connected to violence slowly faded marijuana was connected to violence slowly faded away, only to be replaced by a new notion, the away, only to be replaced by a new notion, the gateway theory. gateway theory.

According to the gateway theory marijuana is According to the gateway theory marijuana is dangerous because its abuse will lead to the dangerous because its abuse will lead to the abuse of heroin, cocaine, or other illicit drugs. abuse of heroin, cocaine, or other illicit drugs.

Marijuana and Hashish Marijuana and Hashish in the Twentieth Centuryin the Twentieth Century

Penalties for involvement with marijuana increased, Penalties for involvement with marijuana increased, in certain states the penalties were harsh. Judges had in certain states the penalties were harsh. Judges had the option of sentencing a marijuana seller or user to the option of sentencing a marijuana seller or user to life imprisonment. In Georgia, a second offence of life imprisonment. In Georgia, a second offence of selling marijuana to a minor could be punishable by selling marijuana to a minor could be punishable by death.death.

In 1969, the U.S. Supreme Court ruled the 1937 In 1969, the U.S. Supreme Court ruled the 1937

Marijuana Tax Act to be unconstitutional. The Marijuana Tax Act to be unconstitutional. The argument was made that requiring a person to pay argument was made that requiring a person to pay tax in order to possess an illegal substance is a form tax in order to possess an illegal substance is a form of self-incrimination, which would be a specific of self-incrimination, which would be a specific violation of the fifth amendment to the constitution. violation of the fifth amendment to the constitution.

Reefer – A common name for a Reefer – A common name for a marijuana cigarette.marijuana cigarette.

Joint – a marijuana cigarette. Joint – a marijuana cigarette.

Psychiatric Symptoms in Psychiatric Symptoms in Marijuana Users Marijuana Users

Effects of moderate intoxication (Zinberg et al) Effects of moderate intoxication (Zinberg et al) attitude and expectations or mental “set” and attitude and expectations or mental “set” and environmental combine with pharmacological effects to environmental combine with pharmacological effects to produce subjective experience of intoxication. produce subjective experience of intoxication.

Euphoria – well-being and peacefulness are universally Euphoria – well-being and peacefulness are universally described in experimental studies in drug naïve and drug described in experimental studies in drug naïve and drug experienced volunteers. experienced volunteers.

During cannabis intoxication an awareness of alteration During cannabis intoxication an awareness of alteration in thought processes is frequently reported. Subjects in thought processes is frequently reported. Subjects may describe their thoughts as being fragmented (Ames, may describe their thoughts as being fragmented (Ames, 1958) or more efficient than usual (Chopra & Smith, 1958) or more efficient than usual (Chopra & Smith, 1974).1974).

Some cannabis users claim that after Some cannabis users claim that after taking the drug they can recall distant taking the drug they can recall distant memories to which they would not memories to which they would not ordinarily have access to. (Tart, 1970). ordinarily have access to. (Tart, 1970).

However experimental studies on the However experimental studies on the effect of THC on memory did not show any effect of THC on memory did not show any measurable effects on long term memory measurable effects on long term memory retrieval. retrieval.

Suspiciousness and paranoia are common Suspiciousness and paranoia are common experiences. experiences.

Subjects also reported that time seems to Subjects also reported that time seems to pass more slowly. pass more slowly.

Marijuana smokers reported increase Marijuana smokers reported increase awareness of their surroundings as well as awareness of their surroundings as well as sharpened sense of sight and sounds. sharpened sense of sight and sounds.

Adverse Reactions Adverse Reactions

Anxiety provoking with mild Anxiety provoking with mild intoxication. intoxication.

Panic attacks – acute anxiety Panic attacks – acute anxiety reactions to Marijuana may include reactions to Marijuana may include restlessness, depersonalization, restlessness, depersonalization, sense of loss of control, fear of panic sense of loss of control, fear of panic and paranoia. and paranoia.

Cannabis induced psychotic Cannabis induced psychotic reaction – Acute toxic reaction – Acute toxic

confusion confusion Toxic psychosis can follow ingestion of Toxic psychosis can follow ingestion of

cannabis.cannabis. Acute toxic psychosis is more common Acute toxic psychosis is more common

to occur with higher doses of Delta-9-to occur with higher doses of Delta-9-THC.THC.

Typically symptoms are apprehension Typically symptoms are apprehension suspiciousness, confusion, memory suspiciousness, confusion, memory impairment, depersonalization, de- impairment, depersonalization, de- realization, and hallucination. realization, and hallucination.

Psychiatric Symptoms in Cannabis Users: Table 1Psychiatric Symptoms in Cannabis Users: Table 1Case reports of psychosis associated with cannabis use Case reports of psychosis associated with cannabis use

YEARYEAR COUNTRCOUNTRYY

NUMBER NUMBER OF OF CASESCASES

COMMENTS COMMENTS

19551955 BrazilBrazil 11 Mental confusion and hallucinations in a Brazilian Indian who had Mental confusion and hallucinations in a Brazilian Indian who had smoked 2g cannabis. smoked 2g cannabis.

19681968 USAUSA 33 First time users. Description of symptoms is scanty. Had extreme First time users. Description of symptoms is scanty. Had extreme paranoid reactions. No mention of outcome. paranoid reactions. No mention of outcome.

19691969 IndiaIndia 33 Full report was of 6 cases – the other three experienced acute anxiety or Full report was of 6 cases – the other three experienced acute anxiety or depersonalization only. depersonalization only.

19691969 Vietnam Vietnam (US (US soldiers)soldiers)

1212 First-time users. All had impaired cognitive function. Ten had paranoid First-time users. All had impaired cognitive function. Ten had paranoid symptoms. Well (1970) comments that these may be true cases of toxic symptoms. Well (1970) comments that these may be true cases of toxic psychosis in view of the soldiers exceptional circumstances. psychosis in view of the soldiers exceptional circumstances.

19711971 USAUSA 88 Authors commented on the absence of previous psychosis of family Authors commented on the absence of previous psychosis of family history of psychosis. history of psychosis.

19731973 IndiaIndia 44 Schizophrenia-like acute psychosis in long-term users of beverage Schizophrenia-like acute psychosis in long-term users of beverage containing cannabis products (‘bhang’).containing cannabis products (‘bhang’).

19821982 SwedenSweden 44 No pre-existing psychosis or abuse of other drugs. Marked confusion No pre-existing psychosis or abuse of other drugs. Marked confusion noted. Reported also included seven cases of ‘subacute’ and ‘chronic’ noted. Reported also included seven cases of ‘subacute’ and ‘chronic’ psychosis. psychosis.

19831983 UKUK 11 Subject had a history of other drug abuse including ‘magic mushrooms’. Subject had a history of other drug abuse including ‘magic mushrooms’.

19841984 AnguillaAnguilla 55 Three schizophreniform psychoses, two manic.Three schizophreniform psychoses, two manic.

19841984 UKUK 99 Various clinical pictures – those with schizophreniform features had Various clinical pictures – those with schizophreniform features had family histories of psychosis. None had abused alcohol or other drugs. family histories of psychosis. None had abused alcohol or other drugs. One patient had features suggesting an acute toxic psychosis. One patient had features suggesting an acute toxic psychosis.

19861986 UKUK 11

Psychiatric Symptoms in Cannabis Users: Table 2Psychiatric Symptoms in Cannabis Users: Table 2Clinical studies of psychosis associated with cannabis useClinical studies of psychosis associated with cannabis use

YEARYEAR COUNTRCOUNTRYY

NUMBER OF NUMBER OF SUBJECTS SUBJECTS (type) (type)

DESIGNDESIGN COMMENTSCOMMENTS

19721972 USAUSA 100 100

(Cannabis (Cannabis Users) Users)

ComparativComparative e

Psychiatric problems precede cannabis Psychiatric problems precede cannabis use. use.

19721972 GermanGermanyy

36,000 36,000

(US soldiers) (US soldiers)

Descriptive Descriptive Confounded by use of other drugs and Confounded by use of other drugs and alcohol. Symptoms included alcohol. Symptoms included disorientation and confusion. disorientation and confusion.

19741974 India India 200200

(Patients)(Patients)

DescriptiveDescriptive Symptoms included disorientation, Symptoms included disorientation, amnesia and confusion. amnesia and confusion.

19761976 JamaicaJamaica 88 88

(In-patients)(In-patients)

DescriptiveDescriptive 37.5% of patients diagnosed as having 37.5% of patients diagnosed as having a ‘schizophreniform’ reaction had a a ‘schizophreniform’ reaction had a history of cannabis use, while the figure history of cannabis use, while the figure was lower for all other diagnostic was lower for all other diagnostic groups. groups.

19821982 S. Africa S. Africa 20 20

(In-patients) (In-patients)

RetrospectivRetrospectivee

Case-control Case-control

Cannabis-using psychotics had a shorter Cannabis-using psychotics had a shorter course and more hypomanic symptoms course and more hypomanic symptoms than non-using psychotics. than non-using psychotics.

Acute psychotic reaction in Acute psychotic reaction in clear consciousnessclear consciousness

An acute psychotic reaction may An acute psychotic reaction may follow cannabis use, clinical picture is follow cannabis use, clinical picture is characterized by rapid onset and characterized by rapid onset and mixture of affective and mixture of affective and schizophrenic like symptoms. schizophrenic like symptoms.

Mood Disturbances Mood Disturbances

Self-limiting, dysphoric reactions are well Self-limiting, dysphoric reactions are well recognized consequences of cannabis use. recognized consequences of cannabis use.

Serious mood disturbances can occur with Serious mood disturbances can occur with prolonged marijuana use, however this has prolonged marijuana use, however this has not been supported by controlled studies. not been supported by controlled studies.

The increased risk of suicide found in one The increased risk of suicide found in one large study needs further consideration. large study needs further consideration.

Clinical reports have suggested that cannabis Clinical reports have suggested that cannabis use may precipitate relapse in patients with use may precipitate relapse in patients with pre-existing depressive disorder. pre-existing depressive disorder.

Relationship to Relationship to SchizophreniaSchizophrenia

Some authors found causative role for the drug use Some authors found causative role for the drug use in the aetiology of chronic functional psychosis on in the aetiology of chronic functional psychosis on the basis that drug using schizophrenic patients had the basis that drug using schizophrenic patients had better pre-morbid personalities and earlier age of better pre-morbid personalities and earlier age of onset than the non-users. onset than the non-users.

Andreasson et al 1987 reported the result of Andreasson et al 1987 reported the result of prospective study of 45,570 Swedish patients over prospective study of 45,570 Swedish patients over 15 year follow-up period the relative risk for 15 year follow-up period the relative risk for developing schizophrenia was 2.4 for cannabis users developing schizophrenia was 2.4 for cannabis users compared to non-users and 6.0 for heavy users.compared to non-users and 6.0 for heavy users.

Marijuana appears to enhance or magnify positive Marijuana appears to enhance or magnify positive symptoms of schizophrenia in established cases.symptoms of schizophrenia in established cases.

Some patients use marijuana to counteract the side Some patients use marijuana to counteract the side

effects of neuroleptics, or to counteract the sense of loss effects of neuroleptics, or to counteract the sense of loss or emptiness a schizophrenic may feel when his/her or emptiness a schizophrenic may feel when his/her delusions or hallucinations are suppressed by medication. delusions or hallucinations are suppressed by medication.

Peralta & Cuesta 1992 published a Spanish study of 95 Peralta & Cuesta 1992 published a Spanish study of 95 schizophrenic patients, 23 were marijuana users, and schizophrenic patients, 23 were marijuana users, and found no difference in positive symptoms, but a found no difference in positive symptoms, but a significantly higher rate of negative symptoms among significantly higher rate of negative symptoms among non-users. non-users.

TheThe Residual Cognitive Effects of Heavy Residual Cognitive Effects of Heavy Marijuana Use in College Students Marijuana Use in College Students Harrison G. Pope Harrison G. Pope

Jr. MD et al JAMA 1996Jr. MD et al JAMA 1996 Design – Single-blind comparison of Design – Single-blind comparison of

regular users vs infrequent users of regular users vs infrequent users of marijuana. marijuana.

Participants – Two samples of college Participants – Two samples of college undergraduates: 65 heavy users, and 64 undergraduates: 65 heavy users, and 64 light users. light users.

Intervention – Neuropsychological tests Intervention – Neuropsychological tests were administered to all subjects , all were administered to all subjects , all subjects were abstinent from marijuana subjects were abstinent from marijuana and other drugs for a minimum of 19 and other drugs for a minimum of 19 hours before testing.hours before testing.

Results – Heavy users displayed Results – Heavy users displayed significantly greater impairment than significantly greater impairment than light users on attentional/executive light users on attentional/executive functions . functions .

Conclusions – Heavy marijuana use is Conclusions – Heavy marijuana use is associated with residual associated with residual neuropsychological effects even after neuropsychological effects even after a day of supervised abstinence from a day of supervised abstinence from the drug. the drug.

Cognitive Functioning of Long-term Heavy Cognitive Functioning of Long-term Heavy Cannabis Users Seeking Treatment Cannabis Users Seeking Treatment

Solowij, PhD et al JAMA 2002 Solowij, PhD et al JAMA 2002

Objective – To examine the effects of Objective – To examine the effects of duration of cannabis use on specific areas duration of cannabis use on specific areas of cognitive functioning . of cognitive functioning .

Design, Setting, and Participants Design, Setting, and Participants Multisite retrospective cross-sectional Multisite retrospective cross-sectional neuropsychological study conducted in the neuropsychological study conducted in the US between 1997 and 2000 among 102 US between 1997 and 2000 among 102 near-daily cannabis users (51 long-term near-daily cannabis users (51 long-term users and 51 shorter-term users) users and 51 shorter-term users) compared with 33 nonuser controls.compared with 33 nonuser controls.

Results – Long-term cannabis users Results – Long-term cannabis users performed significantly less well than shorter-performed significantly less well than shorter-term users and controls on tests of memory term users and controls on tests of memory and attention. Long-term users and attention. Long-term users showed impaired learning , retention , and showed impaired learning , retention , and retrieval compared with controls. retrieval compared with controls.

Conclusions – These results confirm that long-Conclusions – These results confirm that long-term heavy cannabis users show impairments term heavy cannabis users show impairments in memory and attention that endure beyond in memory and attention that endure beyond the period of intoxication and worsen with the period of intoxication and worsen with increasing years of regular cannabis use.increasing years of regular cannabis use.

Amotivational Syndrome Amotivational Syndrome 1986 William McGlothin, a psychologist, and Louis 1986 William McGlothin, a psychologist, and Louis

West, a psychiatrist, proposed that chronic West, a psychiatrist, proposed that chronic marijuana smoking among young people was marijuana smoking among young people was responsible for amotivational syndrome. responsible for amotivational syndrome.

Regular marijuana use may contribute to the Regular marijuana use may contribute to the development of more passive, inward turning development of more passive, inward turning personality characteristics, for numerous middle personality characteristics, for numerous middle class students, the subtly progressive change from class students, the subtly progressive change from conforming, achievement-oriented behavior to a conforming, achievement-oriented behavior to a state of relaxed and careless drifting has followed state of relaxed and careless drifting has followed their use of significant amount of Marijuana. their use of significant amount of Marijuana.

Such individuals exhibit greater introversion, Such individuals exhibit greater introversion, become totally involved with the present at the become totally involved with the present at the expense of their future goals and demonstrate a expense of their future goals and demonstrate a strong tendency toward regressive, childlike strong tendency toward regressive, childlike magical thinking. magical thinking.

Cardiovascular Effect Cardiovascular Effect “circulation 2001”“circulation 2001”

Smoking marijuana increase heart rate, Smoking marijuana increase heart rate, supine hypertension and postural supine hypertension and postural hypotension. hypotension.

Mittleman MD. reported triggering Mittleman MD. reported triggering myocardial infarction with marijuana. myocardial infarction with marijuana.

Interviewed 3,882 patients with acute M.I Interviewed 3,882 patients with acute M.I an average of 4 days after infarction onset. an average of 4 days after infarction onset.

Of the 3,882 patients 124 (3.2%) reported Of the 3,882 patients 124 (3.2%) reported smoking marijuana in the prior year, 37 smoking marijuana in the prior year, 37 within 24 hours and 9 within 1 hour of M.I. within 24 hours and 9 within 1 hour of M.I. symptoms. symptoms.

Compared with non-users marijuana users Compared with non-users marijuana users were more likely to bewere more likely to be::

Men Men Current cigarette smokers Current cigarette smokers Obese Obese

Marijuana smokers were less likely to:Marijuana smokers were less likely to: Have history of angina Have history of angina Hypertension Hypertension

Risk of M.I. was elevated 4.8 times over Risk of M.I. was elevated 4.8 times over baseline in the 60 minutes after marijuana baseline in the 60 minutes after marijuana use, the elevated risk rapidly decreases use, the elevated risk rapidly decreases thereafter. thereafter.

Conclusions – smoking marijuana is a rare Conclusions – smoking marijuana is a rare trigger of acute M.I.trigger of acute M.I.

Myocardial Infarction Following the Myocardial Infarction Following the Combined Recreational Use of Viagra Combined Recreational Use of Viagra

and Marijuanaand Marijuana “clinical cardiology 2002”“clinical cardiology 2002”

Viagra is widely prescribed treatment for Viagra is widely prescribed treatment for male erectile dysfunction.male erectile dysfunction.

Viagra is metabolized by the cytochrome Viagra is metabolized by the cytochrome P450 3A4 hepatic microsemal isoenzyme.P450 3A4 hepatic microsemal isoenzyme.

Marijuana is an inhibitor of the cytochrome Marijuana is an inhibitor of the cytochrome P450 3A4 isoenzyme. P450 3A4 isoenzyme.

Case report about myocardial infarction following Case report about myocardial infarction following combined use of viagra and marijuana. combined use of viagra and marijuana.

Male age 41 years oldMale age 41 years old Non-smoker Non-smoker No history of D.M. or HTNNo history of D.M. or HTN No family history of premature coronary artery No family history of premature coronary artery

disease disease No past history of impotenceNo past history of impotence Admit smoking marijuana the previous evening Admit smoking marijuana the previous evening

and taking recreationally one tablet of viagra 12 and taking recreationally one tablet of viagra 12 hours before onset of chest pain. hours before onset of chest pain.

Myocardial infarction was confirmed by EKG and Myocardial infarction was confirmed by EKG and cardiac enzymes. cardiac enzymes.

Effects on sexual Effects on sexual functioning and functioning and reproduction reproduction

Men Men Reduces level of testosteroneReduces level of testosterone Reduces sperm count Reduces sperm count Increases percentage of abnormally formed Increases percentage of abnormally formed

sperm. sperm.

Women Women Reduction in level of lutenizing hormone (LH), a Reduction in level of lutenizing hormone (LH), a

hormone necessary for fertilized egg to be hormone necessary for fertilized egg to be implemented in the uterus. implemented in the uterus.

Medical Uses for Marijuana Medical Uses for Marijuana

Glaucoma Glaucoma Smoking marijuana reduces I.O.P. in normal Smoking marijuana reduces I.O.P. in normal

human subjects.human subjects. THC eye drops reduce glaucoma symptoms. THC eye drops reduce glaucoma symptoms.

Asthma Asthma Initial bronchodiltion, followed by Initial bronchodiltion, followed by

bronchoconstriction. bronchoconstriction.

Nausea Nausea Cancer treatment. Cancer treatment. AIDS patient.AIDS patient.

The EndThe End