Marijuana: A Complex Clinical and Political Picture

March 5, 2011

As the legalization of marijuana expands throughout The United States, debates about the pros and cons of this policy will continue.  The discussion exists not only among members of the medical community, but also among those who suffer from addictive disorders and the legions of clinicians who treat them.  Regardless of where one stands on this issue, its evaluation requires knowledge about the latest data and information regarding marijuana, particularly as it applies to the risks, benefits and alternatives involved.  It is also important to remember that new information is constantly emerging regarding both the medical benefits of this drug, as well as the potential for clinical risk factors, involving both medical and psychiatric complications.

By far the most widely abused illicit drug worldwide, marijuana has a reputation for being perceived as “safer” than other drugs among adults, adolescents and their parents. (A qualitative comparison of parent and adolescent views regarding substance use. Journal of School Nursing. 26(1):53-64, 2010 Feb.)  Many in favor of legalizing marijuana cite the fact that there are no known deaths that can be explained purely by marijuana overdose – a fact that is most definitely not true for many other drugs including: alcohol, cocaine, heroin, painkillers (opiates), crystal-meth, sedatives, sleeping pills and many over-the-counter and prescription medications.

Fatalities aside, studies indicate that marijuana is hardly a benign drug.  In fact, the marijuana produced today is significantly more potent than what was grown during the 1960’s and 1970’s — which may account for recent findings that marijuana can be dangerous for some people.  Most importantly, it has been clearly demonstrated that adolescents who abuse substances early on (including marijuana), are at an increased risk of developing a severe addictive disorder later.  Marijuana is considered to be a “gateway drug” for many adolescents who then go on to use “harder” drugs such as cocaine and heroin.  Neuropsychiatric studies clearly indicate that chronic marijuana smokers suffer from cognitive impairments in the areas of short-term and working memory, visual-spatial processing and abstract thinking.  Recent data link chronic marijuana use starting at an early age with the later onset of psychosis in young adults who may already be at risk.  (Cannabis use in patients with a first psychotic episode and subjects at ultra high risk of psychosis: impact on psychotic- and pre-psychotic symptoms. Australian & New Zealand Journal of Psychiatry. 44(8):721-8, 2010 Aug.) Finally, while many adolescents and adults seem to “self-medicate” with marijuana, it has been clearly demonstrated that chronic marijuana use is associated with, or “co-occurs” with a number of psychiatric disorders such as bipolar disorder, attention deficit disorder, anxiety disorders, and ultimately has a detrimental effect on treatment outcomes for those suffering with these problems.

The point of this discussion is to remind parents and clinicians that marijuana abuse and dependence often presents a complex clinical picture that should be taken seriously, especially in adolescents and young adults who suffer with psychiatric illness and/or have a family history of addiction.  While marijuana use may have potential medical benefits for some, it poses the risk for short and long-term side effects, as well as the potential for abuse and dependence.

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