Marijuana
Marijuana (cannabis) use is widespread. Surveys of high school students have periodically shown increases, decreases, and then increases in its use. In the United States, marijuana is commonly smoked in the form of cigarettes (joints) made from the stems, leaves, and flowering tops of the dried plant (Cannabis sativa or Cannabis indica). Marijuana is also used as hashish, the pressed resin (tarry substance) of the plant. The active ingredient of marijuana is tetrahydrocannabinol (THC), which occurs in many variations, the most active being delta-9-THC.
As with the use of alcohol, marijuana can be used intermittently by many people without causing noticeable social or psychologic dysfunction or dependence. However, some people become dependent on marijuana, and among those who become dependent, many will exhibit the characteristics of addiction.
Symptoms and Complications
Marijuana depresses brain activity, producing a dreamy state in which ideas seem disconnected and uncontrollable. It is mildly psychedelic, causing time, color, and spatial perceptions to distort and be enhanced. Colors may seem brighter, sounds may seem louder, and appetite may be increased. Marijuana generally relieves tension and provides a sense of well-being. The sense of exaltation, excitement, and inner joyousness (a high) seems to be related to the setting in which the drug is taken--such as whether the smoker is alone or in a group and the prevailing mood. Motor abilities decrease during marijuana use, so driving or operating heavy equipment is dangerous.
People who use large quantities of marijuana may become confused and disoriented. They may develop a toxic psychosis, not knowing who they are, where they are, or what time it is. Some people, particularly those with mental illness, are especially susceptible to these effects, and there is compelling evidence that schizophrenia may become worse with marijuana use. Occasionally, panic reactions occur, particularly in new users. Other effects include an increased heart rate, bloodshot eyes, and dry mouth.
Prolonged heavy use of marijuana among men may reduce testosterone levels, the size of the testes, and sperm count. Long-term use among women may lead to irregular menstrual cycles. However, these effects do not always occur, and the effects on fertility are uncertain. Pregnant women who use marijuana may have smaller babies than nonusers, and delta-9-THC passes into the breast milk and may intoxicate a breastfed infant.
Marijuana is eliminated from the body slowly over several weeks, so withdrawal reactions tend to be mild. Heavy users who stop abruptly may experience jerkiness and insomnia.
Diagnosis and Treatment
Urine test results for marijuana generally remain positive for several days or weeks after use, even for casual users. For regular users, test results may remain positive for several weeks or longer while the drug is slowly released from body fat. Urine testing is an effective means of identifying marijuana use, but a positive urine test result means only that the person has used marijuana; it does not prove that the user is currently impaired (intoxicated).
For those who want to stop using marijuana, counseling may be helpful. However, success relies heavily on the user's motivation to stop and for some willingness to disassociate from his social circle of regular users.
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