Marijuana is the most commonly abused illicit drug in the United States and is classified as a Schedule I substance (high potential for abuse; lack of safety, and no medical use).
It is a dry, shredded green and brown mix of flowers, stems, seeds, and leaves derived from the hemp plant Cannabis sativa. The main active chemical is delta-9-tetrahydrocannabinol (THC.
Marijuana is usually smoked as a cigarette (joint) or in a pipe. It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with a mixture of marijuana and tobacco. Marijuana can also be mixed in food or brewed as a tea. As a more concentrated, resinous form, it is called hashish; and as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.
Cannabis use has been found to have occurred as long ago as the third millennium B.C.E. In modern times, the drug has been used for recreational, religious or spiritual, and medicinal purposes.
Marijuana is used for several reasons including inquisitiveness, peer pressure or for fun. The majority of users claim that the drug often causes euphoria, a sense of relaxation, sexual arousal and easier socialization with other colleagues.
- When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs throughout the body.
- The amount of THC present in a cannabis sample is generally used as a measure of cannabis potency . The three main forms of cannabis products are the herb (marijuana), resin (hashish), and oil (hash oil). Marijuana often contains 5% THC, resin can contain up to 20% THC, and Cannabis oil may contain more than 60% THC.
- THC levels in cannabis samples between 1975 and 2007 increased from 4% to 9.6%.
- Detectable levels of THC can be found in the body for weeks or longer.
- THC acts upon specific sites in the brain, called cannabinoid receptors, kicking off a series of cellular reactions that ultimately lead to the "high" that users experience. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thinking, concentrating, sensory and time perception, and coordinated movement.
- Marijuana intoxication can cause distorted perceptions, impaired coordination, lowering blood pressure, increased heart rate, bloodshot eyes, and a dry mouth and throat, difficulty with thinking and problem solving, and problems with learning and memory.
- Increases heart rate by 20-100 percent shortly after smoking; this effect can last up to 3 hours.
- Marijuana smoke contains 50-70 percent more carcinogenic hydrocarbons than tobacco smoke. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which further increase the lungs' exposure to carcinogenic smoke. Marijuana smokers can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections.
- Heavy marijuana abusers reported impairment in physical and mental health, cognitive abilities, social life, and career status.
- Cannabis used medically does have several well-documented beneficial effects including the amelioration of nausea and vomiting, stimulation of hunger in chemotherapy and AIDS patients, lowered intraocular eye pressure (for treating glaucoma), as well as general pain relief
- Use during pregnancy has been known to cause a small size fetus with low birth weight.
- The most commonly reported effects of smoked marijuana are a sense of well-being or euphoria and increased talkativeness and laughter, alternating with periods of introspective dreaminess, followed by lethargy and sleepiness. A characteristic feature of a marijuana "high" is a distortion in the sense of time associated with deficits in short-term memory and learning. A marijuana smoker typically has a sense of enhanced physical and emotional sensitivity, including a feeling of greater interpersonal closeness. The most obvious behavioral abnormality displayed by someone under the influence of marijuana is difficulty in carrying on an intelligible conversation, perhaps because of an inability to remember what was just said even a few words earlier.
Long-term marijuana abusers trying to quit report withdrawal symptoms including: irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to remain abstinent. These symptoms begin within about 1 day following abstinence, peak at 2-3 days, and subside within 1 or 2 weeks following drug cessation.
Withdrawal and acute panic reactions and flashbacks during marijuana intoxication are usually managed with supportive therapy. In severe cases, low-dose benzodiazepines are used. Generally the withdrawal symptoms from marijuana are mild and do not required any drug therapy.
Depression can also be a withdrawal symptom, and this will need to be treated along with the substance abuse problem.
AFTER DETOXIFICATION: Prior to any intervention, most drug treatment programs include education, monitoring of drug use, strengthening of social support, treatment of possible comorbid psychiatric disorders and referral to a pain specialist. Patients with marijuana abuse or dependence are referred to a comprehensive substance abuse treatment program. Such programs are designed to avoid relapse and include comprehensive substance abuse and psychiatric evaluations, laboratory testing, group therapy, education, social services, individual counseling, promotion of 12-step programs and treatment of any co-morbid psychiatric illness.
These programs should involve individual reflection about how problems with substance abuse develop the direct and indirect costs of substance abuse, biopsychosocial triggers for substance use, relapse prevention strategies, ways to enhance coping skills and spiritual issues.
Inpatient - Typically a 28-day rehab program in a residential community with group sessions and counseling, and where one goes after detoxification.
Outpatient - A medically supervised treatment option that does not involve overnight stay in a hospital or medical facility. It typically involves group sessions and counseling.
- Behavioral interventions, including cognitive-behavioral therapy and motivational incentives (i.e., providing vouchers for goods or services to patients who remain abstinent) have shown efficacy in treating marijuana dependence
Residential Services - provide an array of services for persons suffering from chemical dependence either directly or through cooperative relationships with other community service providers for a period of 21-28 days or longer in some instances.