Cannabis: panacea or poison?

First, some vocabulary. Cannabis is synonymous with marijuana, and refers to a plant, the chemicals in the plant and products derived from the plant. THC, tetrahydrocannabinol, is the primary psychoactive compound in cannabis. Cannabidiol (CBD) is also psychoactive but does not have the euphoric effect of THC. CBD sold is usually derived directly from the hemp plant, a cousin of marijuana, or manufactured in a laboratory. The cannabis plant contains more than 500 chemicals, many not well understood.

Cannabis use has increased dramatically over the past decade. Once illegal throughout the U.S., cannabis is now legal for medical use in 38 states and the District of Columbia and for recreational use in 24 states and D.C. A Gallup poll in 2019 found that 14% of adults had used cannabis during the preceding year and a 2021 survey found this had increased to 21%.

Seniors are the group who are increasing their use most rapidly. In 2007, only about 0.4% of people age 65 and older in the United States reported using cannabis in the past year. That number rose to almost 3% by 2016 and in 2022 it was over 8%.

Another group who use cannabis heavily are those with cancer. A recent survey of cancer survivors found that almost half were current or past users.

What are the benefits of cannabis? Because cannabis is still classed at the federal level as “Class 1” – a drug with no currently accepted medical use and a high potential for abuse (along with heroin and LSD) – it is hard to do research into its medical benefits. Much of what we know comes from observations rather than controlled trials.

Granting that the evidence is soft, cannabis seems to help reduce chemotherapy-induced nausea. It also has antiseizure effects and has been used in patients with epilepsy not responding well to traditional drugs. It can be useful in reducing pain in chronic pain sufferers, and may be a welcome alternative to narcotics. Patients with multiple sclerosis report less spasticity and pain. Finally, patients with inflammatory bowel diseases report better quality of life with cannabis use. It may be useful in treating insomnia.

The downsides are numerous. Inhaled cannabis, the most common way it is used, has adverse effects on the lungs similar to the effects of tobacco smoking. While THC acutely dilates airways, chronic use makes asthma worse. Several asthma deaths have been linked to inhalation of marijuana. Inhaled cannabis increases the risk of lung cancer.

Recent reports at a national cardiology conference found increased risk of heart attacks, strokes and congestive heart failure in regular cannabis users. Women who use cannabis during pregnancy have a 25% increased risk of adverse pregnancy outcomes.

Some regular cannabis users develop severe vomiting requiring hospitalization and IV fluids.

Cannabis impairs driving ability and is clearly linked to increased motor vehicle accidents, though it is not nearly as bad as alcohol in this regard.

While many or most users are looking for the relaxation effect of cannabis, psychiatric side-effects including panic attacks and psychosis are common. Psychiatric problems are particularly common in adolescents, and there is good evidence that cannabis use by young people interferes with brain development.

Bottom line: if you have a problem that is not responding to traditional medication, cannabis may help but its use comes with risk. Adolescents and young adults should not use cannabis, nor should pregnant women. No one should use cannabis before driving or doing other risky things requiring alertness.



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