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Marijuana
Chapter 13

What Is Marijuana?

  • Marijuana is a hemp plant

whose biological name is

cannabis sativa. It consists

of green, brown, or a grey

mixture of dried, shredded

leaves, stems, seeds, and flowers.

  • THC (delta-9-tetrahydrocannabinol) is the primary mind-altering ingredient in marijuana.

Brief History and Trends

  • Marijuana has historically been a valued crop. The woody fibers of the stem yield a fiber that can be made into cloth and rope.
  • Early records of marijuana use:
  • China 2737 BC and India (religious ceremonies)
  • Assyrians, dating back to 650 BC used it for making rope, cloth, and consumed it to experience euphoria
  • Ancient Greeks also knew about marijuana
  • In North America, in Jamestown (1611), marijuana was used to make rope and clothing
  • Currently, marijuana grows wild in many U.S. states

Early History

  • Earliest mention: Chinese pharmacy book (2737 BC)
  • Social use of the plant had spread to the Muslim world and North Africa by AD 1000
  • “Hashishiyya” religious cult carried out political murders
  • Story of cult spread in works by Marco Polo (1299) and Boccaccio (1350s)
  • Possible origin of the term assassin
  • Hashish use mentioned frequently in The Arabian Nights

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Image source: National Library of Medicine, 16th Century (Image Ch15_11CannabisWoodCut)

History: Europe

  • Napolean’s soldiers brought use of hashish back from campaign in Egypt (1790s)
  • Popular account of hashish use appeared in Dumas’ The Count of Monte Cristo (1844)
  • French Romantic writers (1840s to 1860s) wrote about effects of hashish

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U.S. History:
“Marijuana, Assassin of Youth”

  • Early 1900s: Little public interest or use
  • 1926: Series of newspaper articles linked marijuana and crime
  • Other reports by police and in popular literature followed
  • 1936: All states had laws regulating the use, sale, and/or possession of marijuana
  • Federal Bureau of Narcotics- Harry Anslinger
  • “cause for greatest national concern”
  • Testimonnies linking marijuana use with crime or violence

*

U.S. History:
“Marijuana, Assassin of Youth”

  • Contributing factors to “pyramid of prejudice” against marijuana
  • Marijuana use associated with lower-class groups and recent immigrants
  • Regular references made in popular literature to the murdering cult of assassins as suggestive of the characteristics of the drug
  • Testimonies to US Congress by Bureau’s agents told outrageous stories of murder and sexual perversion

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Marijuana Tax Act of 1937

  • Act followed the regulation-by-taxation theme of the 1914 Harrison Act
  • Grower, distributor, seller, and buyer were taxed
  • Administratively almost impossible to deal in Cannabis
  • Bureau of Narcotics uniform law specifically named Cannabis sativa
  • State laws made possession and use of Cannabis illegal per se
  • 1969: U.S. Supreme Court declared the Marijuana Tax Act unconstitutional
  • 1970: marijuana was listed as Schedule I

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After the Marijuana Tax Act

  • 1950s and 60s
  • Little scientific research done on Cannabis
  • Use of Cannabis continued to increase
  • A common symbol of youthful rejection of authority
  • Identification with a new era of personal freedom
  • Usage peaked around 1980, declined until the early 1990s, and then rose again
  • Cost of marijuana increased significantly (black market)
  • Reports continued to be published that marijuana use had less serious effects than commonly believed BUT
  • Substantial disagreement over the interpretation of research findings

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Image source: Royalty-Free/CORBIS (Image Ch15_12_1960sHippie)

© 2008 McGraw-Hill Higher Education. All rights reserved.

Marijuana use among persons age 12-25

Source: National Survey on Drug Use and Health

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Figure 1.2 (See Chapter 1)

Several Questions and Answers

  • Today marijuana is how many times more potent than the marijuana on the street in the 1960s and 1970s?
  • Approximately 20 times more potent as result of more efficient agriculture largely due to new methods of harvesting, new varieties, and special processing marijuana of plants
  • http://www.drugabuse.gov/drugs-abuse/marijuana

  • How many Americans are current marijuana users?

- Aged 12 or older in 2011: Out of 18.1 million illicit drug users, approximately 64.3% reported current use of only marijuana and another 16.2% used marijuana with another illicit drug. (This means that a staggering 80.5% [64.3% + 16.2%] either used marijuana alone or used marijuana with another drug.) The remaining 19.5% of drug users used an illicit drug but not marijuana.

Several Questions and Answers (continued)

Noteworthy Findings Regarding
Marijuana Users

  • It is the most highly abused illicit type of illicit drug.
  • The highest rate of use was found among young adults (ages 18–25) with 18.9% reporting current use (past month) and among youth (ages 12–17) with 7.6% reporting current use.
  • The average age of first use was 17.5 years.
  • There were 2.6 million new marijuana users in 2011, which averages 7,200 initiates per day.

Major Factors Affecting Marijuana Use

  • Structural factors: Age, gender, family background, lack of any religious beliefs
  • Social and interactional factors: Type of interpersonal relationships, friendship cliques, drug use within the peer group setting
  • Setting: Type of community and neighborhood (physical location of drug use)
  • Attitudinal factors: Personal attitudes toward the use of drugs, self esteem, maturation level

Major Factors Affecting
Marijuana Use (continued)

Cannabis Use Disorder
Defined by DSM-V*

  • Cannabis is often taken in larger amounts than was intended
  • There are persistent desires or unsuccessful efforts to cut down or control cannabis use
  • Much time is spent securing the drug, using the drug and/or recovering from its effects
  • Craving the euphoric effects of the drug
  • Failure to fulfill major role obligations at work, school, or home
  • Continued use of cannabis despite persistent or recurrent social and interpersonal problems cased by the effect of cannabis

Peter J Venturelli (PJV) - This is the best order I can think of as slides 9 & 10. Editor: Do you find a better place to sequentially place these two slides?

Cannabis Use Disorder
Defined by DSM-V* (continued)

  • Important social, occupational or recreational activities are given up or reduced because of cannabis use
  • Recurrent cannabis usage in situations in which it is physically hazardous
  • Cannabis use is continued despite persistent or recurrent physical or psychological problems stemming from usage
  • Tolerance develops to offset the diminishing effects of cannabis resulting in more use of cannabis
  • Withdrawal symptoms lead to increased use of cannabis

_________________

*These two slides, (slides 9 and 10), are Heavily paraphrased from American Psychiatric Association (APA). "Substance-Related and Addictive Disorders." In Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed., 509–510. Arlington, VA: American Psychiatric Association, 2013.  

Marijuana

  • Gateway drugs are drugs that often lead to the use of more addictive types of drugs (gateway to the use and abuse of other more potent drugs).
  • Alcohol, tobacco, and marijuana are the drugs most commonly believed to be gateway drugs.
  • Other common gateway drugs include inhalants and anabolic steroids. More recently, the abuse of prescription drugs (mainly painkillers) are also included.

Two Major Types of Marijuana

  • Cannabis Sativa:
  • Originates from Colombia, Mexico, Jamaica, South Africa, Thailand, and Southeast Asia
  • Causes uplifting and energetic feelings, appetite stimulant, and provides pain relief
  • Cannabis Indica:

- Originates from hash producing with very warm climates in

such countries Afghanistan, Pakistan, India, Turkey,

Morocco, and Tibet

- Causes body relaxation, stress relief, and calmness and serenity and has lower THC content than Sativa

Varieties of Marijuana from the Cannabis Sativa Plant

  • Hashish: Average concentration of THC is 12.1% for domestic, 7.03% for non-domestic, and 20.76 for samples seized by law enforcement officials
  • Ganja: Consists of the dried tops of female plants. The term is also used as a slang term for marijuana (pot, weed, reefer)
  • Sinsemilla (without seeds), “hydro” (grown in water), kind bud, dro, 30s, AK-47, and blueberry (more recent names of popular types of marijuana). The average concentration of THC is 7.5% and higher
  • Bhang: Average concentration of THC is 1% to 2%

Pharmacology:
Cannabinoid Chemicals

  • Chemistry of Cannabis is complex and unique
  • Active agent contains no nitrogen and thus is not an alkaloid like other psychoactive plant materials
  • Cannabinoids are 66 chemicals unique to the Cannabis plant
  • Delta-9-tetrahydrocannabinol (THC)
  • Isolated and synthesized in 1964
  • The most pharmacologically active cannabinoid
  • There may be several other active agents in Cannabis

*

Pharmacology:
Cannabinoid Chemicals

© 2008 McGraw-Hill Higher Education. All rights reserved.

Delta-9 THC, the most active substance found in Cannabis (left), and anandamide, isolated from brain tissues (right)

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Figure 15.1 in text

Pharmacology

  • Smoked marijuana
  • THC is absorbed rapidly by the blood and travels to the brain and then the rest of the body
  • Within 30 minutes, most THC is gone from the brain
  • Peak psychological and cardiovascular effects occur together within 5 to 10 minutes
  • Oral THC
  • THC is absorbed more slowly and the liver transforms it into 11-hydroxy-delta-9-THC
  • Less THC reaches the brain
  • Peak effects occur about 90 minutes following ingestion

*

Pharmacology

  • Metabolites have different half-lives
  • After one week, 25 to 30 percent of the THC and its metabolites might remain in the body
  • Two or three weeks may be required to completely eliminate a large dose of THC and its metabolites
  • High lipid solubility of THC and its metabolites
  • Selectively taken up and stored in fatty tissue, to be released slowly
  • No easy way to monitor THC and metabolite levels and relate them to effects
  • Long-lasting low concentrations of THC and metabolites may have effects on the brain and other organs

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Laws regarding Cannabis

  • State and federal action
  • Federal government announced plans to prevent medical marijuana use
  • Closure of Cannabis clubs
  • Revocation of the DEA registration of any physician who advised a patient to use marijuana
  • Prosecution of physicians and patients
  • 2005: U.S. Supreme Court ruled that patients could be prosecuted for possessing marijuana even if their physicians recommended its use for a serious illness

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Medical research of Cannabis

  • Findings from Institute of Medicine report
  • Marijuana is a relatively safe and effective medicine for patients suffering from certain chronic conditions
  • More research is needed on marijuana and synthetic cannabinoids
  • An effective inhaler should be developed to solve the problem of poor oral absorption of THC
  • Compassionate use of smoked marijuana cigarettes should be allowed for no more than six months in certain patients with debilitating, intractable pain or vomiting

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Abuse and Dependence

  • Tolerance to many marijuana effects develops after regular use of high levels
  • Tolerance may not develop uniformly to all effects
  • Marijuana has abuse potential
  • A significant minority (9%) of current marijuana users may be abusing or dependent on the drug
  • DAWN: Nearly 80,000 marijuana-related ER visits per year

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Image source: Doug Menuez / Getty Images (Image Ch15_19RollingJoint)

Abuse and Dependence:
Withdrawal

  • DSM-IV: No listing of cannabis withdrawal BUT
  • Research suggests an abstinence syndrome does exist
  • Not life threatening but unpleasant
  • Symptoms
  • Negative mood states–anxiety, irritability
  • Disrupted sleep
  • Decreased food intake
  • Aggressive behavior (in some cases)
  • Begins about 1 day after the last dose
  • Lasts 4 to 12 days

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Toxicity Potential

  • Acute physiological effects
  • Increased heart rate, possibly risky for someone with preexisting cardiovascular disease
  • No human overdose deaths have been reported
  • Panic reactions
  • Characterized by fear of loss of control and fear that things won’t return to normal
  • More common among less-experienced users

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Toxicity Potential

  • Driving ability: Research findings mixed
  • Laboratory studies of computer-controlled driving simulations
  • Marijuana produces significant impairment
  • Epidemiological studies
  • Little evidence that drivers who use marijuana alone are more likely to be involved in an accident
  • Effects may be more severe in infrequent users
  • Watch Colorado and Washington statistics

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Image source: The McGraw-Hill Companies, Inc./Andrew Resek, photographer (Image Ch15_20CrashedCar)

Driving Performance

  • The ability to perform complex tasks, such as driving, is often impaired while under the influence of marijuana.
  • In limited surveys, from 70% to 80% of marijuana users indicate that they sometimes drive while being high.
  • Research reveals that approximately 600,000 high school seniors drive after smoking marijuana (DEA, 2006) and 41% of teens were not concerned about driving after taking drugs.
  • Habitual cannabis users were 9.5 times more likely to be involved in crashes.

Mechanism of Action

  • Anandamide
  • Endogenous substance isolated from brain tissue with marijuana-like effects
  • From ananda, Sanskrit for “bliss”
  • THC and other cannabinoids bind to two receptors
  • CB1 receptor
  • CB2 receptor

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Mechanism of Action

  • CB1 receptor found primarily in the brain but also unusually widespread throughout the body
  • Potential actions of cannabinoids are widespread
  • High density of CB1 receptors in specific brain regions
  • Basal ganglia (movement coordination)
  • Cerebellum (fine body movement coordination)
  • Hippocampus (memory storage)
  • Cerebral cortex (higher cognitive functions)
  • Nucleus accumbens (reward)
  • CB2 receptor found mainly outside the brain in immune cells
  • Potential role of cannabinoids in the modulation of the immune system

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Mechanism of Action

  • Rimonabant, a selective CB1 receptor antagonist, is being tested
  • Shows promise in reducing food intake and helping people quit smoking
  • Concerns raised over use of the drug due to lack of understanding of the normal function of anandamide’s action on CB1 receptors
  • Obesity drug withdrawn from market:
  • http://www.netdoctor.co.uk/diet-and-nutrition/medicines/acomplia.html

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Behavioral Effects

  • Low to moderate doses produce euphoria and a pleasant state of relaxation.
  • Common effects: dry mouth, elevated heartbeat, some loss of coordination and balance, slower reaction times, reddening of the eyes, elevated blood pressure, some mental confusion (short-term memory loss).
  • A typical high lasts from 2 to 3 hours (length of effect depends on amount of THC), and the user experiences altered perception of space and time as well as impaired memory.

Behavioral Effects (continued)

  • An acute dose of cannabis can produce adverse reactions: mild anxiety to panic and paranoia.
  • In a minority of cases users can exhibit psychosis, delusional and bizarre behavior, and hallucinations. These reactions occur most frequently in individuals who are under stress, anxious, depressed, or borderline schizophrenic, and are using the more potent types of marijuana.

Behavioral Effects (continued)

  • Subjective euphoric effects: The ongoing social and psychological experiences incurred while intoxicated with marijuana. These include both the user’s altered state of consciousness and his/her perceptions while intoxicated.
  • Attachment to the use of Marijuana: Users exhibit a strong attachment to their passsionate feelings about using marijuana.
  • Differential association: Behavioral satisfaction derived from friends who use marijuana (“fun-times when high with friends”).

Driving Performance

  • The ability to perform complex tasks, such as driving, is often impaired while under the influence of marijuana.
  • In limited surveys, from 70% to 80% of marijuana users indicate that they sometimes drive while being high.
  • Research reveals that approximately 600,000 high school seniors drive after smoking marijuana (DEA, 2006) and 41% of teens were not concerned about driving after taking drugs. (Driving while under the influence of a drug termed drugged driving.)
  • Habitual cannabis users were 9.5 times more likely to be involved in crashes.

Critical Thinking Skills

Amotivational Syndrome or
Anti-motivational Syndrome

  • Amotivational syndrome refers to a belief that heavy use of marijuana causes a lack of motivation or impaired desire and reduced productivity.
  • Specifically, users show an increase in:
  • Apathy
  • Poor short-term memory
  • Difficulty with concentration
  • A lingering lack of interest in pursuing goals

Therapeutic Uses of Marijuana

  • Medical marijuana use: Involves using the THC derived from smoking marijuana or using Marinol as a drug to calm or relieve symptoms of an illness.

1985: Oral TCH (dronabinol; brand name Marinol) licensed for sale to cancer patients experiencing nausea from chemotherapy

  • Marinol

Medical Uses

  • Some research shows that THC can be used for treating:
  • Glaucoma: potentially blinding eye disease causing continual and increasing intraocular pressure
  • Analgesic effect: In patients experiencing frequent migraines and chronic headaches or inflammation

Therapeutic Uses of Marijuana (continued)

  • Appetite stimulant: Patients experiencing anorexia, AIDS, chemotherapy and radiation therapy
  • Antiseizure: Aids in the prevention of seizures (epilepsy)
  • Antiasthmatic effect: Short-term smoking of marijuana improves breathing for asthma patients
  • Antidepressant effect: Used in Great Britain as a euphoriant for treating depression
  • Muscle relaxation: Aids in reducing muscle spasms

Arguments Against Marijuana Use

  • It contains 421 chemicals.
  • It is stronger than it was 20 years ago.
  • Smoking this drug is worse for the lungs than tobacco.
  • Impairs short-term memory and may cause “amotivational syndrome.”
  • U.S. federal law continues to legally prohibit the possession, the sale, and use of marijuana. (The federal government believes marijuana has no medically proven use.)

Physiological Effects

  • The brain: THC activates the reward system in the brain by stimulating brain cells to release the chemical dopamine
  • Central nervous system: Alters mood, coordination, memory, and self-perception
  • Respiratory system: Damage to the lungs
  • Cardiovascular system: Marijuana products limit the amount of oxygen that can be carried to the heart
  • Sexual performance and reproduction: Affects the sympathetic nervous system, increasing vasodilation in the genital and delaying ejaculation; high doses can decrease sexual desire

Effects of Marijuana on the Central Nervous System

  • Altered perceptions
  • Changes in the interpretation of stimuli resulting from marijuana use
  • “Munchies”
  • Hunger experienced while under the effects of marijuana
  • Anandamide
  • Possible neurotransmitter acting at the marijuana (cannabinoid) receptor site

Effects on Other Systems

  • Alveolar Macrophages (respiratory system)
  • Special white blood cells that play a role in cleaning lung tissue are less able to remove debris when exposed to smoke
  • Vasodilation (cardiovascular system)
  • Enlarged blood vessels
  • Aphrodisiac (sexual performance and reproduction)
  • In lower doses of marijuana, THC is believed to cause sexual arousal