Marijuana Side Effects
David G. Ostrow (Medical Marijuana Doctor) gives expert video advice on: What are some potential side effects from using medical marijuana?; Is marijuana a gateway drug?; Does marijuana cause brain damage? and more...
What are some potential side effects from using medical marijuana?
We know that if you take too high a dose the pleasant sensation - the euphoria - can be counteracted by feelings of heightened anxiety, severe nausea, vomiting, and even body aches and pains - almost like a flu-like syndrome. However, it's self limiting, the individual will very likely stop ingesting it if that's what happens, but it may take several days for them to feel completely at ease. We think many of these unpleasant side effects are due not to the effects on the cannabinoid system, but actually the anticholinergic effects of some of the compounds in cannabis that are not readily evident if one takes a therapeutic dose. So again, it's largely when one ingests it orally in food or tea, or whatever, that you get that side effect. Depending on where you stand on medical cannabis, some people consider the euphoria that it induces as an undesired side effect. In my treatment of patients with AIDS or advanced HIV disease, I don't think that the euphoria is an undesired side effect, and may well be a positive of it. Similarly with Multiple Sclirosis where the people most often are depressed and feeling very anxious about their future health prospects. But, other people label it not as euphoria, but as intoxication and they say that your coordination is down, and perhaps even your cognative faculties may be reduced for at least a short period of time. There have been a lot of studies on that, there's really very little evidence that the chronic use of cannabis produces any long term effects on mental functioning, but there are certainly case reports of acute effects where individuals may have had an auto accident or an injury while working. So I would say that whole cannabis should have the same warning as so many other psychoactive drugs have - is that you shouldn't be driving or operating dangerous machinery while you're using it.
Is marijuana a gateway drug?
That's another one of the myths that I think the federal government has propagated. When they couldn't come up with data on the negative effects of cannabis, they then switched to this gateway theory that people who use cannabis are much more likely to advance to other drugs. In reality, alcohol is probably the number one gateway drug in the United States. And I believe that research is coming out now that among adolescents and college age young adults, the use of prescription opiods and analgesics that they get from their family or friends' drug cabinets or they get from a doctor prescribed are really the drugs of experimentation which then may be gateways to other drug use.
Does marijuana cause brain damage?
Marijuana, it's been a controversial issue whether long term marijuana or cannabis use causes brain damage. There can be some acute affects of decreased coordination, some slowing down of psychological processes or we call cognitive problems, but these seem to go away after the active ingredients of cannabis are out of the body. I don't believe there's are any good studies that shows that use of just marijuana over any period of time produces any brain damage. Part of the problem though is that very few people use just one drug so they may drink along with cannabis use or they may use other drugs and those drugs may be causing long term brain damage. Certainly we know that about alcohol that it can cause dementia, or psychosis a number of problems over the long term. But marijuana alone, where it's been studied is not associated with permanent brain damage.
Does marijuana cause depression?
I think in youth there is a well described amotivational syndrome which has elements of depression in them. I would not recommend psychoactive drugs for any youth except under very controlled conditions. Say perhaps for treatment of ADHD or something like that. The brain is still developing right on up to the early twenties and marijuana use by high school or younger children tends to lead to some withdrawal from activities with other kids. There is always the stigma that they might be found out to be a druggie or something like that. So there is a lot of reasons why depression or amotivational syndrome is seen in younger people using marijuana. In adults however, I think it is more commonly used as an antidepressant or to treat depression, self-treat depression. Then we see depression caused by marijuana. Obviously if a person is depressed and has poor social relations, the use of any drug that might interfere with that, could worsen the depression. But I do not think marijuana contributes very much to depression in adults.
Does marijuana cause fertility problems?
Again, there were a number of studies published in the seventies and the early eighties about marijuana and fertility problems. I do not think those studies have held up to the test of time. And I am not aware of any good research that indicates that marijuana causes fertility problems in humans.
Is smoking marijuana dangerous for the respiratory system?
The question of whether or not smoking marijuana is dangerous to the respiratory system is, of course, very important. But we have to keep in mind first of all, that there are other ways to get the psychoactive effects of cannabis, such as vaporization, that does not release tar and ash and so forth. Despite the fact that you would think that smoking anything, any plant product over a long length of time might predispose to bronchitis or pneumonia or obstructive lung disease or even cancer, the epidemiological evidence that has come out from two very large studies in California indicates that, in fact, marijuana smokers who don't smoke cigarettes have no increased risk of pulmonary disease. In fact, those individuals who smoked both cigarettes and marijuana were found to have a lower level of smoking-related disorders than the people who smoked cigarettes alone. Now that research has been criticized because people have said that at least in the United States, marijuana users are not smoking as much or as frequently or in such volumes as a two-pack-a-day cigarette smoker but even studies that have gone to Jamaica where you have groups of people who do use marijuana on an almost continuous basis for ten, twenty years have not indicate elevations in either brain affects or pulmonary affects of smoked cannabis.
Does smoking marijuana cause cancer?
In the best study to date, which is out of the very large managed care system based in California, Kaiser Permanente, there was no elevation above that for non-smokers in general of any cancers, except the possible elevation in prostate cancer among men. But it wasn't a very big elevation and its mechanism is unknown.
Is marijuana more dangerous than tobacco?
Certainly when it comes to lung cancer, I think the consensus opinion now is that marijuana is less dangerous than tobacco. In terms of the temporary neuro-cognitive effects perhaps it is more serious than tobacco but less serious than alcohol in interfering with coordination and ability to drive safely. So I really think that if legalized and regulated, it would have to include statutes that an individual not be allowed to drive while intoxicated on marijuana. And we'll probably find that peeing into the cup would replace breathing into the breathalyzer.
Is marijuana too addictive to be used as a medicine?
Absolutely not. Marijuana is not addictive in the sense that its use requires increasing doses, that you develop a tolerance to it or that there's significant withdrawal symptoms. There are some psychological symptoms that an individual might experience if they've been using marijuana, say to treat anxiety or to treat depression. Obviously if they stop suddenly they're going to have some rebound in their anxiety and depression. But by itself I really don't think that marijuana can be can be called a narcotic, and at most it would be a mildly addictive compound and mostly through psychological mechanisms, not physical.
Is marijuana stronger now than it was 20 years ago?
Marijuana today, that is available on the street, is stronger than it was 20 years ago because there's been a movement, particularly overseas where marijuana has been either regulated or de facto decriminalized, there's been a lot of work to breed higher concentrations of THC in the plant itself. But to say that it's 5 or 10 times stronger than it was 20 years ago, I think is an overstatement. I think most people would agree it's gone from like in the low teens to upper teens to perhaps 20 or 30 percent. So you have like a two-fold increase in the concentration of THC. And that can be easily accounted for by just reducing the amount that you smoke or the amount that you put in the cigarette or the pipe et cetera.
How many people have overdosed on marijuana?
I don't believe that there are any valid scientific published reports of people overdosing on marijuana. Of course one can overdose in terms of having the anticulinary side effects of anxiety and dry mouth and blurred vision and so forth but that resolves and I don't think anybody has ever required to have their stomach pumped or cared for in an ICU because of taking too much cannabis.