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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
FAST FACTS
I can't tell you how many times I am asked this question by teenage patients, older patients, their families, my friends and colleagues. Marijuana is the most frequently used illicit drug in the United States. It's not just your imagination; its use is on the rise, especially among junior high and high school students. Among adults in the U.S., the prevalence of use has remained 4 percent since the early 1990s. The prevalence of marijuana abuse and dependence, however, has increased significantly. Risk factors for abuse and dependence include being male, Native American, widowed/separated/divorced, and living in the West.
Is Marijuana really a gateway drug and what does that mean? The "gateway" theory of development of drug abuse describes sequential stages of progression in drug involvement from adolescence into adulthood, starting with legal drugs such as alcohol or cigarettes, followed by marijuana, illicit drugs other than marijuana, and abuse of prescription drugs. The evidence for pot as a gateway drug is a mixed bag really. There are twin studies where evidence shows that when one twin uses pot before the age of 17 their odds of drug or alcohol dependence are 2-5 times higher than the twin who didn't smoke pot. A study of school-age children in Spain identified specific factors associated with onset of marijuana consumption: use of alcohol and tobacco, antisocial behavior, and low academic performance. This study supports the gateway theory, although it does not eliminate the possible existence of a common factor underlying initiation of alcohol, tobacco, and marijuana.
So the question here is whether the association is causal (ie, whether marijuana is a "gateway" drug) OR reflects shared risk factors, and that will always be debated. A large body of evidence does suggest that marijuana use appears to be the best predictor of later use of "harder drugs" like cocaine or heroin. Marijuana use also predicts later ecstasy use. My personal experience as a physician has mirrored this and my patients who use hard drugs did start with pot.
Is it true that it makes you infertile? In men, marijuana causes decreased serum testosterone levels, sperm count, and sperm motility. This may lead to decreased libido (interest in sex) and impotence. An increased risk of infertility may result from changes in semen characteristics seen with marijuana smoking.
In women, chronic pot use causes shorter menstrual cycles and increased prolactin levels which may impair fertility.
Can you have withdrawal symptoms if you stop smoking pot? Yes, if you are a chronic user you may have withdrawal symptoms after abrupt cessation. Marijuana withdrawal begins within ten hours of the last dose and consists of irritability, agitation, depression, insomnia, nausea, anorexia, and tremor. Most symptoms peak in 48 hours and last for five to seven days. Some symptoms, such as unusual dreams and irritability, can last for weeks.
Does marijuana cause lung cancer? We're not sure. Marijuana is not smoked with filters, unlike most cigarettes. Marijuana smoke contains nearly four times as much tar and 50 percent more carcinogens than tobacco.
Here is what complicates the question of smoking pot and lung cancer: marijuana users are five times more likely to smoke cigarettes than non-users. Use of nicotine and marijuana together likely enhance the harmful effects of each used independently.
It should be reassuring for pot smokers that although they are probably at increased risk for lung cancer, the magnitude of risk has not been well quantified. A review of 19 studies did NOT detect a significant association between lung cancer and marijuana use, after adjusting for tobacco smoking.
What about lung problems, will it cause lung disease? The association between tobacco smoking and chronic obstructive pulmonary disease (COPD) HAS been established. Longterm pot smoking is associated with many symptoms of obstructive pulmonary disease: airflow obstruction, chronic cough, bronchitis, and decreased exercise tolerance. Regular smokers of three to four marijuana cigarettes per day experience cough, wheeze, and sputum production and exhibit abnormalities in the lungs equivalent to those who smoke approximately 20 tobacco cigarettes per day.
Does smoking pot make you mentally dull (think Jeff Spicoli Fast Times at Ridgemont high)? Again there may be some reassurance to pot smokers on this front. The association between chronic marijuana exposure and cognitive dysfunction has been extensively studied but with varying results. A syndrome formerly known as the "amotivational syndrome," now called the "chronic cannabis syndrome," has been described in which chronic heavy users with cognitive impairment have a reduced ability to establish or attain goals in life, resulting in jobs that require less cognitive challenge or technological acuity.
In an analysis of 13 studies, long-term marijuana use did not result in deficits in seven of eight neuropsychological ability areas tested; but there was a small but significant decrement in the area of learning new information. Since then, published studies have had conflicting results and here are some highlights. One study compared cognitive function in longer term and shorter term marijuana users at a mean of 17 hours after last reported marijuana use. Deficits in memory, attention, learning and retrieval function were significantly greater among the longer-term marijuana users. Longer term marijuana users (four or more joints per week for a minimum of 10 years), tested after a minimum of 24 hours abstinence, and had impaired verbal memory skills compared to shorter term users and controls. Both longterm and shorter users showed inferior performance on psychomotor speed, attention, and executive functions compared with controls.
Why might this happen? The changes seen in memory do require the use of frontal, cerebellar, and hippocampal brain regions, all of which contain cannabinoid receptors so it would make sense they might be affected.
The evidence is fairly consistent that marijuana use results in cognitive deficits that persist for at least hours, and likely days after use of the drug. Whether these deficits persist in the long term and the effects of persistent heavy use have not been settled.
Thoughts? Experience?
Dr O.
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Displaying comments 70-51 of 70
Got a Question?
i dont believe it's addictive...it makes people dependant.
It does cause depression...but usually if someone does it alone...but depressed people are drawn to it because it might lift the mood....
I think irregular use won't cause harm..not in the long term...maybe short term....unless it really mixed with hard drugs...
i believe that cannabis has been used on prescription...for people with ms i htink it is...or something where they are shaking permenantly...it has been used in the uk...
if it was legalised the drug would be much safer as it wouldn't be poisoned with henna and what not, but also governments could make more money with the tax of it, be able to control it and is it really worse than alcohol/nicotine...?
Thats why I smoked it as a teen. I had a really bad upbringing and couldn't take the pressure and screaming and abuse. Just the stress of living with my parents would make me throw up if I heard one of them walking in the hallway towards my room. I was a mess. And no its not an excuse but I strongly believe pot saved my life.
That being said.... I think it should be allowed for PRESCRIPTION use. Recreational.... I don't think so. Yell at me all day and night about it and it won't change my opinion. I personally know SIX people who got into car accidents because they were high and zoning. Unless they look stoned they don't test for it. Its stupid.
I stopped smoking it on my own because I turned 18 and moved out of my parents' house. The stress was gone and I saw NO need to feel stoned and stupid all the time. The people I was spending time with to get it and who smoked with me..... not mentally stimulating. I personally saw it as idiotic.
Now to today..... I know some one who smokes it before bedtime because otherwise she'd be up all night and couldn't function the next day. Sleeping pills were a bad choice for her because they made her so she couldn't function no matter how long she slept. No matter how low the dose. And I've seen NO bad side effects. She takes 1-2 hits at bedtime and sleeps like a baby.
The friends I have that use it daily (most multiple multiple times a day) have no ambition and have a hard time focusing. They all call it stress relief. Yeah you don't get stressed if your brain is working at 10%. I had the argument recently with 2 of them that pot makes you lose ambition and wastes your life. They both denied it. I said "I hate to say this because I love you but you're both high school dropouts who work for $10/hour and have no plans of ever doing better. You can't pay your rent or barely can each month because you spend your money on pot. Two 30 year olds with no kids, no wives, and no plans to do anything about it." They both looked mad but had nothing to say.
I've heard them both bitch about their situations and talk about how they'd love to make lots of money and do things with their life. Do they ever get off their bums and do anything about it? No. And they're both big time gamers. They veg and smoke pot and play video games every minute they're not at work. AT 30 YEARS OLD! Come on. Really? That's just 2 examples. Most pot heads are all the same. No ambition. 10% brain capacity when stoned. Bitch about things but do NOTHING about it. Come to think of it most of them don't even have a car. Sad. Really sad. And they can't see its the pot thats doing it. They act like its a personal choice. It kind of is..... but its because of the pot.
first, i didn't post the quote, i quoted the quote by copying and pasting, just as i have done here with your response to me.
all i asked was information about more studies. my only comment about the post was that it was good.. and it was.. but certainly not complete. my point is that i am trying to get MORE information, find as many legitimate studies as possible, and educate myself so that i can educate others. many of the newer studies are debunking long-held beliefs about smoking. as the science of medicine grows, we are learning more about genetics and other contributing factors ..co-morbid, if you will.
i stated i do NOT adovcate smoking of any kind. i'm sorry if you felt like i was doing other than that. i just feel we have a responsibility to educate on ALL of the facts, not just the ones that suit our personal beliefs.
thank you for your articles.. again! they are supportive and informative and certainly educational. i love the input from the other readers and your willingness to respond. i hope this clears up any miscommunication about my post.
Tadlem: One of Dr Tashkins only articles published in a peer reviewed journal CHEST is quite different from the quotes you have from him. Here is the article you should look at.
Tracheobronchial Histopathology in Habitual Smokers of Cocaine, Marijuana, and/or Tobacco *Chest - Volume 112, Issue 2 (August 1997)
Suzanne E.G Fligiel MD
Michael D Roth MD,FCCP
Eric C. Kleerup MD,FCCP
Sanford H. Barsky MD
Michael S. Simmons
Donald P. Tashkin MD FCCP
CONCLUSION:
Marijuana and tobacco are each associated with strikingly significant bronchial histopathologic features when smoked as single substances, and the effects of marijuana and tobacco appear additive
Dr O.
By DrOrrange January 28, 2009 9:05pm
i don't think a person should stay totally baked all day, every day.
i would rather smoke than take some of the meds i take for depression, pain, PTSD, and bipolar. my god, it can't be any less toxic for me than these pills that make me feel sick. i don't know if i'm making any sense or not, so i'll stop.
By the way, I don't smoke pot, I stopped totally years and years ago. I would never smoke again. But I recognize other people's rights to smoke if they choose to!
If your transplant team knows you smoke pot they will have you do 6 months of narcotics anonymous and prove you are no longer smoking pot...so yes...the answer is it WILL cause you to lose your spot on the transplant list...Ive seen it happen...and for pot....
I like to smoke pot, will this change any out come to me getting a transplant?
When my husband was drinking and he had to go to classes, he learned alot about drugs. Pot wasn't even on it. So, it was not on the top 10. Thats was 10 years ago.
I do believe that it does help people who is in very bad pain. Also, it helps people who gets sick to their stomach from pain.
So, why do some doctors believe in it and others don't ?
I am 45 yrs old and like I said,I only have done it 6 times in my life. I was so desperate for the pain to go away. I just never got high. That's what I do not understand. I am not for it or againist it.
Although, those that are in dire need of such controlled use for use of medical reasons. I feel that they are to monitored much better and limited with boundaries. As I have witnessed the abuse of medicinal use of marijuana, and without proper monitoring of it's regulation. To those that abuse it's use, have not likewise made positive lifestyle and/or healing within themselves to only rely on it's dependence and need and no other. My view and belief.
It's unfair and untrue to say symptoms last a week. My sponsor had a seizure when she detoxed off pot 20 years ago.
Detoxing from Marijuana
What is Detoxing?
Detoxing is the way in which your body gets rid of the toxins accumulated from years of using. It happens the first few days or weeks after getting clean and/or sober. It is also the very beginning of getting used to dealing with reality and real feelings with no numbing agent.
Can there be physical effects from quitting marijuana?
In spite of numerous years of being told that there are no physiological effects from marijuana addiction, many of our recovering members have had definite withdrawal symptoms. Whether the causes are physical or psychological, the results are physical. Others have just had emotional and mental changes as they stop using their drug of choice. There is no way of telling before quitting who will be physically uncomfortable and who will not. Most members have only minor physical discomfort if any at all. This pamphlet is for those who are having trouble and wonder what's happening to them.
Why do some effects last so long?
Unlike most other drugs, including alcohol, THC (the active chemical in marijuana) is stored in the fat cells and therefore takes longer to fully clear the body than with any other common drug. This means that some parts of the body still retain THC even after a couple of months, rather than just the couple of days or weeks for water soluble drugs.
Can this affect a drug test?
The experiences of some members have shown that if you quit marijuana and expect to take a drug test you should not go on a crash diet at the same time. Fasting, or a crash diet, can release the THC into the bloodstream very rapidly and can give a positive reading. This has happened to several of our members, but each time only with crash diets and major weight loss, not with just eating less than usual.
What are some of the more common symptoms?
By far the most common symptom of withdrawal is insomnia. This can last from a few nights of practically no sleep at all, up to a few months of occasional sleeplessness. The next most common symptom is depression (that is, if you're not euphoric), and next are nightmares and vivid dreams. Marijuana use tends to dampen the dreaming mechanism, so that when you do get clean the dreams come back with a crash. They can be vivid color, highly emotional dreams or nightmares, even waking up then coming back to the same dream. The very vivid, every-night dreams usually don't start for about a week or so. They last for about a month at most and then taper off. "Using" dreams (dreams involving the use of marijuana) are very common, and although they're not as vivid or emotional as at first, they last for years and are just considered a normal part of recovery.
The fourth most common symptom is anger. This can range from a slow burning rage to constant irritability to sudden bursts of anger when least expected: anger at the world, anger at loved ones, anger at oneself, anger at being an addict and having to get clean. Emotional jags are very common, with emotions bouncing back and forth between depression, anger, and euphoria. Occasionally experienced is a feeling of fear or anxiety, a loss of the sense of humor, decreased sex drive, or increased sex drive. Most all of these symptoms fade to normal emotions by three months. Loss of concentration for the first week or month is also very common and this sometimes affects the ability to learn for a very short while.
What about physical symptoms?
The most common physical symptom is headaches. For those who have them, they can last for a few weeks up to a couple of months, with the first few days being very intense. The next most common physical symptom is night sweats, sometimes to the point of having to change night clothes. They can last from a few nights to a month or so. Sweating is one of the body's natural ways of getting rid of toxins. Hand sweats are very common and are often accompanied by an unpleasant smell from the hands. Body odor is enough in many instances to require extra showers or baths. Coughing up phlegm is another way the body cleans itself. This can last for a few weeks to well over six months.
One third of the addicts who responded to a questionnaire on detoxing said they had eating problems for the first few days and some for up to six weeks. Their main symptoms were loss of appetite, sometimes enough to lose weight temporarily, digestion problems or cramps after eating, and nausea, occasionally enough to vomit (only for a day or two). Most of the eating problems were totally gone before the end of a month.
The next most common physical symptoms experienced were tremors or shaking and dizziness. Less frequently experienced were kidney pains, impotency, hormone changes or imbalances, low immunity or chronic fatigue, and some minor eye problems that resolved at around two months. There have been cases of addicts having more severe detox symptoms, however this is rare. For intense discomfort, see a doctor, preferably one who is experienced with detoxing.
How can I reduce discomfort?
For some of the milder detoxing symptoms, a few home remedies have proven to be useful:
Hot soaking baths can help the emotions as well as the body.
Drink plenty of water and clear liquids, just like for the flu.
Cranberry juice has been used effectively for years by recovery houses to help purify and cleanse the body.
Really excessive sweating can deplete the body of potassium, a necessary mineral. A few foods high in potassium are: melons, bananas, citrus fruits, green leafy vegetables, and tomatoes
Eliminate fat from the diet until digestion is better.
Greatly reduce or eliminate caffeine until the sleep pattern is more normal or the shakes are gone.
The old fashioned remedy for insomnia, a glass of warm milk before bedtime, helps some people.
Exercise not only helps depression and other unpleasant emotions, it helps the body speed up the healing process.
Conference Approved Literature
©1992 Marijuana Anonymous
All Rights Reserved
from http://marijuana-anonymous.org/det...
This information was gathered from potheads surveyed at marijuana anonymous meetings. Since this is over a decade old and the pot continues to get stronger, since it is a plan that is forever being "improved" with cross breeding, I fear the symptoms may have even increased since then.
Here is an interesting study...
"Suicidal behaviors in adolescents are a major health problem. They are considered as a continuum ranging from suicidal ideation to attempted and completed suicide. Suicidal behaviors in adolescents are associated with social factors and mental health problems. Of these factors, depression has been identified as the major risk for suicidal ideation, suicide attempts and completed suicide.
The aim of this study was to evaluate the independent contribution of cannabis use to suicidal behaviors after controlling for depressive symptoms and anxious symptoms in a sample of high-school students.
The sample consisted of 248 high-school students from Toulouse, France (172 girls, age range 15–19, mean age = 17 ± 1.3; 76 boys, age range 15–20, mean age = 16.7 ± 1.3). Being free of charge, these public high schools were not discriminatory on the basis of income and admitted adolescents with diverse SES levels. Participants provided written informed consent before completing the questionnaires anonymously.
Participants were asked if they have used cannabis at least once in the last 6 months. Suicidal ideation was measured using the Suicidal Behaviors Questionnaire-Revised (SBQ-R) which is a brief measure of suicidal thoughts and past attempts (Osman et al., 2001). Anxiety and depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale (CES-D) (Radloff, 1977) and the state version of the State-Trait Anxiety Inventory (STAI) (Spielberger, Gorsuch, & Lushene, 1970).
Our study showed that cannabis users had significantly higher rates of suicidal behaviors, depressive and anxious symptoms compared to cannabis non users. This result suggests an association between suicidal behaviors, depressive and anxious symptoms and cannabis use in adolescents. Moreover, cannabis use appeared to be an independent predictor of suicidal behaviors after controlling for depressive and anxious symptoms. This suggests that cannabis use contributes to suicidal behaviors independently from depressive and anxious symptoms. Although this sample is not guaranteed to be representative of the general population of French adolescents, this may not limit the study of relations between cannabis use and suicidal behavior and the generalisability of the study. A limitation to the study was the absence of control for other potential confounding variables. The association between cannabis use and suicidal behaviors may be linked to common risk factors such as conduct problems, sociodemographic and family factors. Another limitation is the absence of control for other drugs use, given that other drug use is rare in our region (Beck, Legleye, & Spilka, 2005). This study needs to be replicated with a broader control of potential confounding factors."
I know from personal experience to try to beat depression and other problems while on pot is crazy, to me.
I know people take it to deal with insomnia, headaches, depression, and other things not accepting that pot can cause the very symptoms being treated, and only when high does the patient feel "relief".
I understand people are ok with it and can use it medicinally. I also understand an addict can abuse the medicinal marijuana availability.
I'm just saying this from my personal experience and the other many potheads I know in marijuana anonymous. MA is for anyone with a desire to quit smoking pot. If there is no desire to quit smoking pot then maybe the problem is only for the loved ones, because addiction is a family disease, and for that thank God there is Al Anon and Nar Anon (I don't know of a Mar Anon - yet).
I took it one night as I was told it would get rid of a migraine, but instead it triggered me to have panic attacks and derealisation. I have been struggling thru life ever since (8YEARS!!). People do not realise the harm it can do to certain people (I sure didn't). It may not affect some people in a bad way but it can change other peoples life for the worst and this needs to be more known to people. NOWAY SHOULD IT BE LEGAL - i will stand by this till the day I die.
"Yes. Marijuana Anonymous (MA) www.marijuana-anonymous.org is a growing fellowship and getting world wide interest, moving to Europe and Japan and other countries. Pot need not be a gateway drug to be problematic. The fact that MA exists shows us that people really have trouble with pot and can need help getting off it and living without it. It can be very addictive and can cause numerous problems, especially because the strains of pot are increasing tremendously in the amount of intoxicant they carry. This is not the pot of the 60's and 60's - the THC is hundreds of times stronger, and growing. I see so many people in the marijuana recovery and support group here (which is not affiliated with MA) with mental health issues including depression, dysphoria (lack of feeling pleasure), anxiety, other disorders, and doctors know so little about pot addiction. These patients are treated for mental illness without being encouraged to get help to get off the drug, like treating an alcoholic for liver problems without getting them help to stop drinking. Medical students attend AA meetings, when is the medical profession going to recognize marijuana addiction as real?
I am a recovering marijuana addict and thanks to the 12 steps of MA and AA life is beyond my wildest dreams clean and sober. I'd never want to live with that shameful and extremely debilitating and damaging addiction to pot again - those with addictions can't just use normally, we want more. Many turn to suicide without help. Many just do not learn how to cope with life, the answer to everything is to smoke more.
It took me 10 years of recreational use to get hooked and feel like I need it everyday, and I used daily for 10 years."
I'm glad you were able to find a way to do what was best for you by stopping use. Obviously marijuana isn't for you. Another problem people have is becoming mentally dependent(not physically) on marijuana. But this can be said for many things including food and sex.