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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 78-59 of 78
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Maybe you should smoke weed and figure out what your missing lady. As for the tar deal look in your disgusting cigarette it's full of it.
How in the world does tar get into a plant leaf? You're perhaps the only doctor in the academic community that seriously believes this claim.
It depends on you, meaning the person, how you let marijuana govern your life.
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http://www.kamagrabuy.co.uk/
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.