Primary Care Physician
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…
Is smoking pot really bad for you?
Posted in Marijuana Addic... by Dr. Sharon Orrange on Jan 27, 2009

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 113-94 of 113
Marijuana's Lasting Effects on the Brain
By TheByzantine  Jan 25, 2013
I have been a heavy smoker of both cigarettes and pot for way over 40 years. My doctor recently ordered a chest x-ray and pulmonary function test, which of course had me kind of worried. Actually, the cigarettes alone should have killed me by now, but the test results showed my lungs in good shape with only the earliest signs of COPD. My doctor REALLY can't understand how I can be in this good of shape yet, but I've GOT to think that the pot COULD have something to do with it. Yes, I agree that those who condemn it don't know SHIT! Speaking as a beeper with a fairly bad temper, pot is probably WHY I'm not in jail! Also, I'm a chronic history and genealogy researcher and people find my memory power absolutely amazing! Smoke THAT in your pipe rednecks!
By Grumpy61  Oct 23, 2012
Oh and , last one just in case you guys didnt know ethanol is a sustainable fuel that can be used in cars and the plastic i was refering to is actually stronger than any other on market today - look it up mr. Ford made the first car ENTIRELY FROM HEMP, ( cannibis).
By Thomas Auld  Aug 17, 2012
... Want to lose money
Sorry power cut
Ps. Im 15 you guys need to brush up on this stuff , oh and i know some people that were told they had a couple of weeks to live with brain tumors they used this cannibis oil from canada and now 7 YEARS LATER the tumor is gone
And the government has this drug on the same page as cocain and heroin, LOL.
By Thomas Auld  Aug 17, 2012
The funny thing is that in this article or essay it more or less states that you are lilely to get lung cancer from smoking it, that is BS, cannibis has been proven to 1 burn with almost NO waste product eg. Tar and smoke( harmful gases ), 2 the THC chemical in weed actually helps to destroy cancer cells leaving the mormal body cells untouched, and 3 IT HAS BEEN SCIENTIFICLY PROVEN THAT YOU ARE LESS LIKELY TO GET CANCER IF YOU ARE A POT SMOKER THAN IF YOU DONT SMOKE TABBACO AT ALL!!!.
the only reasion that this drug is in section 1 of drugs catagorization is because it can be made into ethanol . This means that this is the answer to pollution , lots of illness and material companies , EVEN PLASTICS !. The big companies in the nintees didnt like this and they have friends in the banks, THINK ABOUT IT, the presidents of the united states get sponsored by oil companies for bucket loads and do the oil companies
By Thomas Auld  Aug 17, 2012

This comment does not intend to insult anyone in anyway possible.

WIth that being said, I would like to express my opinion to your Essay kind of, and even though it is really convincing; In my personal opinion is a little bit biased.

Anyways, good luck
By fer213  Aug 01, 2012
Sami2, what exactly happened to you in your life to make you develop such an incredibly dead-set aversion to marijuana? You're either extremely ignorant or have been hurt in some way..
By rubenjruiz27  May 31, 2012
Sami2 what exactly happened to you in your life to make you develop such an incredibly dead-set aversion to marijuana? You're either extremely ignorant or have been hurt in some way..
By rubenjruiz27  May 31, 2012
Sami2, you are the definition of ignorance. You quoted that smoking pot has NEVER shown a sign of causing lung cancer. Calling someone brain dead for smoking is possibly the dumbest thing i have ever heard, you say drinking is acceptable in social events have you seen someone while under the influence of alcohol? If so I would truly hope you wouldn't actually write that. Yes people who smoke pot stand up for it because we have understood that in good moderation we can live a normal successful life. We are no different then you and for you to look down on someone who smokes makes you a judgmental person. The people who move on to greater drugs were destined to go to them to begin with because there life is already going downhill. Goodbye
By FightTheIgnorance  Apr 28, 2012
WTF Sami2

If ever anyone SERIOUSLY needed a spliff. I recommend it's you.
By threesixandtwelve  Mar 16, 2012
I should also add that I make a living as a writer and I am considering taking a degree starting this year.

I don't own a T.V. and read a lot. If you connect your smoking to creativity, that's one way of using, as opposed to abusing.

I went through a few years without it (pregnancy etc.) no problem. But then something terrible happened in my life and I became unable to eat, weed saved me and helped me laugh in seriously unfunny times.
By threesixandtwelve  Mar 16, 2012
Well smoking has given me an appetite for the last 16 years - The new strains (I live in Amsterdam btw) are ridiculously strong. Sometimes I smoke and feel better, but sometimes absolutely NOT.

I've smoked for.... shit I can't remember......(joke) more than 35 years - with some breaks. I had an unbelievably tough life, it helped and un-helped probably about 50/50.

As for the forgetting. Well, most of the time, my dears, that was the object of the mission. I never did like alcohol.
By threesixandtwelve  Mar 16, 2012
First of all, I will say that there's absolutely nothing wrong with smoking weed. Yeah it may kill a few brain cells in the end but I know one thing, it does NOT make ignorant idiots like sami2. My God! I feel bad I've wasted my time reading his posts but I just couldn't believe how ignorant and judgmental someone could be! According to sami2 (Moron), pot is JUST like cocaine, ecstasy, heroin, etc.. You have to be mentally retarded if you think that! Also, weed does not kill who I am as a person! I'm a fun loving individual who loves his daughter more than anything in the world, I spend sooo much time with her, I watch cartoons with her ALL the time, I play outside with her ALL the time, I'm patient with her, etc.. I'm a great father! And it shows because my daughter loves me sooo much! She ALWAYS wants to be with me, she's ALWAYS happy! In the end I'm a very nice person and fun to be with.
By pot4life  Jan 18, 2012
I'm like a kid at heart! And then I have people like sami2 (Idiot) telling me that weed kills who I am as a person! Umm.. OK LOL Also, if you would rather be dead than seeing your kids high on weed than you don't deserve to live in the first place. I'm sure if my parents were like that I would very gladly disown them and never feel guilty. You gotta be a complete moron to say something like that. That clearly shows you'll only love your kids as long as they live to your expectations. The truth is I've been smoking weed all my life and it has never made me a bad person or anything close to it.
By pot4life  Jan 18, 2012
The reality is pot does not make you a violent person, it makes you more patient, calms you down from all the government corruption (children's aid, police, insurance companies, etc..). It's not for nothing that one of the leaders from a major drug squad totally converted and is now FOR weed. His conscience just could not let him ruin another family for something that doesn't do anything bad to people. It makes people more down to earth in my opinion and I'm sure many others think this. Now, sami2 (Heartless) would rather see his kids with diabetes than seeing them high on weed. Again, are you retarded?
By pot4life  Jan 18, 2012
Also, I would like to add that I do not wish to have sex with women and leave them behind and also that if there are some people that do that, it isn't because of weed. It has to be because they are ignorant idiots like yourself. What's this about you saying we're saying Satan is better than God and the government is trying to kill us and blah blah blah??? I've never heard any stoner say retarded s*** like that! LOL Like, seriously what's wrong with you? Again, (takes a deep breath cause I can't believe the level of idiocy), also, for you to say that weed causes people to have troubles with their relationships is retarded.
By pot4life  Jan 18, 2012
The fact is that anyone can have troubles is their relationships. The main cause of relationship problems is dishonesty, infidelity (same thing really), being inconsiderate, being an ass hole, etc.. and weed does NOT cause any of this! Lack of moral values cause this! I am an honest person with people that are honest. For that matter, remove cops, children's aid, insurance companies, and many more..
By pot4life  Jan 18, 2012
Of course weed is gonna cause you problems with cops and children's aid, etc.. but that doesn't change the fact that there is absolutely nothing wrong with weed and that cops, children's aid, etc.. are dishonest, corrupt, etc.. people, therefor one must stand for what is right! MORAL VALUES! Something you clearly lack, sami2 (Not very intelligent individual). I find it very retarded of you (once again) to say "it's the way you think", like you have ANY idea of the way I think!
By pot4life  Jan 18, 2012
However, we all clearly know how you think, you don't! You lack intelligence and consideration. You are what's wrong with the world! You are one special ****! LOL I'm sorry but I just had to create an account and reply to this non-sense! LOL Unbelievable that someone could be so dumb! LOL Also, I wanna say to you sami2, that, according to you, weed causes people to be retarded.. What the hell happened to you for you to be retarded?
By pot4life  Jan 18, 2012
Weed does not make people retarded but I'd sure like to know what turned you into an ignorant bastard that doesn't know squat about weed and makes all sort of self-empowering retarded comments due to your low self-esteem due to your rejection in life due to your retardness?? Whoa! Thanks everyone! I know that was sooo well-said. Did I ever put that ignorant **** in his place?? Smoke weed every and **** what ignorant people say! :)
By pot4life  Jan 18, 2012

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