Marijuana

Cannabis Abuse/Dependence

What is Marijuana?

Marijuana is the most widely abused illicit drug in the US and it also tends to be the first illegal drug used by most people. Marijuana is usually smoked in the form of loosely rolled cigarettes or by the use of pipes, but it may also be taken orally (eaten). Hashish, which is the pure resin of the plant, can also be smoked, eaten, or drunk. The effects of marijuana last two to four hours when it is smoked and five to twelve hours when it is taken orally.

Although marijuana intoxication varies with the expectations of the individual and potency of the drug, the most common response is a calm, mildly euphoric state in which time seems to slow down and sensitivity to sights, sounds, and touch is enhanced.

The marijuana user may consider himself more insightful or knowledgeable, however his memory (especially short-term) and concentration are actually impaired. The user also tends to lose initiative and ambition, becoming less productive and often unable to complete tasks.

Marijuana and THC can be used for treating nausea, vomiting, chronic pain and glaucoma. Marijuana can also be used as an antianxiety agent, muscle relaxant, appetite stimulant, and anticonvulsant. Repeated usage of most drugs results in tolerance, which is an increased resistance to a drug's effects, which necessitates larger doses of the drug to maintain the "high. " With marijuana, relatively little tolerance develops when the doses are small or infrequent and the drug exposure is of limited duration, however there are few reports that indicate an urgent need to increase the dose of marijuana to recapture the expected sensation.

Psychological Addiction To Marijuana

Psychological dependence is likely if a person uses a lot of marijuana or even uses it occasionally over a long period of time. Studies have shown that marijuana has little effect on major physiological functions and there is no known case of a lethal overdose, suggesting limited physical dependence. Also, there have been relatively few reports of spontaneous physical withdrawal symptoms resulting from the sudden interruption of chronic marijuana use. Psychological dependence without physical dependency may be seen in a person who uses marijuana to such a degree that it interferes with psychosocial functioning, but the person does not experience physical discomfort with discontinuation.

How is it diagnosed?

History: It is difficult to draw conclusions regarding the prevalence of psychological dependence on marijuana given the large amount of social and legal factors that impact on the drug user, however there appear to be numerous cases of psychological dependence on marijuana.

Subjective effects of marijuana include dry mouth, thirst, increased appetite, sleepiness, constipation, decreased social inhibitions, and impaired or reduced short-term memory. It can also alter sense of time, and reduce the ability to perform tasks requiring concentration and coordination. Increased anxiety, panic, paranoia, and hallucinations are the most commonly reported unpleasant effects of marijuana.

Withdrawal symptoms due to the discontinuance of marijuana use depend on factors such as how long the person has been taking the drug and the amount of drug taken. Sudden discontinued use of the drug can cause anxiety, restlessness, nausea, decreased appetite, weight loss, craving for the drug, hyper-irritability, insomnia, and cramps. Less frequent symptoms upon cessation of the drug include auditory/visual hallucinations, and hostility. These symptoms may persist for several weeks after quitting the drug.

Physical exam: Objective symptoms of active marijuana use include bloodshot eyes, increased heart rate and blood pressure, decreased intraocular pressure, and loss of coordination (ataxia). Users often have an appearance of intoxication without the smell of liquor, excessive laughter, and yellow stains on the fingers from holding a marijuana cigarette (joint). Upon cessation of the drug, objective changes include weight loss, increased body temperature, hand tremor, and sweating.

Tests: A polydrug screen should be ordered in case the individual is using drugs other than marijuana. Both blood and urine samples may be used, however urine is generally the method of choice. A positive drug screen should always be confirmed by a second test since it may result in serious consequences for the individual.

How is it treated?

There are small segments of the population that have difficulty controlling their abuse of marijuana and will need professional treatment. It is difficult to generalize about specific treatment modalities because the problems associated with marijuana use are so vague.

Depending on the severity of the addiction, treatment alternatives include Employee Assistance Programs, self-help groups, psychotherapy, individual and family counseling, hospitalization, and residential therapy. Treatment programs focusing on counseling and group support systems appear to be used most by those who are dependent on marijuana. Hospitalization and residential therapy are seldom necessary. There are currently no medications for treating marijuana dependence. Whatever approach is taken, it is important to establish a therapeutic relationship with the individuals to gain their trust and assist them in making their life more normal and less controlled.

Medications

Acomplia (Rimonabant)

What might complicate it?

Paradoxical anxiety, panic, and paranoid reactions to acute intoxication have been reported. Long-term effects of using marijuana include decreased testosterone levels for men, which can result in a lower sperm count, and increased testosterone levels for women, possibly affecting reproductive functioning. There is substantial evidence that regular marijuana use produces a slightly weakened immune system, which can result in decreased ability to fight infections. In terms of lung function, frequent use of marijuana has been associated with an increased risk of lung cancer, bronchitis, and emphysema. There is anecdotal evidence that marijuana is detrimental to adolescent development.

Most abusers do not restrict their drug use solely to marijuana. Frequently, in polydrug abuse (where more than one drug is being used), marijuana is used with drugs known to produce physical or psychological dependence, or are of high abuse potential (such as alcohol, stimulants, depressants). While it is quite common for some users addicted to other drugs to use marijuana to alleviate some of the symptoms during withdrawal (of their primary drug), there is little evidence marijuana will take the place of the primary drug in the user's life.

Predicted outcome

There are segments of the population who smoke marijuana in a chronic, compulsive manner and have difficulty discontinuing its use, despite negative consequences in their life. There are others who smoke marijuana occasionally or on a fairly regular basis, who seem to live a normal life and have no difficulties upon cessation of its use. It has been demonstrated that the most reliable predictor of treatment outcome, regardless of treatment strategy, is the individual's readiness to change. Recovery is not an easy process, and first, second, or later episodes may be followed by relapse. Cycling one or more times from recovery back through relapse to dependence or abuse is common. Outpatient detoxification and counseling are becoming more common and most enable the individual to continue working.

Alternatives

It is well documented that some marijuana abusers may also suffer from some type of psychiatric illness, and may be using the drug for purposes of self-medication. Some researchers report that regular, long-term intake of THC (from marijuana) can increase the risk of developing certain mental diseases, such as schizophrenia. Others believe that regular marijuana use can lead to chronic anxiety, personality disturbances, and depression. During a period of abstinence from marijuana, mental disturbances may be due to either the manifestation of an earlier mental problem, withdrawal from the drug, or both.

Appropriate specialists

Physician, psychologist, nurse, social worker, recovering substance abuser, and psychiatrist.

Last updated 6 August 2011


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