There has been growing concern over the use of marijuana by young people.
Tolerance and Dependence
Tolerance in humans:
Research findings are inconsistent
Some discrepancies can be due to dose and duration of use being studied
Tolerance is more likely with higher doses and over longer time periods
Laboratory research generally studies much greater doses and frequencies of use than are reported in the general population
Mechanisms of tolerance are still unknown
A likely candidate = cannabinoid receptor down-regulation and desensitization
Physical dependence – Ongoing debate:
Some argue no significant withdrawal syndrome or indicators are identifiable
Others identify aspects of dependence associated with sustained heavy use
Sleep disturbance, nausea, irritability, restlessness following cessation of use
Debate continues whether these symptoms indicate psychological or physical dependence

Knowledge Check 6: Answer
Question: Research studies have found that THC __________ acetylcholine, __________ serotonin, and __________ blood flow in the brain.
increases; decreases; decreases
decreases; increases; increases
increases; decreases; increases
decreases; increases; decreases
Answer: b. decreases; increases; increases. Researchers have found that THC decreases (inhibits) the activity of acetylcholine, increases (stimulates) the release of serotonin, and increases the blood flow in most brain regions, and especially in the frontal cerebral cortex.

History of Therapeutic Use (1 of 2)
Earliest documented use 28th century B.C.
Earliest physical evidence of medicinal use 1,600 ears ago
Evidence of systematic uses as a therapeutic agent = 1800s
Used to treat mental illnesses by Paris physician Jacques Moreau
1838 treatise by Dr. William O’Shaughnessy: Described use to treat rheumatism, pain, rabies, convulsions, and cholera
Used widely in U.S.; recognized as therapeutic drug well into the 1900s
Listed in United States Pharmacopeia, National Formulary, United States Dispensatory
U.S. Dispensatory recommended cannabis to treat neuralgia, gout, rheumatism, rabies, cholera, convulsions, hysteria, mental depression, delirium tremens, insanity
Cannabis was an ingredient in various OTC medicines well into the 1930s
These uses declined rapidly due to advances in medical knowledge about various diseases, and to the Marijuana Tax Act of 1937

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

History of Therapeutic Use (2 of 2)
Today, most therapeutic uses are of synthetic products that chemically resemble cannabinoids but provide active elements of THC in a more stable manner
A disadvantage of synthetics is they do not give the rapid effect of smoking marijuana
Sativex = recently developed cannabis oral spray
Approved in several countries for treating neuropathic pain of multiple sclerosis
Promising for relieving pain of rheumatoid arthritis; may even suppress the disease
Has shown promise in animal research for improving memory loss in Alzheimer’s
Discovery of cannabinoid receptors:
Has implications for future medical and psychotherapeutic uses
Has advanced knowledge about neurobiology of cannabis misuse
Has enabled study of compounds related to endogenous cannabinoid system for potential use with multiple disorders (one example = complicated obesity)
Dramatic increase in U.S. states legalizing access to medical marijuana
Reduces nausea and vomiting in patients with HIV, AIDS, cancer, other diseases

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Current Status of Medical Uses of Marijuana (1 of 2)
2017 National Academies of Sciences report: Research findings regarding support for medical uses of marijuana
Conclusive or substantial evidence of effectiveness for:
Reducing chronic pain in adults
Antiemetic for chemotherapy-induced nausea and vomiting
Improving multiple sclerosis (MS) spasticity symptoms
Moderate evidence of effectiveness for:
Improving short-term sleep outcomes in various sleep disturbances
Limited evidence of effectiveness for:
Increasing appetite and decreasing weight loss associated with HIV/AIDS
Improving clinician-measured MS spasticity symptoms
Improving symptoms of Tourette syndrome
Improving anxiety symptoms in social anxiety disorders
Improving symptoms of post-traumatic stress disorder

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Current Status of Medical Uses of Marijuana (2 of 2)
Conditions for which the 2017 NAS report found medical marijuana would not be helpful:
Dementia symptoms
Intraocular pressure of glaucoma
Depressive symptoms in patients with chronic pain or multiple sclerosis
Conditions for which the report found no or insufficient evidence to support or refute potential benefits of medical marijuana:
Cancers
Irritable bowel syndrome
Epilepsy
Spasticity in patients with paralysis due to spinal cord injury
Motor system symptoms of Parkinson’s disease or L-Dopa -induced dyskinesia
Conclusions on medical use are often based on limited data
State laws allowing medical use may facilitate future research
Regulatory barriers, including Schedule I classification, impede further research

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Knowledge Check 7: Medical and Psychotherapeutic Uses
Question: The 2017 National Academies of Sciences report found conclusive or substantial evidence of effectiveness for treating which of the following?
Symptoms of Tourette syndrome
Symptoms of glaucoma pressure
Symptoms of Parkinson’s disease
Symptoms of chronic pain in adults

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Knowledge Check 7: Answer
Question: The 2017 National Academies of Sciences report found conclusive or substantial evidence of effectiveness of medical marijuana for treating which of the following?
Symptoms of Tourette syndrome
Symptoms of glaucoma pressure
Symptoms of Parkinson’s disease
Symptoms of chronic pain in adults
Answer: d. Symptoms of chronic pain in adults. This report found limited evidence for the effectiveness of medical marijuana for treating symptoms of Tourette syndrome; evidence that medical marijuana would not be effective for treating intraocular pressure symptoms of glaucoma; and no or insufficient evidence to support or refute the potential effectiveness of medical marijuana for treating symptoms of Parkinson’s disease.

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Physiological Effects
11.8
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Acute Effects
Physiological effects differ in intensity and duration across individuals, but in general, in healthy individuals are not dramatic
Cardiovascular: Vasodilation, causing bloodshot eyes; increased heart and pulse rates; slightly elevated blood pressure
Motor: Generalized decrease in motor activity (excepting talkativeness)
Some users also report drowsiness
Can also affect sleep stages, reducing total REM sleep, but only at higher doses
Other effects—minor, infrequent, and often variable by individual, include:
Dry mouth, thirst, fluctuations in breathing and body temperature, hunger or “the munchies”, nausea, headache, dizziness

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Longer-Term Effects (1 of 3)
Respiratory System
Appears to raise risk of respiratory symptoms, more frequent chronic bronchitis episodes
Typically reversed following abstinence from smoking
Research studies have found regular long-term smoking of marijuana does not impair lung functioning and no relationship between cannabis and lung cancer
Difficult to separate effects in people who smoke both cannabis and cigarettes
Cardiovascular System
No evidence of harmful cardiovascular effects among healthy individuals
Acute effects like increased heart rate are potentially dangerous for people with pre-existing cardiovascular problems (e.g., atherosclerosis, abnormal heart functioning)
Immune System
Cannabis apparently poses no significant long-term threat
Though it can act as an immunosuppressant, decreasing resistance to some viruses and bacteria, clinical significance in otherwise healthy people is questionable

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Longer-Term Effects (2 of 3)
Reproductive System
Animal and human studies suggest cannabis disrupts male and female reproductive systems
Decreases in number of sperm and sperm motility among men
Potential effects of these disruptions are difficult to specify
Frequent use may produce nonovulatory menstrual cycles in females
As with males, long-term effects of these disruptions are not known
Possible teratogenic effects
Active agents in marijuana easily cross the placenta, exposing a fetus to an array of cannabinoids
Few data are available for humans, but it does not appear that major birth defects result
Marijuana use by pregnant women is associated with increased risk of prematurity, shorter body length, lower infant birth weight
Children may be at greater risk of developing certain childhood cancers
Newborns have shown tremors, startle responses, and altered visual responses (functional impact not determined)

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Longer-Term Effects (3 of 3)
Children exposed to marijuana prenatally were found to show deficits at age 6 on sustained attention tasks; to be more impulsive, hyperactive, and delinquent at age 10; and to have cognitive deficits, poorer school performance, and increased risk for tobacco and/or marijuana use later in life
Prudent advice is not to use cannabis during pregnancy
Summary of Longer-Term Effects
Most of the effects associated with marijuana use appear to be acute rather than chronic
Longer-term effects tend to be reversible with the termination of drug use
Significant exceptions may occur
Most negative effects correlate with higher doses and more frequent use than reported by most American users
Regardless, more systematic and controlled research is needed to confirm or refute these suggestions

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Knowledge Check 8: Physiological Effects
Question: While more research is needed, it appears that most effects of marijuana are more _______ than _______. Though no serious, major effects have been found, the existing research seems to have found longer-term effects most in the ___________ system.
acute; chronic; reproductive
chronic; acute; respiratory
acute; chronic; cardiovascular
chronic; acute; immune

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Knowledge Check 8: Answer
Question: While more research is needed, it appears that most effects of marijuana are more _______ than _______. Though no serious, major effects have been found, the existing research seems to have found longer-term effects most in the ___________ system.
acute; chronic; reproductive
chronic; acute; respiratory
acute; chronic; cardiovascular
chronic; acute; immune
Answer: a. acute; chronic; reproductive. Overall, it seems most of marijuana’s effects are more acute than chronic. While current research has not found long-term effects of marijuana on the respiratory, cardiovascular, or immune system, studies have found possible teratogenic effects on the reproductive system s of women who smoked marijuana while pregnant.

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Psychological Effects
11.9
Maisto, Drug Use and Misuse], 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Behavioral Effects
Most common = Generalized decrease in psychomotor activity; decrements in some domains of psychomotor performance
Appears dose-related
Appears pervasive
Is described as associated with feelings of relaxation and tranquility
Many users describe more intense sensory perceptions
Some research has shown a decreased sensitivity to pain
Subtle, dose-related impairments in motor coordination, signal detection, and ability to monitor a moving object
Implications = detrimental to driving a motor vehicle – supported by studies showing increased risk of crashes when driving under the influence
Effects on sexual behavior: Those who find it enhances sex probably are responding to enhanced sensory sensitivity; Effects on sexual functioning: Long-term or heavy use has been associated with temporary impotence in men and temporary lower sex drive in women

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Cognitive Effects
Most common = Impaired short-term memory
Can occur with a somewhat low dose
Degree of impairment increases rapidly with the complexity of the memory task
Impairs encoding, consolidation, and retrieval of information
Adolescents may be more vulnerable to these effects than adults
Second most common = Altered perception of the passage of time
Time seems to slow down
Time distortion is not as pronounced in research reports as in more subjective self-reports
Other effects reported, most short-term: impaired attention and concentration; flight of ideas; enhanced creativity; occasional feelings of “unreality”; attachment of greater meaning to events or objects
Long-term: Research findings include greater cognitive impairment with longer history of use, even after stopping use; worse performance in divided attention and verbal fluency measures with frequent use; but also include apparent reversibility of impairment with abstinence. Available research on persistent cognitive effects from long-term marijuana use is equivocal.

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Emotional Effects
Positive emotional effects are cited frequently as key motivators to smoke marijuana
Many non-pharmacological factors can contribute to these effects:
Past experiences with cannabis
Attitudes about the drug
Expectancies regarding drug use consequences
The situational context of drug use
Typical emotional response = carefree, relaxed state – euphoric, content, happy, excited
Includes laughter, talkativeness, a dreamlike state; most generally viewed as pleasant and positive.
Intensity of the response correlates positively with the dose
Negative emotions and somatic symptoms are also more common than might be expected
Researchers find marijuana use correlates positively with risk for mental health problems, but do not find causation: risk could be from other traits or behaviors of users
Underlying mechanisms unknown but do not seem related to changes in brain anatomy
May reflect impact on dopaminergic pathway, maybe more in the genetically vulnerable

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Social and Environmental Effects (1 of 2)
Enhancing interpersonal skills
Many young users say marijuana improves their social competence
Though data are insufficient for full evaluation, available research does not support this
Users either are more relaxed in social situations and so perceive less anxiety, or interpret their own behavior differently while under the influence of marijuana
Effects on aggression and violence
Data overwhelmingly show cannabis use is not causally related to increased aggression; in fact, levels of aggression decrease following cannabis use

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Social and Environmental Effects (2 of 2)
Amotivational syndrome
Apathy, decreased effectiveness, lost ambition, decreased sense of goals, difficulty attending and concentrating
Causal influence of cannabis has not been established
Debate about syndrome frequency; some say it is not frequent
Not found in other countries
Laboratory studies do not support the hypothesis of this syndrome
Survey studies do not find differences of these effects in marijuana users vs. non-users
Has been observed in non-users
Is often not seen in daily users
When it occurs, it is probably due to a combination of both preexisting personality characteristics and some drug effects

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Self-Assessment
What parts of this chapter did you find most challenging, and thus need to review?
What thing(s) in this chapter did you find most interesting, and may want to study further? What interests you most about them/it?
What did you learn from this chapter that you did not know before, which may have surprised you? What kinds of things did you start to think about as a result?
What thing(s) do you think you can best take away from this chapter and apply in real life, like at school, at work, and/or at home? How would you do this?

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Summary
Maisto, Drug Use and Misuse], 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Summary 1 of 1
Now that the lesson has ended, you should be able to…
Discuss the historical use of cannabis and how the committee reports on marijuana shaped attitudes about its use.
Explain the factors that influence potency of cannabis.
Describe how marijuana is absorbed, distributed, metabolized, and excreted from the body.
Explain the mechanisms of action for cannabis.
Evaluate the evidence concerning whether physical or psychological dependence occurs with marijuana use.
Discuss how marijuana is used in the treatment of specific conditions
Evaluate the physiological and psychological effects of acute and long-term use of marijuana.

Maisto, Drug Use and Misuse, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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