Cannabis, hemp and marijuana are three terms that have been used interchangeably as though they are one and the same, but some important distinctions need to be made. Cannabis is actually a family of plants that has two primary classifications, Indica and Sativa. Marijuana is derived from either Cannabis Indica or Cannabis Sativa, whereas Hemp is derived only from the Cannabis Sativa. Hemp contains very little tetrahydrocannabinol (THC), the psychoactive ingredient responsible for the euphoric “high” associated with marijuana use. Compared to marijuana, hemp only has 0.3% concentration of THC, whereas marijuana contains 10%. Hemp is grown for industrial uses, such as the production of paper, shoes, biofuel and clothing. Marijuana is grown for recreational and medicinal use due to its high level of THC.
• The National Institute on Drug Abuse reports that marijuana is the most commonly used illicit drug with an estimated 22.2 million users in the past month, based on data from the 2015 National Survey on Drug Use and Health.
• Between the periods 2001-2002 and 2012-2013, the percentages of marijuana use among adults more than doubled, and the prevalence of marijuana use disorder rose from 1.5% to 2.9% (National Institutes of Health, 2015)
• More than 1 in 10 women reported marijuana use in the past 12 months. A significant percentage of women were daily users, met the criteria for dependence/abuse criteria, and used marijuana with other substances (Ko, Farr, Tong, Creanga & Callaghan, 2015)
• From 2007 to 2014, there has been a 45% increase in past-month use among the general population (National Academics of Sciences, Engineering and Medicine, 2017)
• In states where recreational adult use of marijuana is legalized, children are more at risk for unintended exposure to marijuana. In Colorado alone, the marijuana industry has generated over $900 million in 2015. Much of that revenue comes from marijuana edible sales. These products look, smell and taste like non-infused food products, especially cookies, candies and brownies, which put children of all ages at risk for unintended exposure and marijuana-related emergency room visits (Wang, 2016)
• Marijuana users are about 25% more likely to be involved in a motor collision than drivers with no evidence of marijuana use (Centers for Disease Control and Prevention, 2017)
• About 13% of night-time, weekend drivers have marijuana in their system (CDC, 2017)
• In 2014, about 2.5 million people aged 12 and older used marijuana for the first time during the preceding 12 months (equivalent to an average of 7,000 new users every day) based on estimates from the National Survey on Drug Use and Health, 2002-2014
A comparative risk assessment of alcohol and other drugs revealed that marijuana had the lowest risk compared to other substances (Lachenmeier & Rehm, 2015). However, to this day, marijuana is still classified as a Schedule I drug, a classification of drugs that is not currently accepted for medical use and has a high potential for abuse, according to the Food and Drug Administration (FDA). Even though medical marijuana has been approved in many states for quite some time, and the legalization of recreational marijuana is gaining traction in more states, marijuana is still not approved by the FDA for medicinal use.
According to the CDC, marijuana is not a gateway to other drugs, but reasons for marijuana use may be linked to polysubstance use. A research study examined a group of high school seniors who reported marijuana use within the past 12 months and their reasons for using marijuana and other illicit substances. Boredom, a commonly cited reason for drug use (31.3%), was linked to increased odds for use of powder cocaine or use of hallucinogens besides LSD. Palamar and colleagues (2015) found that their results were consistent with other findings that linked boredom to use of cocaine and methamphetamine. About 19.8% of the study’s participants reported using marijuana to gain insight and understanding; this motive for marijuana use was linked to increased use of hashish and other hallucinogens, such as magic mushrooms. About 11% of the research sample reported using marijuana to enhance the effects of other drugs, and 2.5% reported using marijuana to decrease the effects of other drugs. The researchers did not distinguish whether these other drugs were illicit or not, but the findings show an association between marijuana use and polydrug use.
Although marijuana is often chosen over other drugs for its perceived lower level of risk, it has been strongly associated with the development of future psychiatric disorders. Research suggests that cannabis use increases the risk of developing schizophrenia and other psychoses; among those diagnosed with bipolar disorder (BPD), those who used marijuana almost daily were linked with greater symptoms of BPD than non-users. Heavy cannabis users were more likely to report suicidal ideation, and regular marijuana use was linked with greater risk for social anxiety disorder. These findings were published in The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.
Risk factors are environmental, familial, biological, psychological and other characteristics that increase a person’s chances for negative outcomes. The National Institute on Drug Abuse (NIDA) identifies five domains where risk factors play a major role in the onset of drug use: individual, family, peer, school and community. Warnings signs can be detected in children and adolescents if they show early aggressive behavior and poor academic performance, have easy access to alcohol and drugs through friends and peers, and come from low-income families that neglect their children in the household. These are just a few risk factors among many that are also identified in SAMHSA’s research which focuses on marijuana use. SAMHSA’s review of research literature includes 76 studies and divides risk and protective factors based on the following socio-ecological model:
• Mental & Behavioral Health
• Interpersonal Behaviors
• Attitudes and Intentions
• Extracurricular Activities
• Physical Health Behaviors
• Peer Interaction
• Birth cohorts
• Social Status
As of 2019, there are currently 33 states that have legalized medical marijuana and 10 states that have decriminalized recreational adult use. Even though medical marijuana is legal in 33 states, it doesn’t mean that it’s approved by the Food and Drug Administration (FDA), as the NIDA website states. The role of the FDA is to regulate all drugs intended for human use, and it has not determined the marijuana plant to be safe or effective enough due to marijuana’s status as a controlled substance. The U.S. Drug Enforcement Administration (DEA) classifies drugs, substances and certain chemicals into five classifications (i.e., drug scheduling) based on the drug’s potential for medical use or abuse. Under section 202 of the Controlled Substances Act (CSA), marijuana is still classified as a Schedule 1 drug, a classification that has the highest potential for abuse and dependence with no currently accepted medical use.
If medical marijuana isn’t approved by FDA, why is still used for medical purposes?
The FDA has not approved a marketing application for marijuana for any indication, because the drug does not sufficiently meet the statutory standards for approval. However, the FDA is aware that marijuana and marijuana-derived products are being used for certain medical conditions.
Marijuana contains over 60 cannabinoids, which are chemical compounds unique to the cannabis plant. Two of those cannabinoids, tetrahydrocannabinol (THC) and cannabidiol (CBD), have been the subject of scientific research for their potential to treat symptoms and health conditions such as chronic pain, cancer, glaucoma and epilepsy. THC has been known to increase appetite and reduce nausea, pain, inflammation and muscle spasms. CBD, a non-psychoactive cannabinoid, is often used as an adjunct therapy to improve patient’s compliance and adherence to treatment for medical conditions such as epilepsy and psychotic disorders (Iffland & Grotenhermen, 2017). Evidence from multiple studies supports CBD’s potential for treatment of anxiety-related disorders, such as social anxiety, generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD) (Blessing, Steenkamp, Manzanares & Marmar, 2015).
Certain cannabinoids (not the plant itself) have been approved by the FDA, according to the National Institutes of Health. The FDA approved Epidiolex as an oral solution for two rare severe forms of epilepsy. The other two are synthetic cannabinoids, dronabinol and nabilone, for the treatment of nausea and vomiting associated with chemotherapy. These synthetic cannabinoids are considered to be the last resort if cancer patients are not responding well to other medications. Dronabinol is also prescribed for HIV patients who experience weight loss and loss of appetite.
Synthetic cannabinoids, also known as K2, Spice, Cloud 9, Mojo and other brand names, first became popular in Europe and then became widespread in the United States among young adults. Synthetic cannabinoids are man-made mind altering substances that can be sprayed on dried plants, vaporized in e-cigarettes or used as herbal/liquid incense (NIDA, 2018). They are also marketed in the form of capsules, tablets and powders (Tai & Fantegrossi, 2014).
Synthetic cannabinoids pose greater risk than marijuana
Synthetic cannabinoids are not derived directly from the plant itself; they contain chemicals that are strikingly similar to the cannabinoids produced naturally by marijuana, and they are often misleadingly advertised as safe alternatives to marijuana. SCBs have become popular for groups who wanted to pass drug tests because the chemical structures of SCBs are not detected through standard drug screenings (Malyshevskaya et al., 2017). SCBs have been linked to seizures, psychosis and death, and they are not safe substitutes for marijuana (Ford, Tai, Fantegrossi & Prather, 2017). Students who have used synthetic cannabinoids were much more likely to engage in substance use and risky sexual behaviors than those who only used marijuana, according to a study that used data from the 2015 Youth Risk Behavior Survey to examine the associations between self-reported marijuana use, self-reported SCB use, and 36 risk behaviors.
While some states have Per Se laws, which make it legal for drivers to have a certain amount of specified drugs in the body while driving, it is difficult for lawmakers to establish a national consensus on setting limits for delta-9- tetrahydrocannabinol (THC) levels, the active ingredient in cannabis, because the presence of THC in the bloodstream at the time of testing does not necessarily mean that the driver is under the influence of marijuana. According to the National Institute on Drug Abuse, THC can stay in the bloodstream for days and weeks after use, and it is often mixed with alcohol.
With the passage of Proposition 64, the ballot measure that legalized adult use of recreational marijuana in 2018, California has not set a limit for THC levels to determine intoxication while driving, which means that if anyone is caught driving under the influence of marijuana regardless of any level of THC in the bloodstream, the driver will be convicted of drugged driving.
Driving under the influence of drugs (DUID), or drugged driving, is defined in two ways: (1) impaired driving resulting from the use of licit or illicit drugs that compromise the driver’s ability to safely operate a vehicle and (2) driving under the combined influence of alcohol and any drug. Under California Vehicle Code Section 23152(f), driving under the influence of drugs (DUID) is considered a criminal offense which can result in license suspension, 3-5 years of DUI probation, DUI school, a fine and/or possible incarceration.
1 Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825 36.
2 Ford, B., Tai, S., Fantegrossi, W., & Prather, P. (2017). Synthetic Pot: Not Your Grandfather’s Marijuana. Trends in Pharmacological Sciences, 2017; DOI: 10.1016/j.tips.2016.12.003
3 Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139-154. doi:10.1089/can.2016.0034
4 Ko, J., Farr, S.L., Tong, V.T., Creanga, A.A. & Callaghan, W.M. (2015). Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age. American Gynecological Society 213(2): 201.e1-201.e10. doi: 10.1016/j.ajog
5 Lachenmeier, D. W., & Rehm, J. (2015). Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach. Scientific reports, 5, 8126. doi:10.1038/srep08126
6 Malyshevskaya, O., Aritake, K., Kaushik, M., Uchiyama, N., Cherasse, Y., Kikura-Hanajiri, R. & Urade, Y. (2017). Natural (Δ9-THC) and synthetic (JWH-018) cannabinoids induce seizures by acting through the cannabinoid CB1 receptor. Scientific Reports, 2017; 7 (1) DOI: 10.1038/s41598-017-10447-2
7 National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US); 2017 Jan 12. 3, Cannabis: Prevalence of Use, Regulation, and Current Policy Landscape. Available from: https://www.ncbi.nlm.nih.gov/
8 NIDA. (2018, February 5). Synthetic Cannabinoids (K2/Spice). Retrieved from https://www.drugabuse.gov/ on 2019, March 14
9 Tai, S., & Fantegrossi, W. E. (2014). Synthetic Cannabinoids: Pharmacology, Behavioral Effects, and Abuse Potential. Current addiction reports, 1(2), 129-136.
10 Wang G. S. (2016). Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 13(1), 99-105.