Marijuana Misconceptions

Marijuana is the most common illicit substance used by teens (and yes, even in states where use is legal, it is still illegal for minors). We spend a good chunk of my clinic counseling teens about marijuana use. Here are some direct quotes that patients bring up in clinic on a regular basis:

“Marijuana is a natural drug –it’s not dangerous!”

E. coli is natural as well, but that’s a different conversation.

Coinciding with the increasing legalization of marijuana, the perceived risk of marijuana among teens has declined sharply over the past few years. Nearly 70% of high school seniors viewed cannabis as not harmful.  Luckily, the rate of use is much lower than this.

Between 2005 and 2015, the proportion of emergency department or urgent care visits by Colorado youth ages 13 to 20 for pot-related illnesses nearly tripled.  Ahhh…Colorado…you will be the beacon of marijuana studies for the foreseeable future.

 “It doesn’t alter my brain in the long-term”

The active ingredient in the plant is tetrahydrocannabinol, or THC. When this is smoked, it passes from your lungs into your bloodstream and eventually to your brain and organs. Your brain has endocannabinoids that act on receptors to carry out normal cognitive functions. But when THC enters the brain, it binds to these same receptors, stopping the endocannabinoids from doing their job. All of the different areas in your brain where these receptors are “hijacked” are what cause your “high”, including, altered senses, altered sense of time, hunger, changes in mood, impaired body movement, difficulty problem solving, and impaired memory.

When the brain’s natural functions are altered like this, we see subsequent effects on mental health and cognition. Adolescent brains are especially susceptible to consequences. Marijuana users show increased risk for developing social anxiety disorder, increased risk of developing schizophrenia and other psychoses, and increased ideas of suicide. Marijuana smokers also have higher rates of depression, anxiety, and PTSD, although cause and effect are not established.

In terms of long-term cognition, studies have shown a decline in neuropsychological functioning (verbal comprehension, processing speed, memory, etc.) in pot-smoking teens. This study showed that people who started smoking marijuana heavily in teens and had ongoing use lost average of 8 IQ points between ages 13 and 38. This lost mental ability did not fully return with cessation of use either.  As Forbes points out, this difference in IQ can have a significant financial impact. Individuals with an IQ of 110 have an average net worth of $71,000 and individuals with an IQ of 120 have an average net worth of $128,000.

“I smoked an hour ago, I’m not high anymore.”

The onset of action, or how long it takes to feel the effects of marijuana, is 15-30 minutes when it is smoked. It stays in your system for 4 hours. The onset of action of edibles, or ingesting marijuana is 30 minutes- 3 hours. This can stay in your system for up to 12 hours.

Interestingly enough, marijuana’s effects on cognition can last 12-24 hours, long after the feeling of being high has worn off. This includes decreased reaction time, impaired attention, impaired motor coordination, and impaired ability to complete tasks that require divided attention.

“I would never drink and drive – that’s stupid.  However, I drive high all the time, no problem”

If the above abilities are impaired for 12 to 24 hours after marijuana use, you can probably guess that our driving skills are greatly impaired when high, or even the rest of the day after being high. Studies have shown that the odds of a driver under the influence of marijuana is 2.6x more likely to be in a motor vehicle accident than a sober driver. This is a huge risk, considering motor vehicle crashes are already the leading cause of death in US adolescents ages 16-25, no matter if you are sober or not.

“Marijuana helps my nausea and stomach pain.”

People that smoke marijuana for a long time can actually develop nausea and stomach pain and begin self-treating by continuing to smoke! Cannabinoid Hyperemesis Syndrome occurs in chronic users when weed (which has natural anti-nausea properties) has a paradoxical effect on the stomach and actually can cause nausea and vomiting.  This starts as months to years of early morning nausea and abdominal discomfort. Many users “self-treat” with more smoking. The next phase of this syndrome is a cyclic nausea and vomiting phase that can last 1-2 days. Users get diffuse abdominal pain and will self-treat these symptoms by taking several hot showers a day to alleviate the pain. Users then recover and return to normal before the cycle repeats itself. Therefore, yes, marijuana may be alleviating your nausea and stomach pains, but only after it was the cause of it in the first place. The only treatment? To stop marijuana use.

“Marijuana smoke is better than cigarettes”

Less is known about marijuana smoke than cigarette smoke. However, we do know that marijuana contains some of the same carcinogens as cigarettes. The inhalation of smoke itself also causes several respiratory problems. A recent study suggests that an increase in parents smoking pot around their children could undo decades of effort to protect our kids from second-hand smoke. Among parents who smoke cigarettes, pot use increased from 11% in 2002 to more than 17% in 2015 (although number of parents smoking around their children has decreased overall). Patients with asthma who are exposed to marijuana smoke have poor control of their symptoms and frequent attacks. A Colorado study found that 1 in 6 children (under 2 years of age!) admitted to hospital for bronchiolitis (lung inflammation) tested positive for marijuana exposure. And lastly, studies have shown a higher risk of lung cancer in marijuana users.

“Synthetic marijuana is safe and legal.”

This is the most dangerous misconception of all (see recent blog post to show how false this is!). Synthetic cannabinoids, also called Spice or K2, are newer drugs that are similar enough to marijuana to bind the same receptors in the brain, but their chemical structure is altered.  This change in structure is just enough that “technically” the drug is not an illegal substance like marijuana. However, the chemical alterations that have occurred can make synthetic marijuana up to 100 times stronger. As legislation bans one substance, a small alteration is made in structure to stay one step ahead. With each alteration, the substance becomes more unpredictable and potent. Health risks include fast heart rate, agitation, nausea, seizures, and death! Synthetic marijuana actually causes a 30 times higher rate of ED visits compared to marijuana.

Looking at high school data from a recent national survey, about 3% of high school students report use of synthetic marijuana in the past year. Unfortunately, these students reported less concern of the health risks associated with these drugs and more concern for marijuana itself. It seems that the appealing packaging, easy accessibility, and “legality” of the drug falsely portray it as a safer alternative to users.

So, there you have it.  Marijuana may be natural and legal in some places, but it’s not risk free.  It’s important to talk about marijuana and make sure the misconceptions get cleared up.