Marijuana

Cannabis sativa (Cannabis sativa), better known as marijuana, is a cannabis plant growing almost all over the world. Cannabis plants are best known today as strong psychoactive substances, but for many years they have been harvested because of their fiber. Durable hemp fiber was used in the manufacture of ropes, clothing and ship gear. Also, for several centuries in many countries of the world, they were used for the purpose of misting the mind, while in the first third of our century in the United States they did not discover their psychoactive abilities. After that, the hemp plant began to collect more often due to its psychoactive effects.

The term “marijuana” comes from the Portuguese word mariguango, which translates as “intoxicating.” Both marijuana and hashish are derived from cannabis sativa. Marijuana is the upper part of the plant with leaves. Hashish is made from resin dust that is released by a hemp plant to protect it from the sun, heat, and to maintain fluid levels. Plants growing in warm climates emit more resin, which is a strong psychoactive agent.

This chapter begins with a historical overview of the origin and use of plants. It is followed by a section on the epidemiology of the use of marijuana. Then there is information about absorption, distribution, metabolism and excretion; mechanisms of action; tolerance and dependence. Next comes the consideration of the medical and therapeutic use of marijuana. The last section of the chapter is devoted to the psychological, physiological and social effects of marijuana.

Reports of marijuana commissions

The Laguardia Commission report was compiled by the New York Academy of Medicine at the request of the mayor of New York, Fiorelle Laguardia. This study, the second in the framework of the Commission on Indian Hemp Drugs only, was essentially an interdisciplinary study. It included the coordinated conclusions of doctors, physiologists, pharmacologists and sociologists. The main statement of the report was that the use of marijuana is not particularly dangerous for the user and for society as a whole. The report provided no evidence that aggression, violence, hostility had anything to do with marijuana smoking. It was not claimed, however, that marijuana does not cause any psychoactive effects. Certain changes in a person were noted, including in more powerful forms “slowing down of thought processes and admiration for delusional reality with periods of laughter and anxiety”.

The findings of this report coincided with the findings of previously published reports. Also, subsequent studies mirrored the main conclusions. These studies include the 1968 report of Baroness Bouton from Great Britain, the Intermediate Report of 1970 to the Delayan Canadian Government Commission and the First Report of the National Commission on Mental Health and Drug Abuse of 1972. Later reports, such as the US Congressional Marijuana and Health Report (1982) and the Study on Drug Abuse (1984, the first in a series of three-year Congress reports), were both presented by the National Institute on Drug Abuse, did not have controversial discoveries, however much more carefully described the negative effects of marijuana use.

Epidemiology Marijuana

Marijuana remains the most commonly used drug in the United States. The growth in the use of marijuana in the 1960s, 1970s was followed by a steady decline in the early 1990s. Nevertheless, there was a surge in the use of marijuana among high school students in 1993.

The data collected by the National Institute for the Study of Drug Abuse in 1991 show that almost 68 million Americans (33% of the population) have tried marijuana at least once in their lifetime. The percentage of those who have ever tried marijuana is as follows: 13% of adolescents (from 12 to 17 years old), 51% of young people (from 18 to 25 years old) and 33% of adults (from 26 years old and above).
These and other data are shown in chart 10-1. The most noticeable changes occur with adolescents. Between 1979 and 1991, the distribution of marijuana among adolescents dropped from 68% to 51%, the number of users once a year fell from 47% to 25% and constantly consuming (once a month) from 35% to 13%. The number of people who have ever used among adults has been steadily increasing, probably as a result of the growing up of people who used marijuana in the previous period.

Several findings from the studies of the 1990s are worth mentioning. First, men are more likely to use marijuana than women. The only exceptions were teenagers from 12 to 17 years old, where men and women use marijuana about equally. The second thing that matters is the frequency of use. The percentage of people using marijuana 100 times or more (among those who have used it at least once in their life) is: 14% for 12-17-year-olds, 21% for 18-25-year-olds, 27% for 26-34-year-olds and 20% for 34-year-olds and older. As a result, data comparing the percentage of regular smokers of marijuana and those who use drugs periodically, reflect the fact that non-regular smokers of marijuana use other drugs more often than regular ones. As an example: 28% of young marijuana smokers account for a certain number of people who use other drugs. In particular, 11% use cocaine.

Chart 10-2 shows that marijuana use in the United States increased significantly in 1993. For example, the number of older students who use marijuana every day increased from 1.9% to 2.4%. This shows that attitudes and stereotypes about drugs among older schoolchildren are “softened,” schoolchildren are no longer confident in the negative consequences of drug use and in their personal failures, which drug use entails.

Marijuana as a way to use other drugs

The theory of the path or “walking stone” – the theory of drug use, based on the fact that the use of legal and illegal drugs leads to predictable consequences. This theory attracted particular attention in the 1960s, 1970s during the debate on the legalization of marijuana. Opponents of legalization, including the Federal Bureau of Drugs, argued that using marijuana is the first step towards addiction to heroin. However, studies have shown that the vast majority of smokers of marijuana do not become heroin users.

However, the use of one substance sometimes leads to the next. One of the first studies on this topic showed that alcohol use among high school students was a necessary transitional step between drug use and cannabis use. This study has been confirmed by others from the New York State Research Institute. They found that high school students usually use drugs in this order: alcohol, marijuana, and then “hard drugs” (such as cocaine, crack, other hallucinogens, and heroin). Recent studies have found that crackers almost always used marijuana before.

Two things to remember. The first, and perhaps most important, that not everyone who drinks alcohol will subsequently smoke marijuana, and whoever smokes marijuana will not necessarily use other drugs. Secondly, the one who starts smoking marijuana after drinking alcohol, usually does not stop drinking alcoholic beverages, and both substances can be included in his “repertoire”.

Ways to use

For psychoactive substances, marijuana and hashish are accepted in many ways. For example, they found out that several centuries ago these substances were taken in the form of liquids or in the form of food. In addition, the psychoactive effects of marijuana can be experienced by chewing on marijuana leaves. However, smoking remains the main mode of cannabis use, usually in the form of a cigarette or a joint. Inhalation of marijuana cigarette smoke is the most effective way to absorb marijuana.

Active ingredients

The first chemical analysis of cannabis was probably undertaken in 1821. Since then, it has been found that cannabis is a complex plant. It consists of more than 400 chemical elements. About 60 of them, called cannabinoids, are unique elements of cannabis. During ongoing research, new substances and compounds are likely to be found in cannabis.

Despite years of research, it was not until 1964 that the main psychoactive element of cannabis was isolated. This substance is called delta-9-tetraksidkannabinol, but most is known as D-9-THC or simply THC. The study found that TNScannabinoid explains the vast majority of known psychoactive effects of marijuana. THC is the main psychoactive element of cannabis, but other cannabinoids, such as cannabidiol and cannabinol, can be biologically active and can produce the effects of THC. Anyway, they are not psychoactive in themselves.

The potency of cannabis can vary greatly. The marijuana smoked in the US today is much stronger than, for example, it was at least ten years ago. Its strength has increased by 13–15% (often in the case of sensims, a strong variation of marijuana without seeds), and sometimes by 30%. Similar differences and an increase in the average strength of action have been observed in hashish. The third form of cannabis, hashish oil, is a concentrated liquid extract obtained from cannabis plants through the use of solvents. The strength of this oil, which could be bought on the street for a number of years, is higher than that of cannabis leaves, from which it is extracted, or hashish. It is believed that this oil may contain up to 60% THC.

Absorption, distribution, metabolism and excretion.

The absorption of THC primarily depends on the method of use. The most rapid and effective absorption of marijuana occurs during smoking. Inhalation of marijuana leads to absorption directly through the lungs, and the manifestation of the effects of HPS begins after a few minutes. Blood plasma tests show that the highest concentration is observed after 30-60 minutes. The effects of the drug are felt for about two to four hours.

The amount of HPS accumulated during the smoking process can be determined by several factors. One of the most important constants is the power of cannabis smoked. Only half of the HPS, in principle possible in marijuana, may be in the smoke of marijuana, and its amount absorbed in the blood, respectively, will be even lower. Another factor is the amount of lag time in the lungs; the longer the smoke lingers in the lungs, the longer it takes to absorb THC. A factor that also influences perception is the number of people smoking a “school”. A large number of smokers to a large extent reduce the amount of marijuana per person.

Eaten cannabis is absorbed much more slowly and less effective. In this case, marijuana is absorbed to a greater extent by the gastrointestinal tract, and the highest content in the plasma occurs two or three hours after ingestion. An important difference from this method of smoking marijuana is that the blood in the oral cavity, which absorbs marijuana, passes through the liver before it enters the brain. The liver clears the plasma of most of the HPS, so less of it penetrates the brain. However, the effect of a drug taken as food can be tested over a long period of time, about four to six hours. It has been established that to achieve the same effect, the dose taken in this way should be three times more than when smoking.

The use of peak plasma THC levels to determine the effect of cannabis can lead to incorrect results, because psychoactive cannabinoids, as lipids, quickly dissolve in lipids and are almost completely insoluble in water. In contrast, cannabinoids are a dark, viscous, oily substance. The level of THC in plasma is greatly reduced, since the THC is distributed to the tissues of various organs, especially those that consist of fatty materials. An examination of the organs, after ingestion of cannabis, shows the concentration of THC in the brain, lungs, kidneys and liver. Thus, even when the level of THC in the blood is zero, the level of THC in other organs can vary greatly. Also, THC is able to pass through the placenta and reach the fetus.

As noted above, the THC is distributed through the blood and is located in various organs. THC over time decomposes into other, less active products. Although this occurs predominantly in the liver, metabolism can also occur in other organs. HNS metabolism products are slowly excreted through urine and skin secretions. Approximately half of the THC remains in the body for about a week and is eliminated after a few days. Some products of the HNS metabolism that can remain in the body system can be detected after 30 days using urinalysis.

Mechanisms of action

The main psychotropic effect of marijuana occurs in the brain and is the result of the effects of the drug on neurotransmitters. Most research in this area focuses on the effects of marijuana on the chemical mediator, acetylcholine. HNS in relatively small doses reduces the circulation of acetylcholine, particularly in the hippocampus, leading to a decrease in the activity of the neurotransmitter. In addition, THC contributes to the release of the neurotransmitter serotonin. While the mechanism of drug action is mainly based on inference, some advances in research are taking place. First of all, this is the latest study of the visible receptor of the HPS in the brain. Research has also opened up new possibilities for exploring pathways in the brain that may be involved in the actions of cannabinoids, and to search for chemicals produced by the body that interact with the detected receptor. Later, a group of scientists discovered the presence of natural chemicals in the body (called anandamides, from the word “bliss” in Sanskrit), which act on the same receptors in brain cells as cannabinoids. In the future, researchers will use the composition of anandamides to study the effects of cannabinoid receptors on functions such as memory, mobility, hunger and pain, which are exposed to marijuana.

Tolerance and dependence

Tolerance to cannabis was confirmed by experiments with animals. However, human tolerance to cannabis is less obvious, since some studies indicate its presence, others do not. Some differences in human studies and his tolerance to cannabis can be explained by the doses of marijuana and the duration of use. Tolerance is most likely to occur when large doses are taken for long periods of time. As a rule, in laboratory studies, the dose and frequency of use is much greater than that usually taken by drug addicts.

The mechanisms of tolerance are still not known.
Physical dependence on cannabis is very rare. According to the data, no significant withdrawal symptoms were observed. No indicators of withdrawal symptoms were found, as was the case for other substances, such as alcohol or heroin. Aspects of dependence during prolonged continuous use mainly affect motor symptoms, such as troubled sleep, nausea, irritability, and relaxation. Some argue that these symptoms are more related to psychological dependence or refusal to use drugs. However, as in the case of tolerance, physical dependence is not obvious. Existing cases are associated with fairly high doses of marijuana taken over long periods of time. Be that as it may, some people do become physically addicted to marijuana, and the mechanism by which this addiction remains is unclear.

Medical and psychotherapeutic use

Cannabis has a long history of its use for medical and recreational purposes, which dates back, according to early evidence, to Shen Nung in the 28th century BC. Shen Nung recommended that people use cannabis because of its medicinal properties. The first evidence of marijuana use as a medicine was recently found by archaeologists who discovered traces of marijuana in the remains of a young woman who died, probably at the birth of a child 1600 years ago. The researchers suggested that marijuana was used to speed up the process of birth and to ease the pain associated with it. The information that cannabis was used during childbirth was first found in Egyptian papyrus and Assyrian tablets. Systematic use of cannabis as a therapeutic agent did not take place until the 1800s. For example, a Parisian doctor, Jaco Mauroy, used cannabis in the mid-1800s to treat headaches. Cannabis has become much more widespread thanks to Dr. William O’Shaughnessia, an Irish doctor who was the first in scientific work in 1838 to outline aspects of cannabis use to help with diseases such as rheumatism, pain, rabies, convulsions and cholera.

Cannabis has also been widely used in the United States to treat a variety of diseases. It was appreciated as a therapeutic drug already in the 1900s. At this time, cannabis was mentioned in the collections: United States Pharmacopeia, The National Formulary and in the United States Dispensatory. In the latest collection, for example, cannabis was recommended for the treatment of neuralgia, gout, rheumatism, rabies, cholera, seizures, hysterics, depression, delirium tremens and insanity.
The decline in the use of cannabis in medicine, observed in our century, is the result of two factors. The first is the progress in the development of new drugs and the discovery of new knowledge relating to many diseases and to the methods of their treatment. The second factor is the 1937 Marijuana Fees Act. This legislation has significantly reduced the use of marijuana for medical purposes.

Currently, the use of marijuana for therapeutic purposes is largely limited. This is mainly due to the use of synthetic drugs (such as Levontradol, Nabilone and Marinol), which are chemically similar to cannabis, they are used today for the treatment of certain ailments. These synthetic substances are widely used, since they provide the active elements of the HPS in a more stable form. Synthetic substances also dissolve better. Unfortunately, their disadvantage is the lack of a quick effect on smoking marijuana. When oral administration of synthetic THC before they enter the blood, they first pass through the gastrointestinal system, so absorption slows down dramatically.

Recently, attempts have been made to legalize the use of marijuana for medical purposes. Most of these attempts are stimulated by an increase in the number of marijuana smokers among AIDS patients, who claim that marijuana reduces the feeling of nausea and vomiting caused by the disease, stimulates the appetite, and thus helps them compensate for the weight loss resulting from the disease. One such attempt is the creation of “cannabis clubs” in some major cities of the United States. These organizations buy marijuana in large quantities and supply it (free of charge or for money) to patients with AIDS, cancer, and other diseases. The cannabis club in San Francisco operates quite legally and is under the auspices of city law, which allows medical use of marijuana.

The final resolution regarding the legalization of marijuana for medical purposes will probably not be passed soon. Meanwhile, there are some diseases – especially glaucoma and seasickness – when cannabis is prescribed in a synthetic form, it will be described in the following sections.

“Before making a decision (not to legalize marijuana for medical purposes), we carried out serious research. Marijuana has no recognized medical value.”
Beal Ruzementi, official DEA. USA Today, October 1, 1993
“All that we ask the DEA is to get the hell out of the way of using drugs that have been proven effective.”
John Morgan, Professor of Pharmacology, New York University Medical School, USA Today, October 1, 1993

Glaucoma

Glaucoma is a generic term for eye diseases that include an increase in intraocular pressure. This pressure damages the optic nerve and is the most common cause of blindness. More than two million Americans over the age of 35 have developed glaucoma, and 300,000 new cases of the disease are recorded every year.
It was found that cannabis is able to reduce intraocular pressure, but when taking cannabis, patients experience side effects, regardless of whether it is administered orally, by injection or while smoking. These side effects include increased heart rate, increased blood pressure, and psychological effects. Some of them take place under the extensive effects of cannabis.

The mechanism by which cannabis reduces eye pressure remains unknown. Cannabis is believed to dilate blood vessels that drain fluids from the eyeball. It is believed that such drainage prevents the concentration of fluid and as a result, pressure does not occur, resulting in damage to the optic nerve.
Clinical studies of the potential benefits of cannabis for treating glaucoma continue in two main areas. The first is the development of synthetic formulas that would eliminate side effects. The second direction concerns methods of application. Particular attention is paid to the development of a drug that can be injected directly into the eye.

.Nausea and vomiting

Cannabis and synthetic THC are used to prevent nausea and vomiting, often caused by chemotherapy (and radiation treatment) of cancer. These side effects, which can last from several hours to several days, are often not mitigated by traditional antiemetic drugs.

Researchers in the 1970s began a systematic study of the anti-emetic effects of TNS, which led to good results. The study was initiated after stories of chemotherapy patients who reported using marijuana on their own to mitigate the side effects of this treatment.

Positive results continue to appear in subsequent studies. Moreover, there is evidence that the effects of chemotherapy treatment for children’s cancer can be partially eliminated by taking oral doses of cannabinoids. More recent research concerns the use of artificially created TNS, such as Nabinole. The main obstacle to the use of cannabis and artificial THS is that they have the mental effects that some patients have experienced. This is discomfort and anxiety. However, many patients treated with chemotherapy consider the side effects of HNS not so serious. Research in this area is likely to advance if a decision is made by the Drug Distribution Authority (DEA) to reclassify synthetic THC into a Group 2 drug (see Appendix N1), which means awareness of its particular medical value. Synthetic THC was originally classified as Group N1 drugs, that is, treated as drugs with no medical value. Marijuana is still a drug of Group N1.

Physiological effects

Although cannabis can cause certain physiological effects, most of them differ from one user to another, and not only their strength and intensity, but also their duration. Basically, the strong physiological effects of marijuana are not dangerous for a healthy body. Indeed, the Ledine Commission (1972) reported that “the short-term physiological effects of a standard dose of cannabis for normal people are mild and do not have much clinical significance.”

The most typical effects are those of the cardiovascular system. Predominant among them is swelling of the mucous membrane of the eye or inflamed eyes. This effect, which occurs as a result of dilation of blood vessels, most often occurs within an hour after smoking and is largely determined by the dose. Although some also noted that pupils are also dilated after smoking, studies have not supported such statements. This is probably most often caused by the fact that marijuana is smoked in a dark room. However, cannabis can somewhat slow down the response to light.

The second most common effect of the cardiovascular system is an increase in heart rate and an increase in heart rate. Both of these effects appear within an hour and both are determined by the dose volume. Maximum heartbeat occurs 20 minutes after smoking. In addition to these effects, blood pressure may increase slightly. There is no evidence that these effects cause irreversible damage to the normal cardiovascular system.
Another common effect of cannabis use is impaired motor function. The only exception to this can be considered a talkative mood. Some smokers show a feeling of relaxation. Cannabis can also affect various stages of sleep, partially affecting the function of PEM. However, this happens mainly with large doses of cannabis.

Other effects, which are evidenced by the patients, may be insignificant or just rare, and, more often, they are different in different people. These effects include (but not limited to) the following: dry mouth, the appearance of thirst, fluctuations in breathing and body temperature, feeling hungry or swallowing saliva (especially strong within three to four hours after smoking), nausea, headache and / or dizziness .

Lasting effects

Data on the long-term effects of marijuana, unfortunately, are rare and difficult to determine. The studies that were undertaken focused on four body systems: respiratory, cardiovascular, immune, and reproductive.

Respiratory system. There is little reliable research on the long-term effects of cannabis smoking. The normal functioning of the lungs, apparently due to cannabis smoking, is changing, causing withdrawal from smoking. Cigarettes with marijuana contain more tar than cigarettes with tobacco. Cannabis resin contains more carcinogens than tobacco tar. This is especially dangerous when a marijuana smoker (trying to increase the effects of a drug) is deeply drawn out and holds smoke in his lungs for a long time. Unfortunately, long-term observations were not conducted. The difficulty in determining these effects is that cannabis smokers usually smoke and cigarettes, so it’s very difficult to separate the effects of those and others. However, the likelihood of incurable lung damage from smoking marijuana remains.

The cardiovascular system. The overwhelming majority of cardiovascular effects associated with cannabis smoking have been described earlier in this section. There is no reliable information that smoking marijuana leads to serious effects on the cardiovascular system of healthy people. Acute effects (such as rapid heartbeat) caused by smoking are likely to be dangerous for people with impaired cardiovascular conditions, such as abnormal heart function or atherosclerosis.

The immune system. Although some studies on this topic provide different conclusions, it is clear that cannabis does not have a significant effect on the immune system. However, cannabis can act as an immunosuppressive agent and lower the body’s resistance to certain bacteria and viruses. The mechanism by which a drug affects the immune system is not yet known.

Reproductive system. Studies with animals and humans made it possible to assume that marijuana has a significant effect on the reproductive system in both men and women. For example, the constant use of marijuana in men is associated with a decrease in the number of sperm and a change in its consistency. The possible effects of these fertility disorders are difficult to predict. Frequent drug use by women can cause the menstrual cycle without ovulation, when menstruation is not preceded by the release of an egg. In a situation with a woman, the effect of this type of disturbance on fertility is not known. Interventions in reproductive processes, at least in women, are unclear. However, minor changes are possible.
More likely to occur teratogenesis, that is, the occurrence of developmental abnormalities. The marijuana active reagents cross the placenta, and cannabinoids can leak into the fetus. These experiments with a person do not indicate the possibility of the consequences of congenital malformations. This does not mean that they can not appear. The use of marijuana by a pregnant woman is associated with the possibility of premature birth, insufficient fetal weight and a strong depletion of the mother. Sometimes there can be a tremor, fear and other manifestations of anxiety in a newborn child of a woman who used marijuana during pregnancy. Functional disorders of this kind of exposure are difficult to determine, partly because it is difficult to determine the duration of postpartum exposure, and cannabis use by pregnant women is usually combined with tobacco smoking and alcohol consumption. A good advice would be to not use cannabis during pregnancy.

The sum of lasting effects. It turns out that most of the effects associated with marijuana are more acute than chronic, and that the long-term effects are reversible at the end of its long-term use. Although there may be exceptions. Smoking marijuana can be associated with various respiratory disorders, including cancer. Most of the negative effects are associated with increased doses and constant use, as evidenced by the majority of smokers. However, these figures are preliminary and require proof by more systematic and controlled studies.

Psychological effects

Despite the fact that cannabis can cause various effects noted earlier, mostly smokers use marijuana in the hope of experiencing psychological effects, some of which are all, others are more individual. The psychological effects experienced by a marijuana smoker can be divided into three main ones: behavioral, cognitive and emotional.

Some effects of cannabis, described by people who use marijuana, are learned by them gradually. The first step is purely mechanical, during which the smoker learns to inhale smoke and retain it in the lungs for maximum perception and absorption. The second step will be learning to perceive effects, causing available cannabis. These effects can be both physiological and psychological. The final step is to identify the most enjoyable ones. This is confirmed by the fact that experienced smokers who are more sensitive to the effects of cannabis than beginners.