CANNABIS CULTURE – There’s one big issue when it comes to determining the short- and long- term health effects of cannabis: we cannot say anything for sure regarding its safety, especially in the long-term.
Much of this is due to the fact that cannabis and cannabinoids are listed as Schedule I on the Controlled Substances Act (CSA), and hence getting the funding to research their effects properly is very difficult. Yes, this ultimately means that we know more about the side-effects of highly addictive opioids that are on Schedule II of the CSA! In fact, in some instances, it seems we don’t even know the consequences of long-term opioid use for certain conditions, either!
So, when people ask, “What are the health effects, both positive and negative, of the short- and long-term use of cannabis?” The only reasonable response in many instances is, “No one truly knows as of yet.” From all available evidence so far, there could be both positives and negatives, just as with any other medication. However, just because there are potential positives and negatives to using cannabis and cannabinoid-terpenoid-based medications, this doesn’t necessarily negate the medical value of cannabis.
In fact, the medical potential of the cannabis plant is enormous, especially when we compare it to many prescription drugs. One of the biggest positives of cannabis is that there is almost no chance of overdose when used on its own. One of the big questions that goes through every doctor’s mind when administering a substance to the body is “What’s the lethal dose/how safe is it?” Connected to this are other questions such as: “What condition am I using this substance for?” “Does it react negatively with other medications?” “How quickly does tolerance develop?”
Cannabis, it seems, comes out tops in many regards when answering these questions. You would need to ingest a massive amount of cannabis in a short amount of time in order to overdose on it. Yes, care must be taken when administering cannabinoid-based substances for certain conditions – some health problems may need specific cannabinoids in various dosages, and for other health problems cannabis might even be contraindicated. For example, THC could well be contraindicated for those with schizophrenia or those going through a manic period of bipolar depression, but CBD could well be an antipsychotic and prove helpful. Another example would be that of cancer, where specific dosages may be needed (or, at least according to Rick Simpson, extremely high doses are needed).
Yes, cannabinoids do seem to have interactions with other drugs. We just don’t have a precise list of which ones, and cannabinoids may even be used to replace many other medications with a lower safety threshold, especially opioids, benzodiazepines, barbiturates and powerful non-steroidal anti-inflammatory drugs (NSAIDs). In fact, cannabis may even be safer than over-the-counter NSAIDs such as ibuprofen, which can have various negative side-effects, including nausea, vomiting, bloating, gas, ringing in the ears and, in cases of overdose, kidney failure. Tolerance may develop quickly or slowly, and could possibly be mitigated against by utilizing a variety of cannabinoid-terpenoid profiles.
The only way we can judge cannabis’s positive and negative short- and long- term effects is by assessing the evidence we have so far, as well as comparing it to other drugs …
Cannabis is not, as far as we know, physically addictive. It is estimated that around 9% of people who use cannabis daily develop cannabis use disorder. This rate of dependence is significantly lower than that of tobacco, alcohol, opioids (prescribed or otherwise), cocaine and prescribed anxiolytics. The side-effects of such drugs also tend to be more severe, with kidney failure, liver failure, increased risk of cardiovascular diseases, an inability to sleep/eat properly, diarrhea/constipation, foggy thinking, physical addiction and much more besides. The withdrawal symptoms are also generally far less severe when cannabis use has stopped.
This is one of the most controversial areas concerning the long-term effects of cannabis, and there is significant amount of debate surrounding whether or not long-term use causes psychosis. Most of the mental health problems associated with cannabis may be due to the age at which use starts, with adolescents being most at risk. However, the causal link is not definite, and there could be many other factors at play.
Yes, cannabis (or perhaps more specifically, THC) may worsen psychotic symptoms and increase the risk of relapse, but there is no evidence so far that cannabis causes psychosis – it’s more likely that those who already have a genetic predisposition to developing psychosis may have an episode triggered by cannabis.
As for schizophrenia or other schizoaffective disorders, using cannabis is probably not wise, and may worsen the condition. Long-term cannabis use may trigger schizophrenia, but is very rare, and only affects those with one copy of the polymorphic catechol-O-methyl transferase (COMT) gene. However, CBD may have antipsychotic effects. Many current antipsychotics have some very nasty side-effects, including muscle spasms, blurred vision, tardive dyskinesia, neuroleptic malignant syndrome, and an increased chance of stroke, diabetes, heart attack and blood clots. CBD may be able to decrease hallucinations and control mood swings without all the negative side-effects.
Other areas of contention include cannabis for depression, bipolar disorder (manic depression) and/or anxiety. Cannabis could not only prove to be a potential medication for people with such disorders, but could also possibly worsen the symptoms of depression, bipolar disorder and anxiety. Though there are some studies that show a correlation between long-term cannabis use and depressive symptoms, anxiety and bipolar disorder, there is also much evidence out there about the possibility of using cannabinoid-terpenoid based medications to treat such conditions.
So, can cannabis be used to beat depression and anxiety, or could it cause it? I suspect that both could be true to an extent, and that we need to work out what the ideal type of cannabinoid-terpenoid medication and at what dosage works, doesn’t work, and could be a potential trigger for depression, bipolar disorder and anxiety. Also, as with most medications, what works for one person may not work for another. As many mental health conditions are complex and can be caused by lots of different variables, it is difficult to whether or not any medication will work for definite. Cannabis is no different in this regard.
There are plenty of pharmaceuticals that cannabis could potentially help replace. However, due to its psychoactive effects, it may not be suitable for everyone. Also, prescription antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are relatively well-tolerated by most people and can be used for many conditions. I do not see cannabis replacing such antidepressants in all instances, but definitely being an adjunct to them.
Effects on the Brain
There is no evidence that cannabis use causes a loss of grey matter or white matter. However, there may be some reductions in hippocampal volume. This is what may cause the impairment of short-term memory after using cannabis. Yet, for older people, a little bit of cannabis may boost the brain rather than dull it. CBD may also have neuroprotective effects, protecting the brain from stroke and other traumatic brain injuries (TBIs) as well as diseases that affect the nervous system.
Using cannabis seems to cause an increase in heart rate and blood pressure whilst sitting down, and a decrease in blood pressure when standing up. In the short-term, this may increase the risk of heart attack. However, THC is a vasodilator, meaning that it can widen the arteries and lower blood pressure overall.
Many of the cardiac problems to do with cannabis may be due to it being smoked rather as opposed to anything about the cannabinoids themselves. Smoking cannabis may increase the likelihood of myocardial infarction (heart attack) and stroke, as well as decrease exercise tolerance. Of course, when it comes to using medical marijuana, it is perhaps better to find alternatives to smoking it wherever possible in order to take advantage of its health benefits.
Whilst using cannabis may cause some cardiac problems in some people, it is arguable that these can be mitigated to some extent by not smoking cannabis. Now, whilst cannabis smoke may not necessarily be as carcinogenic as tobacco smoke, it makes sense intuitively that inhaling any type of burning matter into your lungs may cause cardiovascular problems.
So, how does cannabis compare with other prescription medications in this area? Pharmaceuticals aren’t smoked, obviously, so there is one advantage there. Yet, the advantages may end there, depending on the pharmaceutical we’re talking about. Opioids, benzodiazepines and barbiturates are central nervous system (CNS) depressants, and so slow down heart and breathing rate, causing a loss of consciousness and potentially being fatal. The chances of a fatal overdose are increased if opioids and benzodiazepines are being used in conjunction with one another, and/or with alcohol.
There is, so far, no definitive evidence found linking cannabis use and cancer, although there may be some. To quote from “Medical Consequences of Marijuana Use: A Review of Current Literature”:
“[T]here does appear to be an increased risk of cancer (particularly head and neck, lung, and bladder cancer) for those who use marijuana over a period of time, although what length of time that this risk increases is uncertain.”
The same study also states:
“Unfortunately, methodological limitations in many of the reviewed studies, including selection bias, small sample size, limited generalizability, and lack of adjustment for tobacco smoking, may limit the ability to attribute cancer risk solely to marijuana use.”
Of course, there’s a lot of research out there regarding cannabis’s ability to treat cancer, and cannabinoids may potentially be used to kill cancer cells. As such, it may well be the smoke that’s carcinogenic, not necessarily the cannabinoids themselves. However, more research on cannabinoids needs to be done before we can say that they are non-carcinogenic (or even anti-carcinogenic), and certain cancers may proliferate rather than be destroyed if the right cannabinoids aren’t used.
Properly researched, cannabinoids may well be a form of “phytochemical therapy” to be used in conjunction with other methods of cancer treatment. This is on top of the antiemetic and pain killing effects cannabis may have. This multi-pronged effect means that cannabis may be the ideal replacement for the opioids usually prescribed cancer patients to kill their pain.
So far, the evidence shows that cannabis is relatively safe in comparison to most drugs out there, prescribed or not. Moreover, in some cases, it may even be more effective at managing pain and inflammation than many prescription drugs, especially things like anticonvulsants/antiepileptic drugs (AEDs), opioids and the stronger end of NSAIDs. Now, this is not to say that cannabis has no dangers whatsoever, and for some people it might prove harmful rather than helpful. However, we will never find this out until the federal government legalizes cannabis, or at least gets rid of the regulations surrounding researching it properly. Hopefully, that day will come soon.