vary, and users may present to an emergency room with rapid heart rate; vomiting; and negative mental responses, including hallucinations, after using these substances (NIDA, 2018; 2021a). According to a 1999 report by the Institute of Medicine (IOM; now National Academy of Medicine), marijuana’s adverse effects are “within the range of effects tolerated for other medications.” This is not to say that marijuana is completely without adverse effects, especially when consumed in uncontrolled circumstances. There are chronic effects related to THC and chronic smoking. Marijuana smoking, as with all smoking, may be associated with increased risk of cancer and lung damage (American Lung Association, 2019; IOM, 1999; NIDA, 2021f, g). The primary adverse effect of acute marijuana use is identified as diminished psychomotor ability (IOM, 1999; Karoli et al., 2022). People should be advised not to operate heavy equipment or vehicles when under the influence of marijuana, THC, or any cannabinoid drug. Some people also experience dysphoria (a feeling of unease, discomfort, and generalized dissatisfaction). According to the IOM report (1999), older people with no previous experience with taking marijuana often experience psychological effects that are disturbing to them, such as disorientation after being treated with oral THC. These effects appear to be felt more with oral THC than smoked marijuana. In 2001, researchers who interviewed 3,882 survivors of myocardial infarction (MI) reported that the risk for developing MI was 4.8 times higher than average within the hour immediately after marijuana use (Mittleman et al., 2001). After MI, mortality is significantly higher in marijuana users than in the general population (Thomas, Kloner, & Rezkalla, 2014). On the other hand, a study of 5,113 adult participants’ coronary artery risk found no association with the incidence of cardiovascular disease from cumulative lifetime or recent use of marijuana (Reis et al., 2017). A study of women who smoked marijuana at least once a month during pregnancy found impaired placental development, as indicated through analysis of human tissue obtained at Is marijuana effective? Based on the UNODC opinion above and the conclusions of other regulatory bodies such as the IOM and the National Institutes of Health (NIH), a new open-door initiative for scientific research on the medical potential of marijuana (cannabinoids) was started back in 2002 at the University of California San Diego campus, with the launch of 25 studies through their Cannabis Research Center. According to the National Center for Complementary and Integrative Health (2022), the quality of health research on marijuana and its components varies widely, and, as has been discussed, the plant has been gaining in potency (NIDA, 2021c). The challenge that continues to face healthcare providers, however, is that they can never condone the smoked formulation of any medication given the significant respiratory pathology patients can develop. Furthermore, pyrolysis (the breakdown of organic matter in the presence of heat) followed by inhalation involves too many unknown factors to be considered safe. Researchers need to find more pharmaceutically elegant formulations of marijuana in order to apply the principles of safety, quality, and efficacy, and these formulations need to be subject to the same rigorous scientific testing and regulatory systems that apply to established medicines. According to NIDA (Volkow, 2018), marijuana has become a confusing subject, thanks to the “mixed messages being sent by the passage of medical marijuana laws and legalization of marijuana in some states.” Health professionals need to become informed so that they can play a discerning role in the current dialogue about what is best for their patients in their communities. This course has already addressed historical and cultural aspects of marijuana and its use, as well as some botanical characteristics of the plant. However, to truly understand the attraction of marijuana, it is important to delve
about 7 weeks of gestation. It also found that CB1 and CB2 (cannabinoid 1 and cannabinoid 2 receptors) were decreased in the placenta of marijuana smokers as compared to pregnant nonsmokers (Chang et al., 2017). Marijuana use during pregnancy has been associated with low birth weight and increased risk of both brain and behavioral problems in babies (NIDA, 2021b). The cannabinoid THC can get into breast milk, possibly in high concentrations, if a mother is using marijuana regularly (NIDA, 2021b). As each state re-examines the legal status of marijuana, healthcare professionals may be compelled to re-examine marijuana and their own roles in supporting use in self-care and professional health care. This re-examination does not necessarily mean that healthcare providers will change their opinions. However, reflection is a natural response to mounting public inquiry of health professionals as marijuana use grows exponentially. Contemporary beliefs about marijuana run the gamut from prohibition to social promotion. Some consider marijuana, when compared with alcohol, to be “benign.” Others are concerned that marijuana may serve as a “gateway” drug. Still others ask why people seek the escape of a “high” in the first place. The existential issues of substance use, and misuse are just as important with marijuana as with any other drug. Although concerns over marijuana’s use, misuse, and global market may have been to a certain degree eclipsed by the current focus on the “opioid crisis,” its impact continues to be reported by NIDA and UNODC, which concludes the following: Research has shown that, notwithstanding the usefulness of some cannabinoids in the management of specific medical conditions, their use, particularly in the botanical form of herbal cannabis with unknown content and dosage, can be detrimental to health. To protect human health, it is therefore necessary that the principles of safety, quality and efficacy and the rigorous scientific testing and regulatory systems that apply to established medicines be applied also to cannabis- based medicines (UNODC, 2021b, p. 29). into the chemistry of its components and the ways in which those components are understood to interact with the human brain. Table 2: Marijuana Pharmacokinetics Smoked Oral Bioavailability 18% (2-50) 10% (4-12) Onset (time) Immediate 30-60 minutes Time to peak effect 4-6 minutes 2-3 hours Duration 2-6 hours 2-6 hours Half-life (T 1/2 ) 30-60 hours 30-60 hours Note . Source: Adapted from: Huestis, M. A. (2007). Human cannabinoid pharmacokinetics. Chemical Biodiversity, 4 (8), 1770-1804. The “high” derived from inhaled marijuana occurs when cannabinoids in the leaf are released into the lungs, where they may in turn pass into the bloodstream. The amount of THC and other cannabinoids consumed determines the potency – ranging from sedating to psychoactive – of the drug’s effects. The effects of smoking are rapid, whereas the effects from eating marijuana or hashish can be delayed by at least 30 to 60 minutes (Table 2). When marijuana is inhaled, either as combusted or vaporized plant matter, inhaled cannabinoids reach their peak concentration in five to 10 minutes, declining rapidly for a period of 30 minutes (Fasinu et al., 2016). The action of THC in inhaled oils, as one might find in electronic cigarettes, is not yet known (Abrams, 2016). Orally ingested marijuana has a lower and variable bioavailability. It may take hours for THC to reach peak plasma concentrations, which then remain elevated with a
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