The Dark Side of Cannabis

I always enjoy the rebuttal that cannabis is not as “bad” as drugs like cocaine or heroin. I won’t argue this, but just because it is less bad it does not mean it is risk free. In fact, about 9% of people who try cannabis will develop a dependence, compared to 15% of those who try cocaine or 24% of those who try heroin^[4]. However, given the fact that so many people engage in cannabis use it is important to look at prevalence; cannabis dependence is about twice as prevalent as any other illicit psychoactive substance including cocaine and heroin^[4].

So I might have a weed use problem, what’s the big deal?

Cannabis use is associated with numerous health risks that could be compromising your quality of life. Many folks are unknowingly suffering from the negative side effects of cannabis use and many continue or increase use without realizing weed is the source or significant contributor to their psychological problems. The best example is the use of marijuana to treat symptoms of anxiety. Although it brings temporary relief, regular use significantly contributes to increased levels of anxiety, leading the user into a harmful pattern of cat and mouse.

What does problem use look like?

Given the relatively recent legalization of cannabis, it’s difficult to say what exactly leads to problematic use of cannabis ; however, one study explored this and provided general guidelines. In a study by Guttmannova et al. (2017)^[11] they defined regular use as at least once weekly or more for adolescents, and more than four times a week in adulthood, were both indicative of cannabis dependence which correlated with numerous health risks.

"Approximately 25-50% of those who smoke marijuana daily will develop an addiction."
‍_{Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014).}

Approximately 25-50% of those who smoke marijuana daily will develop an addiction^[20]. Today’s younger population is especially at risk of cannabis use disorder due to the sheer number of people engaging in cannabis use. One study noted that about half the individuals that enter treatment for cannabis use are under 25 years old^[4].

The relationship between cannabis dependence and other substances

One study in particular looked at the relationship between cannabis dependence and other substances. This study found higher rates of alcohol use disorder and nicotine dependence when it looked at participants who were 33 years old ^[11]. People who didn't use marijuana reported fewer signs of alcohol issues, nicotine dependence, and generalized anxiety problems compared to any group of marijuana users. Those who consistently used marijuana into adulthood tended to show more symptoms of cannabis-related problems, alcohol-related issues, and nicotine dependence by the age of 33^[11].

The connection between cannabis use and mental health

Depression and marijuana use

Although limited studies are available there appears to be a relationship between depression and cannabis use. Occasional cannabis use does not seem to have an impact on depression, but regular use is linked to significantly higher rates of depression. Common symptoms of depression triggered by marijuana use include persistent sadness, feelings of hopelessness, a loss of interest in things, agitation or irritability, angry outbursts, lack of energy, unexpected weight changes, and difficulty sleeping.  The relationship only strengthened when more people were added to the study sample^[8]. Studies show that cannabis use from a young age might lead to depression later on in life^[8]. Another study determined that cannabis use is associated with higher levels of depression and anxiety^[6].

Cannabis use to treat anxiety

Concerns about cannabis use are not isolated to depression alone. One meta analysis study, that looked across numerous publications, found evidence that cannabis was associated with higher rates of agoraphobia and social anxiety disorder^[17]. A study looked at anxiety disorders and found a positive correlation between cannabis dependence and anxiety disorders when looking at a higher number of study participants^[15]. In a separate study by Zvolensky et al. (2006)^[21] a link was found between cannabis dependence and panic attacks, and that teens who used were more likely to experience panic attacks at a younger age versus those who do not use. Teens were also interviewed on their cannabis use in relation to anxiety. This study determined that starting cannabis use early can lead to higher levels of anxiety over time versus those who used it less often and increased risk for dependence later in life^[9]. Another study looked at potency and anxiety and found that risks for cannabis use disorder and anxiety disorder were higher among those reporting use of high-potency cannabis^[12]. This same study found a slightly elevated risk of experiencing psychotic episodes with higher potency cannabis use^[12]. Although not a strong study because they focused on one individual, it is still fascinating to look at a study by Johnson et al (2023)^[14]. This study determined that one male participant developed panic attacks following regular use of marijuana who did not have a prior history of anxiety, mental health, or psychiatric issues^[14].

"... one male participant developed panic attacks following regular use of marijuana who did not have a prior history of anxiety, mental health, or psychiatric issues."
_{Johnson, G. A., Guerra, L., & Oxner, A. (2023).}

Psychosis, schizophrenia, and cannabis use

More research still needs to be done on the relationship between cannabis consumption and psychosis. Psychosis refers to a collection of symptoms that affect your perception of reality, making it difficult to recognize what is real and what is not^[18]. A direct cause does not appear to exist between cannabis and psychosis, but it is now believed that those with a vulnerability toward psychosis are more likely to have an episode with cannabis use^[16]. Another study has more concerning information regarding schizophrenia, describing a two fold increase in risk for developing schizophrenia^[2].

Impact on post-traumatic stress disorder

A meta analysis by Lowe et al. (2020)^[17] looked at the effects of cannabis use on PTSD. Unfortunately cannabis is often used to cope with symptoms of PTSD, particularly sleep, but this study found that participants reported poorer sleep quality and physical health when using marijuana to manage PTSD symptoms. When looking at the severity of PTSD symptoms, cannabis use was found to intensify symptoms of PTSD, including increased arousal, feeling tense, on edge, and easily startled; struggling with memory and ongoing feelings of anger, shame, and fear; sleep disturbances; flashbacks to parts of the traumatic memory; and more. The use of cannabis to treat symptoms of PTSD led to worsening emotional states, and it wasn’t until participants abstained from the use of marijuana that these symptoms of PTSD improved.  

Marijuana and physical health

Not only are there adverse implications of marijuana use on mental health; physical health is compromised with heavy cannabis use. We are still discovering some of the adverse side effects from heavy cannabis use, and have created a new diagnosis for the particularly prevalent side effect of nausea. The diagnosis of cannabinoid hyperemesis syndrome, which has been nicknamed “scromiting,” due to screams of pain and uncontrolled vomiting, is linked to high potency cannabis use^[19].

"... cannabinoid hyperemesis syndrome ... nicknamed 'scromiting', due to screams of pain and uncontrolled vomiting"

One such teen mentioned in the article described 11 visits to the ER over a 9 month period for vomiting and stomach pain who stated it was so bad it felt like Edward Scissorhands was trying to pull out his intestines. It wasn’t until this same person, who was 17 years old at the time, stopped smoking cannabis that the symptoms ended^[19]. There is a clear link between digestion problems and cannabis use. A study by Bemanian et al. (2022)^[3] found lower levels of circulating vitamin D levels in cannabis smokers compared to non-smokers^[3].

Adverse effects of cannabis use are not limited to digestion. A meta analysis by Lowe et al. (2020)^[17] discovered that chronic marijuana use impairs short-term memory, motor control and coordination, executive functioning, and altered judgment. Long term cannabis use has increased  risk of developing symptoms of bronchitis from airway and lung inflammation. Adverse health effects also include the cardiovascular system. Those who used marijuana daily were associated with a 42% increased risk of stroke and 25% increased likelihood of a heart attack^[13].

Conclusion

Overall it would seem as though there are numerous adverse effects on mental health and physical health from cannabis use despite the marketing claims that it is a “fix all.” It is incredibly worthwhile to explore if your cannabis use is contributing to your physical or mental health struggles. If you think you might have a problem there are numerous resources available. Not only could group support be beneficial but individual therapy could help to address the reasons for use and underlying conditions that could be contributing to use.

If you're rethinking your relationship with marijuana and you feel you could use some extra support get in touch with Virtual Therapy Clinic today.