Excerpt
“Cannabis use poses a global disease burden, albeit substantially less than that posed by other psychoactive substances such as alcohol, tobacco (nicotine), opioids, and stimulants. The Global Burden of Disease project calculated that cannabis use in 2016 was responsible for an estimated 646,000 years of healthy life lost to disability, an age-standardized rate of 8.5 years per 100,000 persons. Cannabis use is most strongly associated with an increased risk of motor vehicle crashes, suicidality, and cardiovascular and pulmonary disease…Cannabis use was associated with an estimated 10% of drug-related emergency department visits in the United States in 2021.
Adults who use cannabis over the long term have downregulation of brain CB1 receptors.18 receptors are also found outside the central nervous system in the myocardium, the vascular endothelium, adipose tissue, the liver, and reproductive organs. CB2 receptors are found primarily on immune cells, although some are found in the central nervous system. THC is a agonist at both types of cannabinoid receptor.
Cannabis use induces a variety of acute psychological and physiological effects that vary in intensity and duration according to the dose (chiefly of THC), the route of administration, and the degree of tolerance in the user.
Acute psychological effects include euphoria(“high), relaxation, and sedation (usually desired by persons who use cannabis recreationally), increased appetite (“munchies”) and impaired short-term memory, concentration, and psychomotor coordination. Some people experience increased anxiety, panic attacks, or paranoia, especially at higher doses. Psychotic symptoms, such as perceptual alterations, hallucinations, and delusions, are less common. Acute physical effects include impaired motor coordination, slurred speech, dry mouth, conjunctival injection (“red eye), tachycardia, orthostatic hypotension, and horizontal nystagmus. Smoked cannabis induces cough, wheezing, and dyspnea; increases sputum production; and exacerbates asthma. Cannabis use, regardless of the route of administration, may be associated with acute transient cardiac arrhythmias, including atrial fibrillation, supraventricular tachycardia, premature ventricular contractions, and nonsustained ventricular tachycardia.
Cannabis use is also associated with acute impairment of driving ability, as assessed by driving simulators and on-road tests. Cross-sectional surveys suggest that recent cannabis use increases the risk of motor vehicle crashes by 30 to 40%.26 By comparison, a blood alcohol concentration of 0.08% increases the risk of crashes by 250 to 300%. (Source: New England Journal of Medicine 14th December 2023 David A. Gorelick, M.D., Ph.D.)
Also see Cannabis-Related Disorders and Toxic Effects | NEJM Resident 360
