While substance use disorder treatment admissions have been declining overall for marijuana, 71% of all statewide treatment admissions for youth during the first quarter of 2016 were for marijuana.
Recent data suggest that 30% of heavy marijuana users may have some degree of cannabis use disorder, and people who being using marijuana before the age of 18 are 4-7 times more likely to develop CUD than other adults. In Washington state, 7,427 people who were admitted to treatment in 2013 reported marijuana as their primary drug of abuse.
Symptoms of cannabis use disorder include:
Marijuana is used in a variety of different ways:
: Factsheets, an interactive e-learning module series, and more about the basics of marijuana use, health effects, the law, and more. (ADAI/UW)
In 2012, Washington legalized marijuana for medical and non-medical, or "recreational," use. Despite the fact it has been legalized, however, the drug still remains a threat to consumers of all ages.
Marijuana also affects brain development, making it particularly dangerous for youths to use it. When marijuana users begin as teenagers, the drug may reduce thinking, memory, and learning functions, and affect how the brain builds connections between the areas responsible for these functions. These effects may last a long time or even be permanent.
Disclosure: Gregory T. Carter, MD, MS, has disclosed no relevant financial relationships in addition to his employment.
Dense cannabinoid receptor concentrations have been found in the cerebellum, basal ganglia, and hippocampus, accounting for the effects of cannabis on motor tone, coordination, and mood state. Low concentrations are found in the brainstem, accounting for the remarkably low toxicity of cannabis. Of note, lethal doses for cannabis in humans have not been described. So far, we know of at least 2 molecular receptor proteins (CB1 and CB2) and 2 endogenously produced lipid cannabinoids (anandamide and 2-acylglycerol) found in numerous tissues throughout the body, including neural and immune tissues, which comprise the endogenous cannabinoid system.[1,3,4] The cannabinoid system helps regulate the function of other systems in the body, making it an integral part of the central homeostatic modulatory system – the check-and-balance molecular signaling network in our bodies that keeps us at a healthy “98.6.” Despite all of the advances in understanding the physiology and pharmacology of cannabis and cannabinoids, there remains a strong need for developing rational guidelines for dosing cannabis. We (Gregory T. Carter [GTC] and Muraco Kyashna-Tocha [MKT]) have previously attempted to address this issue, deriving a dosing scheme with the available known chemistry and pharmacology of cannabis. However, it would appear that there is still considerable controversy over this issue.
Gregory T. Carter
In our previous study, we (GTC and MKT) used a different method to estimate a 60-day supply. In that study, we based our supply recommendations on the dosing regimen of dronabinol, a soft gelatin-encapsulated, synthetic THC isomer dissolved in sesame seed oil. This has been sold since 1985, with FDA approval, under the trade name Marinol. We took the very conservative dronabinol dosing model and applied it to standard combustion-and-inhalation pharmacokinetics for cannabis. Applying this to the least potent strains, we derived a 60-day cannabis supply of 15.7 oz, which is essentially 1 lb. This is strikingly similar to the 1.105 lb of smoked marijuana as calculated above. Applying our gut delivery 4-fold conversion factor, this translates to a 60-day supply of 62.8 oz or 3.925 lb.
Let us begin with some basic definitions. According to state law, “Medical use of ‘marijuana’ means the production, possession, or administration of marijuana, as defined in RCW 69.50.101(q), for the exclusive benefit of a qualifying patient in the treatment of his or her terminal or debilitating illness” (RCW 69.51A.010, Section 1, emphasis added). In this definition, the concept that is most relevant to the question at hand is the administration of marijuana. This is a technical concept defined in law. The relevant statute cited is RCW 69.50.101(q). The definition there for our purposes is as follows: “Administer” means to apply a controlled substance, whether by injection, inhalation, ingestion, or any other means, directly to the body of a patient. by. (2) the patient.” Thus, the “medical use of marijuana” means the administration of a supply of marijuana directly to the body of a qualifying patient by the patient. Route of administration is an important determinant of the pharmacokinetics of the various cannabinoids in cannabis, particularly absorption and metabolism. Typically, cannabis is smoked, which has the advantage of rapid onset of effect and easy dose titration.[19–21] Due to their volatility, cannabinoids will vaporize at a much lower temperature than combustion, allowing them to be inhaled as a warm air mist. This is a much healthier option than smoking. However, there may be differing vaporization points for the individual cannabinoids. Thus, vaporized cannabis may have differing concentrations and ratios of cannabinoids compared with smoked cannabis.[22,23] Cannabinoids in the form of an aerosol in inhaled smoke or vapors are absorbed and delivered to the brain and circulation rapidly, as expected of a highly lipid-soluble drug.[24,25] With smoking, up to 40% of the available cannabinoids may be completely combusted or lost sin sidestream smoke and thus be biologically unavailable.
Disclosure: Muraco Kyashna-Tocha, PhD, has disclosed no relevant financial relationships in addition to her employment.