Marijuana Side Effects: What You Need to Know

Marijuana has limitations like any drug, mainly its side effects

As medical cannabis use continues to spread around the world, we are also realizing that, as beneficial as it is, it is no panacea. Despite its versatility and clinical efficacy, marijuana and cannabinoid therapy has certain limitations. An example of this are its side effects, just like any other drug. In the end, it is up to the healthcare professional and the patient to weigh the pros and cons of cannabinoid therapy, versus other forms of treatment.

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When evaluating pros and cons, consider the safety profile of cannabis

However, it is important to take into account the broad safety profile and therapeutic index that medical cannabis has, especially in relation to many other drugs (both legal and illegal). For this reason alone, medical cannabis should be considered as a first-line treatment rather than more dangerous drugs with narrower therapeutic indices and higher risks of abuse, dependence, and addiction (i.e., opioids, benzodiazepines, and barbiturates).

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What are the most common side effects of marijuana?

The terms "marijuana" or "cannabis" describe a virtually infinite variety of different strains, genetics and phenotypes of the Cannabis Sativa plant. Therefore, it should be noted that side effects vary depending on the type of cannabis consumed (as well as the mode of administration, patient tolerance, cannabinoid metabolism, etc.). That said, an outline of cannabis' side effect profile can be outlined using the latest scientific data.

For this article, we draw on a comprehensive 2016 review of the side effects associated with short- and long-term cannabis overuse by Volkow and colleagues. Below are some short- and long-term side effects and adverse events related to marijuana use.

Adverse effects of short-term cannabis use:

* Impaired short-term memory
* Impaired coordination
* Altered judgment (Note: This is incredibly different, from a physiological and pharmacological point of view, from the characteristic of "disinhibition" of excessive alcohol consumption to the point of "drunkenness")
* In high doses, panic attacks, paranoia and psychosis (The author would like to point out that people who experience "psychotic interruptions" from medical cannabis use are often people with mental illness. In addition, people with mental illness often have a greater predilection for drug use and abuse. Cannabis is the most widely used illicit drug in the world. Therefore, it cannot be definitively stated (since correlation is NOT causation) that cannabis causes psychosis in some people, without considering all these additional variables. In fact, the two are intertwined in the classic chicken-and-egg paradigm.)
* Euphoria
* Sedation
* Appetite stimulation
* Dry mouth

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Long-term adverse effects/heavy use/abuse of cannabis:

* While the researchers in the study use the word addiction, this author would prefer to distinguish between "addiction" and "dependence." Long-term excessive cannabis use has been linked to some degree of physiological and psychological dependence. Some patients meet the DSM-V criteria for addiction, but not all do. *
* Altered brain development *
* Poor results in school *
* Cognitive impairment *

= The effect is strongly related to initial marijuana use early in development.

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Data on cannabis use in childhood and adolescence

Several studies have suggested links between developmental abnormalities later in life and cannabis use (especially daily/heavy use) when it starts at a young age, before the brain is fully developed.

However, in cases of childhood epilepsy, CBD-rich cannabis has been shown to have incredible potential in high-quality trials. It has even led to the approval of the first FDA-approved cannabis-derived drug, Epidiolex. Since CBD isolates (such as Epidiolex) and CBD-rich extracts are becoming a common product that is more accessible than THC, it's important to explore some of the side effects presented by CBD itself. Since marijuana has so many different active components, it's important to look at its various compounds separately. The adverse effects of its polypharmacy action should also be studied when patients consume whole plant extract and/or full/broad spectrum products.

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Specific Side Effects of Cannabidiol (CBD)

A recent 2017 review investigated the side effects of cannabidiol in available clinical data, as well as in available data from in vivo animal model research. Most clinical applications of cannabidiol are in the treatment of epilepsy and psychosis.

The most commonly reported side effects were "tiredness, diarrhea, and changes in appetite/weight." However, it is important to note that the study authors also reported that CBD had a much more tolerable side effect profile compared to other medications commonly used to treat those same disorders.

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Cannabis abstinence (yes, it's a real thing; no, it's not so much)

While marijuana is generally not associated with physical dependence and withdrawal syndrome, the phenomenon is medically documented and not comfortable. Chronic and excessive cannabis use will inevitably cause the individual's physiology to adapt to a constant influx of cannabinoid compounds, thus altering homeostasis and the current physiological balance. Therefore, it is not surprising, that in the face of the abrupt discontinuation of cannabis, a slight withdrawal and discomfort is expected.

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Most common withdrawal symptom: inability to sleep

One of the most commonly reported withdrawal symptoms from abrupt cessation of cannabis is the inability to fall asleep. Other common withdrawal symptoms include lack of appetite, irritability, and mild anxiety. However, compared to the insidious and debilitating nature of opioid withdrawal, or the life-threatening symptoms of alcohol withdrawal, or benzodiazepine dependence and detoxification, cannabis withdrawal is quite insignificant.

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The Miraculous Side Effect: The "Downturn"

One of the first uses of medical cannabis was in cancer patients. In fact, the first synthetic cannabinoid drugs were used in the treatment of chemotherapy-induced nausea. What is colloquially known as a "downturn" can be a nuisance for cannabis patients looking to avoid sugar.

However, this exact side effect is the main reason why cannabis is effective in patients with severe gastrointestinal problems, usually induced by chemotherapy. These patients have difficulty enjoying their food, not vomiting and developing appetite. Fortunately, cannabis is perfect for making almost anyone very, very hungry. A life-saving benefit of an already wonderful plant that can benefit metabolism!

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Education Enables Medical Cannabis Patients to Optimize Treatment Goals

The best way to continue to successfully integrate (or reintegrate, depending on how you look at it) cannabis into modern pharmaceutical medicine is to subject it to the same scrutiny and hold it to the same standards as other drugs. It is true that cannabis has certain unique characteristics (such as the broad level of intraspecial diversity) that limit the ability to generalize these findings to all types of cannabis and its products. However, in this review you can see an overall picture of what the adverse effects of cannabis are like.

By better preparing patients for potential side effects and educating them on the appropriate dosage and assessments to mitigate and attenuate the intensity of these adverse effects, we can help more people use cannabis to successfully achieve their treatment goals.

Mayur Bhatt

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