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Cannabis

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Drug Abuse and Addiction in Medical Illness

Abstract

Cannabis is the world’s most widely used illicit drug with 5–15% of young people in many western countries being regular cannabis users. Until the 1990s, the prevailing medical opinion was that cannabis use was nonaddictive and caused no long-term harm to health, brain, and brain function. This attitude has changed since, and current consensus is that regular cannabis use can result in dependence, increases the risk of using other illicit drugs, and is associated with increased mental health problems. However, it is still uncertain if these relationships are causal. There is, however, a steady increase in the number of people seeking help for cannabis-related problems. The increase in treatment demands has been linked to the high potency of nowadays cannabis products which may increase the risk of abuse and dependence. Cannabis affects the brain by interacting with the endogenous cannabinoid system which exists of cannabinoid receptors and their endogenous ligands. Acute intoxication with cannabis causes marked changes in subjective mental status (feeling high) and impairs cognition. These effects are accompanied by a number of bodily effects such as increased heart rate. The acute effects of cannabis on behavior, mood, and cognition are dose-dependent and biphasic (e.g., U-shaped pattern). There is still controversy regarding the persistence of effects of cannabis use on behavior, cognition, brain, and brain function once drug use has stopped. There is some evidence for subtle persisting effects, but these effects have predominantly been observed in certain vulnerable populations, i.e., individuals with either very long and very heavy exposure and/or very early onset of cannabis use, and/or comorbid conditions such as psychopathology.

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References

  1. Iversen LL. The science of marijuana. Oxford, UK: Oxford University Press; 2000.

    Google Scholar 

  2. Howlett AC, Breivogel CS, Childers SR, Deadwyler SA, Hampson RE, Porrino LJ. Cannabinoid physiology and pharmacology: 30 years of progress. Neuropharmacology. 2004;47 Suppl 1:345–58.

    Article  PubMed  CAS  Google Scholar 

  3. Mackie K. Cannabinoid receptors as therapeutic targets. Annu Rev Pharmacol Toxicol. 2006;46:101–22.

    Article  PubMed  CAS  Google Scholar 

  4. UNODC. World Drug Report 2008. Vienna: United Nations Office on Drugs and Crime; 2008.

    Google Scholar 

  5. Katona I, Freund TF. Endocannabinoid signaling as a synaptic circuit breaker in neurological disease. Nat Med. 2008;14(9):923–30.

    Article  PubMed  CAS  Google Scholar 

  6. Kogan NM, Mechoulam R. Cannabinoids in health and disease. Dialogues Clin Neurosci. 2007;9(4):413–30.

    PubMed  Google Scholar 

  7. Hosking RD, Zajicek JP. Therapeutic potential of cannabis in pain medicine. Br J Anaesth. 2008;101(1):59–68.

    Article  PubMed  CAS  Google Scholar 

  8. Pertwee RG. Ligands that target cannabinoid receptors in the brain: from THC to anandamide and beyond. Addict Biol. 2008;13(2):147–59.

    Article  PubMed  CAS  Google Scholar 

  9. NDM. NDM annual report 2006. Utrecht: Trimbos Instituut; 2007.

    Google Scholar 

  10. SAMHSA. The national survey on drug use and health. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA); 2005.

    Google Scholar 

  11. NIDA. Research report series marijuana abuse. Lexington, KY: National Institute on Drug Abuse; 2005.

    Google Scholar 

  12. Budney AJ, Novy PL, Hughes JR. Marijuana withdrawal among adults seeking treatment for marijuana dependence. Addiction. 1999;94(9):1311–22.

    Article  PubMed  CAS  Google Scholar 

  13. Budney AJ, Hughes JR, Moore BA, Novy PL. Marijuana abstinence effects in marijuana smokers maintained in their home environment. Arch Gen Psychiatry. 2001;58(10):917–24.

    Article  PubMed  CAS  Google Scholar 

  14. EMCDDA. Annual report 2007. Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2007.

    Google Scholar 

  15. EMCDDA. Annual report 2004. Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2004.

    Google Scholar 

  16. Copersino ML, Boyd SJ, Tashkin DP, Huestis MA, Heishman SJ, Dermand JC, et al. Cannabis withdrawal among non-treatment-seeking adult cannabis users. Am J Addict. 2006;15(1):8–14.

    Article  PubMed  Google Scholar 

  17. Mechoulam R, Hanus L. A historical overview of chemical research on cannabinoids. Chem Phys Lipids. 2000;108(1–2):1–13.

    Article  PubMed  CAS  Google Scholar 

  18. Howlett AC, Barth F, Bonner TI, Cabral G, Casellas P, Devane WA, et al. International Union of Pharmacology. XXVII. Classification of cannabinoid receptors. Pharmacol Rev. 2002;54(2):161–202.

    Article  PubMed  CAS  Google Scholar 

  19. Hollister LE. Structure-activity relationships in man of cannabis constituents, and homologs and metabolites of delta9-­tetrahydrocannabinol. Pharmacology. 1974;11(1):3–11.

    Article  PubMed  CAS  Google Scholar 

  20. Jones G, Pertwee RG, Gill EW, Paton WD, Nilsson IM, Widman M, et al. Relative pharmacological potency in mice of optical isomers of delta 1-tetrahydrocannabinol. Biochem Pharmacol. 1974;23(2):439–46.

    Article  PubMed  CAS  Google Scholar 

  21. Herkenham M, Lynn AB, Johnson MR, Melvin LS, de Costa BR, Rice KC. Characterization and localization of cannabinoid receptors in rat brain: a quantitative in vitro autoradiographic study. J Neurosci. 1991;11(2):563–83.

    PubMed  CAS  Google Scholar 

  22. Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI. Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature. 1990;346(6284):561–4.

    Article  PubMed  CAS  Google Scholar 

  23. Begg M, Pacher P, Batkai S, Osei-Hyiaman D, Offertaler L, Mo FM, et al. Evidence for novel cannabinoid receptors. Pharmacol Ther. 2005;106(2):133–45.

    Article  PubMed  CAS  Google Scholar 

  24. Pacher P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58(3):389–462.

    Article  PubMed  CAS  Google Scholar 

  25. Piomelli D. The molecular logic of endocannabinoid signalling. Nat Rev Neurosci. 2003;4(11):873–84.

    Article  PubMed  CAS  Google Scholar 

  26. Freund TF, Katona I, Piomelli D. Role of endogenous cannabinoids in synaptic signaling. Physiol Rev. 2003;83(3):1017–66.

    PubMed  CAS  Google Scholar 

  27. Mackie K. Cannabinoid receptor homo- and heterodimerization. Life Sci. 2005;77(14):1667–73.

    Article  PubMed  CAS  Google Scholar 

  28. de Rodriguez FF, Del A, Bermudez-Silva FJ, Bilbao A, Cippitelli A, Navarro M. The endocannabinoid system: physiology and pharmacology. Alcohol Alcohol. 2005;40(1):2–14.

    Google Scholar 

  29. Justinova Z, Tanda G, Redhi GH, Goldberg SR. Self-administration of delta9-tetrahydrocannabinol (THC) by drug naive squirrel monkeys. Psychopharmacology (Berl). 2003;169(2):135–40.

    Article  CAS  Google Scholar 

  30. Justinova Z, Goldberg SR, Heishman SJ, Tanda G. Self-administration of cannabinoids by experimental animals and human marijuana smokers. Pharmacol Biochem Behav. 2005;81(2):285–99.

    Article  PubMed  CAS  Google Scholar 

  31. Tanda G, Goldberg SR. Cannabinoids: reward, dependence, and underlying neurochemical mechanisms–a review of recent preclinical data. Psychopharmacology (Berl). 2003;169(2):115–34.

    Article  CAS  Google Scholar 

  32. Braida D, Iosue S, Pegorini S, Sala M. Delta9-tetrahydrocannabinol-induced conditioned place preference and intracerebroventricular self-administration in rats. Eur J Pharmacol. 2004;506(1):63–9.

    Article  PubMed  CAS  Google Scholar 

  33. Valjent E, Maldonado R. A behavioural model to reveal place preference to delta 9-tetrahydrocannabinol in mice. Psychopharmacology (Berl). 2000;147(4):436–8.

    Article  CAS  Google Scholar 

  34. Zangen A, Solinas M, Ikemoto S, Goldberg SR, Wise RA. Two brain sites for cannabinoid reward. J Neurosci. 2006;26(18):4901–7.

    Article  PubMed  CAS  Google Scholar 

  35. Bossong MG, van Berckel BN, Boellaard R, Zuurman L, Schuit RC, Windhorst AD, et al. Delta9-tetrahydrocannabinol induces dopamine release in the human striatum. Neuropsychopharmacology. 2009;34(3):759–66.

    Article  PubMed  CAS  Google Scholar 

  36. Maldonado R. Study of cannabinoid dependence in animals. Pharmacol Ther. 2002;95(2):153–64.

    Article  PubMed  CAS  Google Scholar 

  37. Nava F, Carta G, Colombo G, Gessa GL. Effects of chronic Delta(9)-tetrahydrocannabinol treatment on hippocampal extracellular acetylcholine concentration and alternation performance in the T-maze. Neuropharmacology. 2001;41(3):392–9.

    Article  PubMed  CAS  Google Scholar 

  38. Kirk JM, de WH. Responses to oral delta9-tetrahydrocannabinol in frequent and infrequent marijuana users. Pharmacol Biochem Behav. 1999;63(1):137–42.

    Article  PubMed  CAS  Google Scholar 

  39. Swift W, Hall W, Teesson M. Characteristics of DSM-IV and ICD-10 cannabis dependence among Australian adults: results from the National Survey of Mental Health and Wellbeing. Drug Alcohol Depend. 2001;63(2):147–53.

    Article  PubMed  CAS  Google Scholar 

  40. Meyer JS, Quenzer LF. Marijuana and the cannabinoids. In: Psychopharmacology, Drugs, the brain, and behavior. Massachusetts, USA: Sinauer Associates; 2005. p. 327–46.

    Google Scholar 

  41. Justinova Z, Munzar P, Panlilio LV, Yasar S, Redhi GH, Tanda G, et al. Blockade of THC-seeking behavior and relapse in monkeys by the cannabinoid CB(1)-receptor antagonist rimonabant. Neuropsychopharmacology. 2008;33(12):2870–7.

    Article  PubMed  CAS  Google Scholar 

  42. Aceto MD, Scates SM, Lowe JA, Martin BR. Dependence on delta 9-tetrahydrocannabinol: studies on precipitated and abrupt withdrawal. J Pharmacol Exp Ther. 1996;278(3):1290–5.

    PubMed  CAS  Google Scholar 

  43. Wilson DM, Varvel SA, Harloe JP, Martin BR, Lichtman AH. SR 141716 (Rimonabant) precipitates withdrawal in marijuana-­dependent mice. Pharmacol Biochem Behav. 2006;85(1):105–13.

    Article  PubMed  CAS  Google Scholar 

  44. Paton WDM, Pertwee RG. The actions of cannabis in man. In: Mechoulam R, editor. Marijuana. New York: Academic; 1973. p. 287–333.

    Google Scholar 

  45. Solowij N. Cannabis and cognitive functioning. Cambridge: Cambridge University Press; 1998.

    Book  Google Scholar 

  46. Heishman SJ. Effects of marijuana on human performance and assessment of driving impairment. In: Onaivi ES, editor. Biology of marijuana: from gene to behavior. New York: Taylor and Francis; 2002. p. 308–32.

    Google Scholar 

  47. Castle D, Murray R, editors. Marijuana and madness: psychiatry and neurobiology. Cambridge: Cambridge University Press; 2004.

    Google Scholar 

  48. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327–60.

    Article  PubMed  CAS  Google Scholar 

  49. Pope HG, Yurgelun-Todd D. Residual cognitive effects of long-term cannabis use. In: Castle D, Murray R, editors. Marijuana and madness: psychiatry and neurobiology. Cambridge: Cambridge University Press; 2004. p. 198–210.

    Chapter  Google Scholar 

  50. Gonzalez R. Acute and non-acute effects of cannabis on brain functioning and neuropsychological performance. Neuropsychol Rev. 2007;17(3):347–61.

    Article  PubMed  Google Scholar 

  51. Green B, Kavanagh D, Young R. Being stoned: a review of self-reported cannabis effects. Drug Alcohol Rev. 2003;22(4):453–60.

    Article  PubMed  Google Scholar 

  52. Wachtel SR, ElSohly MA, Ross SA, Ambre J, de WH. Comparison of the subjective effects of Delta(9)-tetrahydrocannabinol and marijuana in humans. Psychopharmacology (Berl). 2002;161(4):331–9.

    Article  CAS  Google Scholar 

  53. Ameri A. The effects of cannabinoids on the brain. Prog Neurobiol. 1999;58(4):315–48.

    Article  PubMed  CAS  Google Scholar 

  54. Thomas H. A community survey of adverse effects of cannabis use. Drug Alcohol Depend. 1996;42(3):201–7.

    Article  PubMed  CAS  Google Scholar 

  55. Ranganathan M, D’Souza DC. The acute effects of cannabinoids on memory in humans: a review. Psychopharmacology (Berl). 2006;188(4):425–44.

    Article  CAS  Google Scholar 

  56. McDonald J, Schleifer L, Richards JB, de WH. Effects of THC on behavioral measures of impulsivity in humans. Neuropsychopharmacology. 2003;28(7):1356–65.

    Article  PubMed  CAS  Google Scholar 

  57. Lane SD, Cherek DR, Tcheremissine OV, Lieving LM, Pietras CJ. Acute marijuana effects on human risk taking. Neuropsychopharmacology. 2005;30(4):800–9.

    Article  PubMed  CAS  Google Scholar 

  58. Ramaekers JG, Kauert G, van RP, Theunissen EL, Schneider E, Moeller MR. High-potency marijuana impairs executive function and inhibitory motor control. Neuropsychopharmacology. 2006;31(10):2296–303.

    PubMed  CAS  Google Scholar 

  59. Curran HV, Brignell C, Fletcher S, Middleton P, Henry J. Cognitive and subjective dose-response effects of acute oral Delta 9-­tetrahydrocannabinol (THC) in infrequent cannabis users. Psychopharmacology (Berl). 2002;164(1):61–70.

    Article  CAS  Google Scholar 

  60. Hart CL, van GW, Foltin RW, Fischman MW. Effects of acute smoked marijuana on complex cognitive performance. Neuropsychopharmacology. 2001;25(5):757–65.

    Article  PubMed  CAS  Google Scholar 

  61. Quickfall J, Crockford D. Brain neuroimaging in cannabis use: a review. J Neuropsychiatry Clin Neurosci. 2006;18(3):318–32.

    Article  PubMed  Google Scholar 

  62. Chang L, Chronicle EP. Functional imaging studies in cannabis users. Neuroscientist. 2007;13(5):422–32.

    Article  PubMed  Google Scholar 

  63. O’Leary DS, Block RI, Koeppel JA, Flaum M, Schultz SK, Andreasen NC, et al. Effects of smoking marijuana on brain perfusion and cognition. Neuropsychopharmacology. 2002;26(6):802–16.

    Article  PubMed  Google Scholar 

  64. Phan KL, Angstadt M, Golden J, Onyewuenyi I, Popovska A, de WH. Cannabinoid modulation of amygdala reactivity to social ­signals of threat in humans. J Neurosci. 2008;28(10):2313–9.

    Article  PubMed  CAS  Google Scholar 

  65. Borgwardt SJ, Allen P, Bhattacharyya S, Fusar-Poli P, Crippa JA, Seal ML, et al. Neural basis of Delta-9-tetrahydrocannabinol and cannabidiol: effects during response inhibition. Biol Psychiatry. 2008;64(11):966–73.

    Article  PubMed  CAS  Google Scholar 

  66. Jager G, Ramsey NF. Long-term consequences of adolescent cannabis exposure on the development of cognition, brain structure and function: an overview of animal and human research. Curr Drug Abuse Rev. 2008;1:114–23.

    Article  PubMed  CAS  Google Scholar 

  67. Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319–28.

    Article  PubMed  Google Scholar 

  68. Di FM, Morrison PD, Butt A, Murray RM. Cannabis use and psychiatric and cognitive disorders: the chicken or the egg? Curr Opin Psychiatry. 2007;20(3):228–34.

    Google Scholar 

  69. Leweke FM, Koethe D. Cannabis and psychiatric disorders: it is not only addiction. Addict Biol. 2008;13(2):264–75.

    Article  PubMed  Google Scholar 

  70. Pope Jr HG. Cannabis, cognition, and residual confounding. JAMA. 2002;287(9):1172–4.

    Article  PubMed  Google Scholar 

  71. Pope Jr HG, Gruber AJ, Yurgelun-Todd D. The residual neuropsychological effects of cannabis: the current status of research. Drug Alcohol Depend. 1995;38(1):25–34.

    Article  PubMed  Google Scholar 

  72. Solowij N, Stephens RS, Roffman RA, Babor T, Kadden R, Miller M, et al. Cognitive functioning of long-term heavy cannabis users seeking treatment. JAMA. 2002;287(9):1123–31.

    Article  PubMed  Google Scholar 

  73. Solowij N, Battisti R. The chronic effects of cannabis on memory in humans: a review. Curr Drug Abuse Rev. 2008;1:81–98.

    Article  PubMed  Google Scholar 

  74. Grant I, Gonzalez R, Carey CL, Natarajan L, Wolfson T. Non-acute (residual) neurocognitive effects of cannabis use: a meta-analytic study. J Int Neuropsychol Soc. 2003;9(5):679–89.

    Article  PubMed  CAS  Google Scholar 

  75. Nair DG. About being BOLD. Brain Res Brain Res Rev. 2005;50(2):229–43.

    Article  PubMed  Google Scholar 

  76. Jager G, Van Hell HH, De Win MM, Kahn RS, Van Den Brink W, Van Ree JM, et al. Effects of frequent cannabis use on hippocampal activity during an associative memory task. Eur Neuropsychopharmacol. 2007;17(4):289–97.

    Article  PubMed  CAS  Google Scholar 

  77. Sneider JT, Pope Jr HG, Silveri MM, Simpson NS, Gruber SA, Yurgelun-Todd DA. Altered regional blood volume in chronic cannabis smokers. Exp Clin Psychopharmacol. 2006;14(4):422–8.

    Article  PubMed  CAS  Google Scholar 

  78. Murray RM, Morrison PD, Henquet C, Di FM. Cannabis, the mind and society: the harsh realities. Nat Rev Neurosci. 2007;8(11):885–95.

    Article  PubMed  CAS  Google Scholar 

  79. Sundram S. Cannabis and neurodevelopment: implications for psychiatric disorders. Hum Psychopharmacol. 2006;21(4):245–54.

    Article  PubMed  CAS  Google Scholar 

  80. Grech A, van OJ, Jones PB, Lewis SW, Murray RM. Cannabis use and outcome of recent onset psychosis. Eur Psychiatry. 2005;20(4):349–53.

    Article  PubMed  Google Scholar 

  81. Boydell J, van OJ, Caspi A, Kennedy N, Giouroukou E, Fearon P, et al. Trends in cannabis use prior to first presentation with schizophrenia, in South-East London between 1965 and 1999. Psychol Med. 2006;36(10):1441–6.

    Article  PubMed  CAS  Google Scholar 

  82. Rathbone J, Variend H, Mehta H. Cannabis and schizophrenia. Cochrane Database Syst Rev 2008;(3):CD004837.

    Google Scholar 

  83. Sarne Y, Keren O. Are cannabinoid drugs neurotoxic or neuroprotective? Med Hypotheses. 2004;63(2):187–92.

    Article  PubMed  CAS  Google Scholar 

  84. Sarne Y, Mechoulam R. Cannabinoids: between neuroprotection and neurotoxicity. Curr Drug Targets CNS Neurol Disord. 2005;4(6):677–84.

    Article  PubMed  CAS  Google Scholar 

  85. Walsh D, Nelson KA, Mahmoud FA. Established and potential therapeutic applications of cannabinoids in oncology. Support Care Cancer. 2003;11(3):137–43.

    PubMed  Google Scholar 

  86. Fogarty A, Rawstorne P, Prestage G, Crawford J, Grierson J, Kippax S. Marijuana as therapy for people living with HIV/AIDS: social and health aspects. AIDS Care. 2007;19(2):295–301.

    Article  PubMed  CAS  Google Scholar 

  87. Pertwee RG. The therapeutic potential of drugs that target ­cannabinoid receptors or modulate the tissue levels or actions of endocannabinoids. AAPS J. 2005;7(3):E625–54.

    Article  PubMed  CAS  Google Scholar 

  88. Scuderi C, Filippis DD, Iuvone T, Blasio A, Steardo A, Esposito G. Cannabidiol in medicine: a review of its therapeutic potential in CNS disorders. Phytother Res. 2009;23(5):597–602.

    Article  PubMed  CAS  Google Scholar 

  89. Bortolato M, Mangieri RA, Fu J, Kim JH, Arguello O, Duranti A, et al. Antidepressant-like activity of the fatty acid amide hydrolase inhibitor URB597 in a rat model of chronic mild stress. Biol Psychiatry. 2007;62(10):1103–10.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Human Nutrition, Wageningen University, Room 302A, Bomenweg 2, 6703 HD, Wageningen, The Netherlands

    Gerry Jager Ph.D.

  2. Division of Human Nutrition, Wageningen University, Courier 62, 8129, 6700 EV, Wageningen, The Netherlands

    Gerry Jager Ph.D.

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  1. Gerry Jager Ph.D.
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Correspondence to Gerry Jager Ph.D. .

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Editors and Affiliations

  1. Inst. Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, Universiteitsweg 99, Utrecht, 3584CG, Netherlands

    Joris C. Verster

  2. Dept. Psychiatry, Medical University of South Carolina, President St. 67, Charleston, 29425, South Carolina, USA

    Kathleen Brady

  3. School of Medicine, Div. Alcoholism & Drug Abuse, New York University, First Ave. 550, New York, 10016, New York, USA

    Marc Galanter

  4. Institute of Psychiatry, King's College London, National Addiction Centre, Windsor Walk 4, London, SE5 8AF, United Kingdom

    Patricia Conrod

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Jager, G. (2012). Cannabis. In: Verster, J., Brady, K., Galanter, M., Conrod, P. (eds) Drug Abuse and Addiction in Medical Illness. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3375-0_11

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