• Marc A. Schuckit
Part of the Critical Issues in Psychiatry book series (CIPS)


Cannabis, or marijuana, is among the most widely used of the drugs described in this text. The health-care problems involved with delta-9-tetrahydrocannabinol (THC; the key active ingredient in marijuana and in hashish) include alterations in mood, toxicity for the lungs, and impaired driving abilities with subsequent accidents. Because, as a healthcare provider, you will be called on to give information about this drug to worried parents and to teenagers attempting to make decisions about future use, this chapter presents information on the history, the physiology, and the medical effects of the cannabinols.


Biological Psychiatry Cannabis Abuse Cannabis Dependence Middle Cerebral Artery Velocity Chronic Marijuana 
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  1. 1.
    O’Brien, C. P. Drug addiction and drug abuse. In J. G. Hardman, L. E. Limbird, P. B. Molinoff, et al. (Eds.), The pharmacological basis of therapeutics (9th ed.). New York: McGraw-Hill, 1995, pp. 557–577.Google Scholar
  2. 2.
    Woody, G. E., & MacFadden, W. Cannabis-related disorders. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 810–817.Google Scholar
  3. 3.
    Grinspoon, L., & Bakalar, J. B. Marihuana. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 199–206Google Scholar
  4. 4.
    Pitts, J. E., O’Neil, P. J., & Leggo, K. P. Variation in the THC content of illicitly imported cannabis products— 1984–1989. Journal of Pharmacy and Pharmacology 42:817–820, 1990.PubMedCrossRefGoogle Scholar
  5. 5.
    Liskow, B. Marijuana deterioration. Journal of the American Medical Association 214:1709, 1970.PubMedCrossRefGoogle Scholar
  6. 6.
    Mathew, R. J., Wilson, W. H., & Melges, F. T. Temporal disintegration and its psychological and physiological correlates. Annals of Clinical Psychiatry 4:235–245, 1992.CrossRefGoogle Scholar
  7. 7.
    Pertwee, R. G. Medical uses of cannabinoids: the way forward. Addiction 94:317–320, 1999.PubMedCrossRefGoogle Scholar
  8. 8.
    Schuckit, M. A. Does marijuana have any medicinal value? Vista Hill Foundation Drug Abuse & Alcoholism Newletter, 25(5), 1996.Google Scholar
  9. 9.
    Winger, G., Hofmann, F. G., & Woods, J. H. A handbook on drug and alcohol abuse (3rd ed.). New York: Oxford University Press, 1992, pp. 117–131.Google Scholar
  10. 10.
    Johansson, E., Gillespie, H. K., & Halldin, M. M. Human urinary excretion profile after smoking and oral administration of [14Cldelta1-tetrahydrocannabinol. Journal of Analytical Toxicology 14:176–180, 1990.PubMedGoogle Scholar
  11. 11.
    Schuckit, M. A. Science, medicine, and the future: Substance use disorders. British Medical Journal 314:1605–1608, 1997.PubMedCrossRefGoogle Scholar
  12. 12.
    Stein, E. A., Fuller, S. A., Edgemond, W. S., & Campbell, W. B. Selective effects of the endogenous cannabinoid arachidonylethanolamide (anandamide) on regional cerebral blood flow in the rat. Neuropsychophar-macology 19:481–491, 1998.Google Scholar
  13. 13.
    Cadas, H., Gaillet, S., Beltramo, M., et al. Biosynthesis of an endogenous cannabinoid precursor in neurons and its control by calcium and cAMP. Journal of Neuroscience 16:3934–3942, 1996.PubMedGoogle Scholar
  14. 14.
    Venance, L., Piomelli, D., Glowinski, J., & Glaume, C. Inhibition by anadamide of gap junctions and intercellular calcium signalling in striatal astrocytes. Nature 376:590–593, 1995.PubMedCrossRefGoogle Scholar
  15. 15.
    Tanda, G., Pontieri, F. E., & DiChiara, G. Cannabinoid and heroin activation of mesolimbic dopamine transmission by a common ul opioid receptor mechanism. Science 276:2048–2050, 1997.PubMedCrossRefGoogle Scholar
  16. 16.
    Gifford, A. N., Gardner, E. L., & Ashby, C. R. The effect of intravenous administration of delta-9-tetrahy-drocannabinol on the activity of A10 dopamine neurons in vivo in anesthetized rats. Neuropsychology 36:96–99, 1997.Google Scholar
  17. 17.
    Jentsch, D. J., Andrusiak, E., Tran, A., et al. Δ9-tetrahydrocannabinol increases prefrontal cortical cate-cholaminergic utilization and impairs spatial working memory in the rat: Blockade of dopaminergic effects with HA966. Neuropsychopharmacology 16:426–432, 1997.PubMedCrossRefGoogle Scholar
  18. 18.
    Sethi, B. G. B., Trivedi, J. K., Kumar, P., et al. Antianxiety effect of cannabis: Involvement of central benzodiazepine receptors. Biological Psychiatry 21:3–10, 1986.PubMedCrossRefGoogle Scholar
  19. 19.
    Mathew, R. J., Wilson, W. H., Humphreys, D., et al. Depersonalization after marijuana smoking. Biological Psychiatry 33:431–441, 1993.PubMedCrossRefGoogle Scholar
  20. 20.
    Chesher, G. B., Bird, K. D., Jackson, D. M., et al. The effects of orally administered ΔA9-tetrahydrocannabinol in man on mood and performance measures: A dose-response study. Pharmacology Biochemistry & behavior 35:861–864, 1990.CrossRefGoogle Scholar
  21. 21.
    Mathew, R. J., Wilson, W. H., Humphreys, D. F., et al. Changes in middle cerebral artery velocity after marijuana. Biological Psychiatry 32:164–169, 1992.PubMedCrossRefGoogle Scholar
  22. 22.
    Feeney, D. M. Marihuana and epilepsy. Science 197:1301–1302, 1977.PubMedGoogle Scholar
  23. 23.
    Gottschalk, L. A., Aronow, W. S., & Prakash, R. Effect of marijuana and placebo-marijuana smoking on psychological state and on psychophysiological cardiovascular functioning in anginal patients. Biological Psychiatry 12:255–266, 1977.PubMedGoogle Scholar
  24. 24.
    American Psychiatric Association. The diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press, 1994.Google Scholar
  25. 25.
    Gold, M. S. Marijuana. In N. S. Miller (Ed.), Comprehensive handbook of drug and alcohol addiction. New York: Marcel Dekker, 1991, pp. 353–382.Google Scholar
  26. 26.
    Wiesbeck, G. A., Schuckit, M. A., Kalmijn, J. A., et al. An evaluation of the history of a marijuana withdrawal syndrome in a large population. Addiction 91:1469–1478, 1996.PubMedCrossRefGoogle Scholar
  27. 27.
    Schuckit, M. A. Is there a clinically significant marijuana withdrawal syndrome? Vista Hill Foundation Drug Abuse & Alcoholism Newsletter, 24(2), 1995.Google Scholar
  28. 28.
    Crowley, T. J., Macdonald, B. S., Whitmore, E. A., & Mikulich, S. K. Cannabis dependence, withdrawal, and reinforcing effects among adolescents with conduct symptoms and substance use disorders. Drug and Alcohol Dependence 50:27–37, 1998.PubMedCrossRefGoogle Scholar
  29. 29.
    Mendelson, J. H., Mello, N. K., Lex, B. W., & Bavli, S. Marijuana withdrawal syndrome in a woman. American Journal of Psychiatry 141:1289–1290, 1984.PubMedGoogle Scholar
  30. 30.
    Kendler, K. S., & Prescott, C. A. Cannabis use, abuse, and dependence in a population-based sample of female twins. American Journal of Psychiatry 155:1016–1022, 1998.PubMedGoogle Scholar
  31. 31.
    Lyons, M. J., Toomey, R., Meyer, J. M., et al. How do genes influence marijuana use? The role of subjective effects. Addiction 92:409–417, 1997.PubMedCrossRefGoogle Scholar
  32. 32.
    Schuckit, M. A. Biological, psychological and environmental predictors of the alcoholism risk: A longitudinal study. Journal of Studies on Alcohol 59:485–494, 1998.PubMedGoogle Scholar
  33. 33.
    Schuckit, M. A., & Smith, T. L. An 8-year follow-up of 450 sons of alcoholic and control subjects. Archives of General Psychiatry 53:202–210, 1996.PubMedCrossRefGoogle Scholar
  34. 34.
    Bachman, J. G., Johnston, L. D., & O’Malley, P. M. Explaining recent increases in students’ marijuana use: impacts of perceived risks and disapproval, 1976 through 1996. American Journal of Public Health 88:887–892, 1998.PubMedCrossRefGoogle Scholar
  35. 35.
    Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National Household Survey on drug abuse: Population estimates 1997. Rockville, MD: U.S. Department of Health and Human Services, 1998.Google Scholar
  36. 36.
    Hammer, T., & Vaglum, P. Initiation, continuation, or discontinuation of cannabis use in the general population. British Journal of Addiction 85:899–909, 1990.PubMedCrossRefGoogle Scholar
  37. 37.
    Johnston, L. D., O’Malley, P. M., & Bachman, J. G. National survey results on drug use from the Monitoring the Future Study, 1975–1997, Vol. I, Secondary School Students. Rockville, MD: National Institute on Drug Abuse, U.S. Department of Health and Human Services, 1998.Google Scholar
  38. 38.
    Bell, R., Wechsler, H., & Johnston, L. D. Correlates of college student marijuana use: Results of a U.S. national survey. Addiction 92:571–581, 1997.PubMedCrossRefGoogle Scholar
  39. 39.
    Silva, M. T., Barros, R. S., & de Maglhães, M. P. Use of marijuana and other drugs by college students of São Paulo, Brazil. International Journal of Addictions 29:1045–1056, 1994.Google Scholar
  40. 40.
    Royo-Bordonada, M. A., Cid-Ruzafa, J., Martin-Morena, J. M., & Guallar, E. Drug and alcohol use in Spain: Consumption habits, attitudes and opinions. Public Health 111:277–284, 1997.PubMedGoogle Scholar
  41. 41.
    Mora, M. E., Villatoro, J., & Rojas, E. Drug use among students in Mexico’s northern border states. In Department of Health and Human Services, Epidemiologic trends in drug abuse. Washington, DC: U.S. Government Printing Office, 1996, pp. 367–375.Google Scholar
  42. 42.
    Reilly, D., Didcott, P., Swift, W., & Hall, W. Long-term cannabis use: Characteristics of users in an Australian rural area. Addiction 93:837–846, 1998.PubMedCrossRefGoogle Scholar
  43. 43.
    Forster, L. M., Tannhauser, M., & Barros, H. M. Drug use among street children in southern Brazil. Drug and Alcohol Dependence 43:57–62, 1996.PubMedCrossRefGoogle Scholar
  44. 44.
    Kandel, D. B., & Raveis, V. H. Cessation of illicit drug use in young adulthood. Archives of General Psychiatry 46:109–116, 1989.PubMedCrossRefGoogle Scholar
  45. 45.
    Kandel, D. B., Davies, K., Karus, D., & Yamaguchi, K. The consequences in young adulthood of adolescent drug involvement. Archives of General Psychiatry 43:746–754, 1986.PubMedCrossRefGoogle Scholar
  46. 46.
    Mathers, D. C., Ghodse, A. H., Caan, A. W., & Scott, S. A. Cannabis use in a large sample of acute psychiatric admissions. British Journal of Addiction 86:779–784, 1991.PubMedCrossRefGoogle Scholar
  47. 47.
    Swift, W., Hall, W., Didcott, P., & Reilly, D. Patterns and correlates of cannabis dependence among long-term users in an Australian rural area. Addiction 93:1149–1160, 1998.PubMedCrossRefGoogle Scholar
  48. 48.
    Hall, W., & Solowij, N. Long-term cannabis use and mental health. British Journal of Psychiatry 171:107–108, 1997.PubMedCrossRefGoogle Scholar
  49. 49.
    Rodroguez de Fonseca, F., Carrera, M. R. A., Navarro, M., et al. Activation of corticotropin-releasing factor in the limbic system during cannabinoid withdrawal. Science 276:2050–2054, 1997.CrossRefGoogle Scholar
  50. 50.
    Sidney, S., Beck, J. E., Tekawa, I. S., et al. Marijuana and mortality. The American Journal of Public Health 87:585–590, 1997.CrossRefGoogle Scholar
  51. 51.
    British Medical Association. Therapeutic uses of cannabis. Amsterdam: Harwood Academic Publishers, 1997.Google Scholar
  52. 52.
    Whitfield, R. M., Bechtel, L. M., & Starich, G. H. The impact of ethanol and marinol marijuana usage on HIV+/AIDS patients undergoing azidothymidine, azidothymidine/dideoxycytidine, or dideoxyinosine therapy. Alcoholism: Clinical and Experimental Research 21:122–127, 1997.CrossRefGoogle Scholar
  53. 53.
    Rose, M. Cannabis: A medical question? Lancet 1:703, 1980.PubMedGoogle Scholar
  54. 54.
    Chaudry, H. R., Moss, H. B., Bashir, A., & Suliman, T. Cannabis psychosis following bhang ingestion. British Journal of Addiction 86:1075–1081, 1991.PubMedCrossRefGoogle Scholar
  55. 55.
    Allebeck, P., Adamsson, C., Engström, A., & Rydberg, U. Cannabis and schizophrenia: A longitudinal study of cases treated in Stockholm County. Acta Psychiatrica Scandinavica 88:21–24, 1993.PubMedCrossRefGoogle Scholar
  56. 56.
    Imade, A. G. T., & Ebie, J. C. A retrospective study of symptom patterns of cannabis-induced psychosis. Acta Psychiatrica Scandinavica 83:134–136, 1991.PubMedCrossRefGoogle Scholar
  57. 57.
    Leweke, F M., Giuffrida, A., Wurster, U., et al. Elevated endogenous cannabinoids in schizophrenia. NeuroReport 10:1665–1669, 1999.PubMedCrossRefGoogle Scholar
  58. 58.
    Caspari, D. Cannabis and schizophrenia: results of a follow-up study. European Archives of Psychiatry and Clinical Neuroscience 249:45–49, 1999.PubMedCrossRefGoogle Scholar
  59. 59.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders. Geneva: World Health Organization, 1992.Google Scholar
  60. 60.
    Leweke, M., Kampmann, C., Radwan, M., et al. The effects of tetrahydrocannabinol on the recognition of emotionally charged words: An analysis using event-related brain potentials. Neuropsychobiology 37:104–111, 1998.PubMedCrossRefGoogle Scholar
  61. 61.
    Solowij, N., Michie, P. T., & Fox, A. M. Differential impairments of selective attention due to frequency and duration of cannabis use. Biological Psychiatry 37:731–739, 1995.PubMedCrossRefGoogle Scholar
  62. 62.
    Deahl, M. Cannabis and memory loss. British Journal of Addiction 86:249–252, 1991.PubMedCrossRefGoogle Scholar
  63. 63.
    Block, R. I., & Ghoneim, M. M. Effects of chronic marijuana use on human cognition. Psychopharmacology 110:219–228, 1993.PubMedCrossRefGoogle Scholar
  64. 64.
    Fletcher, J. M., Page, B., Francis, D. J., et al. Cognitive correlates of long-term cannabis use in Costa Rica men. Archives of General Psychiatry 53:1051–1057, 1996.PubMedCrossRefGoogle Scholar
  65. 65.
    Pope, H. G., Jr., & Yurgelun-Todd, D. The residual cognitive effects of heavy marijuana use in college students. Journal of American Medical Association 275:521–527, 1996.CrossRefGoogle Scholar
  66. 66.
    Patrick, G. Straumanis, J. J., Struve, F A. et al. Reduced P50 auditory gating response in psychiatrically norman chronic marihuana users: A pilot study. Biological Psychiatry 45:1307–1312, 1999.PubMedCrossRefGoogle Scholar
  67. 67.
    Brook, J. S., Gordon, A. S., Brook, A., & Brook, D. W. The consequences of marijuana use on intrapersonal and interpersonal functioning in black and white adolescents. Genetic, Social, and General Psychology Monographs 115:349–369, 1990.Google Scholar
  68. 68.
    Andreasson, S., Allebeck, P., Engstrom, A., & Rydberg, U. Cannabis and schizophrenia: A longitudinal study of Swedish conscripts. Lancet 2:1483–1486, 1987.PubMedCrossRefGoogle Scholar
  69. 69.
    Goodwin, D. W., & Guze, S. B. Psychiatric Diagnosis (5th ed.). New York: Oxford University Press, 1996.Google Scholar
  70. 70.
    Troisi, A., Pasini, A., Saracco, M., & Spalletta, G. Psychiatric symptoms in male cannabis users not using other illicit drugs. Addiction 93:487–492, 1998.PubMedCrossRefGoogle Scholar
  71. 71.
    Hall, W. The respiratory risks of cannabis smoking. Addiction 93:1461–1463, 1998.PubMedCrossRefGoogle Scholar
  72. 72.
    Feldman, A. L., Sullivan, J. T., Passero, M. A., & Lewis, D. C. Pneumothorax in polysubstance-abusing marijuana and tobacco smokers: Three cases. Journal of Substance Abuse 5:183–186, 1993.PubMedCrossRefGoogle Scholar
  73. 73.
    Dax, E. M., Pilotte, N. S., Adler, W. H., et al. The effects of 9-one-tetrahydrocannabinol on hormone release and immune function. Journal of Steroid Biochemistry 34:263–270, 1989.PubMedCrossRefGoogle Scholar
  74. 74.
    Taylor, D. N., Washsmuth, I. K., Shangkuan, Y. H., et al. Salmonellosis associated with marijuana: A multistate outbreak traced by plasmid fingerprinting. New England Journal of Medicine 306:1249–1253, 1982.PubMedCrossRefGoogle Scholar
  75. 75.
    Zimmerman, S., & Zimmerman, A. M. Genetic effects of marijuana. International Journal of the Addictions 25:19–33, 1991.Google Scholar
  76. 76.
    Robins, L. N., & Mus, J. L. Effects of in utero exposure to street drugs. American Journal of Public Health, Supplement to Vol. 83, 1993.Google Scholar
  77. 77.
    Zuckerman, B., Frank, D. A., Hingson, R., et al. Effects of maternal marijuana and cocaine use on fetal growth. New England Journal of Medicine 320:762–768, 1989.PubMedCrossRefGoogle Scholar
  78. 78.
    Smith, C. G., & Asch, R. H. Drug abuse and reproduction. Fertility and Sterility 48:355–373, 1987.PubMedGoogle Scholar
  79. 79.
    Block, R. I., Farinpour, R., & Schlechte, J. A. Effects of chronic marijuana use on testosterone, luteinizing hormone, follicle stimulating hormone, prolactin, and Cortisol in men and women. Drug and Alcohol Dependence 28:121–128, 1991.PubMedCrossRefGoogle Scholar
  80. 80.
    Murphy, L. L., Muñoz, R. M., Adrian, B. A., & Villanúa, M. A. Function of cannabinoid receptors in the neuroendocrine regulation of hormone secretion. Neurobiology of Disease 5:432–446, 1998.PubMedCrossRefGoogle Scholar
  81. 81.
    Bier, M. M., & Steahly, L. P. Emergency treatment of marihuana complicating diabetes. In P. G. Bourne (Ed.), A treatment manual for acute drug abuse emergencies. Washington, DC: U.S. Government Printing Office, 1974, pp. 88–94.Google Scholar
  82. 82.
    Lukas, S. E., Benedikt, R., Mendelson, J. H., et al. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacology 7:77–81, 1992.PubMedGoogle Scholar
  83. 83.
    Kurzthaler, I., Hummer, M., Miller, C., et al. Effect of cannabis use on cognitive functions and driving ability. Journal of Clinical Psychiatry 60:395–399, 1999.PubMedCrossRefGoogle Scholar
  84. 84.
    Yesavage, J. A., Leirer, V. O., Denari, M., & Hollister, L. E. Carryover effects of marijuana intoxication on aircraft pilot performance: A preliminary report. American Journal of Psychiatry 142:1325–1329, 1985.PubMedGoogle Scholar
  85. 85.
    Liguori, A., Gatto, C. P., & Robinson, J. H. Effects of marijuana on equilibrium, psychomotor performance, and simulated driving. Behavioural Pharmacology 9:599–609, 1998.PubMedCrossRefGoogle Scholar
  86. 86.
    Schuckit, M. A. Educating yourself about alcohol and drugs. New York: Plenum Publishing Co., 1998.Google Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Marc A. Schuckit
    • 1
  1. 1.University of California Medical School and Veterans Affairs San Diego Healthcare SystemSan DiegoUSA

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