Marijuana

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Marijuana

Your Questions Answered

Aharon W. Zorea

Q&A Health Guides

Copyright © 2022 by ABC-CLIO, LLC
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted, in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, except for the inclusion of brief quotations in a
review, without prior permission in writing from the publisher.
Library of Congress Cataloging-in-Publication Data
Names: Zorea, Aharon W., author.
Title: Marijuana : your questions answered / Aharon W. Zorea.
Description: Santa Barbara, California : Greenwood, [2022] | Series: Q & A
health guides | Includes bibliographical references and index.
Identifiers: LCCN 2022012577 | ISBN 9781440877155 (hardcover ; alk. paper)
| ISBN 9781440877162 (ebook)
Subjects: LCSH: Marijuana—Health aspects. | Marijuana—Physiological
effect. | Marijuana—Social aspects.
Classification: LCC RM666.C266 Z67 2022 | DDC 615.7/827—dc23/eng/20220318
LC record available at https://lccn.loc.gov/2022012577
ISBN: 978-1-4408-7715-5 (print)
978-1-4408-7716-2 (ebook)
26 25 24 23 22 1 2 3 4 5
This book is also available as an eBook.
Greenwood
An Imprint of ABC-CLIO, LLC
ABC-CLIO, LLC
147 Castilian Drive
Santa Barbara, California 93117
www.abc-clio.com
This book is printed on acid-free paper
Manufactured in the United States of America
To my parents, Moshe and Rivka.
Thank you.
 Contents

Series Foreword xi
Acknowledgmentsxiii
Introductionxv
Guide to Health Literacy xix
Common Misconceptions about Marijuana xxvii

Questions and Answers1

The Social Context of Marijuana Use 3
1. What is marijuana? 3
2. What is the difference between marijuana
that people smoke and other products that contain
marijuana or marijuana extracts? 6
3. What compounds are found in marijuana,
and which make you feel high? 12
4. How common is marijuana use in the United States and
around the world today? 15
5. How is marijuana different today than it was in the past? 18
6. How have attitudes about marijuana use changed
over time in the United States? 19
viii Contents

Marijuana’s Effects on the Body and Mind 27

7. What are the general effects of THC on
the biochemistry inside the human body? 27
8. How does THC impact motor functions such as physical
movement, speech patterns, and reaction times? 30
9. How does THC impact cognitive functions and
the limbic system? 32
10. Is there a difference in the kind of “high” resulting from
marijuana when compared to alcohol and other drugs? 36
11. How do CBD extracts affect the body? 40
12. Does marijuana (THC) affect all people in
the same way? 41
13. Does marijuana make people more creative? 44
Medical Marijuana 47
14. What were the main maladies that medical
marijuana was originally intended to treat? 47
15. What do most patients actually use marijuana for? 48
16. What is “off-label” use? 51
17. Does marijuana provide unique benefits that cannot
also be provided through other prescription drugs? 52
18. How long have researchers studied the usefulness of
marijuana as a type of medicine? 56
19. How confident can patients be about the quality and
potency of medical marijuana? 58
20. Does CBD provide more medical benefits than THC? 59
21. What other potential uses of medical marijuana are
researchers currently studying? 60
Risks from Marijuana Abuse and Addiction 63
22. Is marijuana addictive? 63
23. Is marijuana a gateway drug? 67
24. What is marijuana abuse? 70
25. What are the signs of marijuana abuse? 71
26. How much marijuana can I take without
becoming an abuser? 73
27. How do the health risks of marijuana compare to
the health risks associated with alcohol and tobacco? 76
28. What are the most common social effects of
marijuana abuse? 81
Contents ix

29. Is there a connection between marijuana abuse and

mental illness? 83
30. Can marijuana use and abuse kill you? 86
31. I want to stop using marijuana. What treatment
plans are available? 90
Marijuana Policy and the Law 93
32. Why are marijuana policies so controversial? 93
33. When did marijuana (and hemp) become
restricted/prohibited by law? 98
34. My state legalized marijuana, so can I still get arrested for
using, growing, buying, or selling it? 104
35. Is it illegal to buy marijuana products online? 105
36. Has legalization of marijuana ended
the illegal drug trade? 106
37. How does marijuana policy reflect current political or
moral ideologies? 107
38. Have other drug-related policy movements been
affected by the movement to regulate marijuana? 113
Case Studies 119

Glossary133
Directory of Resources 151
Index161
 Series Foreword

All of us have questions about our health. Is this normal? Should I be

doing something differently? Whom should I talk to about my concerns?
And our modern world is full of answers. Thanks to the Internet, there’s
a wealth of information at our fingertips, from forums where people can
share their personal experiences to Wikipedia articles to the full text of
medical studies. But finding the right information can be an intimidating
and difficult task—some sources are written at too high a level, others
have been oversimplified, while still others are heavily biased or simply
inaccurate.
Q&A Health Guides address the needs of readers who want accurate,
concise answers to their health questions, authored by reputable and
objective experts, and written in clear and easy-to-understand language.
This series focuses on the topics that matter most to young adult readers,
including various aspects of physical and emotional well-being as well as
other components of a healthy lifestyle. These guides will also serve as a
valuable tool for parents, school counselors, and others who may need to
answer teens’ health questions.
All books in the series follow the same format to make finding informa-
tion quick and easy. Each volume begins with an essay on health literacy
and why it is so important when it comes to gathering and evaluating
health information. Next, the top five myths and misconceptions that
surround the topic are dispelled. The heart of each guide is a collection
xii Series Foreword

of questions and answers, organized thematically. A selection of five case

studies provides real-world examples to illuminate key concepts. Round-
ing out each volume are a directory of resources, glossary, and index.
It is our hope that the books in this series will not only provide valuable
information but will also help guide readers toward a lifetime of healthy
decision making.
 Acknowledgments

This book was written in the midst of the global pandemic, which means
that most of my communications with friends and colleagues were con-
ducted over email or phone. There are many people to thank, many of
whom I have never had a chance to see face-to-face. My first thanks
should go to my editor Maxine Taylor, who brought this opportunity to
my attention. I have been thinking about this subject for many years,
and the timing was perfect. I would also like to recognize the hard work
of our University of Wisconsin–Platteville librarians Le Suong Cina and
Sara Winger who managed to procure and convey nearly 700 books from
around the state to be housed in my little home office even though many
of the university facilities had been closed to the public. I would also like
to thank my friends Dr. Michael Kloess from Our Lady of Hope Clinic in
Madison and Bruce Roesler and Dr. Andrew Wright from the Richland
Hospital Paul Corcoran from Richland Family Prescription Center, as
well as my campus colleagues Eric Brewer, Stephanie Kernik, Faye Peng,
and Dorothy Thompson for their insights and suggestions every time we
spoke on the subject. Similarly, Ron Fruit and Phil Nee from WRCO
Radio and the Weigel family (Chuck, Madeleine, Emma, Stephen, and
Virginia) and my numerous family members in Alaska, Iowa, Minnesota,
Wisconsin, California, and Colorado who patiently let me talk through
many of the questions that are found in this volume and appropriately
played devil’s advocate as needed. Above all, I would like to thank my
xiv Acknowledgments

family at home who are always supportive every time I write a book. My
sons, Jacob and Jonah, and especially my lovely wife, Emily, each make a
home environment both warm and productive. The pandemic may have
forced us all to work from home, but they transformed our house into a
warm and comforting retreat.
 Introduction

About 15 years ago a student came to my office to gauge my opinion on

marijuana legalization. This was long before the subject was popular, and
marijuana was only legal for medical use in a few states. He was respond-
ing to a flyer that I had posted outside my office that relayed some basic
facts and statistics about the dangers of marijuana, alcohol abuse, and
addiction. At that time, our campus experienced a surge of students who
were failing their classes due to substance abuse problems, and I was trying
to provide helpful information. I recall having to replace the flyer num-
erous times.
This student opened the conversation by talking about drinking and
how many of his relatives (uncles and cousins) had serious problems with
alcohol. After a few anecdotes, he gradually turned the conversation to
marijuana and his general opinion that it was a safer habit than drinking.
That semester especially, when so many of my promising students were
being sidetracked and were failing due to their substance abuse issues, I
was curious and asked him to tell me more. His tone became more excited
as he explained that marijuana was very poorly understood and that it pro-
moted imagination, mental acuity, and was safer than both alcohol and
tobacco. He simply could not understand why anyone would be opposed
to it. When I asked him how he formed these conclusions, he told me that
he had been reading “a lot of information online” and that he was discov-
ering so many facts that he had never known before. He added, “[N]o one
xvi Introduction

has ever died from marijuana, but people die all the time from alcohol.”
My student was convinced that his conclusions were self-evident and that
people were simply ignorant and prejudiced against the drug. He pointed
to my flyer and said that there were “a lot of myths about marijuana.”
My student was right in one respect—there are a lot of myths and
misconceptions about marijuana. All of them can be easily found online
written by people who share their experiences and who are personally
invested in their drug use. These blog posts rarely talk about the impact
their addictions have had on their relationships and school and job per-
formance. Like many others, my student’s perceptions on alcohol, mar-
ijuana, and addiction were heavily influenced by popular media, which
stresses the excitement of experience and avoids the more problematic
reality of consequences.
The birth of social media in the first decade of the 2000s ushered in
a major shift in public opinion on marijuana specifically and on recre-
ational drug use in general. Thirty years ago, public service announce-
ments ran on most youth-themed programs with the message “Just say no”
to drugs and alcohol, and now in the 2020s, the more common message
is “Just do it.” A simple internet search for “Where to buy marijuana?”
can turn up more than 2.1 billion results, whereas a simple search for “Is
marijuana bad for you?” results in 1/20th as many hits. The information
online is certainly not balanced, and there are far more blogs and private
sites marketing and promoting marijuana than there are those that stress
the dangers of the drug.
Social media and the internet are only partially responsible for the
noticeable shift in opinion on drug use, but the rapid increase in tech-
nological dependency has also contributed to our cultural habits. Addic-
tions of all kinds have become more common at all levels of society, and
health care professionals are becoming increasingly aware of just how
widespread the problem extends—not only for teens and young adults
but also for parents and grandparents. Alcohol, gambling, and drug use
were obvious sources of addiction in the past, but today modern addic-
tions include pornography, video games, social media, online shopping,
and even obsessively consuming news media. Recently, we have become
so reliant on digital technology that it can determine our daily routines,
exaggerate our personal insecurities, and lead to widely fluctuating emo-
tional reactions. Digital-based addictions show clearly that addiction does
not require chemical dependency to be harmful to individual well-being.
As rates of depression, schizophrenia, and other forms of mental and emo-
tional illnesses rise, including rates of suicide, the need for more balanced
information about the risks of addiction also rises.
Introduction xvii

This book provides thorough answers to questions about marijuana. It

includes factual details about its chemistry, its effects on human cognition
and emotions, and answers common questions about what it does. What
makes this book unique is that it also places strong emphasis on ques-
tions related to marijuana addiction, the sociopolitical trends that seem
to encourage its use, and especially the impact of marijuana use on judg-
ment and moral reasoning. More than 600 published academic sources
were used as part of the research, and these were supplemented by an
equal number of nonacademic sources found through popular media. The
purpose of this book is to provide readers with more balanced informa-
tion that they can use to make informed choices outside of the confus-
ing and misleading emotions that usually accompany active drug use and
psychological addiction. This book does not take a position for or against
legalization but instead focuses on the likely consequences of increased
marijuana use.
 Guide to Health Literacy

On her 13th birthday, Samantha was diagnosed with type 2 diabetes. She
consulted her mom and her aunt, both of whom also have type 2 diabe-
tes, and decided to go with their strategy of managing diabetes by tak-
ing insulin. As a result of participating in an after-school program at her
middle school that focused on health literacy, she learned that she can
help manage the level of glucose in her bloodstream by counting her car-
bohydrate intake, following a diabetic diet, and exercising regularly. But,
what exactly should she do? How does she keep track of her carbohydrate
intake? What is a diabetic diet? How long should she exercise and what
type of exercise should she do? Samantha is a visual learner, so she turned
to her favorite source of media, YouTube, to answer these questions. She
found videos from individuals around the world sharing their experiences
and tips, doctors (or at least people who have “Dr.” in their YouTube
channel names), government agencies such as the National Institutes of
Health, and even video clips from cat lovers who have cats with diabetes.
With guidance from the librarian and the health and science teachers at
her school, she assessed the credibility of the information in these videos
and even compared their suggestions to some of the print resources that
she was able to find at her school library. Now, she knows exactly how to
count her carbohydrate level, how to prepare and follow a diabetic diet,
and how much (and what) exercise is needed daily. She intends to share
her findings with her mom and her aunt, and now she wants to create a
xx Guide to Health Literacy

chart that summarizes what she has learned that she can share with her
doctor.
Samantha’s experience is not unique. She represents a shift in our soci-
ety; an individual no longer views himself or herself as a passive recipient
of medical care but as an active mediator of his or her own health. How-
ever, in this era when any individual can post his or her opinions and
experiences with a particular health condition online with just a few clicks
or publish a memoir, it is vital that people know how to assess the credi-
bility of health information. Gone are the days when “publishing” health
information required intense vetting. The health information landscape
is highly saturated, and people have innumerable sources where they can
find information about practically any health topic. The sources (whether
print, online, or a person) that an individual consults for health informa-
tion are crucial because the accuracy and trustworthiness of the informa-
tion can potentially affect his or her overall health. The ability to find,
select, assess, and use health information constitutes a type of literacy—
health literacy—that everyone must possess.

THE DEFINITION AND PHASES OF HEALTH LITERACY

One of the most popular definitions for health literacy comes from Ratzan
and Parker (2000), who describe health literacy as “the degree to which
individuals have the capacity to obtain, process, and understand basic
health information and services needed to make appropriate health
decisions.” Recent research has extrapolated health literacy into health
literacy bits, further shedding light on the multiple phases and literacy
practices that are embedded within the multifaceted concept of health
literacy. Although this research has focused primarily on online health
information seeking, these health literacy bits are needed to successfully
navigate both print and online sources. There are six phases of health
information seeking: (1) Information Need Identification and Question
Formulation, (2) Information Search, (3) Information Comprehension,
(4) Information Assessment, (5) Information Management, and (6)
Information Use.
The first phase is the information need identification and question formu-
lation phase. In this phase, one needs to be able to develop and refine a
range of questions to frame one’s search and understand relevant health
terms. In the second phase, information search, one has to possess appro-
priate searching skills, such as using proper keywords and correct spelling
in search terms, especially when using search engines and databases. It
is also crucial to understand how search engines work (i.e., how search
Guide to Health Literacy xxi

results are derived, what the order of the search results means, how to use
the snippets that are provided in the search results list to select websites,
and how to determine which listings are ads on a search engine results
page). One also has to limit reliance on surface characteristics, such as
the design of a website or a book (a website or book that appears to have
a lot of information or looks aesthetically pleasant does not necessarily
mean it has good information) and language used (a website or book
that utilizes jargon, the keywords that one used to conduct the search,
or the word “information” does not necessarily indicate it will have good
information). The next phase is information comprehension, whereby one
needs to have the ability to read, comprehend, and recall the information
(including textual, numerical, and visual content) one has located from
the books and/or online resources.
To assess the credibility of health information (information assessment
phase), one needs to be able to evaluate information for accuracy, evaluate
how current the information is (e.g., when a website was last updated or
when a book was published), and evaluate the creators of the source—for
example, examine site sponsors or type of sites (.com, .gov, .edu, or .org)
or the author of a book (practicing doctor, a celebrity doctor, a patient
of a specific disease, etc.) to determine the believability of the person/
organization providing the information. Such credibility perceptions tend
to become generalized, so they must be frequently reexamined (e.g., the
belief that a specific news agency always has credible health information
needs continuous vetting). One also needs to evaluate the credibility of
the medium (e.g., television, Internet, radio, social media, and book) and
evaluate—not just accept without questioning—others’ claims regarding
the validity of a site, book, or other specific source of information. At
this stage, one has to “make sense of information gathered from diverse
sources by identifying misconceptions, main and supporting ideas, con-
flicting information, point of view, and biases” (American Association
of School Librarians [AASL], 2009, p. 13) and conclude which sources/
information are valid and accurate by using conscious strategies rather
than simply using intuitive judgments or “rules of thumb.” This phase is
the most challenging segment of health information seeking and serves
as a determinant of success (or lack thereof) in the information-seeking
process. The following section on Sources of Health Information further
explains this phase.
The fifth phase is information management, whereby one has to orga-
nize information that has been gathered in some manner to ensure easy
retrieval and use in the future. The last phase is information use, in which
one will synthesize information found across various resources, draw
xxii Guide to Health Literacy

conclusions, and locate the answer to his or her original question and/
or the content that fulfills the information need. This phase also often
involves implementation, such as using the information to solve a health
problem; make health-related decisions; identify and engage in behaviors
that will help a person to avoid health risks; share the health informa-
tion found with family members and friends who may benefit from it; and
advocate more broadly for personal, family, or community health.

THE IMPORTANCE OF HEALTH LITERACY

The conception of health has moved from a passive view (someone is
either well or ill) to one that is more active and process based (someone
is working toward preventing or managing disease). Hence, the dominant
focus has shifted from doctors and treatments to patients and prevention,
resulting in the need to strengthen our ability and confidence (as patients
and consumers of health care) to look for, assess, understand, manage,
share, adapt, and use health-related information. An individual’s health
literacy level has been found to predict his or her health status better
than age, race, educational attainment, employment status, and income
level (National Network of Libraries of Medicine, 2013). Greater health
literacy also enables individuals to better communicate with health care
providers such as doctors, nutritionists, and therapists, as they can pose
more relevant, informed, and useful questions to health care providers.
Another added advantage of greater health literacy is better information-
seeking skills, not only for health but also in other domains, such as com-
pleting assignments for school.

SOURCES OF HEALTH INFORMATION: THE GOOD,

THE BAD, AND THE IN-BETWEEN
For generations, doctors, nurses, nutritionists, health coaches, and other
health professionals have been the trusted sources of health information.
Additionally, researchers have found that young adults, when they have
health-related questions, typically turn to a family member who has had
firsthand experience with a health condition because of their family mem-
ber’s close proximity and because of their past experience with, and trust
in, this individual. Expertise should be a core consideration when consult-
ing a person, website, or book for health information. The credentials and
background of the person or author and conflicting interests of the author
(and his or her organization) must be checked and validated to ensure
Guide to Health Literacy xxiii

the likely credibility of the health information they are conveying. While
books often have implied credibility because of the peer-review process
involved, self-publishing has challenged this credibility, so qualifications
of book authors should also be verified. When it comes to health infor-
mation, currency of the source must also be examined. When examining
health information/studies presented, pay attention to the exhaustiveness
of research methods utilized to offer recommendations or conclusions.
Small and nondiverse sample size is often—but not always—an indication
of reduced credibility. Studies that confuse correlation with causation is
another potential issue to watch for. Information seekers must also pay
attention to the sponsors of the research studies. For example, if a study
is sponsored by manufacturers of drug Y and the study recommends that
drug Y is the best treatment to manage or cure a disease, this may indicate
a lack of objectivity on the part of the researchers.
The Internet is rapidly becoming one of the main sources of health
information. Online forums, news agencies, personal blogs, social media
sites, pharmacy sites, and celebrity “doctors” are all offering medical and
health information targeted to various types of people in regard to all
types of diseases and symptoms. There are professional journalists, citizen
journalists, hoaxers, and people paid to write fake health news on various
sites that may appear to have a legitimate domain name and may even
have authors who claim to have professional credentials, such as an MD.
All these sites may offer useful information or information that appears to
be useful and relevant; however, much of the information may be debat-
able and may fall into gray areas that require readers to discern credibility,
reliability, and biases.
While broad recognition and acceptance of certain media, institutions,
and people often serve as the most popular determining factors to assess
credibility of health information among young people, keep in mind
that there are legitimate Internet sites, databases, and books that publish
health information and serve as sources of health information for doctors,
other health sites, and members of the public. For example, MedlinePlus
(https://medlineplus.gov) has trusted sources on over 975 diseases and
conditions and presents the information in easy-to-understand language.
The chart here presents factors to consider when assessing credibility
of health information. However, keep in mind that these factors function
only as a guide and require continuous updating to keep abreast with the
changes in the landscape of health information, information sources, and
technologies.
The chart can serve as a guide; however, approaching a librarian
about how one can go about assessing the credibility of both print
xxiv Guide to Health Literacy

All images from flaticon.com

and online health information is far more effective than using generic
checklist-type tools. While librarians are not health experts, they can
apply and teach patrons strategies to determine the credibility of health
information.
With the prevalence of fake sites and fake resources that appear to be
legitimate, it is important to use the following health information assess-
ment tips to verify health information that one has obtained (St. Jean
et al., 2015, p. 151):

• Don’t assume you are right: Even when you feel very sure about an
answer, keep in mind that the answer may not be correct, and it is
important to conduct (further) searches to validate the information.
• Don’t assume you are wrong: You may actually have correct infor-
mation, even if the information you encounter does not match—that
is, you may be right and the resources that you have found may con-
tain false information.
• Take an open approach: Maintain a critical stance by not including
your preexisting beliefs as keywords (or letting them influence your
choice of keywords) in a search, as this may influence what it is pos-
sible to find out.
Guide to Health Literacy xxv

• Verify, verify, and verify: Information found, especially on the Inter-

net, needs to be validated, no matter how the information appears on
the site (i.e., regardless of the appearance of the site or the quantity
of information that is included).

Health literacy comes with experience navigating health information.

Professional sources of health information, such as doctors, health care
providers, and health databases, are still the best, but one also has the
power to search for health information and then verify it by consulting
with these trusted sources and by using the health information assessment
tips and guide shared previously.
Mega Subramaniam, PhD
Associate Professor, College of Information Studies,
University of Maryland

REFERENCES AND FURTHER READING

American Association of School Librarians (AASL). (2009). Standards
for the 21st-century learner in action. Chicago, IL: American Association
of School Librarians.
Hilligoss, B., & Rieh, S.-Y. (2008). Developing a unifying framework of
credibility assessment: Construct, heuristics, and interaction in con-
text. Information Processing & Management, 44(4), 1467–1484.
Kuhlthau, C. C. (1988). Developing a model of the library search process:
Cognitive and affective aspects. Reference Quarterly, 28(2), 232–242.
National Network of Libraries of Medicine (NNLM). (2013). Health
literacy. Bethesda, MD: National Network of Libraries of Medicine.
Retrieved from nnlm.gov/outreach/consumer/hlthlit.html
Ratzan, S. C., & Parker, R. M. (2000). Introduction. In C. R. Selden, M.
Zorn, S. C. Ratzan, & R. M. Parker (Eds.), National Library of Medicine
current bibliographies in medicine: Health literacy. NLM Pub. No. CBM
2000–1. Bethesda, MD: National Institutes of Health, U.S. Depart-
ment of Health and Human Services.
St. Jean, B., Taylor, N. G., Kodama, C., & Subramaniam, M. (February
2017). Assessing the health information source perceptions of tweens
using card-sorting exercises. Journal of Information Science. Retrieved
from http://journals.sagepub.com/doi/abs/10.1177/0165551516687728
St. Jean, B., Subramaniam, M., Taylor, N. G., Follman, R., Kodama, C.,
& Casciotti, D. (2015). The influence of positive hypothesis testing on
youths’ online health-related information seeking. New Library World,
116(3/4), 136–154.
xxvi Guide to Health Literacy

Subramaniam, M., St. Jean, B., Taylor, N. G., Kodama, C., Follman,
R., & Casciotti, D. (2015). Bit by bit: Using design-based research to
improve the health literacy of adolescents. JMIR Research Protocols,
4(2), paper e62. Retrieved from http://www.ncbi.nlm.nih.gov/pmc
/articles/PMC4464334/
Valenza, J. (2016, November 26). Truth, truthiness, and triangulation: A
news literacy toolkit for a “post-truth” world [Web log]. Retrieved from
http://blogs.slj.com/neverendingsearch/2016/11/26/truth-truthiness
-triangulation-and-the-librarian-way-a-news-literacy-toolkit-for-a
-post-truth-world/
 Common Misconceptions about
Marijuana

1. MARIJUANA HAS BEEN USED SAFELY

FOR THOUSANDS OF YEARS BY PEOPLE ALL OVER
THE WORLD
It is true that the Cannabis plant has been cultivated for at least 5,000
years and that it has been used as a drug for almost as long. That does not
mean that marijuana has been used safely as a drug for all that time, nor
does it mean that it was socially acceptable for most people to use mari-
juana recreationally. For most of its history, Cannabis was known as hemp
and was cultivated mostly as a source for textile (cloth). Hemp was grown
all over the world, but it was not used as a drug. Most hemp farmers did
not use or even know about the potential drug use of their crops. Variet-
ies of Cannabis used for drug purposes were much less widely cultivated
and usually limited to small groups in each society who knew about the
drug and who used it for ritualistic purposes. Widespread recreational drug
abuse of any kind was rare in most premodern societies. Marijuana did not
become widely recognized as a drug in the United States until the early
20th century, and marijuana smoking did not become prevalent among all
classes of society until the late 1970s. For more information, see questions
2 and 33.
xxviii Common Misconceptions about Marijuana

2. MARIJUANA IS THE BEST AND

MOST EFFECTIVE WAY FOR DEALING WITH
MANY MEDICAL AILMENTS
It is true that some researchers have identified potential uses for marijuana
to treat the symptoms of certain medical conditions and the Food and
Drug Administration (FDA) has approved the use of cannabidiol (CBD)
extracted from Cannabis plants and a synthetic form of tetrahydrocannab-
inol (THC) to treat those symptoms. That means that marijuana-derived
drugs may provide some benefit in these cases, but that does not mean
there are not also other more effective treatments available to treat the
same conditions. Marijuana has not been approved to treat any disease
directly but has only been recognized as providing temporary remedy for
certain symptoms. For each of these, other treatments exist that are gen-
erally regarded by the scientific community as more effective. Marijuana
has not been identified as the most effective treatment for any medical
disease or condition. People who choose to take marijuana for medical
purposes do so because they prefer it to other alternatives, not because it
is the most effective treatment option available. For more information, see
questions 14, 15, 16, and 17.

3. MARIJUANA IS SAFER FOR ME TO USE THAN

ALCOHOL, AND VAPING IS SAFER FOR
ME THAN LEGAL TOBACCO
Every drug, including alcohol, tobacco, and marijuana, is unsafe if it is
abused and when it is used to excess. Any of these three drugs might
be used without lasting or permanent side effects if taken infrequently.
Smoking tobacco does not include any psychoactive properties and will
not cause any impairment to judgment or motor functions, and of the
three, it is the safest to take while performing any other task. Smoking
marijuana increases the same cancer risks as tobacco, plus it also impairs
judgment and motor responses. Alcohol can lead to alcohol poisoning,
but users usually become unconscious before alcohol levels reach deadly
concentrations. Like marijuana, alcohol intoxication also impairs judg-
ment and motor responses, making both drugs equally dangerous when
operating vehicles. The difference is that alcohol may be consumed with-
out producing intoxication. Marijuana use produces intoxicating effects
every time it is used. Marijuana is also the only drug to produce mild
hallucinogenic effects, which may permanently impair judgment and
Common Misconceptions about Marijuana xxix

learning potential. All three drugs can be addictive. For more information,
see questions 10, 27, 28, and 30.

4. MARIJUANA IS NOT ADDICTIVE, AND THERE IS

NO EVIDENCE THAT IT WILL LEAD TO OTHER MORE
DANGEROUS DRUGS (A “GATEWAY DRUG”)
Limited evidence suggests that marijuana may be physically addictive for
some habitual users. The risk for psychological dependency is very high
because marijuana indirectly stimulates dopamine reactions, which are
tied to the brain’s reward system. Its effects on mood and cognition make
users highly prone to psychological dependency. Users with a family his-
tory of substance abuse or mental illness and young users (teenagers) who
take the drug while their brains are still developing have much higher
risks of developing dependency on marijuana and other drugs later in life.
Marijuana does not force users to take harder drugs like cocaine, her-
oin, or methamphetamines. There is, however, substantial evidence that
marijuana can create a psychological dependency that lowers the users’
ability to resist the temptation to take other drugs. Early use at young ages,
frequent use over long periods of time, and use of the drug as a means to
escape current mental health issues, all increase the risk of dependency on
marijuana and other drugs. Not all marijuana users take harder drugs, but
almost all users of harder drugs take marijuana. For more information, see
questions 22, 23, 24, 25, 26, and 29.

5. LAWS PROHIBITING MARIJUANA ARE BASED ON

OUTDATED CULTURAL NORMS AND DO NOT
REFLECT RECENT SCIENTIFIC RESEARCH
Recreational drug use is generally discouraged by every society because
it hurts the individual user, removes the user from serving as a produc-
tive member of society, and leads to increasing social costs (health care
or crime control). American lawmakers began developing drug policies
with the central goal of protecting the public from drug abuse since the
19th century. Drug enforcement laws culminated in 1970 in a compre-
hensive schedule that classified all drugs based on whether they posed a
danger of abuse, whether they were currently used for medical purposes,
and whether there were existing protocols for safe medical use. Marijuana
abuse did not emerge as a social issue until the 1920s when it became
xxx Common Misconceptions about Marijuana

strongly associated with the criminal underworld. The risks and dan-
gers of marijuana abuse have not changed, even if public opinion has.
The FDA routinely evaluates potential benefits of marijuana. As of the
early 2020s, scientific research has not led to any evidence that warrants
change to existing classification at the federal level. For more information,
see questions 6, 18, 32, 33, 37, and 38.
QUESTIONS AND ANSWERS
 The Social Context of
Marijuana Use

1. What is marijuana?

The word “marijuana” has several meanings in modern society. It com-

monly refers to the dried leaflike substance that people smoke in order to
get high, and it also refers to the plant where the drug comes from. There
are different varieties of marijuana plants; not all of them produce the
same effect when smoked. Some breeds can produce a feeling of intoxi-
cation, while others have no impact at all when ingested. Some varieties
are used for their fibers to produce rope or cloth, while others are used to
harvest seeds and oils that may be eaten or added to nutritional supple-
ments or used in topical ointments. People often distinguish the types of
marijuana plants by the end products they produce.

Types of marijuana plants

There are two main types of the marijuana plant. One is called Cannabis
sativa, and the other is named Cannabis indica; they are usually abbreviated
as C. sativa and C. indica, respectively. Both kinds of plant can produce
drug-like effects, but most marijuana that people smoke comes from C.
sativa. The type of marijuana that people eat (called hashish) comes from
C. indica. C. sativa originally came from China and South Asia before
4 Marijuana

making its way to Europe and the West. It is usually taller, with many
leaves. C. indica originated in the Middle East around Afghanistan and is
usually smaller and more bush-like, with more flowers. C. indica is a rel-
atively new import into the West. Since the 20th century, though, both
kinds have been interbred to produce mixed varieties, and all these breeds
are usually referred to simply as Cannabis.
Cannabis plants also come in two sexes. The male plants have stamens,
which produce the pollen that is carried by the wind to the female plants.
Female plants include pistils, which receive the pollen and produce flowers
and seeds. Both sexes look similar during the early stages of development
(usually six to eight weeks). Once they mature, the plants will look differ-
ent, and the male plants usually die immediately after they release their pol-
len. Female plants can live for many years if they are kept indoors and away
from the winter frost. Both sexes include the chemicals that affect human
perception (called tetrahydrocannabinol, or THC), but the female Canna-
bis plants contain the highest concentration of these chemicals. Almost all
marijuana sold for medical or recreational use comes from female plants.
Most Cannabis plants follow the same life cycle, but human interven-
tion has created variations that emphasize certain desired characteristics.
The plants that are grown primarily for fiber are tall (up to 15 feet high)
with long, woody stems. These varieties are popularly called hemp plants.
They usually produce no intoxicating effects, and up until World War
II, these plants were grown extensively in Europe and the United States
as a source of rope and some types of cloth. After the war, plastics were
invented, and hemp was no longer commercially viable. Hemp is still
used in small markets to produce hats, bags, and other specialized cloth-
ing items. Artificial petroleum-based fibers (such as nylon, acrylic, and
polyester) are less expensive to produce and manipulate and are usually
stronger, softer, and warmer to the touch, so the hemp fiber market has
largely disappeared.

Marijuana by-products
Most Cannabis plants are no longer grown for their fiber but are only
grown for their pharmacological effects, which means they are used for
various drugs—sometimes legal drugs, and sometimes illegal drugs. Dif-
ferent parts of the Cannabis plant have different effects on the human
body, though most of them will produce some type of euphoria or other
mind-altering feelings. Growers who are looking for particular effects will
cultivate varieties that emphasize one part of the plant over another. The
psychoactive (i.e., “drug” producing) part of the plant is found mostly in
The Social Context of Marijuana Use 5

the buds, flowers, and nearby stems. These are dried and usually smoked in
a pipe or as a cigarette. This is what most people think of when they refer
to marijuana or “weed.”
Other varieties of Cannabis are grown mostly for their seeds, which are
sometimes eaten or crushed to produce marijuana extracts. The seeds do
not yet include the chemicals that alter human emotions or perceptions.
Nevertheless, they are often used for nutritional supplements, or they are
pressed to form hemp oils that are added to topical creams and ointments.
Seeds are also sometimes sold to new growers who want to start their mar-
ijuana crops from seed, though most commercial marijuana farms prefer to
use cuttings from existing plants to clone their plants so as to ensure more
consistent characteristics in their crops.
The most potent part of the Cannabis plant is the sticky sap-like sub-
stance called resin that is found in the buds and the leaves. Resin becomes
most abundant in female buds that have not yet been pollinated. Some
growers specialize in unpollinated female plants called sinsemilla. These
plants produce no seeds at all and are harvested mostly for their resin,
which is extracted primarily for the intoxicating chemicals. These can
be used in many forms, including concentrated oils that are often burned
in a pipe or added to electronic cigarettes (called “dabs”). They produce
quicker and more intense mind-altering effects than smoking. Resin that
is compressed into small chunks is called hashish and may be eaten orally,
vaporized, or smoked.
Most of the Cannabis plants that used to be grown for fiber are now grown
for their chemical extracts called cannabidiol (abbreviated as CBD). These
hemp resins do not contain the same chemicals that produce the mind-
altering effects found in sinsemilla or hashish. Nevertheless, the association
with those traditional marijuana effects inspired a strong commercial mar-
ket for CBD-related products that are believed to provide medical relief for
joint aches, anxiety, and many other physical ailments. These CBD-related
supplements produce no noticeable effects to your perception or in the way
you feel and are often included in topical ointments or in nutritional sup-
plements that are sold in grocery and other convenience stores.

The marijuana symbol

It is sometimes confusing to tell the difference between marijuana prod-
ucts that produce intoxicating effects and those products that have no
mind-altering effects. The same symbol of the marijuana plant with its
seven green leaves spread out in a fan shape is frequently used to indi-
cate many different products. It can represent the plant or any of the
6 Marijuana

plant parts or any of the products that the plants create. Usually, cus-
tomers know the difference because recreational marijuana is not legal
in most states. In those states where medical or recreational marijuana is
legal, retailers will include the marijuana symbol to let customers know
that they sell Cannabis as a legal drug in its many different forms, most of
which will induce mind-altering effects. In those states where marijuana
is illegal, the symbol is used to identify the marijuana extracts that do not
have intoxicating effects.
Sometimes, retailers will use the word “hemp” to indicate that the
marijuana product has no intoxicating effects (such as “hemp lotion” or
“hemp-extract supplement”). In other cases, retailers will use the symbol
but will also include large warnings that explain that their products do
not produce any intoxicating effects. Almost all CBD products are adver-
tised in this way. When the marijuana symbol is used by itself, on clothing
or on posters or as a design element, the reference most often means the
kind of marijuana that is smoked as a mind-altering drug.

2. What is the difference between marijuana that people

smoke and other products that contain marijuana or
marijuana extracts?

The main difference between marijuana that people smoke and other
marijuana-based products is the amount of processing that the Cannabis
plant is subjected to before being turned into a product that users buy.
Marijuana plants are used as a source of fiber for cloth and rope, as a
nutritional supplement, and as an intoxicating drug. At one time, mari-
juana was used almost exclusively as a major source for cloth and rope in
the era before the invention of polyester and synthetic substitutes. Today,
man-made fibers make up nearly three-quarters of the textile market.
Hemp grown for fiber was never smoked and was processed in the same
way as other natural fibers. It was not used for recreational purposes.
In the 21st century, marijuana is mostly known for the drug-like effects
it produces. Some of these effects are noticeable to human mental pro-
cesses, meaning they are psychoactive. Any marijuana product that con-
tains tetrahydrocannabinol (THC) will produce intoxicating effects.
Marijuana products that contain only cannabidiol (CBD) do not produce
any noticeable effects, but they may still produce drug-like effects inside
the human body that could include some medicinal potential. The bulk
of marijuana grown today is used for either THC- or CBD-based products.
If someone were to eat raw marijuana directly off the plant, then it is
very unlikely that they would experience any drug-like effects. The active
The Social Context of Marijuana Use 7

chemicals in Cannabis plants, including THC and CBD, require heat to

be released. That is why most marijuana is smoked. Combustion releases
all the chemicals bound within the plant at once. Unfortunately, for the
user, smoking also releases about 1,500 other chemicals, many of which
are toxic and believed to be cancer causing (carcinogens).
Over the past century, both amateur users and pharmaceutical research-
ers developed ways to extract certain chemicals from the marijuana plant
without having to burn it directly. Clinical laboratories can extract CBD
from hemp plants using distillation and solvent-based filtration processes.
THC is also extracted in a variety of similar ways. In the United States,
smoking is still the most common way that THC is ingested, but vaping,
alcohol-infused extracts, and marijuana edibles have also become more
common since the advent of legalization by many states in 2008.

CBD and CBD products

Most CBD products come from the same sort of hemp plants that pro-
duce fibers, except they have been bred to produce more of the flowers
that contain active chemicals and less of the fibrous material. Histori-
cally, like the hemp varieties grown for fiber, hemp plants grown for CBD
contained very little THC (usually no more than 0.3%). Recently, mod-
ern cross-breeding designed to increase the active chemical content and
lower the fibrous content has changed the genetic makeup of many hemp
plants.
Hemp farmers experimenting with variations to increase CBD lev-
els very often also increase THC levels. Legal hemp farms are regulated
by federal and state agencies, and if the THC levels rise above a certain
threshold, the farmer must then destroy the entire crop. That makes hemp
farming for CBD a risky business despite its high profit potential. Never-
theless, once the hemp plants are harvested, there is very little oversight
of the final CBD product. The FDA does not regulate the vast majority of
CBD products because it is not recognized as providing proven remedies
for any specific medical disorder. The FDA has recognized only one CBD
extract as providing potential relief for symptoms associated with a rare
form of childhood epilepsy. CBD chemicals have not been demonstrated
to provide any consistent benefit for other conditions. CBD very likely
causes chemical reactions at the cellular level, and those reactions may
provide health benefits (or side effects), but neither of these have been
consistently demonstrated in clinical studies.
Products that market themselves by their CBD content may refer to
broad potential for general health and wellness, but they may not make
any claims that the product will cure or treat any specific disease or
8 Marijuana

condition. The FDA has not approved and does not provide oversight for
CBD products that are sold without a prescription. As such, buyers have
no guarantee that the CBD product will work as advertised, and the seller
has no obligation to ensure that the product is medically effective because
they do not claim to cure any specific medical ailments. As with any sup-
plement, the quality of the product is determined by the reputation of
the seller. Without FDA oversight, there are very few guarantees for any
product advertised as containing CBD. In some cases, CBD products sold
by disreputable sellers may not even include CBD.

Smoking and THC

Marijuana products marketed for their THC content come from Cannabis
plants grown especially for their buds and flowers (usually unpollinated
female plants). These drugs can be divided into two groups: first are mari-
juana buds that are smoked directly, requiring very little preparation; and
second are those products that have already been processed to produce a
higher concentration of THC per volume unit. There is a third group of
synthetic marijuana products that imitate the effects of THC but do not
come from marijuana plants. At one time, these products were legally
sold as marijuana substitutes and/or disguised under non-marijuana names
(such as “K2” or “Spice”), but most of these have been prohibited for legal
sale, though they continue to be sold through illegal sellers.
The method of delivering THC determines the rate of action and
the intensity of the effects. Smoking produces a noticeable effect within
seconds and will peak after about 10 minutes. The feeling of intoxica-
tion continues for about an hour before it fades away. Marijuana can
be smoked either through cigarettes (called joints) or through a variety
of types of pipes. Smoking releases the THC from the marijuana plant
through immediate combustion, and the smoke vapors carry the THC
into the lungs where it is ingested directly into the bloodstream. Different
types of pipes can trap the smoke in order to increase the density of the
THC gases, but they will all be limited in their immediate potency. Most
THC extracts were created by users wanting to avoid the smoke or who
want to increase the intensity or duration of the intoxicating effects.

Vaping and e-cigarettes

One method of ingesting THC without smoking is to vaporize the mar-
ijuana by heating the material without actually burning it. Vaporizers
work because the boiling point of most cannabinoids is anywhere between
The Social Context of Marijuana Use 9

393 and 428 degrees Fahrenheit, which is below the point of combus-
tion (around 451 degrees Fahrenheit). This means that if enough heat is
applied, the psychoactive cannabinoids can be “vaporized” directly from
their solid form into a gas form without actually burning, and the THC
and cannabinoids may be delivered without smoke.
The vaporizing (or vaping) method can be used on either marijuana
buds or on concentrated THC extracts, and both require special devices.
The first method was developed by amateur users during the 1990s through
the use of balloons to separate the heat source from the plant material and
still convey the gases to the user. Portable units were developed later,
which looked like small straight pipes and were marketed as electronic
cigarettes (now known as vape pens or e-cigarettes). These require con-
centrated materials called dabs, which are heated electronically. Dabs can
look like thin crystal crumbles, whipped peanut butter, a semitransparent
wax, or like a thick oil. Their appearance and presentation depend on
who made it and how it was manufactured. Sometimes, other flavors are
added to disguise the actual ingredients. Marijuana dabs usually contain
three to four times as much concentrated THC levels as unprocessed mar-
ijuana buds and, in some cases, can contain more than 98% THC.
In states where marijuana is illegal, vaping devices are marketed for
nicotine delivery only. In states where marijuana is legal, these devices
may be marketed also for THC dabs. Wherever they are sold, e-cigarettes
are usually marketed as an alternative to smoking, but their popularity is
due mostly to the fact that they can be used to vaporize many materials,
including THC and other drugs.
The effects of vaping are just as quick as traditional smoking, but the
intensity can be much greater because of the high THC concentration in
the dabs. Concentrated dabs that are sold through illegal vendors often
include other drugs that increase the speed and duration of the effects.
Users can easily overdose using vaping devices, especially when non-
marijuana drugs are included in the mixture, such as fentanyl. These over-
doses have frequently caused death.

Medical marijuana extracts

In states where medical marijuana is legal, doctors may prescribe THC in a
variety of different forms. In some cases, patients are given marijuana cards
that allow them to buy from special dispensaries, so they can smoke mar-
ijuana in the manner they are most used to. In other cases, where smoke
may increase the problems of the patients’ condition, doctors may pre-
scribe THC extracts in the form of sprays, drops, patches, or pills/capsules.
10 Marijuana

THC extracts that are infused in alcohol are called tinctures. These
concentrates are administered with a dropper and placed under the
tongue. The liquid dissolves quickly and enters the bloodstream a lit-
tle more slowly than inhalation but still much more quickly than other
ingestion methods because there is a large blood vessel under the tongue.
Effects are felt within 15 minutes and reach their peak strength within 90
minutes. Due to the high concentration of THC, tinctures may produce
more intense effects that last longer than smoking.
In some cases, THC is combined in equal parts with CBD and admin-
istered as a spray, which patients squirt under their tongue. It can also be
infused onto a piece of sticky cloth called a patch and applied directly to
the skin. These patches may take up to 30 minutes to take effect but can
be designed to administer the drug to patients over long periods of time,
often many hours or up to half a day. Doctors often use these THC con-
centrates in combination with other chemicals that customize the rate of
release and may also moderate or extend the duration of effects depending
on the therapeutic needs of the patient. These tools are also used for a
variety of other pharmaceutical drugs.
Most of the THC extracts prescribed by medical professionals are cre-
ated in pharmaceutical laboratories under FDA regulations, and they are
prescribed as a clinical therapy. THC patches, tablets, and sprays are usu-
ally only used for recreational purposes if they have been obtained or dis-
tributed through illicit vendors. Due to their high THC concentrations,
illegal use of these products can easily lead to overdosing.

Edible marijuana: Hashish, drinks, and confectionaries

Marijuana edibles can include any part of the Cannabis plant that has
been infused or added to any beverage, baked goods (usually brownies and
cookies), or candies (usually gummies or mints). In most states, CBD-
infused goods may be sold legally and are subject to very few restrictions
as long as the accompanying THC levels remain less than 0.3%. THC-
infused goods are only legal in states that permit medical or recreational
use of marijuana.
The use of CBD and THC extracts in the United States has only
become common since the early 2000s, but eating marijuana has a very
long history. Prior to the 1500s, almost all marijuana was eaten in the
form of hashish. Hashish was first developed in parts of Central and East-
ern Asia as a mixture of marijuana buds that were compressed, heated,
and further processed to produce a thick, waxy compound that contained
high concentrations of THC. Smoking was a late innovation that was
The Social Context of Marijuana Use 11

developed after the discovery of tobacco during the Columbian exchange

(after the 1600s), so most hashish was eaten or indirectly vaporized in
glass pipes. The resulting thick, waxy substance is still frequently eaten
directly but may also be smoked or vaporized.
Since the 1960s, marijuana producers (which at the time were all ille-
gal) would gather the crystal-like residue that forms in the containers used
to store and process Cannabis plants to produce a high THC concentrate
powder called kief. This powder could be added to baked goods (usually
brownies, which include chocolate to disguise the harsh marijuana taste)
to produce a THC-infused edible. These powders were also added to teas
or other hot drinks. Cannabis plants must be heated to release THC com-
pounds, so marijuana edibles are usually baked. Beginning around the early
2000s, the popularity of concentrated THC extracts led to the development
of marijuana-infused candies and gummies. These edibles are often com-
bined with CBD and other drugs to enhance or moderate the effect of THC.
After the wave of state-based legalization of medical and recreational
marijuana in the 2010s, edibles have become increasingly popular. The
edibles market share doubled every year between 2016 and 2020. Estimates
suggest that nearly a third of marijuana is sold in the form of THC-infused
edibles in solid and liquid forms.
Marijuana edibles can take up to an hour before the user begins to feel
any effects, but they usually last two to four times longer than inhaling
and can often reach greater intensities. Due to the time delay, users may
not always realize how much THC they have consumed before the effects
begin to take place. There is usually a much greater risk of overdosing
because users are not always aware of how much concentrate they should
add to the mix. Or, more commonly, they eat the marijuana products and
feel nothing and then continue to eat more for nearly an hour before the
effects are noticeable. By then, the concentration of THC in the blood-
stream is often much higher than expected, leading to strong side effects.

Non-Cannabis THC analogs

Last, synthetic marijuana refers to products created in laboratories to simu-
late the chemical makeup of THC but which do not come from marijuana
plants. These were legal in many states during the early 2000s because
they were marketed as aromatic incense or as nutritional supplements and
thereby slipped under the guidelines of existing regulations. They were
very popular among youth especially and were sold legally in retail stores
under the brand names “Spice” or “K2.” These drugs did not contain any
THC and did not involve any Cannabis plants, which were illegal in most
12 Marijuana

states at the time. Nevertheless, they contained a new chemical called

HU-210, which when consumed through smoking or baked goods, pro-
duced the same effects as THC and was often more potent.
After many cases of overdoses, these products were outlawed at the
federal level in 2012, and most states followed suit. These and other ana-
log compounds (CP 47, 497, JWH-018, JWH-073, JWH-398, JWH-250,
and oleamide) continue to be developed and sold through illegal markets
and form a part of the same drug culture that includes marijuana, opi-
oid, and alcohol dependency. These and other synthetic compounds carry
very high risks for potential overdosing.
There are many different marijuana products that are available legally
and illegally. CBD and other hemp products have no intoxicating effects,
and they are usually marketed as wellness supplements. They are not regu-
lated by the FDA unless they are combined with THC as part of a specific
therapeutic treatment regimen. The popularity of CBD is mostly due to
its association with THC products and their intoxicating effects, even
though there is very little evidence that CBD produces medical benefits.
THC-based products all produce psychoactive effects in humans, but
the form by which they are ingested determines the speed, potency, and
duration of those effects. Medical marijuana can be smoked or ingested
through patches, sprays, or edibles (including capsules and tablets). Rec-
reational marijuana is most often smoked but can also be ingested as
concentrated THC extracts through vaping, tinctures, or edibles. Con-
centrated forms of THC carry higher risks of overdosing.
The FDA only regulates medically prescribed marijuana products (only
three existed as of the early 2020s). Other state agencies regulate products
that are sold through legal vendors. There are very few enforceable regu-
lations for products sold online, and there are no regulations or safeguards
at all for marijuana products sold through illegal vendors.

3. What compounds are found in marijuana,

and which make you feel high?

The marijuana plant contains more than 100 different cannabinoid com-
pounds that will potentially interact with the human physiology, but only
tetrahydrocannabinol (THC) produces the feeling of intoxication associ-
ated with marijuana.
Marijuana is usually smoked, so it is often associated with tobacco
products. Many people think of marijuana as a “weed” as if it were made
of leaves that are dried and then rolled up in a cigarette to be smoked. In
fact, the leafy parts of the marijuana plant produce mostly smoke and have
The Social Context of Marijuana Use 13

very little (if any) intoxicating effect. If all other elements of the mari-
juana plant are removed and only the psychoactive molecules remained,
then you would find a sticky, waxy substance that looks more like an oily
tar than any kind of leaf. This material would contain all the cannabinoid
molecules that produce drug-like effects, including THC, cannabidiol
(CBD), and more than a hundred other chemical compounds that affect
the human endocrine and nervous systems.
Marijuana plants contain more than 400 different chemical com-
pounds, more than 100 of these are classified as cannabinoids, and both
THC and CBD are types of cannabinoids. All cannabinoid molecules
carry the same basic number of atoms, but the atoms are arranged differ-
ently for each type. It is the geometry, or shape, of the chemical molecule
that determines its effect on the human body.

How drugs work

Only certain kinds of molecular shapes will fit into certain kinds of recep-
tors in the human endocrine and nervous systems. Each molecular shape
(also called an isomer) is a little like a “key” that will only fit into certain
cell receptors. A receptor is a special chemical protein located on cell
membranes that acts like the keyhole. If an isomer reaches the recep-
tor and it has the wrong shape, then it will just pass on by. If an isomer
reaches the receptor with the matching molecular shape, then the mole-
cule passes through the cell membrane and triggers a series of other reac-
tions. In this way, these molecules act like chemical messengers that tell
the body to act in certain ways. These messengers may tell the body to
release certain chemicals, retain other chemicals, or to turn on or turn off
other bodily functions. This is how all drugs can affect the human body.
The body includes many different systems that rely on chemical mes-
sengers. Almost all hormones play a part in these systems. The brain,
the internal organs, the immune system, and all the muscle groups rely
on these chemical messengers to function. Drugs usually work by inter-
rupting, or substituting, the natural messengers created by the body with
artificial messengers introduced through the drug.
Cannabinoids interact with hundreds of different receptors found
mostly in the nervous system (those dealing with thinking, concentra-
tion, memory, emotions, and mood) and the immune system (those deal-
ing with your ability to fight off diseases), along with a few other systems.
Though cannabinoid receptors are spread throughout many different sys-
tems in the human body, when they are studied all together, they are
generally referred to as the cannabinoid system. Most chemicals found in
marijuana work because they affect this system.
14 Marijuana

Different drug effects

Only some of these cannabinoid isomers, like THC, will produce the
mind-altering effects that people most associate with marijuana. Other
isomers, like CBD, may produce drug-like effects at the cellular level, but
the person who takes them will not “feel” any different. The person taking
the drug may not even know what effects those isomers are causing.
Scientists try to isolate the isomers that produce effects that people
want—like euphoria, a feeling of confidence, and mild relief from phys-
ical aches and pains. At the same time, they also want to remove those
other isomers that produce effects that people do not want—including
increased anxiety and nervousness, confusion, disorientation, and loss of
muscle coordination. In some cases, the same isomers can produce both
the positive and negative effects, and scientists then try to create new
compounds to customize those effects so that only the positive benefits
will be felt and the side effects will be limited. These are very difficult
tasks, and in most cases, scientists have been unable to be so precise. That
is why almost every drug (whether marijuana based or not) has side effects
for those taking the drug.
Another problem scientists face is delivering the cannabinoids to the
human body safely. Most people ingest THC by inhaling the chemical
when they smoke marijuana. Even if the healthy compounds of marijuana
were isolated through genetic engineering, the smoker always ingests
other non-cannabinoid components found in the smoke itself that are
very toxic. These smoke-related elements are responsible for most of
the physical harm to the heart and lungs caused by marijuana smoking.
Clinical researchers have devised delivery methods that do not require
smoke: capsules, tablets, or patches. The problem for the researcher is that
the form of delivery will always determine the speed and intensity of the
effects. In many cases, some patients feel that the capsules and tablets of
THC take too long to work; therefore, they choose to continue smoking
because they want the speed and intensity that only smoking provides.

Amateur experimentation
Amateur researchers also experiment with marijuana for recreational pur-
poses. These users do not worry as much about identifying or customizing
chemical isomers, but instead try to extract those elements from mari-
juana that produce the most satisfying “high.” Recreational users focus on
the effects alone and will experiment with smoking, inhaling, eating, or
any other method that produces the results they are looking for. They try
to minimize side effects, but they can only work on those effects that the
The Social Context of Marijuana Use 15

user can actually feel. Amateur users are unaware of many unobvious side
effects, especially those that harm the internal organs or that can cause
cancer or mental illness through long-term use.
Over the past 50 years, both clinical and the amateur researchers have
produced hundreds of different marijuana products that can be ingested
in dozens of different ways. Most marijuana is still smoked, but other con-
centrated forms of THC and other cannabinoids can be inhaled through
special smokeless devices; ingested through capsules, patches, and topical
ointments; or just eaten directly in the form of a variety of foods and can-
dies. Some of these new products are intended to treat medical ailments
and are therefore carefully studied in laboratories and regulated by the
government through the FDA, which is responsible for ensuring that the
public is exposed to the safest and healthiest drugs with the least number
of known side effects.
At the same time, there is also a very large commercial market for mar-
ijuana products that are not regulated by the FDA, developed by amateur
users who sell drugs for recreational purposes. Some of these products are
legal, but in most states, most of the products are not. These products are
marketed for their perceived effects only, and these unregulated products
often provide few healthy effects but are also often highly toxic or dan-
gerous to use.

4. How common is marijuana use in the United States and

around the world today?

Marijuana is described as the most commonly used illegal drug in the

world. The Centers for Disease Control and Prevention (CDC) estimated
in 2021 that 22 million people in the United States consume marijuana
each month. The World Health Organization reported in their 2019
World Drug Report that Cannabis was the “most commonly used psycho-
active substance under international control,” and they estimated 188
million people used marijuana each year.
Drug use, and marijuana use especially, has increased among all age
groups worldwide since 1960, with more rapid increase in drug use since
2010. Recreational drug use is most noticeable in wealthy nations like
the United States and in Europe. As a practical matter, though, it is very
difficult to know for certain how many people use some marijuana on a
daily, weekly, or monthly basis.
Before legalization, estimates of drug use in the United States were
based on arrest reports and drug seizures, admissions into drug treat-
ment centers, overdose and mortality rates, and surveys administered to
16 Marijuana

students and national pollsters. After states began legalizing marijuana,

researchers also used sales of marijuana and THC (tetrahydrocannabi-
nol) infused products to estimate usage. In 2014, states’ treasury depart-
ments recorded $400 million in legal sales of marijuana products. Sales
increased to $1 billion in 2015, $4.4 billion in 2018, and an estimated
$4.7 billion in 2021. These estimates are still unreliable because they
do not account for illegal sales, which occur everywhere, even in states
where marijuana is legal. In addition, online sales (both legal and illegal)
are rarely tracked. Legalizing marijuana makes tracking individual drug
use more difficult.
The National Institute for Drug Abuse (NIDA) has conducted annual
surveys of drug use among students in the 8th, 10th, and 12th grades every
year since 1975. Other surveys of adults are conducted through media
organizations and entertainment websites, but most internet surveys are
unreliable because they focus on very narrow population sizes. NIDA sur-
veys are more reliable, but they only track responses from teenagers cur-
rently in school. Researchers are only able to make educated guesses about
the extent of marijuana use for any age group, and these estimates often
reflect a very broad range of results.

How marijuana is most often consumed

National surveys indicates that marijuana is mostly smoked, though
annual sales reports from legal marijuana producers indicate increasing
use of vaping products, THC-infused edibles, and tinctures between 2018
and 2022. In 2019, the CDC and FDA both reported a sharp increase of
nearly 3,000 injuries from THC-vaping products during a three-month
period in 2019 (which included 168 deaths). The age of the victims
who were admitted to the emergency room ranged from 13 to 88 and
was evenly distributed between age groups (18–24, 25–34, 35 and older).
This sample group suggests that vaping has become popular among all
age groups. Nevertheless, other surveys report that a majority of users still
consume THC through smoking because it produces a quicker sensation
and is more easily available.

Age groups with the highest usage

During the late 1960s, marijuana use was most prevalent among college-
age students (18–24), with marginal representation among adults aged
25–49. Students who were in college between 1965 and 1980 are part of
a generational cohort known as baby boomers. As that cohort aged, their
The Social Context of Marijuana Use 17

rate of marijuana use remained generally constant as they passed through

each subsequent age group. For example, younger adults (29–45) smoked
marijuana during the 1980s, and older adults (49–65) continued to take
marijuana during the 2000s.
As the baby boomers grew older, each later generation followed similar
patterns. The highest percentage of marijuana use among high school–age
students occurred in the late 1970s, when 35% of 12th-grade students
admitted to monthly marijuana use. The lowest rate of marijuana use
occurred in the early 1990s, when only 12% of seniors reported monthly
use. Rates began to increase again in 2000 and then increased signifi-
cantly after 2008. Since 2008, the number of high school seniors using
marijuana appears to be increasing gradually every year, with estimates of
monthly marijuana use nearing the rates from the late 1970s.
During the 1970s, almost 50% more boys used marijuana than girls.
That trend changed after the spike in 2008, when usage among boys
and girls became more even. Rural areas of the Midwest tend to have
the lowest rates of marijuana use among students, but the available data
suggest every region has consistent rates of drug use. States where mari-
juana is legal for either medical or recreational use usually see a signifi-
cant increase of weekly drug use among all age groups. After the initial
increase following legalization, later rates of marijuana use usually flat-
ten out.
One statistical trend to note is that most people who begin smoking
marijuana never quit. Prior to 1970, only a small minority of people
smoked marijuana. A Gallup poll from 1969 reported that only 4% of
adults had tried marijuana, and more than a third (34%) had no idea
what the effects of marijuana were. As the 1970s wore on, the poll num-
bers changed quickly as more baby boomers reached the age of adulthood.
In 1973, 12% of surveyed adults said they had tried marijuana, and in
1977, that number was 24%. By the 1980s, the number of adults who had
tried marijuana ranged consistently around 50%. Best-guess estimates
from 2021 indicate that the same percentage of adults who smoked mari-
juana consistently during the 1970s continued to do so during the 1980s,
1990s, and 2000s. A study from Columbia University in 2018 showed
that the 12th graders in 1978 with the highest rates of high school–age
marijuana use still had some of the highest use rates among all adults as
60-year-olds.
Trends from CDC research indicate that once people begin using mar-
ijuana, then it is less likely that they will ever stop using it. If teenage
students avoid using marijuana while in high school and college, then the
likelihood of remaining drug-free their entire life increases significantly.
18 Marijuana

5. How is marijuana different today than it was in the

past?

Marijuana that people smoke today, in the 2020s, is about three times
more potent than the marijuana that the baby boomer generation smoked
during the late 1960s and early 1970s. The percentage of THC (tetra-
hydrocannabinol) content increased from between 3% and 10% to any-
where between 10% and 30%. In addition, modern vaping technologies
that use dabs and THC extracts can reach potency levels very close to
100%. THC-infused edibles and tinctures also range in potency from mild
to very strong. The overall strength of psychoactive chemicals available
through marijuana after 2000 is generally much greater than what was
available to users in the early 1970s.
Prior to the mid-1960s, marijuana was consumed mostly by people on
the margins of society. Popular culture did not promote the drug, and most
Americans were unfamiliar with it. This changed as the baby boomer gen-
eration reached college age around 1965 and began to experiment with a
variety of mind-altering drugs. Marijuana use by the end of the decade was
still mostly limited to younger adults, but users were spread throughout
all levels of society, and the drug became more widely known in popular
culture.
The main reason why THC levels changed in modern marijuana plants
is because a large number of amateur farmers began experimenting inde-
pendently with cross-breeding of different Cannabis plants during the
1970s to achieve a certain desired mixture of potency, flavor, and effect.
The more common Cannabis sativa used in the United States was mixed
with Cannabis indica plants that were usually reserved for making hashish.
Most of these breeding experiments were conducted by amateurs working
through trial and error. Since selling marijuana was illegal in every state
until the 1990s, the practices were conducted in relative secret with little
consistency.
After California legalized marijuana for medical purposes in 1996,
commercial marijuana producers were legally permitted to grow, exper-
iment, and test their products. Since medical marijuana was regulated by
the state, the potency of each crop sample was watched closely, forcing
growers to adopt careful techniques to ensure consistent yields. The rate
of horticultural research increased significantly after 2000. A dozen years
later, large-scale commercial farms began appearing in many states that
legalized both medical and recreational marijuana use. Business enter-
prises invested money into increasing the potency of their products in
The Social Context of Marijuana Use 19

order to be more competitive in the marketplace. All these efforts resulted

in higher concentrations of THC per plant.
As marijuana became legalized in more states, the market for nonpsy-
choactive CBD products began to increase in other states where mari-
juana was still illegal. This demand led to large-scale hemp cultivation
by farmers who grew Cannabis plants primarily for their CBD content.
The federal 2018 Farm Bill legalized hemp farming nationwide, subject to
state regulations. Their crops are also highly regulated, requiring farmers
to frequently test to ensure THC levels do not exceed 0.3%. These tech-
niques were also used by other marijuana farmers to further increase THC
content.
Electronic cigarettes were invented in China in 2004 but became very
popular in the United States around 2010. As users became accustomed
to replacing nicotine extracts with other flavors, the demand for THC
dabs (and other drug combinations) grew. This led commercial marijuana
farmers to increase the THC content in their plants as much as possible so
that they could be used for extracts. These plants often have an unpleas-
ant taste and are not smoked in the traditional way, but pharmaceutical
companies use them for their THC content alone.
Since 2010, THC has become more widely available than ever both
through traditional marijuana varieties that are smoked and through var-
ious extractions. The popularity of extracts through dabs and tinctures
means that the natural potency of particular Cannabis plants is less rele-
vant because pure forms of THC can be consumed using a variety of new
forms. Unfortunately, that means the potential for dangerous (sometimes
life-threatening) effects has increased significantly since 2000.

6. How have attitudes about marijuana use

changed over time in the United States?

Attitudes about marijuana use changed considerably in the United States

between 1920 and 2020. The changes are not consistent though. Pub-
lic attitudes about marijuana (and drug use in general) reflect a cultural
divide that is split along moral, political, and clinical lines. Though cul-
tural divisions are complex and not easily categorized, we can identify
two broad perspectives on marijuana. One perspective represents modern
attitudes of popular culture that emphasize entertainment and recreation,
and the other represents more traditional attitudes that emphasize con-
cerns for drug abuse and treatment.
20 Marijuana

Popular cultural attitudes are best illustrated by Hollywood films and

streaming television shows that portray marijuana as a harmless recre-
ational activity. Fictional characters often smoke marijuana but may or
may not get involved in other dangerous activities. Often, the marijuana
use is portrayed as something funny. This viewpoint reflects the moral and
political priorities that are shared most among those who advocate for
the legalization of marijuana for any purpose and who do not view recre-
ational drug use as a moral issue but as a matter of individual preference.
By contrast, law enforcement agencies and clinicians who routinely
come in contact with the victims of substance abuse and who treat
addiction tend to reflect more traditional attitudes about the dangers of
marijuana. This viewpoint portrays marijuana as a gateway drug that sym-
bolizes the edge of a growing drug-dependent subculture, and these groups
often produce materials that promote public awareness about the dangers
of drug use and the high risks of unintended dependency.
Politicians and policymakers are equally divided along these lines.
Exceptions can be found for any large group; nevertheless, Democrat law-
makers tend to follow the trends of popular cultural attitudes and usually
support legislation that legalizes marijuana use for medical and recre-
ational purposes. They also often advocate for the reduction or removal of
penalties for drug use, sales, or manufacturing. From this perspective, mar-
ijuana is distinguished from harder drugs such as cocaine, methamphet-
amines, and the illegal use of opioids. In the opposing camp, Republican
politicians generally advocate for more rigid penalties for illicit drug use
and especially for illegal sales and manufacturing. Though marijuana is
recognized as a less dangerous drug, it is associated with a drug-dependent
lifestyle, and lawmakers strive to limit access to reduce the rates of addic-
tion to any drug.

Historical perspective
Marijuana is often described as one of the world’s oldest drugs. It is true
that marijuana has been used by many different cultures and societies
around the world, and for thousands of years. That does not mean that
it was used by many people. Marijuana use was never viewed as socially
acceptable by the majority of people in any society. Even by modern stan-
dards, drug use is limited to the margins of society. Successful people are
rarely associated with drug addicts, and high school counselors will never
promote marijuana use as key to a promising future. Any drug that impairs
normal function and is used for recreational purposes carries some level
of social stigma.
The Social Context of Marijuana Use 21

In primitive societies, drug use was usually relegated to shamans—

people believed to be able to communicate between the physical and
spiritual worlds. For example, ancient Native Americans sometimes used
hallucinogenic plants, including forms of Cannabis, to induce visions for
themselves or others in their care. These drugs were viewed as a form of
medicine and were not used for recreational purposes. The plants were
usually collected in small quantities, and the knowledge of how to prepare
them was not always widely known. For example, the hemp farmers who
grew Cannabis for rope and cloth for England and the American colonies
during the 1700s knew very little about its mind-altering effects. Indus-
trial hemp contained very little THC and was not smoked in the same
way as tobacco, so it was not viewed by farmers as a drug of any kind.
Drug use and manufacturing techniques changed during the mid-1800s
as scientists began identifying and extracting potential chemicals from
traditional plants as potential medicinal treatments. Absinthe is a com-
bination of wormwood and other herbs that was given to French troops
during the Napoleonic wars to treat malaria. Morphine was taken from
opium and used during the same time period as a treatment for extreme
pain. Heroin was later developed from morphine compounds in the 1870s
and used to treat migraine headaches. Cocaine was extracted from coca
leaves and prescribed by doctors like Sigmund Freud, as a stimulant to
treat depression.
As science developed the ability to extract the psychoactive com-
ponents from medicinal plants and herbs, the availability of mind- and
mood-altering drugs in popular society increased significantly. By the
1880s, many ordinary soldiers who were exposed to powerful drugs while
in battlefield hospitals continued their habits back home. As regular trade
routes developed between the opium production centers in Asia and new
consumers in Europe, the problem of drug addiction became more apparent
in popular society. These habits were generally viewed as self-destructive
and more dangerous than alcohol addiction. Victorian writers like Arthur
Conan Doyle used drug addiction in their fictional characters to symbol-
ize the edge of the criminal underworld. Drug use as a recreational activity
existed in most places around the late 1800s, but it was never viewed as a
socially acceptable habit.
In the United States, some of the first laws regulating illegal drug use
appeared around 1900 after the creation of the FDA. The 1906 law mostly
required pharmacists to correctly label their products to ensure that con-
sumers were aware of the psychoactive content in commercial products.
Marijuana use became more popular after the influx of immigrants fol-
lowing the 1910 Revolution in Mexico, but it was viewed as an ethnic
22 Marijuana

habit. Alcohol was the most commonly problematic drug at the time, and
the temperance movements focused most attention on the prohibition of
alcohol. After the traumatic experiences of the World War I, American
lawmakers passed a national prohibition on the sale and manufacture of
alcohol with the ratification of the Eighteenth Amendment in 1919.
During the Prohibition years of the 1920s, most state laws only pro-
hibited the sale of alcohol, not its consumption. That meant that if peo-
ple could find an illegal bar (called a speakeasy), then they could order
alcohol with little risk to themselves. This resulted in a large transfer
of money from legitimate sources (businessmen) to underworld sources
(criminals). Since speakeasies were already illegal, they usually provided
access to other illegal activities such as gambling; prostitution; and drugs,
including marijuana, morphine, cocaine, and heroin.
In urban areas, alcohol was viewed as mostly harmless, so law enforce-
ment often ignored the speakeasies. As the 1920s unfolded, the gambling
and vice from these illegal bars reached public notice through increased
crime rates from addiction, extortion, and gangland violence. By 1930,
speakeasies were inseparably associated with public vice of all kinds and
were symbolic of the criminal underworld.
Public pressure pushed to separate alcohol from these other vices, and
the Eighteenth Amendment was repealed in 1933. At the same time, most
individual states began specifically criminalizing other activities such as
gambling and drug use, including marijuana use. Marijuana was criminal-
ized at the national level in 1937. During World War II, alcohol was legal,
but marijuana remained strongly associated with the criminal underworld
and drug subculture. It was never viewed as the most dangerous drug, but
marijuana use was seen as a gateway vice that led to other self-destructive
behaviors like gambling, prostitution, and harder drug use.

Baby boomers and the new drug culture

Immediately following World War II, servicemen and women came
back from the war and started families. Between the years of 1945 and
1955, the United States experienced massive growth in population, with
approximately one in four people aged 10 or younger. This generation
became known as the baby boomers, and by the time they reached the
age of adulthood in the mid-1960s, much of popular culture was focused
on gaining their trust and purchasing power. By the 1970s, most baby
boomers were finishing college or entering the workforce. By the 1980s,
they were having families of their own. President Clinton became the first
baby boomer president in 1992, and every president that followed up until
The Social Context of Marijuana Use 23

2020 came from the same generation. Baby boomers were responsible for
political changes on both the left and right and can be found on both
sides of the cultural divide over marijuana in the 2020s.
Marijuana entered the mainstream awareness of popular culture begin-
ning in 1970. A strong minority of baby boomers began to experiment
with drug culture as college students during the late 1960s, but their par-
ents and the rest of American society remained largely unaware. A 1969
poll reported that only 4% of adults had ever tried marijuana, and more
than a third were unaware of its effects. Nevertheless, for the baby boomer
generation, marijuana was part of a counterculture movement that was
associated with the sexual revolution, rock-and-roll music, and rebellion
against authority.
There was a generational reaction to the growing counterculture, and
President Nixon was elected largely on his promise to restore law and
order amid an outbreak of urban riots (more than 450 between 1966
and 1968). As part of his anti-crime campaign, Nixon signed the Con-
trolled Substances Act of 1970, which classified marijuana in the same
category as heroin, lysergic acid diethylamide (LSD), and methamphet-
amines as a Schedule I drug. These drugs are defined as having high poten-
tial for abuse and for which there were no current therapeutic uses as a
medical treatment option. Nixon also supported other laws that created
new enforcement agencies and task forces to combat the growing drug
subculture.
Throughout the 1970s, high school–age students experimented with
marijuana in large numbers. At the same time, their parents became
increasingly concerned about the availability of drugs in schools and
demanded more political action. When President Ronald Reagan took
office in 1980, strong public pressure resulted in more laws that targeted
drug dealers connected with juvenile street gangs and school zones. Rea-
gan proclaimed a “War on Drugs,” and First Lady Nancy Reagan launched
the “Just Say No” campaign in public schools. These efforts proved effec-
tive, and student drug use dropped by two-thirds in the 1990s.
The antidrug culture began to fade when the Reagan/Bush era was
replaced by the new Democrat administration. Baby boomer Bill Clinton
was the first president to admit to using marijuana though he pretended
that he “didn’t inhale.” Most people thought it was a joke, and later baby
boom–age presidents all admitted to having smoked marijuana at some
point in their youth. By 2000, baby boomer adults dominated leadership
positions in business and politics, and the antidrug messages of the 1980s
gradually changed. In 2020, President Biden became the first president to
openly advocate for the legalization of marijuana nationwide.
24 Marijuana

Legalization movement
In 1993, Presidents Clinton’s surgeon general Joycelyn Elders suggested
legalization of drugs would reduce crime rates. The public did not support
Elder’s position, and she was forced to resign over the comments, but the
movement to legalize marijuana for medical use became popular in many
states. California introduced the first state law to legalize medical mari-
juana in 1996, and two years later, three more states (Oregon, Washing-
ton, and Alaska) also passed legalization measures. Fourteen more states
followed suit between 1999 and 2012. Most of these states held Dem-
ocrat majorities, but some (such as Alaska and Montana) were consid-
ered Republican strongholds. The main point that united Democrat and
Republican lawmakers was the belief that marijuana might provide spe-
cial relief to illnesses that were most common for an aging baby boomer
population.
In most states, legalization for medical use was the first step toward full
legalization for any use. Colorado and Washington legalized recreational
marijuana in 2012, and four more states passed similar laws in 2016. A
dozen more states did so before 2021, resulting in more than a third of
Americans living in states where recreational marijuana is legal, with less
than a third living in states where marijuana is illegal for all purposes.
During the first two decades of 2000, marijuana use doubled among all
age groups, and about 13% of Americans (one in eight) consider them-
selves “avid” users (daily or weekly). Attitudes toward marijuana obvi-
ously changed as more people used the drug and more states legalized it.

Cultural divide
While the majority of states have legalized marijuana in some form, it
does not mean that the general public shares a consensus on marijuana.
In some cases, those who support legalization argue that treatment is
more cost effective than criminal prosecution—they may still disapprove
of marijuana use but view it as less harmful than sending people to jail.
In other cases, those who support medical marijuana believe that every
therapeutic option should be available to any patient, but they may still
oppose the recreational use of any drug. Cultural attitudes toward mari-
juana have changed, but they have not all changed in the same way.
In most states, police no longer investigate possession of marijuana
because it is no longer criminal. That does not mean that marijuana is no
longer associated with crime. Numerous studies conducted by the Depart-
ment of Transportation after 2012 indicated that there is no difference in
The Social Context of Marijuana Use 25

crash rates between drivers impaired by alcohol and drivers impaired by

marijuana. Since 1973, the rate of alcohol-impaired driving has decreased
by 80%, while rates of marijuana-impaired driving have significantly
increased. During the seven-year period between 2007 and 2014, marijuana-
impaired driving increased 48%, and marijuana is the most common drug
found at crash sites other than alcohol.
From the perspective of law enforcement, marijuana remains a dan-
gerous drug and is associated with higher rates of property crimes and
violence. A 2021 study of Oregon crime rates in the decade before and
after legalization of recreational marijuana indicated increases not only in
property crime rates, but also in violent crimes as compared to states where
marijuana is not legal. Other studies report 40% of offenders arrested for
any crime test positive for the presence of THC in their bloodstream at
the time of arrest. There is no scientific evidence to indicate that mari-
juana causes criminal behavior, but there is a strong association between
crime and drug use, and marijuana is the most commonly used drug in the
United States.
Clinicians and those who treat addictions and disorders related to sub-
stance abuse also report increasing risks due to rising marijuana use. The
most common problem is the increase of users who regularly consume
multiple drugs at the same time (polydrug users). More than 67% of mar-
ijuana users also use other drugs. That means that most marijuana users
experience the same risks associated with any drug use. Since 1990, deaths
caused by opioid-based drug overdoses increased 600%, and opioids and
alcohol are most common drugs taken with marijuana.
The most significant change in cultural attitudes between the 1920s
reform efforts that prohibited alcohol and criminalized drugs is the
emphasis on moral health. In the 2020s, drug policies are guided almost
exclusively by standards that weigh the risks of drug use in terms of how
these behaviors impact physical health. Lawmakers no longer consider the
morality of drug abuse, and political reform movements do not emphasize
the importance of protecting the moral health of the public. New drug
laws tend to favor restrictions or penalties for recreational use. At the
same time, however, the physical and social risks of drug abuse have not
changed, so there have been significant increases in government support
for social services that treat the psychological and social effects of drug
abuse and addiction.
 Marijuana’s Effects on the Body
and Mind

7. What are the general effects of THC on

the biochemistry inside the human body?

THC, or tetrahydrocannabinol, works on the central nervous system

with added effects on cells related to reproduction, immunity, and other
internal functions. That means marijuana mostly affects user experience
and triggers chemical reactions related to the sense of pleasure and satis-
faction. These emotions are usually reached through the natural experi-
ences we share through human interactions, but THC artificially triggers
hormones that trick the body into producing similar feelings of pleasure
without having to engage in the physical experiences.

Drug biochemistry
The central nervous system is made up of the brain, spinal cord, and nerve
cells that extend out to tissues. Chemical messages pass along nerve cells
(called neurons) through a series of chemical interactions. Unlike the
circulatory system, there is no moving fluid in the nervous system. The
spinal cord is made up of billions of neurons aligned like a train on several
parallel tracks, and information is passed through chemical interactions
that span the tiny space between neurons (called the synaptic gap). Tiny
28 Marijuana

molecules from one cell pass from specially shaped neurotransmitters over
to another similarly shaped receptor in the next cell. At each step, numer-
ous feedback loops tell the surrounding tissues how to respond.
The same nervous system that controls our bodily movements also
controls functions of our internal organs as well as those higher func-
tions related to mood, memory, concentration, and thinking. Each neu-
ron has many receptors that permit multiple messages to pass along the
same nerve at the same time. More than 10,000 different types of neurons
trigger different functions, creating as many as one quadrillion (1,000 tril-
lion) synaptic connections. The chemical relay system passes information
from the senses into the nervous system, triggering waves of reactions to
the brain, which in turn acts like a main computer and sends correspond-
ing chemical signals back to the appropriate tissues. This process happens
extremely fast, at rates of a trillion connections in a second.
Under ordinary conditions, the body supplies its own chemicals based
on the types of food we eat and the types of stimulants we experience
through our senses. If our finger touches something hot, the sensation
passes through the skin to the nervous system, which triggers the brain
to send out immediate signals prompting the muscles to pull back. The
entire process may take a fraction of a second. Similarly, if we take a ride
on a roller coaster, the sensations of excitement and fear triggers chemi-
cal reactions that increase our heart rates and stimulate certain pleasure
circuits that make us feel differently—whether that feeling is positive or
negative often depends on the person’s expectations.

The drug experience

Drugs are used to artificially stimulate reactions that would otherwise be
dependent on internal or external experiences. Some drugs trigger only
internal functions (like heart rate or cholesterol levels), and these reac-
tions usually occur the same way for most people. However, drugs that
trigger emotional reactions are not as predictable because emotions usu-
ally depend on the users’ prior experiences and expectations.
For example, if researchers figured out which neurotransmitters are
triggered by the experience of a roller-coaster ride, and if they identified
and copied the chemical that fits into the right neural receptors, then you
might be able to take a pill and experience the thrill of a roller-coaster
ride without ever leaving your room. Of course, whether that experience
is positive or negative depends on the expectations of the user. For those
users who just want to experience thrilling sensations, the pill would pro-
duce positive effects. There are others, though, who might feel confused
Marijuana’s Effects on the Body and Mind 29

by sensations that are unconnected to an actual experience. In those cases,

the pill may trigger a panic attack and cause great anxiety, producing neg-
ative effects. Still others may become so used to the sensations that they
no longer produce the same “thrill.” For them, they may try to increase
the dose in order to capture the same emotional high. In the same way,
marijuana can stimulate certain emotional reactions, but different users
will often report different experiences from the same amounts of THC.

Dopamine (the “pleasure circuit”)

THC fits into a set of neural transmitters and receptors belonging to the
endocannabinoid system. Scientists do not know the full purpose of this
system, but they do know that when it is triggered, the brain reduces lev-
els of a chemical called gamma-aminobutyric acid (GABA), which usu-
ally happens when someone experiences fear, stress, or anxiety. GABA
blocks signals that limit the stimulation of dopamine receptors, which are
neurotransmitters directly related to sensations of pleasure. THC does not
directly stimulate pleasure, but instead it indirectly stimulates dopamine
by blocking the chemicals that usually block dopamine receptors.
Dopamine produces the sense of pleasure and satisfaction and is usually
triggered by personal experiences, like an exhilarating roller-coaster ride.
It is also triggered by less obvious experiences like finishing a difficult
yet rewarding project or doing really well on a test. It is part of a reward
system in our brain that influences what we like and what we do not like.
Different categories of recreational drugs involve different sets of
receptor systems (for example, the opioid system of transmitters is entirely
separate from the endocannabinoid system), yet they all eventually work
by stimulating dopamine neurotransmitters. In this way, even though
marijuana triggers different neurotransmitters than heroin, methamphet-
amines, or alcohol, they all eventually stimulate dopamine. It is the dopa-
mine reaction that causes people to take the drugs.

Possible withdrawal signs

Drugs taken for recreational purposes release 5–10 times the normal levels
of dopamine to produce the “high” that users look for. If the brain gets
used to high levels of dopamine, then it develops corresponding coun-
terbalancing systems to limit the excess pleasure sensations with new sig-
nals that trigger sickness and pain. These lead to withdrawal symptoms.
If the drug directly stimulates dopamine receptors, then the withdrawal
can be very harsh, including flu-like symptoms of nausea, muscle aches,
30 Marijuana

hot flashes, tremors, and hallucinations. If the drug indirectly stimulates

dopamine receptors (like THC), then withdrawal symptoms are more psy-
chologically expressed as increased irritability, anxiety, depression, and
paranoia.
Endocannabinoid receptors are found throughout the central nervous
system and in the liver, testicle and uterus, and muscle and fat tissues.
They are not found in cells associated with the heart and lungs, which
is probably why THC overdoses do not appear to directly cause death.
Though THC does not appear to produce physical signs of withdrawal,
the psychological effects of long-term use produce dependency symptoms
similar to those found in people who are addicted to exhilarating expe-
riences, such as gambling, pornography, and video games. Symptoms of
psychological dependency result in strong emotional reactions during
withdrawal that make quitting the behavior very difficult.

8. How does THC impact motor functions such as physical

movement, speech patterns, and reaction times?

Marijuana affects mood, muscle coordination, balance, and both physical

and cognitive reaction times. Nevertheless, the effects of tetrahydrocan-
nabinol (THC) are not always immediately noticeable to outward observ-
ers because each person reacts differently depending on their weight, the
frequency of use, and their level of experience with the drug.
Some first-time users who consume very little THC will have difficulty
with their speech and balance and show noticeably slow reaction times.
Other longtime marijuana users may consume four or five times as much
THC and show no obvious signs of intoxication.

Impact on movement
In very general terms, while THC indirectly stimulates the dopamine
neurotransmitters related to pleasure and satisfaction, it also slows down
the speed by which messages travel from the brain to the muscle tissues.
That means that mental processes are slowed all around, both for thinking
and for movement. Since the dopamine reactions are separate from the
direct THC reactions, there is not always a connection between “feeling
high” and “physical impairment.”
In some cases, THC effects on motor control can last much longer than
the short-term effects of the dopamine. This is because, unlike alcohol,
THC passes through the lungs and enters the bloodstream on its way to
Marijuana’s Effects on the Body and Mind 31

tissues that are connected to the central nervous system. THC does not
remain in the bloodstream very long, and some of the immediate effects
from the dopamine reactions can fade away quickly depending on how
the THC was consumed. Inhalation through smoking or vaping produces
immediate effects, which also fade away more quickly. Vaping often uses
highly concentrated dabs that produce intense effects that have more
immediate impact on muscle coordination. Other THC extracts con-
sumed through edibles may take longer to ingest, but they also last much
longer in the system.
As THC is absorbed from the bloodstream into the surrounding tissues,
it can be stored in fat cells. Frequent use of marijuana over an extended
period of time can also cause some THC to be stored in the bone marrow.
That means that THC can remain in a person’s systems for days, weeks,
and even months after they last used marijuana and long after the original
high faded away.

Habitual use and tolerance

Users who smoke marijuana as a matter of habit can live continuously
under the influence of THC, which means they develop ways of coping
with the physical impairment. The central nervous system compensates
with counterbalancing chemicals to ensure more consistent function of
gross motor skills. Habitual users often adapt to the small amounts of
THC that is continuously in their system, allowing them to speak, act,
and move in ways similar to how they would react with no THC in their
system at all.

Police detection
All users experience some effect on their motor skills immediately after
taking marijuana. These include slower reaction times, loss of muscle
coordination, increased likelihood of risk-taking, and reduced cognitive
functions (especially memory and decision-making). These effects fade
much more quickly for habitual users.
THC-impaired driving is illegal in every state. The problem is that
state lawmakers have a difficult time defining “impairment.” In some
cases, high-frequency users do not show signs of impairment even if they
may still feel some effects of the dopamine stimulation due to high THC
levels in the bloodstream. In other cases, less experienced users may have
low levels of THC yet still suffer impairment. Traditional Breathalyzer
tests can only scan for blood alcohol levels, and testing for THC levels
32 Marijuana

requires specialized equipment that few officers have. Yet most scientific
studies conducted since 1970s show that blood THC levels may not indi-
cate impairment. As a result, officers are trained to focus most attention on
standardized field sobriety tests that measure balance, gross motor control,
and cognitive impairment. Officers look into the pupils for unequal dila-
tion or involuntary twitching. They may ask drivers simple questions or
to walk a straight line. Systematic sobriety tests are usually effective more
than 90% of the time, which means that THC impairment can usually be
recognized by trained observers even if blood tests are inconclusive.

9. How does THC impact cognitive functions and

the limbic system?

With few exceptions, marijuana users take the drug because of how it
affects their mood, perceptions, and general attitude. Emotions are dif-
ficult to measure objectively, so researchers must analyze the self-reports
from marijuana users to understand their experiences. Most users report a
sense of euphoria, a heightened awareness of music and color, and a gen-
eral sense of confidence and well-being. For many users, these experiences
feel pleasurable. That is why so many users believe marijuana helps them
relax and reduce stress.
Yet marijuana is also a mild hallucinogenic that impacts users’ sense of
time and often influences other senses of sight, sound, touch, and smell.
These senses are all perceptions from the perspective of the user, which
may not always be reliable.

Role of attitude and expectations

Marijuana causes both physical and emotional reactions. Physically, tet-
rahydrocannabinol (THC) stimulates endocannabinoid neurotransmit-
ters in the central nervous system, which in turn indirectly stimulates the
hormones that produce sensations of pleasure and satisfaction. Chemical
reactions always affect the user in similar ways at the cellular level, but
these reactions impact emotions and perceptions, so actual user experi-
ences are not always the same.
One research study tested two groups of college students taking mari-
juana. The first group was told their marijuana was very potent, and the
other group was told theirs was very weak. In fact, both groups were given
the exact same Cannabis at the same dosage. The group that believed they
were smoking strong marijuana not only felt more impaired, but their
physical reaction times were also significantly lower than the group that
Marijuana’s Effects on the Body and Mind 33

thought they were smoking weak Cannabis. There is no chemical reason to

explain the influence of perception on the cognitive effects of THC, but
researchers theorize that human attitudes play a large role in determining
physical reactions. Since THC primarily affects human perceptions, then
our preexisting attitudes and expectations always influence those effects.
The influence works both directions. Our attitudes change the out-
come of taking the drug, but the THC also changes the way our senses
work at a chemical level. That means that over time, frequent marijuana
use will change the way users perceives its effects. Habitual marijuana
users often believe the drug is producing effects that it does not produce.
They also tend to disbelieve the side effects of dependency that outside
observers can see more clearly. THC impairs the cognitive tools that are
ordinarily used to evaluate its effects.

Short-term cognitive effects

THC stimulates the central nervous system by increasing blood flow to the
frontal region of the brain that controls executive functions. This is the
part of the brain that is responsible for attention, concentration, short-
term (working) memory, impulse control, judgment, and problem-solving.
Marijuana users feel the cognitive effects of THC very quickly after
taking the drug. As THC passes into the bloodstream, it is metabolized
through the liver. It does not stay in the bloodstream long but is usually
passed out of the body through urine, or it is absorbed into fat cells, where it
slowly dissolves before eventually passing out through urine at a later time.
The effects are most intense while THC is in the bloodstream. The
intensity and duration vary depending on how the marijuana was ingested.
Smoking takes THC from the lungs directly into the bloodstream, pro-
ducing maximum intensity of effects within 10–15 minutes and that last
another 10–15 minutes just as long. Vaping intensifies these same symp-
toms, and they may last slightly longer depending on the dose (up to 3 or
4 hours). Tinctures and edibles that are eaten pass through the digestive
tract into the bloodstream, which may take up to an hour to produce
effects. Since marijuana is digested slowly, these effects may last from any-
where between 3 and 24 hours, depending on the dose.
Marijuana impairs the brain’s executive functions, which results in
mild visual and auditory distortion, impaired memory (especially short-
term working memory), judgment, and impulse control. Users report a
distorted sense of time, which is probably due to the THC limiting encod-
ing of new memories. Learning and concentration and other mental tasks
that require short-term memory (like mental math) become more difficult
for the same reasons.
34 Marijuana

THC bogs down basic cognitive functions because the cannabinoid

receptors are overstimulated, which explains why users take longer to
make decisions while under the influence. Users also show more will-
ingness to take risks, which is related to impulse control and judgment,
which is how we distinguish between good ideas and bad ideas. At the
same time, as the effects of THC wear off, users tend to feel more anxious
and suspicious (described as paranoia).

The role of CBD and frequency

Intensity depends on the dose and on the ratio of THC and cannabi-
diol (CBD) ingested. Higher doses of THC usually produce more intense
effects. CBD can limit the intensity, so most modern Cannabis strains are
bred to produce very high THC levels and very low CBD levels. Extracts
used for vaping and edibles also have very high levels of THC, with mini-
mal (if any) CBD. Recreational users looking mostly for the “high” prefer
high THC ratios, while medical users are sometimes prescribed Cannabis
strains with lower THC ratios and high CBD amounts to limit those same
effects. Some extracts used in tinctures and sprays also include higher
CBD levels for medical purposes.
Intensity of effects also changes depending on how often the user takes
marijuana. Ingesting THC more than once a week creates tolerance,
which means that users do not experience the same intensity with the
same amount of drug as when they first used. Tolerance may cause users
to increase both the dose and frequency of use to experience the same
level of effects, which can lead to Cannabis use disorder (a psychologi-
cal dependency on marijuana). Researchers believe tolerance levels may
return to normal if the user stops taking marijuana for four to six months.

Long-term effects
THC molecules that do not escape through the urine immediately are
stored in fat cells, which means that the THC may influence the central
nervous system long after the short-term effects are no longer noticeable.
In some cases, THC may show up in urine tests anywhere between 3 and
10 days after using the drug. For heavy users, THC may be absorbed into
the bone marrow, which means it can remain in the system for more than
a month after the last use.
Frequent (daily) use of marijuana will influence memory because new
memories are not easily encoded while under the influence of the drug.
THC does not appear to damage long-term memory functions, and most
Marijuana’s Effects on the Body and Mind 35

memory impairment fades away after 30 days of not using. Heavy use,
though, can lead to permanent damage to short-term memory functions.
Brain scans taken on chronic marijuana users suffering damages to their
short-term memory sometimes show permanent changes in the frontal
cortex. Sometimes the scans show no difference, and scientists do not
know exactly why that happens.
Casual marijuana users may never develop any brain damage. The
probability of permanent brain damage is higher for long-term users and
for users with Cannabis use disorder. These permanent effects can include
impaired decision-making, impulse control, and short-term memory.
Researchers are uncertain as to how long it takes to permanently change
brain structure, and the effects are not uniform. Some users may experi-
ence long-term damage after limited use, while others may experience
few long-term effects even after heavy use. In all cases, though, users must
stop taking marijuana if the long-term effects are to wear off.

Special effects on young brains

Long-term use among teens can be dangerous because the brain is still
developing until age 24. Numerous studies show that THC can damage
young brains—especially in areas of learning and memory functions—as
well as verbal fluency and risk-taking (inhibition control). Longitudinal
studies taken over 25-year time spans show significant loss of verbal mem-
ory in adulthood, which can permanently impact learning ability and IQ.
Unfortunately, marijuana use most often begins at young ages (between
16 and 24), which is precisely when marijuana is most dangerous. This
may explain why users who begin smoking in high school are 18 times
more likely to become dependent, and 2–3 times more likely to develop
psychosis or other mental disorders later in life than nonusers. Most teens
who start taking marijuana find it very difficult to permanently stop tak-
ing marijuana, even into their old age.

Less obvious dopamine effects

Marijuana indirectly stimulates dopamine reactions. Overstimulation of
these pleasure circuits may lead to dependency and other psychological
disorders.
Our attitudes determine the relative strength of dopamine sensations,
and overstimulation can cause the body to react with countermeasures that
limit the activation of these pleasure circuits naturally. That means it can be
more difficult to feel the same excitement for ordinary experiences without
36 Marijuana

taking the drug. This overstimulation may occur with any drug (opioids,
THC, methamphetamine, ecstasy, and others) and can significantly dam-
age the natural reward system that we depend on for personal motivation.
Habitual marijuana users frequently experience a decline in (or com-
plete lack of) personal motivation. The drug can act as a substitute for
other natural pathways to the feeling of satisfaction, which often require
more effort and are less appealing than simply taking more of the drug.
Since marijuana increases personal confidence, the lack of motivation is
not always recognized by the user. Habitual users often look elsewhere to
explain the problems in their lives, without realizing their own role in
causing those problems. This cycle leads to dependency, depression, and
feelings of paranoia, which can lower the general sense of life satisfaction.
Another side effect of overstimulation of dopamine is a decrease in the
body’s natural ability to feel pleasure and satisfaction of any kind. This
is called flat affect, and habitual marijuana users can develop symptoms
where they are unable to feel and express emotions that normally affect
other people. Artificial dopamine stimulation is many times stronger than
natural stimulations, so normal interactions feel “flat” in comparison.
In some cases, the hallucinogenic distortion causes users to feel discon-
nected from the world around them—as if they are watching their actions
like they were an outside observer. Researchers theorize that flat affect is
due in part to chemical tolerance within the nervous system, but also par-
tially due to permanently changed attitudes/expectations. Habitual THC
use changes emotional reactions, which in the long term can dull the
effect of any stimulation. The pursuit for greater stimulation is possibly
why chronic marijuana users are generally more likely to use other drugs.

10. Is there a difference in the kind of “high” resulting

from marijuana when compared to alcohol and other
drugs?

The experience of being “drunk” from alcohol is noticeably different than

the experience of being “high” on marijuana. Both alcohol and marijuana
indirectly stimulate dopamine receptors, but they work in completely dif-
ferent ways.

Effects of alcohol
Too much alcohol slows down motor activities and sensory perceptions,
so it is called a depressant. People can consume small amounts of alcohol
(typically less than one serving per hour depending on the user’s height,
Marijuana’s Effects on the Body and Mind 37

weight, and sex) and never feel any effects because the dose is so low that
it does not trigger noticeable reactions in the body. This is how people can
drink wine, beer, or liquor for its flavors and never reach the point of feel-
ing intoxicated. Like marijuana, users can develop a tolerance to alcohol,
which means they can drink more alcohol without feeling or exhibiting
any effects of intoxication. However, drinking more than one serving per
hour usually increases blood alcohol levels that trigger biochemical reac-
tions (above 0.05%).
If users drink more than two to three servings per hour, then blood
alcohol levels can reach between 0.05% and 0.12%, and the user experi-
ences a sense of euphoria as the alcohol begins to inhibit the chemicals
that control dopamine reaction levels. At this stage, users feel “tipsy” and
generally become more talkative and less inhibited. Judgment is impaired,
and motor control is slightly impaired but may not always be noticeable
to the user or outside observers. Users may feel more confident and more
willing to engage in social interactions that they would otherwise avoid.
In most states, blood alcohol levels of 0.08 is sufficient to be arrested for
drunk driving.
Full intoxication occurs between 0.09% and 0.25% alcohol (around
three to five servings per hour for men and two to four servings for
women). When users are legally drunk, alcohol begins to slow down neu-
ral functions: motor control is impaired, and users will slur their words,
easily lose their balance, and begin to feel sleepy. They become less active
physically, but also less inhibited, which means they may take actions that
they would otherwise not take. This is the point when some users become
overly emotional—equally quick to laugh or cry and, in some cases, they
may become violent.
The last stage of intoxication borders on alcohol poisoning (from
0.18% to 0.30%) and usually involves more than one serving every 8–10
minutes. Users become confused; they may have difficulty walking and
may lose memory functions (called a blackout). If the user continues to
drink and alcohol levels reach between 0.25% and 0.4%, they will begin
to vomit or pass out. In some cases, their internal organs may shut down,
and the user may have trouble breathing; body temperatures will begin to
fall, and in extreme cases, the user may fall into a coma and die.

Effects of THC
Unlike alcohol, tetrahydrocannabinol (THC) is not ingested for its flavor.
There is no level of sobriety where users take marijuana without feeling
anything. The transition between feeling sober and feeling high happens
as soon as THC levels are high enough to trigger cannabinoid receptors
38 Marijuana

(CB1 and CB2). One moment the user feels normal, and then suddenly
the dopamine effects kick in, and users experience a sudden change of
mood and perception (like feeling buzzed or high).
The experience of a THC high may enter different stages of inten-
sity with repeated doses. Marijuana users have their own vocabulary for
describing these stages, but since every experience is a little different,
the terms are not universal (common terms include feeling buzzed, high,
stoned, wasted, blazed, or tripping.) There is no easy way to distinguish
one level from another except that each one is slightly more intense than
the other. THC is stored in fat cells and does not remain long in the
bloodstream, or in the lungs, so scientists cannot measure expected stages
of THC intoxication with the same specificity that blood alcohol content
is measured.
After the first dopamine effects are triggered (called the “buzz”), users
feel the effects gradually become stronger with each additional dose. The
increasing sense of euphoria causes users to laugh more easily, while a
sense of physical relaxation spreads over the body. The limbs feel heavier,
and the user becomes more immobile. Users may or may not begin to talk
more, but they tend to be more introspective and may believe they are
being more thoughtful and insightful. Sights and sounds might become
more intense, and the sense of assurance and well-being increases so much
that users may feel they are discovering new insights. This might lead
to delusions of grandeur where the user believes they understand great
truths. Some users may become so drawn into their own imagination that
they describe a sense of being disconnected from their own sense of self.
In extreme cases, this can trigger psychotic episodes among people who
are vulnerable to mental illness.
At some point, THC levels reach peak concentration when the high
feels most intense without leading to physical sickness. The sense of
euphoria is usually accompanied by a growing sense of paranoia. Users
become suspicious that other people are trying to harm them or that
they are being watched and scrutinized. At the same time, user appetites
increase, and they want to eat. These peak experiences are usually posi-
tive because they follow the sense of euphoria, but they can also be nega-
tive and cause intense anxiety.
If the user increases the dose beyond peak levels through concen-
trated THC extracts, then the user may feel physically sick with a racing
heartbeat; panic attacks; an extreme sense of confusion; hallucinations;
and intense paranoia, including some physical signs of dizziness, stom-
ach pains, and vomiting. Overdose includes cannabinoid hyperemesis
Marijuana’s Effects on the Body and Mind 39

syndrome and marijuana-induced psychosis. These symptoms can last up

to 24 hours, but since there are no cannabinoid receptors in the cardio-
vascular system, THC poisoning will not lead directly to death. If THC
impairment is linked with other drugs (such as alcohol and/or opioids),
then the poisoning may result in death indirectly.

Summary of differences
Users who alternate between getting drunk and getting high usually
report that alcohol makes them tired and depressed, while THC makes
them happy and thoughtful. They also report, though, that habitual THC
use causes the high to become more and more bland, while the alcohol
more consistently produces the same sense of drunkenness. Marijuana
makes them feel more in control, while alcohol can lead to blackouts and
physical sickness.
THC mostly affects user cognition and emotional experiences. Both
alcohol and THC are depressants because they inhibit certain neural
functions, but THC can also distort other psychological perceptions.
Marijuana can and does impact gross motor functions, but these outward
signs may be less obvious in habitual users. Both THC and alcohol will
impair driving even if the user is not stumbling or slurring their words.
People who reach a certain blood alcohol level will noticeably lose con-
trol over their balance and coordination. Users who reach peak THC
levels may or may not exhibit obvious physical signs when they walk or
talk. Nevertheless, in both cases, alcohol and THC limit judgment and
inhibitions, which delay reaction times and cause impaired drivers to
make risky decisions that significantly increase accident rates. All states
prohibit impaired driving.
The most noticeable difference between being high and being drunk
is experienced after the effects wear off. Unless THC levels reach over-
dose concentration, the user does not usually feel physically ill when the
effects begin to fade away. Instead, they feel tired and want to fall asleep.
Alcohol may also induce sleep (like being passed out), but high blood
alcohol levels almost always lead to uncomfortable physical symptoms as
the effects wear off. These include headaches, nausea, and physical pains.
This is commonly called a hangover, and it may take many hours to fade
away.
Unlike THC, alcohol can become physically addicting, which means
that habitual users may experience headaches, muscle tremors, fevers,
and even hallucinations if they stop taking alcohol regularly. Marijuana
40 Marijuana

is highly addictive psychologically, but not physically. Cessation of THC

does not appear to produce physical signs of withdrawal. In most cases,
signs of THC use will fade away completely within six months of stopping.

11. How do CBD extracts affect the body?

Cannabidiol (CBD) is one of the hundreds of chemical compounds found

within the Cannabis plant and which is linked to the endocannabinoid
system of neurotransmitters in the central nervous system. In its natural
form, it is almost always accompanied by tetrahydrocannabinol (THC).
Scientists did not isolate and describe either the CBD or THC chemical
molecules until the mid- to late 1960s, and it was only then that they
realized THC caused psychoactive reactions, while CBD did not.
Later, research was conducted in the 1980s related to its potential use
as an anticonvulsant to treat symptoms of epilepsy, but there was insuf-
ficient evidence to support its use as a reliable treatment. In 2013, CBD
was shown to have positive effects on controlling seizures from a rare
form of epilepsy known as Dravet syndrome. The following year 15 states
approved the use of CBD as a medical therapy even in cases when medical
marijuana was still illegal. In 2018, the FDA approved a synthesized form
of CBD as a potential treatment for symptoms of Dravet syndrome, which
significantly increased public awareness.

Working in conjunction with THC

Researchers are not precisely certain how CBD functions within the
body. It appears mostly to inhibit certain functions of the CB1 receptor,
which is usually triggered by THC and is responsible for the psychoactive
effects to mood, perception, and other executive functions in the brain.
Whereas THC stimulates the CB1 receptor, CBD appears to suppress
some of the effects of the receptor, especially those related to psychosis
and hallucinations.
For medical purposes, Cannabis plants that include a high ratio of CBD
in relation to THC appear to soften some of the psychoactive affects. For
example, if medical marijuana is prescribed to a patient to encourage their
appetite, then the doctor wants to increase the functions of THC that
make people feel hungry, but also limit the effects that make people feel
disconnected from their emotions. Tinctures that combine CBD extracts
with THC extracts can help to ease pain, increase appetite, but otherwise
Marijuana’s Effects on the Body and Mind 41

limit the hallucinogenic distortion. Other cognitive functions may still be

impaired, but the impact is less intense. In some cases, the THC levels can
be so low (less than 0.3%) that the user may not notice the psychoactive
effects at all.
For recreational purposes, CBD limits the main psychoactive effect
that users are trying to achieve. Most Cannabis grown for recreational use
has very high THC levels and very low CBD levels. If CBD is extracted
completely from the Cannabis plant, then it has no psychoactive proper-
ties at all because it does not stimulate the CB1 or CB2 receptors in the
central nervous system. Researchers are uncertain whether CBD has any
meaningful effect on the human body outside of its role of softening the
potency of THC.

Summary
CBD is very popular as a potential therapeutic treatment, but researchers
have not been able to show that it has any other medical uses beyond as
an anticonvulsant. Private companies hope to find use for it as a treatment
for anxiety, a muscle relaxant for joint pains, and general pain reliever, but
there is no evidence to scientifically support these claims. The FDA has
approved the use of CBD as a cosmetic, but it is not approved as a dietary
supplement or for any other medical therapy except as an anticonvulsant.
Nevertheless, the widespread popularity of marijuana as a potential med-
ical treatment has spilled over to CBD as an equally promising chemical.
To date, there is limited research to support that expectation. CBD seems
to most affect the human body when it is activated alongside other can-
nabinoid compounds and mostly in its ability to limit the intensity of
THC. As an independent extract, CBD has not been shown to have any
noticeable effects on normal healthy functions.

12. Does marijuana (THC) affect all people in

the same way?

People do not experience the effects of marijuana in the same way. Tet-
rahydrocannabinol (THC) is a chemical that triggers the endocannabi-
noid system within the central nervous system in similar ways in each
individual. Only minor genetic variations will alter these basic chemical
processes. However, since marijuana mostly impacts cognitive functions
(like mood and memory), each individual will experience these chemical
reactions in unique ways.
42 Marijuana

Expectations
Assuming the marijuana or THC concentrate is given at the same dose,
individuals will react differently depending on their expectations. THC
produces physical changes, but individuals interpret those changes based
on prior experiences. Ultimately, marijuana affects mood, cognition, and
muscular coordination. Users who are expecting positive experiences
through these changes will interpret them in positive ways. They may
react to each new sensation as an exciting stimulation. Users who are
not expecting these physical changes may not understand why they are
happening, or they may feel like they have lost control over their bodily
functions. These users may react negatively with heightened anxiety or
even develop a sense of panic that does not go away until the experience
is over. Habitual users who have become overly accustomed to these phys-
ical changes will not experience the same intensity because their sense
memories of past usage limit the unique qualities of each new experience.

Endocannabinoid tolerance
Researchers cannot actually see neural activity working in the central
nervous system, so they are not certain precisely how neurotransmitters
and neuro-receivers change after repeated activation. The theory is that
the chemical shape of each hormone (e.g., THC or GABA or endorphin)
fits into the receiver like a key fits into a lock. Chemical molecules that
do not have the correct shape will pass by the receivers without triggering
any reactions. Molecules that have similar shapes may fit inside the recep-
tor to trigger a reaction even if it does not have the exact same chemical
makeup. That is how synthetic marijuana works (known by the street
names “K2” or “Spice”)—they trick the neural-receivers into reacting as
if the artificial molecule was the same as the THC molecules.
Scientists theorize that after many reactions, the shape of the receiver
may begin to change. Like a keyhole that gradually wears down after so
many thousands of keys passing through, so too the neural receptors may
wear down. When this happens, the receiver may begin to shut down
some of its functions so that it does not accidentally accept other similarly
shaped molecules. This is called a biochemical tolerance.
There seems to be some evidence that habitual marijuana users may
develop a biochemical tolerance that results in permanent changes to the
central nervous system. Researchers are uncertain whether these changes
are due to psychological expectations or biochemical changes. In most
cases, habitual users seem to recover their sensitivity if they stop using
Marijuana’s Effects on the Body and Mind 43

THC for a long period of time. However, other research indicates that
some of these biochemical changes may be permanent. Neural receptors
are so tiny that scientists cannot measure these physical changes, so they
must rely on theories based on complex correlations of probable effects.

Dopamine receptivity
Whether or not habitual THC use leads to biochemical tolerance, there
is strong evidence that users develop psychological tolerance. Dopamine
reactions are associated with pleasant experiences and a sense of satisfac-
tion, but they do not cause these sensations directly. They tell the brain
that certain sensations are pleasurable and act as a reward mechanism.
People seek out these rewards in order to experience the same sense of
pleasure.
Hyperstimulation of the dopamine system causes it to become less
sensitive to new experiences. Either the brain will reduce the amount
of dopamine reactions, or it will shut down the dopamine receptors alto-
gether. In either case, the user will experience less of a sense of pleasure.
It does not matter whether the dopamine reactions are stimulated by nat-
ural means (excitement from achieving a difficult goal) or from unnatural
means (through THC or opioids); in either case, hyperstimulation will
result in decreasing dopamine receptivity.
Habitual THC users may find their marijuana seems more bland than
it used to be, so they will increase the dosage to achieve the same effect.
Or they may combine marijuana with other drugs, like alcohol or opioids.
Similarly, users who take other drugs may have already compromised their
dopamine receptivity, which means marijuana will not produce the same
experience.

Physical body type

Size and weight are less significant in marijuana than in alcohol. Blood
alcohol levels are strongly correlated with the user’s physical size and
weight. A large male weighing 300 pounds will be able to drink more
than a small female weighing 90 pounds. It is a matter of alcohol density
in the bloodstream.
Marijuana does not have the same thresholds. Almost any amount of
THC in the bloodstream will trigger the endocannabinoid system, and
the user will experience its effects. The only variables are due to long-
term usage. THC can be stored in fat tissues and, in some cases, within the
bone marrow of habitual users. In these cases, differences in metabolism
44 Marijuana

will affect the time it takes for THC to leave the body. Metabolism is the
speed at which the body breaks down and processes chemicals throughout
the body.

13. Does marijuana make people more creative?

Marijuana does not bring anything new into the body. Tetrahydrocan-
nabinol (THC) stimulates the endocannabinoid system that indirectly
triggers dopamine reactions by suppressing gamma-aminobutyric acid
(GABA). In the process, the neurons that are preoccupied by hyperac-
tivity within the endocannabinoid system are less efficient in relaying
other information to the brain, which results in slower reaction times and
impaired cognitive functions. In plain language, marijuana slows down or
otherwise disrupts the normal functions of the brain. It does not add any
new functions or provide any new insights.
The reason why users sometimes feel like they are more creative when
they take marijuana is because THC is a mild hallucinogenic. Perceptions
(especially sight and sound) are distorted, and the brain’s pleasure circuits
are indirectly stimulated simultaneously. Judgment and impulse control
are also impaired. This combination of effects causes the user to believe
that they are thinking more deeply and experiencing truths in ways that
no one else has experienced them. This effect is a delusion of grandeur,
where the user firmly believes in their own exceptional genius without
any corroborating evidence.
Outside observers who see the effects of marijuana on the user do not
form the same conclusions. Instead, they see someone who has difficulty
answering complex questions in a coherent manner; who has slower reac-
tion times; who is easily confused, prone to inappropriate emotions; and
who generally appears to be distracted by their own experiences. Genius
and creativity are the last characteristics that an outside observer would
think of when they see someone high on marijuana.
Researchers have a difficult time defining creativity under normal cir-
cumstances, and there is little agreement on how or why some people may
be more creative than others. Some point to divergent thinking as a sign
of creativity (i.e., the ability to consider multiple options to approaching a
problem without focusing overmuch on the final objective). There is some
research to suggest that marijuana does promote more divergent thinking.
At the same time, creativity must also include convergent thinking for
the problem-solving process to be complete (i.e., the ability to evaluate
Marijuana’s Effects on the Body and Mind 45

and consider all available options to arrive at a single solution). The same
research suggests that marijuana significantly impairs convergent think-
ing because it disrupts the parts of the brain that deal with judgment and
evaluation. Divergent thinking that is unbalanced by convergent think-
ing generally impedes the creative problem-solving process. In this way,
marijuana may significantly impair effective creativity.
The last obstacle to creativity is motivation. THC indirectly stimulates
dopamine reactions, which provides the sense of pleasure and satisfaction
that makes marijuana psychologically addictive. Hyperstimulation of the
dopamine pleasure circuits usually results in a decline in motivation for
other sensations. Marijuana makes users less motivated in general. Cre-
ativity relies on some action and usually involves a great amount of trial
and error. As motivation decreases, so too do the processes of creativity.
 Medical Marijuana

14. What were the main maladies that medical marijuana was
originally intended to treat?

In 1996, through Proposition 215, California became the first state to

legalize the use of marijuana for medical treatment. Between 1998 and
2012, 18 more states passed similar laws, and in 2012, Washington and
Colorado became the first states to also legalize marijuana for recreational
use. Since 1996, more than two-thirds of U.S. states have passed laws
legalizing marijuana (Cannabis-based derivatives) for medical use.
In 2017, more than 20 years after California passed Proposition 215,
the National Academies of Science, Engineering, and Medicine posted a
report that identified 100 conclusions about medical marijuana. The report
indicated there was “substantial and conclusive evidence” that marijuana
could provide relief for the treatment of chronic pain in adults and from
nausea and vomiting as a result of certain chemotherapy treatments and
moderate spasms related to multiple sclerosis (MS) as reported by patients.
There was “moderate evidence” that marijuana might improve sleep pat-
terns for patients from obstructive sleep apnea, fibromyalgia, chronic pain,
and MS. Substantial to moderate support means that numerous studies
were conducted, and most of them agreed with each other.
The report also listed out conclusions for which there was only “lim-
ited evidence,” meaning that many studies were conducted, but they did
not always provide similar conclusions. In plain language, this means
48 Marijuana

that there is strong doubt as to whether the conclusions are true for most
patients. There was limited evidence to support the claim that marijuana
was effective in increasing appetite for acquired immune deficiency syn-
drome (AIDS) patients, for moderating spasms related to MS as actu-
ally measured by doctors, for improving symptoms of Tourette syndrome,
or for improving symptoms of anxiety and post-traumatic stress disorder
(PTSD). By contrast, the report also concluded that there was limited evi-
dence to reject the claims that marijuana improves symptoms of dementia
and intraocular pressure related to glaucoma and reduces depression in
patients suffering from chronic pain or MS.
Finally, the report indicated that there was no (or “insufficient evidence”)
to support claims that marijuana could treat cancer or cancer-related
anorexia, irritable bowel syndrome, spasms related to spinal cord injuries,
symptoms related to Huntington’s disease, schizophrenia, or that it would
help in treating addictions to any substance (like alcohol or opioids). These
negative conclusions were listed because there are many popular claims that
marijuana can treat any of these (and other) diseases or pathologies.
In addition to possible treatment options, the risks of medical mari-
juana were also outlined in the academy’s conclusions. There is substan-
tial evidence that long-term marijuana use damages respiratory functions;
increases incidents of chronic bronchitis; increases risk of schizophrenia
and other psychoses; and impairs learning, memory, and attention span.
Marijuana use also increases risks of mania, bipolar disorder, suicidal
thoughts, and successful suicide attempts. There is limited evidence indi-
cating that marijuana smoking increases chronic obstructive pulmonary
disease (COPD), liver disease, and the risk of developing anxiety disorders.
In 2020, the American Heart Association issued a public statement
that repeated many of the conclusions listed by the American Academy
of Sciences, Engineering, and Medicine. They added, however, that most
benefits from marijuana occurred when tetrahydrocannabinol (THC) was
administered as a tincture, repository, or in edible or pill form. Smoking
marijuana significantly increased cardiovascular disease and the risks of
certain cancers. Due to the likelihood of contamination, the FDA and
CDC both issued explicit warnings about the significant dangers of vap-
ing, which is not recommended for any medical uses.

15. What do most patients actually use marijuana for?

Most popular websites that advertise the advantages of medical marijuana

point to treatments for very harsh diseases, such as cancer, multiple sclerosis
Medical Marijuana 49

(MS), acquired immune deficiency syndrome (AIDS), and post-traumatic

stress disorder (PTSD). The vast majority of legal prescriptions for mari-
juana are given out for more mild causes, specifically for treatments asso-
ciated with chronic pain and anxiety. To a lesser extent, marijuana is also
prescribed to treat the mild symptoms caused by harsh diseases (such as
cancer, MS, or AIDS) that may involve increased anxiety.

Chronic pain
Chronic pain is defined as any pain that lasts more than three months and
is associated either with an ongoing illness or is from some initial injury.
The feeling of pain is relative to each individual, and doctors cannot
measure it with precision. Generally, chronic pain describes aches that
make ordinary or routine actions difficult or uncomfortable at some point
during the day. Chronic pain is distinguished from traumatic pains in that
it does not interfere with most daily activities. These aches may not be
measurable by a doctor, so the diagnosis of chronic pain mostly depends
on reports by the patient.
Marijuana may provide moderate pain relief, but it is not as strong as
most opioids and is not effective against serious pains related to traumatic
injury. It is, however, stronger than most over-the-counter (OTC) pain
relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs
(NSAIDs), which are in the same family as aspirin and ibuprofen. The
primary difference between marijuana and opioids is that the pain relief
from opioids is significantly stronger, but they are also physically addic-
tive. The primary difference between marijuana and OTC medications
is the added psychoactive elements that affect mood, which makes mari-
juana psychologically addictive. NSAIDs may provide similar pain relief
as marijuana, but the tetrahydrocannabinol (THC) also triggers dopa-
mine reactions that provide the added sense of euphoria, so the patient
feels like they have more pain relief even if the pain is still present.

Anxiety
Anxiety is defined as a set of physical and emotional reactions to the fear
of current and future events. Patients with anxiety disorders are preoccu-
pied with worry and can show physical symptoms like hot flashes, cold
sweats, racing heartbeats, dizziness, or an inability to sleep. Some of these
conditions are measurable by a doctor, but most are dependent on the
patient’s experiences. People may experience anxiety for many reasons,
most of which are not related to any underlying physical illness.
50 Marijuana

Marijuana can provide an immediate sense of euphoria, so most users

describe it as immediately relaxing. The effects of marijuana are highly
subjective, which means that each person reacts differently, and though
some users may feel more relaxed, other users may feel more anxious
because THC usually increases heart rate, and it also increases the sense
of fear and paranoia as it begins to fade. After the euphoric effects of mar-
ijuana wear off, users often feel uncomfortable and begin craving for the
return of that euphoric feeling. This can lead to psychological addiction.
Users who become psychologically addicted to marijuana can find relief
for their cravings by taking more of the drug, but they often also find
their overall anxiety increased. The hallucinogenic properties of THC
may convince the user that these added anxieties are due to other exter-
nal causes that have nothing to do with the marijuana. This also increases
the cycle of dependency.
Doctors who treat addiction rarely prescribe marijuana for anxiety
disorders because they recognize that the marijuana may actually be the
cause of the patient’s anxiety. However, other doctors who do not special-
ize in addictive disorders may prescribe marijuana because it is so strongly
associated with mood and perception that it seems a natural diagnosis.
Users who are seeking out a marijuana prescription usually report great
relief when taking it.

Other prescriptions
Marijuana does not provide enough relief to manage extensive pain, but
it does affect memory, nausea, minor spasms, neural transmission, immu-
nity, and appetite. Research does not indicate whether these effects are
positive or negative, but many doctors are willing to experiment with
trial prescriptions for patients who may not respond well to other existing
drugs. Marijuana is sometimes prescribed to patients suffering from loss of
appetite due to chemotherapy treatments or for AIDS patients. It is some-
times prescribed for patients suffering nerve pain or other nervous system
diseases such as MS, fibromyalgia, Parkinson’s disease, amyotrophic lateral
sclerosis (ALS), and glaucoma, which affect the optic nerves.
Research does not support, nor specifically refute the potential that
marijuana might potentially provide some benefit for these diseases. In
many cases, though, even if specific research refutes the benefit (such as
for PTSD), doctors may still prescribe marijuana based on patient pref-
erence. Every individual has a unique medical history, and some doctors
are willing to prescribe marijuana on a trial basis if the individual patient
believes it may help their symptoms.
Medical Marijuana 51

“Cannabis-friendly” doctors
States that legalize marijuana provide some way of identifying patients with
legal prescriptions. In California and Colorado, they issue marijuana cards
that can be taken into any legal dispensary. Medical marijuana is usually
more expensive but also more consistent in quality than recreational mar-
ijuana. In most states, marijuana is only legal for medical purposes, not for
recreational purposes. For this reason, people who want marijuana for rec-
reational use will often look for ways of obtaining a medical marijuana card.
By 2020, marijuana users spanned all demographics and all age groups.
Users may be doctors, lawyers, or teachers, as well as politicians or other
workers in society. That means that some doctors may advocate for the
recreational use of marijuana, even in states where recreational use is
still illegal. These Cannabis-friendly doctors are more likely to prescribe
marijuana for any reasonable ailment, including headaches, stress, diffi-
culty sleeping, and other symptoms that are difficult to measure but easy
to describe. The internet and social media sites that promote marijuana
often list out the names of these doctors in states where recreational mar-
ijuana is not legal. These same websites also provide instructions to users
on how to describe their symptoms in a way to justify a legal prescription.
In many cases, doctors will advertise themselves as “marijuana clinics”
that specialize in writing prescriptions for marijuana.
Marijuana is prescribed most often for chronic pain and social anxiety
because these problems are most dependent on patient self-reporting. If a
patient is seeking a reason to take marijuana, then these two conditions
are the easiest to describe. If the doctor is friendly to marijuana, then
they use these diagnoses as safe justifications for prescribing marijuana for
interested patients.
In states where recreational marijuana is legalized (like California), the
number of prescriptions for medical marijuana declined significantly. In
2018, after Canada legalized Cannabis for both medical and recreational
use, the amount of marijuana sold for medical use declined by 37%, and
the amount sold for recreational use increased by 265%. Medical mari-
juana is often a pathway for legally accessing THC and Cannabis for rec-
reational purposes.

16. What is “off-label” use?

The FDA reviews and tests drugs that are prescribed to treat illnesses. To
gain approval, companies show that the benefits of the drug for a certain
52 Marijuana

ailment are greater than its potential side effects. Every prescription is
approved for a specific purpose. When the drug is prescribed for purposes
beyond what it was originally approved for, then it is called an off-label
prescription.
As of 2021, the FDA had not approved Cannabis as a treatment for
any disease or condition. It has, however, approved four drugs that have
been derived from the Cannabis plant. One is a purified version of CBD
(Epidiolex) that was approved in 2018 to treat seizures related to Dravet
syndrome for young children over two years of age. The other three drugs
are based on synthetic versions of tetrahydrocannabinol (THC). Cesa-
met is based on nabilone and is approved to treat symptoms of nausea
for chemotherapy patients. Marinol and Syndros are based on dronabinal
and have been approved to treat nausea and also to encourage appetites
for acquired immune deficiency syndrome (AIDS) patients suffering from
extreme weight loss. Any prescription for marijuana (or CBD) outside of
these three conditions is considered an off-label prescription.
The FDA prohibits manufacturing companies from marketing their
drugs for off-label use. However, as long as doctors are not working for a
drug company, they may prescribe almost any drug for any use as long as
there is a responsible therapeutic reason and as long as the patient fully
understands and agrees with the decision. Since marijuana is often viewed
as a nonlethal drug, many doctors are willing to discuss trial uses for mar-
ijuana for multiple diagnoses. In states where marijuana is only legal for
medical use, most patients actively look for doctors who are willing to
prescribe marijuana off label.

17. Does marijuana provide unique benefits that cannot

also be provided through other prescription drugs?

Marijuana may be used to treat symptoms for many different diseases or

conditions, but that does not mean it is the best treatment. A 2016 report
from the Drug Enforcement Agency stated clearly that “there is no cur-
rently accepted medical use for Marijuana in the United States.” Doctors
have a wide choice of treatment options available to them, and they usu-
ally discuss possible benefits and likely side effects of each prescription
with their patients. Even though it is legal in many states, marijuana is
not the first recommended treatment for any ailment. Nevertheless, some
patients may still prefer it as their first therapeutic choice because they
like marijuana for other nonquantifiable reasons.
Marijuana does not provide any medical benefits that are not also
available through other treatment options. However, the recreational
Medical Marijuana 53

value of marijuana has created a strong public demand for using marijuana
as a therapy. In many cases, patients might prefer marijuana even when
other more effective drug options are available because they have had
more experience taking the drug, or they may believe it includes fewer
side effects, or they simply feel marijuana is a more pleasurable treatment
option. It is a little like using a rock to pound a nail into wood; it can work,
but it is never going to be as good as a hammer. In some cases, though, if
the only available hammer is too big or if you have more experience using
a rock instead of a hammer or if you simply like how a particular rock feels
in your hand, then you may choose the rock over the hammer. In the end,
the patient has the final say over which legal medication best suits their
needs, and marijuana has become a popular therapeutic choice for many
patients.

Encouraging appetite
Marijuana can help increase appetites for patients who have conditions
that may decrease appetite such as a patient suffering from anorexia related
to acquired immune deficiency syndrome (AIDS). The FDA approved a
synthetic version of tetrahydrocannabinol (THC) called dronabinal to
encourage appetites for AIDS patients suffering from extreme weight loss.
The drug includes the same euphoric effects of marijuana and the same
risks of cognitive impairment and psychological dependency. For users
who have experience taking the drug, the effects are all familiar.
The FDA approved three other more traditional drug options that also
increase appetite. Serostim and Somatropin are both a type of human
growth hormone, and Megestrol is a steroid hormone similar to proges-
terone. None of these three options impair judgment, nor are they habit
forming. Nevertheless, they each include other side effects and may
include some negative interaction with other drugs. Marijuana is con-
sidered more of a nontraditional treatment for encouraging appetite, but
it is often a popular option for AIDS patients who might also take the
drug for recreational use and who might be looking for the accompanying
euphoric side effects.

Nervous disorders
Any disease or condition that affects the spinal cord and nervous system
or impairs the communication between one neuron and another is called
a nervous disorder. Researchers have identified more than 1,200 such dis-
orders that affect movement and touch, sight, hearing, taste, cognition
and memory, and many other actions in the body. Marijuana specifically
54 Marijuana

affects the nervous system, so researchers have tried to find if there is any
therapeutic value in THC for treating nervous disorders.
During the late 1970s, scientists studied THC’s usefulness for treat-
ing glaucoma, which is a condition that damages the optic nerve, usually
caused by high pressure in the eyeball. Since marijuana increases blood
flow to the front part of the brain, where the optic nerves are located,
researchers hoped THC would provide some relief. During many years of
experimental trials, doctors noticed that marijuana could lower eye pres-
sure, but the effects were temporary (just three or four hours). By the
1980s, the American Academy of Ophthalmology publicly stated they
did not recommend marijuana for treating glaucoma. Instead, the FDA
has approved more than a dozen different eye-drop solutions that provide
more effective relief.
During the 1990s, researchers found that cannabidiol (CBD) may pro-
vide some relief for controlling spasms and seizures associated with a rare
form of childhood epilepsy, and the FDA approved Epidiolex to treat very
severe symptoms for very young children suffering from Dravet syndrome.
For most cases, however, traditional anti-seizure medications are more
effective for treating both children and adults. The FDA has approved
20 different medications, and 10 of them are approved especially for chil-
dren. Research has not shown that THC or CBD has any demonstrable
effect in treating seizures in adults.
Beginning in the 2000s, researchers began studying whether THC
might help symptoms of multiple sclerosis (MS). MS is an immune system
disorder that occurs when the body attacks the protective covering of the
nerve fibers, which interferes with the communication between one neu-
ron and the next. MS can cause paralysis and spasms. Since THC directly
affects neural transmitters, researchers were hoping to use marijuana to
treat spasms related to MS. The American Academy of Neurology stated
that THC extracts may provide some relief for treating muscle spasms and
mild pain management but also noted that other research found that there
was no evidence to suggest Cannabis would help any other MS symptoms.
The FDA has not approved any Cannabis-based drug to treat MS spasms,
but they have approved about a dozen other unrelated drugs based on cat-
abolic steroids that effectively help reduce inflammation, relax muscles,
limit fatigue, and provide some pain relief.

Opioid alternatives
The most common use for medical marijuana is as a treatment for chronic
pain. Since people feel pain differently, it is difficult to treat a diagnosis
Medical Marijuana 55

of chronic pain with a single category of medications. The FDA has

approved nearly 50 different drugs to treat a broad spectrum, from mild
to severe pain. The most potent of these drugs are opium based (called
opioids) that include variations such as codeine, fentanyl, hydrocodone,
morphine, oxycodone, and others. Opioids are all highly addictive phys-
ically and psychologically and are the leading cause of death from drug
overdoses (mostly from THC and fentanyl combinations). Some doctors
prescribe marijuana as an alternative to opioids.
The least potent treatments for chronic pain are sold over the counter
(OTC) without a prescription and include two different families of anal-
gesic drugs: acetaminophen (also sold as Tylenol) and nonsteroidal anti-
inflammatory drugs (NSAIDs), which are sold as ibuprofen, aspirin, Advil,
and under other names. Both types provide pain relief that is similar to
marijuana, though without the euphoric effect or cognitive impairment.
Analgesic drugs are not habit forming and carry few side effects, which is
why they are sold without a doctor’s permission. NSAIDs and acetamin-
ophen are the most recommended treatment options for chronic pain.
Research shows that opioids provide the best relief for traumatic or
acute pain, especially in short-term situations, but they also have harsh
side effects and a high risk for addiction. Opioids are not recommended
as a treatment for chronic pain. OTC analgesics combined with healthy
diet and exercise are generally recognized as the best treatment option
for chronic pain, but some patients do not feel they provide a strong
enough remedy. Some doctors prescribe marijuana as a middle alternative
between opioids and OTC drugs because it combines mild pain relief with
euphoric experiences.
A diagnosis of chronic pain is often based more on psychological dis-
orders than on physical causes. That means that people take marijuana
mostly for its euphoric effects on mood and only secondarily for pain relief.

Antidepressant alternatives
Chronic pain is often closely related to psychologically based anxiety dis-
orders. Some patients feel uncomfortable and become fearful in certain
situations, and they can confuse their emotional discomfort with physical
discomfort. In some cases, doctors prescribe antidepressants or other psy-
chologically based sedatives to treat chronic pain. In other cases, doctors
may prescribe marijuana as a short-term treatment for anxiety.
Antidepressants are not addictive and do not produce euphoric effects,
but they do help to balance out neurotransmitters that communicate from
one neuron to the next. THC has not been shown to be an effective
56 Marijuana

treatment for depression, and in some cases, marijuana use may make the
condition worse. Some antidepressants also treat symptoms of anxiety,
but more common anxiety treatments include psychotherapy options that
involve journaling, talking, and group therapy.
Recreational drug use usually increases anxiety and marijuana is not
recommended as a treatment for anxiety disorders. Nevertheless, THC
produces a euphoric effect that many users believe helps them to better
relax and reduce their anxiety levels. Marijuana is a mild hallucinogenic,
and it can cause users to believe the drug is more effective than it is. For
this reason, users often self-medicate with marijuana to treat their symp-
toms of anxiety. Some Cannabis-friendly doctors will prescribe marijuana
as an off-label treatment for anxiety and depression.
Most clinical research indicates that THC provides no long-term ben-
efit for treating anxiety or depression. Any other FDA-approved drug
would provide more effective relief.

Alternatives to diet and exercise

For almost every serious illness, doctors encourage patients to supplement
their treatment options with daily exercise that includes stretching, a
healthy diet, and a daily routine of meditation or prayer. These treatments
are also the first recommendation for conditions related to chronic pain
or anxiety, which are the two most common prescriptions for medical
marijuana. These options are very effective, but they require the patient
to be more active and become more accountable for their actions. For
some users, marijuana might seem to provide similar levels of relief with
much less individual effort. This might explain why so many users choose
to self-medicate with marijuana.
Every drug includes benefits and likely risks. Diet and exercise rou-
tines are not drugs, but they provide many benefits. They also require
more effort, and there is a treatment risk for patients who may not follow
through with the doctor’s recommendations. In most cases, patients who
choose to accept a marijuana prescription believe the benefits outweigh
the risks. There are always more effective treatments than THC, but users
may simply prefer it to other options.

18. How long have researchers studied the usefulness of

marijuana as a type of medicine?

Marijuana was listed as a Schedule I drug in the 1970 Controlled Sub-

stances Act because: 1) it had a high potential for abuse; 2) it had no
Medical Marijuana 57

currently acceptable use as a medical treatment; and 3) it lacked accepted

safety requirements to be used under medical supervision. There are five
categories of drugs listed in the Controlled Substances Act, and Schedule
I drugs are the most rigidly restricted. Marijuana was grouped together
with heroin, lysergic acid diethylamide (LSD), methylenedioxymeth-
amphetamine (MDMA, also known as ecstasy), and other addictive and
dangerous drugs. The Drug Enforcement Agency (DEA) was also created
in 1970 and charged with the mission of regulating and enforcing anti-
drug laws.
Almost immediately after Congress passed the Controlled Substances
Act, advocates for legal marijuana began researching ways in which it
might be used for medical treatment. If marijuana could be shown to
have some medical value, then it might be recategorized under a less
rigidly controlled schedule such as Schedule III and IV, which include
drugs with moderate to low potential for physical or psychological
dependency and which provide some medical therapeutic value. Anti-
depressants, mild sedatives, and anabolic steroids are included in this
group. Some Schedule V drugs (used mostly for cough suppression and
antidiarrheal medicine) may be sold without a prescription. If marijuana
were included in any of these categories, then more people would have
access to it.
Most of the marijuana research conducted over the past 50 years was
undertaken in order to support or overturn the Schedule I classification.
During the 1970s, as marijuana use among high schoolers increased to
historical highs, the DEA and federal agencies began funding research
that focused on the specific dangers of marijuana use among teens. This
research reached a high point during the 1980s era and President Reagan’s
“War on Drugs” campaign. By the 1990s, though, the President Clinton
administration ended the “War on Drugs” campaign and devoted more
federal support toward researching potential medical benefits of mari-
juana. Since 1995, most marijuana research has focused on identifying
the potential therapeutic value of the drug.
Marijuana is one of the most studied drugs in the world, mostly because
it is one of the most commonly abused drugs. Despite the very long history
of research, the DEA reported in 2016 that there have not been “ade-
quate” well-controlled studies that demonstrate the safety or the effec-
tiveness of marijuana. This does not mean that there has not been enough
research; it only means that the research does not indicate any reliable
reason for changing the Schedule I classification. There have been tens
of thousands of studies over the past 50 years, but as of 2021, the general
biochemical description of marijuana remains unchallenged at the federal
level.
58 Marijuana

19. How confident can patients be about the quality and

potency of medical marijuana?

Most people who take marijuana for medical purposes do so without doc-
tor supervision. The FDA has only approved one purified form of canna-
bidiol (CBD) called Epidiolex and three versions of a synthetic form of
tetrahydrocannabinol (THC) called dronabinol. All other forms of med-
ical marijuana are grown outside of FDA supervision and control. That
means that users have very few assurances about the quality or potency of
their marijuana supplies.
Each state that legalizes the sale of medical marijuana has additional
regulations for Cannabis farmers, but there are few controls over specific
marijuana products that users purchase for medical use. If a user obtains a
legal prescription for medical marijuana (like a marijuana card), then they
are free to choose from among hundreds of Cannabis-based options that
may or may not be regulated or approved for any specific treatment use. In
states where recreational marijuana is legal, there are no requirements that
medical patients buy only from approved medical marijuana dispensaries.
In addition, users who self-medicate with marijuana may purchase
their Cannabis products from marijuana sellers intended for recreational
use. Typically, medical marijuana should have higher amounts of CBD
in relation to THC, whereas marijuana grown for recreational purposes
have very low CBD levels. Self-medicating users may believe that the
euphoria associated with THC is more important than any other poten-
tial therapeutic benefit, and they may select high THC varieties of Can-
nabis believing that they will provide more benefit.
Last, THC concentrates used as tincture, edibles, or for vaping prod-
ucts (called dabs) are not regulated by any governing agency. In 2018, the
FDA and CDC both issued explicit warnings that these products often
contain impurities, which may include inactive substances (leafy mate-
rial) or other drugs (often fentanyl) or even other poisons (rat poison was
found in batches of synthetic THC, called “K2” or “Spice”) resulting in
numerous deaths and hundreds of hospital admissions. Users have very
few assurances about the quality or consistency of any THC concentrate
or synthetic THC analog.
In states where marijuana is not legal for either medical or recreational
purposes, users who self-medicate must purchase their supplies from illicit
dealers. Even in states where marijuana is legal in one form or another,
there is always an underground market for illegal drugs. There is never
any assurance about the quality or potency of drugs purchased through
Medical Marijuana 59

illegal vendors. This is true whether the sale is made in person or indi-
rectly through illegal vendors hosted online.

20. Does CBD provide more medical benefits than THC?

The Cannabis plant that marijuana comes from contains more than 560
chemical substances, of which more than 100 are cannabinoid com-
pounds. The two most prominent compounds are tetrahydrocannabinol
(THC) and cannabidiol (CBD), but all cannabinoids will trigger some
part of the cannabinoid neurotransmitters in the central nervous system.
That means that every compound affects the body in some way, even if
those effects are not noticeable to most people.
THC alters mood, perceptions, cognition, and motor control when it
stimulates the CB1 neurotransmitter. The drug quickly triggers the eupho-
ria effects that most people look for when they take marijuana. CBD and
other cannabinoids do not stimulate the CB1 transmitter, so they do not
trigger the neurotransmitters that cause these outward changes. All these
changes occur at the molecular level, which means they cannot be actu-
ally seen, so it is very difficult for researchers to know with certainty what
the drug is doing to the living human system unless it produces some mea-
surable effects. Since CBD does not produce obvious effects, the medical
community has much less evidence to use to measure its potential effec-
tiveness as a therapeutic tool.
To explain it very simply, scientists usually isolate the cannabinoid
compound and then inject it into an animal to see what happens by mea-
suring heart rate, immunity probabilities, life span, and so on. If they see a
significant effect in animals, then they may try human test subjects. There
are millions of possible changes that may be occurring with each cannabi-
noid, but researchers need to know what to look for and what to measure
before they can know if it has any possible medical value.
THC produces obvious effects in the human body, so research into
potential medical value is easier and much more extensive. CBD does not
produce these effects, so research is much more limited. As of 2021, the
only demonstrable medical benefit shown by CBD is in controlling sei-
zures in very young children suffering from a rare form of epilepsy. There is
also research indicating that CBD can moderate the psychoactive effects
of THC, but scientists cannot explain exactly why that is. Researchers are
studying the potential of CBD, but the progress is slower than studying
the potential of THC.
60 Marijuana

Finally, the other limiting factor in CBD research comes from public
pressure. Research into the medical potential of marijuana began in the
1970s mostly as a way of removing Cannabis from the list of Schedule I
drugs. Most of the research was conducted with the goal of either jus-
tifying or overturning the criminalization of marijuana as a controlled
substance. People take marijuana because of the euphoric effects of THC,
so if the eventual goal is to legalize marijuana for recreational use, then
researchers focus most attention on studying THC. CBD research began
much later as a way of justifying the legalization of hemp farming during
the late 1990s. Most CBD research continues to be largely motivated by
the growing popularity of marijuana as a recreational drug.

21. What other potential uses of medical marijuana are

researchers currently studying?

Research into the potential medical value of marijuana began in the 1970s
as a reaction to its inclusion as a Schedule I drug in the Controlled Sub-
stances Act of 1970. Between the 1970s and 1990, most federally funded
research focused on identifying the dangers and risks of marijuana use,
especially among teens, and the social costs of addiction—learning devel-
opment and impaired driving. During the mid-1990s, President Clinton’s
administration ended federal support for the “War on Drugs” research
programs and focused more attention on the potential medical benefits
of marijuana.
This shift in focus meant that researchers devote more attention trying
to find any positive benefits of marijuana with the goal that a pathway
might be found toward legalizing marijuana—first for medical use and
then eventually for recreational use. Since 2000, most marijuana research
has been guided by an effort to remove the stigma of marijuana as a dan-
gerous drug or as source of addiction and social disorder.
Since the most obvious effects of marijuana involve elevated moods,
altered perceptions, mild numbing sensations and muscular relaxation,
increased appetites, and potential psychosis, most of the research since
2000 has focused on these symptoms—specifically, pain control, nausea
control related to cancer chemotherapy treatments, increasing appetite
related to acquired immune deficiency syndrome (AIDS) patients. New
related research is focusing on irritable bowel syndrome, inflammatory
bowel disease, and other digestive tract issues where marijuana may pro-
vide benefit.
Medical Marijuana 61

The analgesic effects of marijuana lead to research into treating mus-

cle spasms and mild pain relief for nervous disorders including multiple
sclerosis (MS), glaucoma, epilepsy, fibromyalgia, Parkinson’s disease, and
amyotrophic lateral sclerosis (ALS). Since cannabidiol (CBD) seems to
moderate the effects of tetrahydrocannabinol (THC), research is investi-
gating the potential of CBD to protect neural processes. The effectiveness
of marijuana in treating any of these conditions remains inconclusive, but
research is ongoing.
New research also focuses on the potential of using marijuana as an
intermediary tool to lessen the effects of opioid addiction and other psy-
chologically based conditions. Rates of psychosis and mental illness have
increased following legalization in many states, but new research focuses
on identifying the potential benefits as well as the additional risks of mar-
ijuana to mental health and a wide range of anxiety disorders. Since mar-
ijuana also distorts or disrupts memory, more research is investigating its
potential for treating Alzheimer’s disease, dementia, and post-traumatic
stress disorder.
As of 2021, very few specific medical benefits of marijuana have been
demonstrated by clinical research. Nevertheless, there is strong public
pressure to find some significant medical breakthrough, which might jus-
tify removing the stigma of marijuana as mostly a recreational drug and a
source of personal addiction.
 Risks from Marijuana Abuse
and Addiction

22. Is marijuana addictive?

Marijuana is included as a Schedule I drug because of its high potential for

abuse and because it is not recognized by the federal government as cur-
rently safe for medical use. Unlike most opioid drugs, marijuana does not
appear to be physically addictive, but it does trigger the brain’s internal
reward system that often leads to psychological addiction. Not everyone
who takes marijuana will become dependent, but the risk of dependency
and addiction is always present. Frequency, dosage, and personal life
experiences increase the probability of addiction.

What is addiction?
Addiction is a psychological condition with very real physical expres-
sions. We may begin taking an addictive substance or engaging in addic-
tive behaviors because they are enjoyable at first, and they cause us to
naturally desire to repeat the experiences. We may discover that these
substances or activities are harmful, yet when we continue taking the
drugs or engaging in the behaviors even when we know they are not good
for us, then we are abusing the experiences. If we develop a habit of abuse,
then these habits become very hard to stop. When we try to stop, our
64 Marijuana

bodies can feel sick. These symptoms are signs of withdrawal, and they
can occur for any addiction, both physical and psychological.
After a period of habitual drug use, neurotransmitters within the pre-
frontal cortex of our brains adapt by increasing motivation and craving and
altering our memories that limit our impulse control or impair our judg-
ment. These chemical changes can occur from drug use but may also occur
from certain addictive behaviors that stimulate dopamine reactions that
manage our brain’s reward system. Behaviors that involve single-person
choices, such as gambling, masturbation, and even the thrill of video
games, or shopping can trigger these reactions. Habitual stimulation of
the dopamine reward system usually leads to abuse, and eventually, we
might feel compelled to continue the drug habit or the addictive behav-
iors even when we know they are harmful to ourselves or to others. When
that happens, it is called an addiction.

Physical versus psychological addiction

The American Psychological Association defines addiction as an over-
whelming urge to take a drug or to engage in a behavior even when we
know it will be harmful to self or society. There are two types of addic-
tion: physical and psychological. Physical addiction occurs when the body
becomes so used to a particular substance that it leads to biological reac-
tions when the substance is no longer present. People with physical addic-
tions experience physical symptoms of withdrawal that include headaches,
nausea, fevers, tremors, and even hallucinations. These physical reactions
can be very harsh, and in some cases, they may become life-threatening if
they occur without a doctor’s supervision.
Psychological addiction occurs when our emotional and behavior
patterns become so dependent to certain experiences that we feel very
uncomfortable when those experiences are missing in our routines. These
experiences almost always involve chemical reactions; withdrawal symp-
toms can be very strong and may include both emotional and physical
reactions such as irritability, strong mood swings, increased anxiety, cold
sweats, racing heartbeats, and an inability to concentrate or focus. The
physical reactions are never life-threatening, but the emotional symptoms
may be if they lead to suicidal actions or risky behaviors.
Physical addiction almost always includes psychological addiction as
well. Psychological addiction may include some lesser elements of physical
addiction, but not always. People can become addicted to substances like
cocaine or heroin or methamphetamines, or they may become dependent
Risks from Marijuana Abuse and Addiction 65

on certain addictive behaviors like gambling, shopping, playing video

games, or watching pornography. Not every addiction is equally strong,
and the strength is usually demonstrated by the intensity of withdrawal
symptoms. Researchers recognize signs of addiction when the user tries
to stop and then suffers some form of withdrawal. Evidence of physical or
emotional symptoms of withdrawal can indicate actual addiction.
Marijuana does not appear to be physically addictive. Nevertheless,
users can develop a dependency and become psychologically addicted
to marijuana resulting in both physical and psychological withdrawal
symptoms.

Tolerance and marijuana

Regular substance abuse or frequent experiences of addictive behavior
will lead to tolerance. This happens with any psychoactive drug or behav-
ior that stimulates dopamine receptors. Tolerance occurs when the stim-
ulating or euphoric effects gradually fade after each use, causing users to
take more of the drug or engage in different variations of the activity in
order to achieve the same feeling they experienced when they first started.
Tolerance may be acute, chronic, or learned. In most cases, tolerance
caused by marijuana is acute, which means it is temporary and lasts any-
where from a few days to many months. Even heavy users may be able to
return to the same level of dopamine sensitivity as they were before using
if they stop taking the drug for six months or more. This is usually true
for adult users but may not be true for younger users (teenagers) who take
marijuana while their brains are still in development.
Recent research suggests that marijuana use at young ages (12–18 years)
may involve chronic tolerance, which means the diminishing effects may
be permanent. Chronic tolerance is usually caused by physical changes to
the neural receptors in the nervous system, which permanently limits the
users’ ability to experience the same reactions. Tolerance does not affect
craving or judgment, so the user may still desire the drugs as much as ever,
but they are less able to achieve the same sense of satisfying effects that
they first remembered. Chronic tolerance can occur in young people or
in habitual users who take very high doses (usually from concentrates).
Marijuana can also lead to learned tolerance, which is a behavioral
adaptation that comes from long-term use. That means that users can
be physically impaired by the drug but still may not show any symptoms.
Through habitual practice, marijuana users may learn to adapt to the rou-
tine tasks of a normal day without outside observers noticing that they are
66 Marijuana

under the influence. They experience the same cognitive impairments,

but they may not feel the effects in the same way.

Dependency versus addiction

Tolerance very often leads to dependency because users try to reclaim
the same intense experiences by increasing their dosage and frequency
of use. Eventually, the body begins to adapt to the drug always being in
the system. The human body craves balance (called homeostasis), and
if something new is added to the system, then the body compensates
with physical and emotional changes that make the new addition seem
more normal. That adaptation creates dependence. Once a user becomes
dependent on a drug (or a behavior), then they will suffer symptoms of
withdrawal whenever that substance (or behavior) is ended.
Dependency is not the same as addiction. People may suffer the symp-
toms of withdrawal, but if they are able to resist the urge to take the drug
or engage in the behavior long enough for the body to readjust back to its
normal condition, then they avoid addiction. Cravings from drugs that
involve chemical dependency can be very difficult to resist and usually
involve some doctor’s supervision. Marijuana does not seem to involve a
chemical dependency. Nevertheless, cravings from psychological depen-
dency are often just as difficult to resist.
Users who have underlying mental health issues or who are using the
drug to escape personal frustrations may find the psychological cravings
more difficult to resist because they are (in part) reacting to some under-
lying conditions. Drug use will not solve the personal problems and may
even make them worse, so the user feels a strong urge to fall back to their
drug use as way to escape. This cycle can only be broken if the user resolves
the underlying issues. Usually, psychological addiction requires some form
of counseling to treat. Marijuana addiction almost always requires such
counseling.
If the craving for the drug becomes so strong that the user is unable to
stop using even when they know that it is harmful, then the user becomes
addicted. Marijuana addiction is called marijuana use disorder.

Debate over marijuana addiction

Not everyone who uses marijuana becomes addicted. Statistics gathered
since the 1970s suggest that most people who smoked marijuana prior to
2000 did not develop addiction. However, after the wave of states legal-
izing marijuana for medical and recreational use in the 2000s, the rates of
Risks from Marijuana Abuse and Addiction 67

marijuana addiction increased. Government statistics indicate that more

than 70% of Americans who develop a drug problem began their history
of drug use with marijuana. There is strong correlation between marijuana
use and problematic drug addiction.
Correlations do not determine causation. It is very difficult for research-
ers to determine what actions definitely cause which social results: Is the
rise of addiction due to marijuana legalization, or is legalization due to
increasing rates of marijuana use? Is marijuana use a reflection of higher
rates of drug use, or does it contribute to a drug culture that leads to addic-
tion? These questions cannot be answered decisively because marijuana
addiction is psychological, not physical. There may be any number of
causes for addiction that are not related to the Cannabis plant. The lack
of clear answers fuels the debate over further legalization of marijuana.

23. Is marijuana a gateway drug?

Throughout the 20th century, marijuana was always considered a gateway

drug because of its strong association with the drug culture and with users
who developed addictions to more potent substances like heroin, cocaine,
and methamphetamines. At the start of the 21st century, after a wave of
states began legalizing marijuana for medical and recreational purposes,
these presumptions were challenged. Nevertheless, statistical evidence
shows that marijuana use at early ages makes users significantly more
likely to engage in other drug use or to develop addictions later in life.

Understand the “gateway” concept

By 2010, it was popular among pro-marijuana websites to dismiss the idea
that marijuana made users more likely to engage in later more dangerous
drug use. These critics point to the fact that marijuana is not physically
addictive, and therefore, users do not develop cravings for harder drugs
just because they take marijuana. They also pointed to evidence that indi-
cates most marijuana users never take other more dangerous drugs, and
therefore, marijuana clearly does not force users to become drug addicts
later in life.
Many of these points are accurate. However, these popular arguments
also misinterpret the concept “gateway drug.” The National Institute of
Drug Abuse (NIDA) affirms that “marijuana use is likely to precede use
of other licit and illicit substances and the development of addiction to
other substances.” The idea of a “gateway” is based on the likelihood and
68 Marijuana

probability that one action will lead to another. It does not mean that
one action will always lead to another—that is, causal connection, not a
probability connection.
There are no causal guarantees with human behavior. That means peo-
ple can (and often do) take marijuana and never develop an addiction to
it, and they may never take other drugs or become addicted to other sub-
stances. Nevertheless, the probability of becoming addicted and the like-
lihood of someone developing an addiction to other drugs is significantly
greater for a marijuana user than it is for someone who has never taken
marijuana. In that way, marijuana is certainly a gateway drug.
Marijuana is not the only gateway drug. Binge drinking of alcohol
among high school seniors also increases the likelihood that users will
engage in illicit drug use later in life. To a lesser extent, so too does tobacco
use at young ages. The difference between each substance is in the level of
probability. Teenage marijuana users are more likely than teenage alcohol
users, and both are more likely than teenage tobacco users to take more
dangerous drugs and develop addictions later in life. When two or more
of these substances are taken simultaneously and more frequently, then
the probability of later addiction is even higher. Alcohol, tobacco, and
marijuana use at young ages is usually symptomatic of life choices that
increase the likelihood of later drug addiction.

Why marijuana is a gateway drug

Marijuana is primarily taken for its euphoric effects, and for this reason, it
impairs decision-making, inhibitions, and behavioral choices. Marijuana
affects the part of the brain that controls inhibition and moral judgment,
and it changes users’ understanding of the difference between a good idea
and a bad idea. It also lowers inhibitions, which makes users more likely
to engage in risky behavior than if they were not on the drug.
Most of these effects wear off shortly after each use, but since the pri-
mary psychoactive agent in marijuana, tetrahydrocannabinol (THC), is
attracted to and stored in fat cells, the imperceptible effects of THC can
last longer than the short-term euphoric sensations. Evidence suggests
that for heavy users, inhibitions and moral judgments may be impaired for
as long as six months after use. Habitual users who take marijuana once
a week may never be completely free from the impairment. Young users
(teenagers) may develop permanent changes to the prefrontal cortex of
the brain, which may lead to lifelong impairment.
If marijuana use decreases inhibitions and increases the likelihood
of risk-taking behaviors, then it is easier to understand why marijuana
Risks from Marijuana Abuse and Addiction 69

users may be more likely to experiment with other drugs. Sober users who
might never try cocaine or heroin in normal situations may become more
willing to experiment with those drugs when impaired by marijuana use.
The risk of physical and psychological addiction to opioid drugs even after
a few uses is very high. In that way, the pathway from marijuana use to
later addiction is not difficult to trace.

Primed for addiction

Marijuana is not physically addictive, but it is highly susceptible to
psychological addiction. This is because it triggers dopamine reactions,
which the brain normally uses as a reward system for when we feel sat-
isfaction or a sense of achievement after completing an important task.
Marijuana bypasses the normal work that is required to achieve that
sense of satisfaction and taps into the reactions biochemically. For exam-
ple, instead of studying hard to ace the exam in order to achieve a sense
of satisfaction, the marijuana user simply takes the drug and experiences
a more intense version of the same satisfaction, even if they failed the
exam.
Behavioral psychologists say that the more we train ourselves to seek
rewards using artificial means (like drugs), the more difficult it is to go
back to seeking rewards that require the harder work. These habits often
develop into addictions because users train themselves to seek immediate
sensory gratification through artificial means and learn to avoid tasks that
require more extensive effort or that involve delayed gratification. Habits
of drug abuse in one area (like marijuana) can prime the user for more
drug abuse in another area.
In the field of neurophysiology (scientists who study the central ner-
vous system), researchers have found that the neural transmitters associ-
ated with dopamine will actually change their chemical signatures after
persistent drug use. The brain is not used to excessive and frequent dopa-
mine stimulation, so it deals with habitual drug use (like marijuana) by
taking over additional neural receptors from other areas of the brain so
that it can become more ready for higher dopamine stimulation.
A drug addict’s brain may become permanently primed for dopamine,
which means the neurotransmitters become “hardwired” so that they are
always ready for a new drug. The young user (teen) may stop taking mar-
ijuana, but if their brain becomes primed for dopamine reactions, then
they live in a constant state of preparedness looking for more marijuana
or for similar stimulation provided by another kind of drug. People who
never take marijuana do not have these predispositions.
70 Marijuana

A variety of factors in drug abuse

A gateway drug does not mean that every user who takes marijuana will
move on from one drug to the next. It does mean, however, that the prob-
ability of future addiction or future use of harder drugs (cocaine, heroin,
methamphetamines, ecstasy) increases. Marijuana, alcohol, and nicotine
each prime the users’ brain to be more receptive to further drug use.
Most people who use marijuana never move on to use harder drugs. That
means that there are also other factors that help to determine drug use and
addiction. Some of these factors are genetic. The American Psychological
Association estimates that half of the motivations behind addiction are
due to genetic predisposition that makes users more likely to abuse certain
substances over others. Other factors include family environment, local
community culture, and social situations. People who have greater access
and exposure to drugs are more likely to abuse them. Younger users who
start marijuana (or any drug) as teens are more likely to develop habits
that lead to addiction. People who are suffering from mental illness or are
more susceptible to anxiety disorders and depression are also more likely
to develop addiction. Also, people who live in a subcultural community
that promotes drug use are also more likely to abuse drugs.
Marijuana is not the only cause for someone later developing a sub-
stance abuse problem. Nevertheless, marijuana use may become a sign of
vulnerability for later addiction. More than 70% of Americans who suffer
from substance abuse began their first drug use with marijuana. People
who avoid all drugs (marijuana, alcohol, and nicotine) are many times
more likely than users to avoid later addictions.

24. What is marijuana abuse?

Prior to the late 1990s, when marijuana was illegal at both the federal and
state levels, any use of the drug was considered an “abuse” of the drug.
After individual states began legalizing marijuana for medical or recre-
ational purposes in the 2000s, then the definition of “abuse” changed.
Marijuana can be used without necessarily abusing it if it is used legally
and in a way that is not harmful to self or others. The definition of “abuse”
is based on the user’s intentions and on legal restrictions.
The difference between casual use and abuse is not always easy to deter-
mine. In general terms, drug abuse usually involves either dependency or
addiction. Whether that first use of marijuana turns into an addiction or
into abuse depends on many factors, including the reasons why someone
Risks from Marijuana Abuse and Addiction 71

started using to begin with. Users who begin taking marijuana out of a
desire to escape or avoid a difficult personal issue or situation have a much
higher likelihood of developing an addiction later. This is because avoid-
ance does not solve the underlying problem, and the drug use can become
a tool that eventually makes the underlying problem worse. People who
take marijuana (or any drug) as a form of escape are much more likely to
develop addictions. Their use is often a form of abuse.
Younger users (from 12 to 18 years of age) also face much higher risks
that their first use will turn into abuse, leading to addiction later in life.
Brain development is not complete until around age 24, and because
marijuana directly impairs the prefontal cortex that is responsible for
learning, memory, and judgment, then any use of marijuana may lead
to permanent damage. Unless they are using marijuana under a doctor’s
order, teen users are (by definition) abusing the drug because they risk
harm to themselves. This is especially true for users who are prone to
depression, mental illness, or other anxiety disorders because they are also
more likely to develop addiction.
The frequency of use does not automatically determine abuse. Gen-
erally, any use of a substance against the recommendation of a doctor or
the use of a substance that is against the law is considered abuse. Recre-
ational marijuana is legal in many states, but driving a vehicle while using
marijuana even one time is always illegal in every state. Using marijuana
and then engaging in irresponsible behavior (like driving) is always con-
sidered abuse because it significantly increases crash rates that may harm
self and others. Taking marijuana at any time when it may interfere with
interpersonal relationships and job or school performance are also forms
of abuse. Anytime someone takes a drug when they know it is harmful is a
form of abuse. The line between “casual use” and “abuse” depends on why
the user is taking the marijuana.

25. What are the signs of marijuana abuse?

No one plans on becoming dependent on anything—whether it is gam-

bling, online pornography, alcohol, or marijuana. Something that begins
as a form of recreation slowly turns into a habit or routine, and if we are
not careful, we can become dependent and addicted either physically (as
with alcohol or harder drugs like methamphetamines, cocaine, or heroin)
or psychologically (as with marijuana or some other behaviors).
Lifestyle choices can contribute to the risks of dependency. If a drug
or addictive behavior becomes integrated closely into a daily or weekly
72 Marijuana

routine, then it is easy to fall into habits of abuse. There are hundreds of
addiction treatment centers online that deal with drug abuse and addic-
tive behaviors, and almost all these websites list common signs that a user
may have developed a substance abuse problem. The signs of marijuana
use disorder are very similar to what you would expect from any other drug
addiction. Some of these warning signs include the following:

• The user wants to stop but does not seem to be able to; they keep
taking marijuana even after pledging to themselves (or others) that
they will stop.
• The user experiences physical symptoms of withdrawal when they try
to stop, which might include increased anxiety and depression, irrita-
bility and anger, sleeplessness, lower appetite, nausea, and a fixation
on wanting to take marijuana to satisfy the craving.
• The user continues to use even when marijuana becomes more
expensive than they can afford.
• The user takes risks or engages in risky (sexual) behaviors in order to
have access to the drug.
• They use marijuana even when the experience is no longer pleasurable.
• The user spends a lot of time thinking about marijuana and always
ensures they have access to it.
• The user continues to take the drug even they know there could be
serious legal, financial, or social consequences (they could lose their
job, they could be arrested or kicked out of school, or the continued
use could end their relationships with others).
• The user justifies their marijuana use as a form of self-medication or
uses the drug even when doctors recommend against it (or changes
doctors in order to find a recommendation).
• The user finds themselves isolated from people they love as a result of
their drug use; they prefer to be alone rather than face other people’s
judgment, or they gravitate toward new friends who support their
habit and lose touch with the friends and family who disapprove.

These signs are common to any substance abuse. According to the Depart-
ment of Health and Human Services, the surgeon general’s report on alco-
hol, drugs, and health indicated that more than 20 million Americans
suffered from addiction in 2017. Of that number, only 1 in 10 addicts
sought treatment. Statistics from 2016 suggest that only 10% of marijuana
users become addicted, but those numbers are drawn from surveys of peo-
ple who self-report their abuse. The actual number of people suffering
Risks from Marijuana Abuse and Addiction 73

from marijuana use disorder is probably much higher than commonly

estimated.
The most effective means of identifying marijuana abuse is to consider
the lifestyle choices of the user. If the drug plays an important role in daily
or weekly routine or if it dominates the topic of conversation or if influ-
ences the choice of friends, then there is a good chance that it is being
abused.

26. How much marijuana can I take without

becoming an abuser?

The most common question about marijuana among high school students
is very practical: How much marijuana can I take before I get hurt or
addicted or in some other kind of trouble? The first answer is that any use
by a teenager almost always involves abuse. With very few exceptions for
medical use, every state prohibits recreational marijuana by minors just
as they prohibit consumption of alcohol for minors. This is because mari-
juana can lead to serious developmental issues and may cause permanent
damage to learning, memory, and motivation. The simple answer is that
any amount of marijuana use by teenagers should be considered abuse.
The deeper questions students are asking relate to dependency: At what
levels of abuse will I become psychologically addicted? At what point will
I see my grades suffer or when will my family begin to notice problems
or my relationships with other nonusers become strained? At what point
will my health be compromised? How much marijuana is too much, and
how often? These questions are more complicated and depend on many
variables including the user’s genetic predisposition, personal and family
experiences, and the dosage and frequency of use. To better understand
their risk, students should ask themselves certain key questions.

Is there evidence of abuse in my family?

The American Psychological Association notes that genetics may be
responsible for nearly half of a person’s vulnerability to addiction. If your
parents, aunts, uncles, and grandparents have any history of substance
abuse, then there is a strong chance that you may also be vulnerable. In
addition to genetic factors, environmental factors also play an important
role. If your family is struggling with any kind of addiction at home, then
you may be influenced by life choices that promote habits of dependency.
74 Marijuana

If you or your family spends much time with friends who have substance
abuse problems or if you hang out at places marked by substance abuse,
then you are at greater risk of imitating those behaviors.
Last, if you are prone to anxiety disorders, depression, or other forms of
mental illness, then you are at greater risk of dependency and/or develop-
ing psychosis. Marijuana may not cause mental illness, but there is strong
evidence that it increases susceptibility and problematic symptoms of
mental illness. Addiction becomes more likely as does the risk of psycho-
sis. If any of these variables apply to your life situation, then you are more
vulnerable because your social networks are already primed for depen-
dency. Higher vulnerability means that it may take only a few occasions
for you to develop a habit and eventually a dependency on marijuana.

Why am I taking (or considering) marijuana?

If you are struggling with difficult personal issues and are looking for a
temporary escape, then you are more susceptible to addiction. Similarly,
if you start taking marijuana through peer pressure or out of insecurity to
fit into a group, then also you are more vulnerable. Such issues are not
resolved by drug use and rarely go away on their own. Whatever triggered
the initial use will very likely influence additional uses later. Unless the
issues that are causing the initial frustration are addressed, you are more
vulnerable to developing a dependency.

How am I taking marijuana?

The method and dosage of taking marijuana can determine the strength of
the experience and the probability of developing acute tolerance. Smok-
ing marijuana usually produces the quickest effects, but they also fade
more quickly than other methods. Since the 2010s, most marijuana vari-
eties contain about 10% tetrahydrocannabinol (THC), with some vari-
eties containing as much as 25%–30%. Higher concentrations of THC
are more likely to result in acute tolerance in a shorter period of time.
Developing tolerance to any drug increases the likelihood of dependency.
Tolerance depends on body size, the amount of available fat cells,
and metabolism rates. For some people, daily use for two or three weeks
will result in noticeable tolerance effects. For others, regular use for six
months may be required. Tolerance does not always lead to dependency
or addiction. Heavy users take T-breaks (tolerance breaks) for anywhere
between one and six months to regain their sensitivity to marijuana.
However, if users shift their drug of choice from marijuana to something
else (like alcohol) but never completely end their drug use, then they
Risks from Marijuana Abuse and Addiction 75

are only shifting the cause of dopamine tolerance from one substance to
another, but the tolerance issue remains unchanged. If you are forced to
address problems of tolerance and T-breaks, then you are likely already
experiencing dependency issues.
Other methods of taking marijuana rely on THC extracts. Tinctures
and edibles may have THC concentrations as high as 95%, and depend-
ing on how much of the extract is added in the food, the actual dose of
THC may be significantly higher than the amount taken through smok-
ing. Since THC in edibles is broken down in the digestive system, the user
may have to wait an hour or longer before effects kick in. Users may keep
eating thinking that nothing is happening, and then suddenly the effects
begin, and the user is unable to limit what they have already eaten. Mari-
juana overdoses occur most often when taking edible products.
Vaping produces quicker results than edibles, and users are more able
to manage their doses. At the same time, the THC dabs used in vaping
machines may contain extremely high concentrations and often contain
other contaminants that the user has little control over. These contami-
nants may even include other more addictive drugs like opioids (fentanyl
is popular). Since the actual ingredients of the dab are unknown to the
user, there is much greater risk of accidental overdoses or of becoming
physically addicted to a non-marijuana drug. There have been many cases
where a user vapes just once and suffers permanent damage to their health
(including death) due to contaminated THC concentrates.
Last, if you are taking marijuana with any other drug, then you have
very high vulnerability. The most common drug is alcohol (usually taken
before the marijuana), which increases the intensity of impairment.
Other common drugs are opioids and methylenedioxymethamphetamine
(MDMA, also known as ecstasy). Urban police statistics reveal that very
high percentages of youth (in some cases 90% or more) between the ages
of 18 and 24 who participate in the dance club culture often take three or
more drugs at the same time. These polydrug combinations are responsible
for the highest death tolls due to drug overdose. Marijuana is often a cen-
tral ingredient, and any polydrug use will very likely result in addiction.
There is no single answer to this question. Marijuana affects every indi-
vidual differently. The users’ age, family history, home environment, and
personal motivation for using marijuana play important roles in determin-
ing susceptibility to dependence and addiction. Other factors, including
body type, metabolism rates, tolerance levels, and dosage also play roles
in the likelihood of whether even a single use (or a few uses) may result in
immediate physical dangers to health or future dependency.
Statistically, most people who use marijuana occasionally do not
become dependent or develop an addiction. At the same time, most
76 Marijuana

people who later become addicted to other drugs like methamphetamines,

cocaine, or heroin began their drug use with marijuana. More than 10%
of teens who begin smoking marijuana will develop marijuana use disor-
der within a year (compared to 6.4% of adults). That means that there
is always some risk involved with marijuana use. Generally, higher doses
taken frequently increase the likelihood of dependency and substance
abuse, but other social and genetic factors are probably more important in
determining the ultimate level of risk.

27. How do the health risks of marijuana compare to the

health risks associated with alcohol and tobacco?

A 2019 survey conducted by the Harvard School of Public Health reported

that twice as many Americans believed alcohol was more harmful than
marijuana, and three times as many believed tobacco was more harmful.
There are many social and political reasons that might explain this trend
in public perceptions, but this widespread public misconception does not
reflect scientific fact. In terms of physical and mental health risks, mari-
juana is significantly more dangerous than tobacco. It is just as dangerous
to the internal organs as alcohol but is more likely to be abused than alco-
hol. Of the three drugs, marijuana also poses the greatest risk to mental
health, learning, and judgment.
Alcohol, tobacco, and marijuana are all addictive either physically or
psychologically, and though they each may pose fewer health risks if used
in moderation, all three substances can be dangerous if abused or used to
excess for long periods. None of these are “safe” for teens because their
minds, bodies, and faculties of judgment are still developing. Each drug
carries different dangers. Marijuana provides very high risks to both the
lungs (when smoked) and the liver (when eaten) and the greatest risks to
brain functions, especially in terms of the risk of psychosis and long-term
impairment to learning, memory, and judgment. Tobacco poses risk to the
lungs but has little to no impact on the brain because it is not psychoac-
tive. Alcohol may pose some risk to the brain and internal organs (espe-
cially the liver), but it is also the most likely of the three to be consumed
without being abused.

Tobacco risks
The main addictive ingredient in tobacco is nicotine. It is a mild stimu-
lant, but it is not psychoactive. It does not affect judgment. The primary
Risks from Marijuana Abuse and Addiction 77

danger of tobacco does not come from nicotine itself, as much as from the
smoke that brings the nicotine into the body. The other chemicals that
enter into the lungs can permanently damage respiratory function, which
can lead to cancer, heart disease, stroke, diabetes, and chronic pulmonary
disease (COPD).
These risks, however, are not due to the nicotine. They are due to the
process of smoking. All these risks are compounded when smoking mari-
juana. Studies suggest marijuana smoking is at least three to seven times
more dangerous to the lungs than tobacco smoking for two reasons. The
first is that marijuana smokers do not use any filters, whereas tobacco-based
cigarettes almost always have filters. The filter cuts down some of the toxins
from the smoke, but not all of them. The second reason is due to the pecu-
liar way users smoke marijuana. In order to achieve the greatest euphoric
effect, marijuana is inhaled deeply and then held in the lungs for as long
as possible before being exhaled. That means the marijuana smoke stays in
the lungs significantly longer than tobacco smoke for each use. Marijuana
smoke contains twice as many cancer-causing polyaromatic hydrocarbons.
Smoking marijuana poses substantially more dangers to the lungs and
internal organs than smoking tobacco. The main difference emerges from
frequency. Heavy tobacco users may smoke 10 cigarettes or more in a sin-
gle day; therefore, the risk from heavy tobacco smoking may be higher
than occasional marijuana smoking (once a week). However, due to the
density of smoke, daily marijuana use still poses a higher risk of cancer and
other smoke-related diseases than tobacco. Recent studies indicate mar-
ijuana users have a 20% higher risk for cancer and other cardiovascular-
related diseases than regular tobacco users.
The risk of physical dependency on tobacco is higher than marijuana,
which does not appear to be physically addictive. However, since tobacco
does not produce any psychoactive effects, the risks of psychological
dependency on marijuana is substantially higher than tobacco. Users
smoke marijuana to achieve the euphoric effects, and if they begin using
it as a tool for dealing with difficult personal issues, then the risk of depen-
dency is very high. There are no risks of psychosis or other mental dis-
eases from tobacco, whereas marijuana increases both risks significantly.
Tobacco users will never develop hallucinations, suffer panic attacks, or
increased paranoia like marijuana users.
The risk to others from secondhand smoke is roughly the same between
tobacco and marijuana, except that marijuana is typically not smoked
in public places (especially in states where it is illegal), and therefore,
bystanders are less affected. Tobacco use might be more of a public nui-
sance than marijuana smoking, but that might change as more states
78 Marijuana

legalize recreational use of marijuana. Danger to fetal development (for

pregnant smokers) is high for both tobacco and marijuana, but marijuana
has the added potential of harming the baby’s cognitive functions.

Alcohol risks
Alcohol can produce mild euphoric effects if consumed to the point of
intoxication. It also impairs muscular coordination and other motor func-
tions, lowers inhibitions, impairs memory, and may lead to poisoning (and
death) if taken at very high doses. Alcohol can become physically addic-
tive, but it requires habitual use. More often, users will become psycholog-
ically dependent long before they become physically dependent. The risk
of a physical alcohol dependency is not as high as the risk of psychological
marijuana dependency. Typically, dependency on either alcohol or mari-
juana requires counseling to break the psychological addiction first.
The main difference between alcohol and marijuana is that alcohol
may be consumed without producing any intoxicating effects at all. Most
people drink alcohol for the taste, not to reach the point of intoxication.
Statistically, more than 70% of alcohol users drink without ever feeling
the effects of alcohol, because they limit their consumption to one or two
drinks. Alcohol does not appear to carry any health risks if it is limited
to once or twice a day (depending on gender). Some studies indicate that
alcohol consumption once a week may provide health benefits. The seri-
ous dangers of alcohol are not triggered until the user takes so much that
they become intoxicated. This is called binge drinking, and it requires at
least four or five drinks taken within an hour.
By contrast, every marijuana user experiences impairment every time
they use because that is the only reason why they are using. That means
the risks of marijuana use are triggered with every use. Any effective
comparison between the relative risks of alcohol and marijuana should
consider the effects of moderate marijuana use (once or twice a week)
to binge drinkers (those who consume at least four to five drinks in an
hour, once or twice a week). In 2012, there were slightly more adults
who regularly engaged in binge drinking than there were those who reg-
ularly used marijuana (8.6 million vs. 5.1 million). By 2019, those figures
were balancing out with the number of binge drinkers declining and the
number of regular marijuana users increasing. Among teens, marijuana
abuse became more common than binge drinking. In 2019, nearly 20% of
high school students took marijuana at least once a month, whereas only
13.5% of the same students engaged in binge drinking. The risk of abuse
is higher for marijuana than for alcohol.
Risks from Marijuana Abuse and Addiction 79

Most of the risks from alcohol abuse are short term while the user is
intoxicated. The same risks of impaired judgment, impaired driving, loss
of inhibition, and irresponsible decision-making are about the same when
someone is intoxicated by alcohol as when they are impaired from mari-
juana. The risk of auto accidents is the same for both. Excessive alcohol
if taken quickly in high concentrations can pose acute risks. Those who
drink hard liquors (like whiskey or vodka) very quickly may induce alco-
hol poisoning that leads to unconsciousness and, in some cases, death.
Typically, alcohol consumed through lower doses (beer or wine) will cause
the user to become sick or unconscious before they reach deadly levels.
Excessive use of marijuana will not kill directly.
Death by alcohol poisoning most often affects men in their late for-
ties, suffering from severe alcoholism (about 0.0007% of the popula-
tion). Direct alcohol poisoning is rare, but death through risky decisions
while under the influence of alcohol is much more common (0.0274%
of the population). Drunk driving and other accidents cause about 40
times more deaths per year than alcohol poisoning. The cognitive impair-
ment from marijuana can lead to the same level of risks as alcohol: lower
reflexes, impaired judgment, and increased likelihood to take risks. In
both cases, when a user is intoxicated from either substance, they lose
their ability to make responsible decisions. The secondary risk of death
through impaired decision-making is the same for both alcohol and mar-
ijuana, though slightly more people engage in regular marijuana use than
in regular binge drinking.
The physical health risks for long-term abuse are somewhat similar.
Extensive alcohol abuse can cause damage to the liver and digestive
system, cause heart disease, and increase stroke risks. The psychologi-
cal and social risks of alcohol dependency are similar to any substance
abuse disorder. Users may develop physical and learned tolerances so
that they appear to function normally in their jobs, but the physical tolls
continue. Social risks are the same for any substance abuse that leads
to psychological dependency; these are the same for both alcohol and
marijuana. Alcohol can be dangerous to others if the user drinks while
pregnant. Alcohol may impact fetal development and, in serious cases,
lead to fetal alcohol syndrome that can cause permanent brain damage
and impair growth development in children that cannot be reversed.

Marijuana risks
Marijuana produces euphoric effects that primarily impair cognition,
memory, perception, and inhibition, with less noticeable effects on muscle
80 Marijuana

coordination. It does not appear to be physically addictive but is more

likely than alcohol to become psychologically addictive. Unlike alcohol
or tobacco, marijuana is a mild hallucinogenic that influences visual and
auditory perceptions.
Smoking marijuana leads to greater health risks to the lungs and the
related cardiovascular system than smoking tobacco. Since the early 2000,
an increasingly larger percentage of users take marijuana through concen-
trated extracts used in vaping e-cigarettes or in tinctures and edibles that
are consumed orally. Vaping does not involve smoke, so puff for puff, it is
safer for the lungs than smoking tobacco. Nevertheless, vaping still involves
heat and carries a high percentage of other contaminants present in the
concentrated mixture (or dab). Most of the serious reactions that lead to
emergency room visits from marijuana users come from vaping products. In
2019, more than 2,500 hospital visits were reported after marijuana vaping
products were discovered to contain small amounts of rat poison. The CDC
and FDA both issued warnings that vaping products pose inherent risks and
that no vaping products have been authorized for medical use.
The most popular forms of marijuana extracts are tinctures and edi-
bles, especially in the form of candies, gummies, and baked foods (like
brownies or cookies). These forms of ingestion do not pose any risks to
the lungs, but they still pose risks to the liver and other internal organs.
Like alcohol, the tetrahydrocannabinol (THC) from of marijuana is bro-
ken down and processed through the liver. Increased marijuana use in
any form places greater stress on the liver, though to a lesser extent than
alcohol. The greatest risk from edibles is dosage control. Edibles account
for the most common source of dangerous overdosing from marijuana,
including intense vomiting/sickness or death following panic attacks or
paranoid hallucinations resulting in harm to themselves or others (sui-
cide, accidental death, or accidental homicide).
The greatest risks from frequent marijuana use are effects on learn-
ing, memory, judgment, and mental health. The psychoactive properties
of THC act as a mild hallucinogenic, which combines euphoric feelings
with distorted perceptions that can influence mood, attitudes, and per-
sonal convictions. Like alcohol, these temporary effects also impair mus-
cle coordination, which means that the intoxicated user is at increased
risk of car crashes and other dangers from risky decision-making. Unlike
alcohol, some of these side effects of cognition, learning, and memory
remain even after the user is no longer intoxicated. Depending on fre-
quency or use, the THC can be stored in fat cells, which gradually release
at low levels into the system for days, weeks, or even as long as six months
after use. Chronic marijuana use significantly increases the risk of psycho-
sis and other psychiatric diseases.
Risks from Marijuana Abuse and Addiction 81

Health risks of marijuana use are comparable to the risks associated with
regular binge drinking. They are much higher than the risks associated
with moderate drinking that does not result in intoxication (one drink
for women and one to two drinks for men). The risks to other people are
similar while users are impaired, and both marijuana and alcohol also carry
increased risks to fetal development in pregnant mothers at any level.

Summary
In 2021, rates of alcohol addiction appeared to be slightly higher than rates
of marijuana addiction among the adult population except that marijuana
addiction rates are usually underreported. Statistics also rarely account
for polydrug addictions (alcohol and marijuana and tobacco or marijuana
and other physically addictive drugs like opioids or amphetamines).
The abuse of any drug can lead to death—if not directly, then in asso-
ciation with risky behaviors and increased probability of deadly diseases.
Among the three drugs, only tobacco has no effect on risky behaviors. Binge
alcohol drinking and marijuana use both impair judgment and decision-
making. If alcohol drinking is limited (drinking less than required for
intoxication), then it poses much less risk than marijuana, which always
involves some level of impairment. More than 70% of alcohol users drink
limited amounts that do not reach any level of intoxication. By contrast,
all marijuana users reach the level of intoxication every time they use.
Since 2002, alcohol has become less of a threat to high school students
and marijuana has become more of a threat. By 2021, tobacco use among
American teens is at an all-time low (and is also low for the adult pop-
ulation). Alcohol use among teens is slightly lower than it had been in
2000 as it is among the general adult population. By contrast, marijuana
use among all age groups and especially among teens increased. More teen
users abused marijuana than alcohol (by 50%), and more teens abused
marijuana than tobacco (by 800%). In part, the shift in youth drug use
is due to the widespread misconception that marijuana is less dangerous
than alcohol or tobacco.

28. What are the most common social effects of

marijuana abuse?

By definition, marijuana abuse means that the user is unable to stop taking
the drug, and they continue to take the drug even when they know it is
hurtful to themselves or others. Most marijuana abuse disorders go unde-
tected because marijuana is a mild hallucinogenic that directly affects
82 Marijuana

judgment and promotes delusions of success. This causes many users to

feel like their drug use is under control and is not hurtful to themselves or
to others even when outside observers see it much differently. These side
effects can disrupt relationships that impact family, friends, and cowork-
ers or other colleagues. Like any other substance abuse disorder, mari-
juana abuse develops slowly over time, and most users do not realize that
they have become addicted until after they begin to experience serious
social consequences of their habit.

Effect on relationships
Marijuana lowers inhibitions immediately after use, and many users
believe it helps them to better relate to those around them. This is short
term. After the initial stages of impairment, marijuana usually increases
the users’ sense of paranoia—the feeling that the people near them are
somehow intending to do them harm. At this stage of intoxication, the
user often isolates themselves, and they become less sociable.
Even if users do not act less sociable, the sober people around them may
find the intoxicated user more difficult to be around. In extreme cases,
heavy doses of marijuana may induce a panic attack or hallucinations that
trigger irrational reactions. In almost all cases, the user loses the ability
to focus or communicate in a logical manner. As the effects of the drug
wear off, the euphoric effects are often replaced by a great tiredness. Some
users often fall asleep, and others with learned tolerance just slow down.
In either case, the user becomes less connected to those around them.
Daily marijuana users can learn to adapt to the drug effects and manage
to hold down jobs even if they are continually under the influence at some
level. Users can complete their daily routines and hide their impaired
thinking and motor functions by reacting more slowly and limiting them-
selves to simple tasks. Nonusers who are around them all notice the effects
of the drug even if they do not know which drug the user is taking. They
see someone who is easily confused, often quick to form illogical judg-
ments, and who makes risky choices. These behaviors usually add strain
and stress to existing relationships.

Personal and social isolation

The National Institute of Health reports that many daily marijuana users
develop amotivational syndrome, which is a general decline in personal
motivation for anything. That means that chronic users feel less urgency
to complete tasks, even when they are important to friends, family, and
Risks from Marijuana Abuse and Addiction 83

the people they love. Job and school performance usually declines, and the
user feels more isolated but tends to blame other causes rather than the
drug (which they believe is actually helping them).
Habitual marijuana users spend a lot of time trying to get, use, and
recover from the aftereffects of the drug, because marijuana dominates
most of their life decisions. The preoccupation with drug use takes time
away from other priorities, and abusers often fail to complete tasks and
find themselves letting others down. These habits prompt abusers to avoid
nonusers who do not seem to understand the importance of their drug use.
Instead, they tend to gravitate toward new friends and situations where
marijuana use is accepted.
At the same time, marijuana increases the sense of paranoia that often
prevents users from venturing into new settings with people or places that
are unconnected to their drug use. Marijuana use can stunt emotional
and academic development. Research indicates that long-term marijuana
use results in lower IQ points and lower achievement, both of which can
harm relationships with others. These behaviors increase the sense of iso-
lation, which is usually made worse by the accompanying feeling of para-
noia that marijuana stimulates.

Effects on other people

Users who suffer from marijuana use disorder often achieve lower socio-
economic status than nonusers; they tend to have increased difficulty in
academic and social settings and are also more likely to abuse other sub-
stances like alcohol or other illicit drugs. If the abuser lives in a house with
children, then the children are more likely to develop the same symptoms
of substance abuse disorder themselves. Children in such households are
also more likely to suffer from abuse or neglect and have higher rates of
mental and behavioral disorders. In 2017, one in eight children lived in
households that included one or more parents with a substance abuse dis-
order (alcohol, marijuana, or other illegal drugs). The social effects of mar-
ijuana abuse are mostly the same as any other substance abuse disorders.

29. Is there a connection between marijuana abuse and

mental illness?

There is a strong association between marijuana abuse and mental ill-

ness. Researchers are not certain whether marijuana causes initial mental
illness or if the drug merely increases the likelihood that people who are
84 Marijuana

already vulnerable will develop mental illnesses. In either case, the risk
of developing psychosis, schizophrenia, bipolar disorder, depression, or
other anxiety-related disorders increases significantly with marijuana use,
especially among young users (teenagers) and those with family histories
of mental illness.

Correlation versus causation

The National Alliance on Mental Illness reports that one-third of
patients diagnosed with schizophrenia use marijuana frequently. The
CDC similarly reports that heavy users are more likely to engage in sui-
cidal thoughts, and long-term users are more likely to develop social anx-
iety disorder, which means that sufferers become unusually anxious about
ordinary daily interactions and are constantly afraid of being judged by
others. Habitual marijuana use also increases the risk of bipolar disorder,
which is when the user swings back and forth between “up periods” of
energetic excitement and optimism to “down periods” of depression, sad-
ness, and a general lack of motivation or hopefulness.
Mood and emotions are difficult to measure biochemically, so research-
ers cannot be certain if cannabinoid reactions from marijuana cause tem-
porary or permanent changes to the central nervous system. That means
that it is almost impossible to determine if marijuana causes mental illness.
Nevertheless, there are strong correlations with mental illness. Research-
ers can measure what happens in the short term after someone takes mar-
ijuana, and these risks include sudden panic attacks or psychosis, which is
a break from reality when the user hears voices or sees hallucinations or
when the user experiences unreasonable fears (paranoia) that people are
out to persecute them. These short-term risks can be measured while they
are happening, and they almost always fade away within 24 hours, just like
the other cognitive effects of marijuana.
A 2017 Study from the American Journal of Psychiatry reported that half
of all patients who experienced marijuana-induced psychosis eventually
developed schizophrenia or bipolar disorder later. Scientists do not know
exactly how the drug affects the brain, and it is not impossible that some
permanent damage to perceptions, mood sensitivity, and judgment may
occur even after minimal marijuana use. The vast majority of marijuana
users do not slip into psychosis after a single dose of marijuana. Never-
theless, a large percentage of people who suffer from schizophrenia and
psychosis also take marijuana. There is a strong correlation, but not the
kind of evidence necessary to show causation.
Risks from Marijuana Abuse and Addiction 85

Teens who take marijuana regularly (weekly) are twice as likely to

experience mental disorders, including mania and bipolar disorder, later
in life, and female users are five times more likely to develop depression
or anxiety disorders. These statistics suggest that marijuana may be caus-
ing permanent changes to the central nervous system at some level that
researchers are unable to detect.

Anxiety and PTSD

Marijuana is frequently prescribed off label to treat anxiety disorders,
including post-traumatic stress disorder (PTSD). Most clinical evidence
suggests marijuana actually makes these conditions worse. Users think
that the drug helps relieve their anxiety issues because they feel the imme-
diate effects of euphoria, well-being, and relaxation after taking the drug.
These effects are temporary and are due to altered perceptions because
marijuana is a mild hallucinogenic. The drug cannot resolve the underly-
ing issues that originally caused the anxiety. At best, it can help the user
avoid the issue. However, if the drug is used as a tool for avoidance, then
the drug is likely compounding the problem. That is why most mental
health professionals are in strong agreement that any drug use (including
marijuana) usually makes problems of anxiety and depression worse.
Ending marijuana use may be difficult, especially for those who are
already prone to depression. Any user who develops dependency will expe-
rience withdrawal symptoms when they try to end their marijuana habit.
Symptoms include tiredness, lower energy, and worsening of depression
and anxiety. The last two symptoms can make people who already struggle
with anxiety or depression more likely to relapse into using the drug as
they attempt to avoid the withdrawal symptoms.

Treatment complications
Research reported by the American Psychological Association indicated
that patients already suffering from schizophrenia, bipolar disorders, or
anxiety disorders should stop taking marijuana to ensure more successful
treatment results. This recommendation holds true for any illicit drug or
alcohol, but marijuana is especially problematic because it creates a tem-
porary sense of euphoria and well-being that may convince the user that
all is well, even when it is not. Delusions of grandeur, which can cause
users to feel more intelligent and powerful than they actually are, appear
to linger even after the temporary effects of the marijuana wear off.
86 Marijuana

Habitual users run higher risks of permanent damage to their judgment

and ability to easily distinguish a good idea from a bad idea. These side
effects greatly undermine treatment plans that attempt to encourage users
toward more positive behavior choices. Users who take marijuana as a
form of self-medication are especially vulnerable because they usually do
not take into account family history, genetics, or childhood traumas that
may increase risk of mental illness.

30. Can marijuana use and abuse kill you?

Marijuana use does not appear to cause death directly, even if taken in
very high amounts. But the evidence is not absolutely clear on this point.
The primary psychoactive ingredient in marijuana is tetrahydrocannab-
inol (THC), and since the early 2000s, legal and illegal manufacturers
developed increasingly potent THC concentrates. Since the mid-2010s,
after the legalization of recreational marijuana use in several states, poi-
son control centers and emergency rooms have reported a spike in the
number of overdoses and questionable deaths related to THC. In addi-
tion, the number of deadly motor vehicle accidents due to THC has also
increased significantly.

Direct risk of death

For nearly 50 years prior to the 2010s, scientists frequently stated that
marijuana overdoses cannot kill the user directly. Up until the 2000s,
most marijuana was smoked, and the concentration of THC per dose
was relatively low (between 3% and 10%). After legalization of medical
marijuana in the mid-1990s, certain varieties of marijuana plants were
grown with extremely high THC levels, and by the 2010s, some of these
plants reached THC levels of more than 30%. At the same time, both
legal and illegal manufacturers began developing THC concentrates that
could contain as much 90%–95% THC. Once these products reached the
legal (and illegal) markets, the number of overdose cases and questionable
deaths increased significantly—by as much as 34% per year between 2009
and 2015.
The most common source of overdose cases come from edibles, which
have a delayed reaction time of up to an hour or more. Edibles are typi-
cally 5–20 times more potent than smoking marijuana, but because the
THC is processed through the digestive system instead of the lungs, the
effects take 60–90 minutes before they are felt. Overdoses most often
Risks from Marijuana Abuse and Addiction 87

occur because users take a little of the edible and feel no effect during
the first hour, so they take a lot more hoping to speed up the process. By
the time the THC begins to affect the central nervous system, there is
already 20–50 times more drug than the user expected, and they fall into
overdose.
Most cases of marijuana overdose symptoms include rapid heartbeat
(from 20% to 100% faster), increased anxiety, vomiting, and difficulty
breathing. In many cases, the user falls into psychosis, where they hear
voices or see hallucinations, which is usually accompanied by panic
attacks and/or intense feelings of paranoia. These overdose symptoms do
not usually include death. However, in 2014, three separate cases (two
young men and a woman) involved patients who died, and doctors could
not find any other cause except the presence of THC in their system. The
number of deaths that involve only THC use has increased every year
since 2015.
Synthetic THC (known as “K2,” “Spice,” or “Black Zombie”) was
criminalized nationally in 2017 because of its potential health risks. K2 is
not derived from marijuana, but it contains molecules that are extremely
close to THC in their shape, and so they produce the same effects as
marijuana, only stronger. Synthetic THC increases the risk of internal
bleeding, may stop breathing, lead to paralysis and seizures, and may
induce comas. In many cases, these symptoms also lead to death when left
untreated. There is little difference between synthetic THC and natural
THC found in marijuana except in the level of potency. As the potency
of THC concentrates taken from Cannabis plants continues to increase,
the risk that an overdose may cause direct death also increases. Current
researchers do not know if and when that point becomes likely, but the
possibility remains that THC concentrates used for vaping (dabs), in tinc-
tures, or in edibles may become potent enough to cause lethal overdoses.
Whether it is a Cannabis-based THC extract or a synthetic THC com-
pound, doctors do not know for certain if THC causes death or if the
overdose symptoms pushed certain people with preexisting conditions
over the edge. There are no cannabinoid receptors in the heart and lungs,
which is why most researchers claim that marijuana is never deadly. Yet if
someone already had a weak heart and the marijuana increased heart rate,
then that could trigger a heart attack. Statistics show users are 4.8% more
likely to develop a heart attack within an hour of smoking. That does not
mean that the marijuana causes heart attacks, but it certainly increases
the risk of death for people with preexisting heart conditions. Even if
marijuana overdoses do not directly cause death, there is increased risk of
death for users who already have certain preexisting conditions.
88 Marijuana

“Risk of death” versus “Cause of death”

Marijuana may not directly cause death, but there is no question that it
increases the risk of death for all users. In the same way that tobacco use
also never causes death directly, it would not be accurate to say that smok-
ing is always safe or that it does not increase the risk of death. There is
ample evidence to show that smoking tobacco increases the risk of cardio-
vascular diseases significantly, which explains why each pack of cigarettes
includes a warning from the surgeon general that smoking can kill you.
Smoking marijuana is three to seven times more likely to cause cancer
than smoking tobacco, which means that all the deadly associations of
tobacco use also apply to marijuana use.
Several studies from the 1990s and early 2000s tracked the mortality
rates of marijuana users (aged 15–49) over the course of 10 or 15 years.
When they accounted for other risk factors (such as tobacco use, alcohol
use, and family histories), most of these studies found that marijuana users
were generally at a higher risk of death by any cause than people who did
not use marijuana at all. These correlational studies are not absolutely
reliable because there may be any number of reasons for the increased risk
of death than were unaccounted for. Nevertheless, there is evidence to
support the idea that marijuana users tend to engage in lifestyles that carry
increased risks of death.
The risk of death is not the same as a direct cause of death. Motor injury
accidents are the leading cause of deaths in the United States, and there
is no noticeable difference between risk of lethal accidents from alcohol
impairment or from marijuana impairment. Both are equally deadly in
terms of auto-crash probability. A 2016 study of over 239,739 motor vehi-
cle crashes found THC increased the odds of crashing by 20%–30%, and
researchers suggested this estimate was lower than the actual risk because
an accurate record of THC is not always measured at crash sites due to the
speed at which it leaves the bloodstream). Other reports from 2019 indi-
cate that THC is found in the bloodstream of up to 40% of fatal crashes.
Other drugs are also present in these cases, including alcohol.
Marijuana users are also more likely to use other drugs. In 2020, the
United States experienced the highest number of overdose deaths ever
recorded. As of 2020, U.S. mortality reports only identify the primary
cause of death from drug overdose, and since marijuana does not appear
to cause death directly, U.S. statistics do not record the number of cases
where marijuana was also present. In other European countries, though,
all drugs are included in mortality reports, and in 2017, THC was found in
21%–38% off all fatal overdose cases. The numbers might be higher in the
Risks from Marijuana Abuse and Addiction 89

United States because marijuana is frequently combined with fentanyl,

and fentanyl is the leading cause of death in cases where more than one
drug was present.

Suicide and drug addiction

In 2014, a 19-year-old college student bought THC-laced cookies from
a legal marijuana dispensary in Denver, Colorado. He ate just part of a
marijuana cookie, and after an hour, he felt no effects, so he ate the rest of
the cookie. During the next two hours, he fell into a panic attack due to
extreme paranoia, exhibiting harsh outbursts, and eventually jumped out
of a fourth story balcony and died. The only drug in his system was from
the single cookie: 65 mg THC (which is much higher than that in a sin-
gle marijuana cigarette, but typically lower than most THC candies and
cookies, which often have 100 mg THC). The student suffered psychosis
after only one dose from the cookie. During the same year, in the same
town, a man ate some THC-infused candies, and after an hour, he also
suffered psychosis and began experiencing hallucinations, which caused
him to launch into paranoid outbursts, threatening his wife and children,
and finally prompting his wife to call the police. While she was on the
phone, he took a gun and shot her dead.
The risk of harm to others or self-inflicted death is high with any sub-
stance abuse disorder. The risk of psychosis is higher for marijuana than
some other drugs, but it is not the highest risk. Risk of self-harm is also
high when abusers try to end their addiction. One of the common symp-
toms of withdrawal is increasing feelings of depression, hopelessness, and
sadness. This can turn to suicidal thoughts, though there is no evidence
that any drug causes suicide. There are strong correlations between drug
addiction and suicidal ideas and attempts. During 2020, the same year of
record drug overdoses, the nation also experienced a record number of
suicide attempts and successful suicide deaths.
It is true that marijuana will probably not cause death directly. It is not
true that marijuana carries no risk of death. The risk of death is increased
significantly anytime an individual loses control over their judgment or
decision-making or if they fall into psychosis. These risks are increased
even further when muscular coordination is impaired. Every year, thou-
sands of people die with marijuana in their system—often as the only
substance, and more often as one of many substances (including alcohol,
opioids, and other illicit drugs). No one can know for certain whether the
victim would have made the decisions they made if they had not taken
90 Marijuana

marijuana first. As with any drug, marijuana use increases the risk of death
significantly.

31. I want to stop using marijuana. What treatment

plans are available?

The National Institute for Drug Addiction notes that patients suffering
from marijuana use disorders have, on average, been using marijuana
every day for more than 10 years and have tried to quit at least six times
before they sought treatment. Most people diagnosed with marijuana use
disorder also have other addictions or mental illnesses that can be treated
at the same time as their marijuana addiction. The internet is filled with
thousands of websites that advertise local and national addiction treat-
ment centers. These websites often provide summaries of marijuana abuse
and offer services that help users end their addictions.
The good news is that every addiction is treatable. Some of these treat-
ment plans may be completed at home, and others may require the user to
remove themselves completely from the places where they practice their
habits; these are called in-patient programs, and they typically last up
to 30 days. These are also called detox programs because they provide
a safe place for users to wait while the drugs leave their body. In some
cases, the withdrawal symptoms may be harsh and could require medical
supervision.
Most treatment centers also combine therapy sessions for other activ-
ities that help the user to break the habits and routines that were so
strongly associated with their drug abuse. Some of these programs include
cognitive behavioral therapy, contingency management, and motiva-
tional enhancement therapy. Cognitive behavioral therapy teaches users
to adopt strategies that help encourage greater self-control and discourage
the previous behaviors that led to addiction. Contingency management
is another therapeutic program that focuses mostly on specific triggering
behaviors with the goal of removing the positive rewards that typically
lead to addiction. Motivational enhancement therapy focuses more on
teaching the user to increase their interpersonal desire to change their
lifestyle so that they actively seek out sober living. Various treatments
may use one or more or all these techniques to help users overcome their
overwhelming addictive urges.
Most patients undergoing treatment will suffer relapses, when they
fail to maintain their recovery goals, and fall back into addiction. This is
Risks from Marijuana Abuse and Addiction 91

very common, even among patients who eventually live their lives free
of addiction. Most treatment centers expect their patients to relapse, so
they encourage posttreatment programs that focus on maintaining a sober
lifestyle. These programs often involve self-help groups, such as Mari-
juana Anonymous, Alcoholics Anonymous, and Narcotics Anonymous,
though other local programs may exist under different names. In addition,
patients often seek individual therapy sessions to work on the underlying
psychological issues that may have prompted the addiction in the first
place.
Unlike alcohol, cocaine, heroin, or other drugs that involve physical
addiction, there are no drugs that will relieve the withdrawal symptoms
from marijuana use disorder. Addiction to marijuana is mostly psycholog-
ical in nature; therefore, almost all treatment options require some thera-
peutic element. The most common advice offered by addiction treatment
centers is to seek help immediately if you suspect you may have a problem
or if your loved ones have indicated that you might have a problem. Early
intervention is always easier than struggling with long-term habitual use.
The Substance Abuse and Mental Health Services Administrations
provides a free website that connects users to potential treatment provid-
ers at https://findtreatment.gov/.
 Marijuana Policy and the Law

32. Why are marijuana policies so controversial?

Most therapeutic drug policies are not controversial. When a company

develops a new medicine to control cholesterol or a new drug to control
blood sugar or almost any other therapeutic drug, the general public is
always very supportive. New drugs developed to solve specific medical
problems generate very few controversies. Most drugs only become con-
troversial when there is a high risk that they may be used for recreational
purposes. Drug abuse causes harm to the user, to their families, and to
their community, and when the public suspects that a drug is highly prone
to abuse, then it is controversial. Marijuana is controversial because it is
so frequently abused.

Controversy of medical marijuana

The Cannabis plant, or marijuana, is prone to abuse. Medical marijuana is
legal in most states, but it is still used more frequently for recreational pur-
poses than for therapeutic purposes. For most of its history, the variant of
marijuana that people smoked was recognized by almost every society as
a dangerous drug because it distorted perceptions and was usually linked
to crime and vice.
The idea that marijuana may have some medicinal value came about
very late in history—mostly in the United States shortly after 1970.
94 Marijuana

The Controlled Substances Act (CSA) of 1970 classified marijuana as a

Schedule I drug, which meant: (1) it was highly susceptible to abuse; (2)
it had no current medical use; and (3) doctors did not know how to use
it for medical purposes in a safe way. The CSA grouped marijuana with
other drugs that were also likely to be abused (heroin and cocaine) and
that were not used to treat any medical condition. The Drug Enforcement
Agency (DEA) grew out of the previous Bureau of Narcotics and was
responsible for regulating all potentially dangerous drugs to ensure that
people who peddled them to the public would be caught and punished.
Not everyone agreed with the classification system of the CSA, and
pro-marijuana advocates began looking for ways to prove that marijuana
was different from the other drugs in its category. One of the main pur-
poses for researching the medical uses of marijuana was to remove the
drug from its Schedule I classification and reclassify it at some other level
(either Schedule II or Schedule III), which would allow for fewer regula-
tions and make the drug more easily available to the public. Every drug
in the Schedule I classification is most highly regulated and most likely
to lead to jail time if abused. The idea of medical marijuana was mostly a
reaction to the CSA.

Drug classification system

Doctors cannot prescribe drugs in the Schedule I category without very
specific guidelines for the purposes of research. For example, doctors do
not prescribe heroin to treat any sickness, so anyone who makes and sells
heroin would go to jail if they were caught. Doctors can prescribe other
medicines in the Schedule II category because they can be used to treat
specific conditions. If researchers could find a specific condition that mar-
ijuana could treat, then it could be moved to another category.
Most Schedule II drugs are based on narcotics (opium-based drugs
called opioids) and stimulants (like methamphetamines) and are included
in about 500 other drug combinations sold under thousands of different
names. These drugs may be just as dangerous (in some cases, more danger-
ous) than Schedule I drugs and are just as likely to lead to abuse as Sched-
ule I drugs, but they have specific medical purposes. That means doctors
can write prescriptions for them to be administered in safe and controlled
ways. Schedule III drugs are similar to Schedule II drugs except that they
are less likely to be abused (less likely to lead to addictions or to be sold
through illegal drug dealers for recreational purposes). Schedule IV and
Schedule V drugs are least likely to be abused, but they are still controlled
by doctor’s prescriptions.
Marijuana Policy and the Law 95

The main difference between Schedule I drugs and all the others (II,
III, IV, and V) is that Schedule I drugs are not given out to the public as
medical treatments, and so their use and distribution is highly regulated
by law enforcement. Drugs in the other Schedules (II, III, IV, and V)
all have some medical use, so they are regulated mostly by doctors and
pharmacists through the use of prescriptions. Law enforcement often gets
involved with regulating Schedule II and III drugs, but only when the
drugs are sold illegally through underworld dealers without a prescription.
The illegal market for legally prescribed drugs is the leading source of drug
abuse in the United States.

The Tenth Amendment and marijuana legalization

As of the early 2020s, the federal government continues to classify mari-
juana as a Schedule I drug, which means it is illegal to sell or prescribe for
medical purposes at the federal level. In 2018, Congress passed the Hemp
Farming Act, which allowed farmers to legally grow Cannabis for canna-
bidiol (CBD), but not for its tetrahydrocannabinol (THC). Since then,
marijuana farmers can legally grow the hemp variety of Cannabis as long
as the psychoactive element (THC) is below 0.3%.
The federal government can decide if some products are legal or illegal,
but most law enforcement is actually conducted at the state level. Since
1996, beginning with California, various states passed laws that legalized
Cannabis for medical use. Since 2012, some states (beginning with Colo-
rado and Washington) also legalized marijuana for recreational use. These
state laws violate federal laws, but since most law enforcement for drug
violations occur at the state level, states can choose for themselves what
to enforce. The Tenth Amendment to the U.S. Constitution says that
any power that is not specifically given to the federal government is left
to the state governments. Since marijuana production is not listed in the
Constitution, that means that states can decide for themselves if it is legal
or not.
That means California may allow someone to legally set up a marijuana
retail shop, but that retailer may still be violating federal laws. The fed-
eral government has told states that they will not send drug enforcement
agents into states where the drug is legal. However, if the retailer attempts
to sell their products to other states or if buyers try to transport the drugs
over state lines, then the federal government can arrest them.
The fact that marijuana is only legal in some states, and only for some
purposes, makes marijuana controversial in terms of the law. Banks who
operate in multiple states fall under federal jurisdiction. They do not want
96 Marijuana

to loan money to marijuana businesses, even if they are legal in a certain

state (like Colorado, for example), because the federal government may
seize funds or prosecute transportation if the product crosses state lines.
Also, since bankruptcy laws are all handled at the federal level, marijuana
businesses cannot claim bankruptcy if their business collapses. Investing
in marijuana business carries a heavy risk.

Legal controversies
Why is marijuana still illegal at the federal level as a Schedule I drug if
so many states have passed laws declaring marijuana has some medical
use? Marijuana may be used to treat certain medical conditions, but it is
not the preferred treatment for any condition. Marijuana is controversial
because many people do not believe that legalization of medical marijuana
is actually intended to help medical treatments. Most opponents believe
medical marijuana is a stepping stone toward legalizing recreational mar-
ijuana. Statistically, even in states where marijuana is legalized for med-
ical use, most users still take marijuana primarily as a recreational drug.
The idea that marijuana provides genuine therapeutic treatment remains
highly controversial.
There are very well educated people on both sides of the debate. On one
side, advocates for more relaxed drug laws usually follow three different
lines of argument. The first line argues that drug laws do not stop drug use.
Law enforcement agents can send people to jail, but that does not always
ensure that abusers are receiving the help they need to end their addiction.
They also claim that marijuana is so frequently abused that criminalization
leads to too many people going to jail. Instead, these advocates believe
marijuana should be legal and the money that is currently spent on law
enforcement should be used to support addiction treatment centers.
The second line of argument in favor of legalization says that states
can earn much money if they tax marijuana sales. The added tax revenue
would more easily fund drug treatment centers for those who develop an
addiction. The third line of reasoning argues that marijuana is mostly
harmless, and if it is harmful, then it only hurts the individual using it and
not the people around them. This line of argument often also supports
legalizing recreational use in the same way that alcohol is legalized.
Opponents of marijuana legalization argue that medical marijuana is
just an excuse to open the pathway to popularizing the drug as a first
step toward complete legalization of marijuana for recreational use. As
a matter of historical trends, states where recreational marijuana is legal
usually began the process by first legalizing it for medical use. In Oregon,
Marijuana Policy and the Law 97

for example, legal medical marijuana in 1998 eventually led to legal rec-
reational marijuana in 2014, and six years later, in 2020, the public voted
to legalize small amounts of any drug for personal use (such as heroin,
cocaine, methamphetamines, or other addictive Schedule I and II drugs).
The movement to legalize medical marijuana is controversial because
people who oppose recreational drug use worry that medical legalization
is just the first step to full legalization.

Culture war
Those who oppose legalizing recreational drug use argue that drug abuse
always harms the community and society at large. Drug addiction is not a
“victimless” crime because it hurts three groups of people. First, it harms
the user directly. Even if the drug is not deadly, drug addiction increases
medical costs overall because drug dependency causes users to neglect
other aspects of their health, and users are more likely to fall into disease.
Second, drug addiction harms the families of drug addicts who also suffer
neglect and may suffer direct physical or psychological abuse as a result of
the addiction. Houses with substance abuse typically have access to fewer
available resources. Last, addiction also harms the community of the drug
addict, because the user is removed as a productive member of society
and is more likely to turn to crime to support their habit. Drug users may
feel like they are only hurting themselves, but no one is completely alone
in society, so a single person’s drug use can indirectly affect thousands of
people in their community.
The debate over marijuana is part of a larger culture war between groups
of people who hold conflicting values about the importance of individual
accountability, productivity, and the role of government oversight.

• Those who oppose marijuana legalization tend to believe that mar-

ijuana is a dangerous drug that the society needs to maintain some
control over.
• Those who support marijuana legalization usually believe that mar-
ijuana is harmless and that there are more important issues that the
government should focus on instead of drug enforcement.

Those who want stronger drug enforcement laws believe that the gov-
ernment must actively protect individuals, families, and society from the
dangers of drug addiction. Those who want more relaxed drug laws usually
believe recreational drug use is a private matter and that the government
should regulate the activity through taxation rather than criminalize it.
98 Marijuana

Whether or not a government legalizes drug use says much about the
values a society most tries to preserve and protect, and since the 1990s,
there has been considerable political controversy between these different
cultural viewpoints.

33. When did marijuana (and hemp) become restricted/

prohibited by law?

The marijuana plant (also known as the Cannabis) has been cultivated for
almost 5,000 years. That does not mean people have been smoking and
using marijuana freely as a drug for thousands of years or that it has only
been regulated or criminalized recently. Marijuana use has almost always
been limited to the fringe elements of any society.
For most of its history, only the less-psychoactive varieties of Cannabis
plants were cultivated as hemp and grown exclusively for textile purposes
(to make rope and cloth). Hemp farmers in the 1700s did not use or sell
their crops as a drug. Only a small variety of Cannabis plants were grown for
their psychoactive effects as a drug, and these crops were much more limited
in scope and rarely cultivated beyond that required for a single individual.
With few exceptions, until the 19th century, marijuana was mostly used as
a drug only for ceremonial or ritualistic purposes in limited areas around the
world. Most people in Europe and the United States, the common workers
or farmers or people in business, rarely even knew that marijuana was a drug
or how it was used. Hemp farmers were not drug farmers.

Hemp textile
The Cannabis plant comes in two main varieties, and for most of its his-
tory, the nonpsychoactive variety was cultivated as a crop called hemp.
The earliest examples of string or rope or cloth came from natural plant
fibers. Flax was most common and was used to make linen as early as
30,000 years ago, which was more than 25,000 years before the first cities
or civilizations (or the discovery of bronze and writing) were developed.
Ancient hunter-and-gatherer societies picked grasses, took bark off trees,
or used the leaves of certain plants and rolled them out into long thin
fibers. These were intertwined into string, which was then knitted (and
eventually woven) together to form cloth. Flax was used first; then cotton
came a few thousand years later. Wool from sheep was not used until they
were domesticated around 5,000 years ago, and China first cut open the
cocoons of silkworms to extract silk threads around the same time.
Marijuana Policy and the Law 99

The first archaeological evidence of Cannabis plants being used for tex-
tiles dates from around 4,800 years ago in China. The use of hemp spread
from China to the Middle East and Egypt and then to Europe within a
span of few hundred years. The ancient Greeks were familiar enough with
hemp cloth that they coined the word Cannabis to describe the plant.
Cannabis is also the root word for canvas.
During the modern era, hemp was legal because it was not viewed as a
drug. When the psychoactive variety of marijuana became more widely
abused as a drug in Western nations, then all Cannabis plants fell under
more strict controls. By that time, synthetic fibers replaced hemp as the
main source of textiles, so all varieties of Cannabis were limited to avoid
confusion, since they look similar to each other.

Marijuana use as a drug

The earliest archaeological evidence of marijuana grown for its use as a
drug was discovered in the tomb of a shaman in China around 2,800 years
ago. Drug use existed in ancient times, but alcohol was much more com-
monly available. The fermentation process that creates alcohol is almost
unavoidable and occurs anytime sugar and grains are mixed together and
allowed to sit in the sun for any length of time. Wine, beer, and other
intoxicating drinks emerged shortly after the development of agriculture,
about 10,000 years ago. Drugs also existed, but drinking alcohol was the
most common way that any people became intoxicated.
From the earliest times, every society has made a distinction between
alcohol and drugs and treated each differently. Safe use of drugs requires
special knowledge of unusual herbs, and their effects were often unpre-
dictable. For example, certain mushrooms in meso-America produce
hallucinations, while other mushrooms in the same vicinity can kill you
immediately, and still others have no effect at all. These sorts of dan-
gers forced even the most primitive societies to limit drug use to certain
specialized individuals who were trained (or experienced) in identifying
proper roots, herbs, and other poisons. These people were known as sha-
mans or witch doctors or some other word to describe a person with spe-
cial mystical knowledge. There is very little evidence of significant drug
abuse in any ancient or premodern society.

Real doctors versus fake doctors

The line between healer and magician was very thin in the earliest eras
of medicine. Most shamans or healers combined their herbs and potions
100 Marijuana

with spells and incantations. The first Chinese emperor Qin Shi Huang
was prescribed a potion of mercury, gold, and other ingredients that was
supposed to let him live to be hundreds of years old. Of course, he died
immediately because mercury is very poisonous. Ancient shamans used
many types of drugs, but they did not really understand what the drugs
were doing to people.
The ancient Greeks were the first to treat medicine as a practice that
did not require religious formulas. Hippocrates wrote down careful obser-
vations of the effects of certain herbs and potions and even experimented
with various treatment options. Though he never mentioned Cannabis,
his list of herbs included poppy seeds (source of opium) as a pain reliever
and other practices like massage therapy, exercise, and healthy diets to
avoid disease.
Doctors did not really understand the internal functions of the human
body (like blood circulation) until the 1700s. Nevertheless, the scien-
tific revolution and other innovations of the 1800s sparked strong public
interest in finding chemicals and treatments to heal any ailment. The
public believed new medicines could potentially cure anything.
Unfortunately, the hope for scientific success was faster than actual
scientific understanding. During most of the 1800s, certain opportunistic
doctors and unscrupulous scam artists took advantage of public excite-
ment for medical miracles to sell magic cures. The fake salesmen traveled
from town to town peddling tonics, ointments, or powders to people want-
ing miracle cures. These concoctions usually contained high amounts of
alcohol, so the user felt some effect, but they were rarely effective. In
some cases, the potions included strychnine or opium or other potentially
dangerous chemicals like radium that made users sick (and sometimes
die) after taking them. As real science became better understood, these
fake-science salesmen faced increasing public criticism, resulting in new
laws criminalizing the abuse of medical drugs.

American drug enforcement

By the start of the 20th century, widespread immigration and increasing
global trade created very large cities throughout the major ports of the
United States, which prompted the federal government to pass more laws
to protect urban centers. In 1906, the Pure Food and Drug Act outlawed
the interstate transport of unsafe foods or illegal drugs. In 1906, though,
doctors still did not completely understand which drugs were safe and
which were prone to addiction, so few drugs were actively regulated.
Marijuana Policy and the Law 101

During the American Civil War, doctors used opium (and morphine)
to relieve pain from traumatic injuries, and many soldiers who were given
morphine in the hospital developed an addiction after they returned
home. Drug abuse was a relatively rare problem in the 1910s, but it had
become serious enough to warrant more federal action. In 1914, the Har-
rison Narcotics Act regulated the interstate sales of opium and cocaine.
It only required opium and cocaine importers to register, pay a tax, and
to track where the drugs were distributed. However, if doctors gave out
drugs for nonmedical uses, then both the doctor and the user could go to
jail. Many clinics were shut down, and people were sent to federal prison
for drug violations. Nevertheless, drug abuse was still mostly limited to
urban areas, and federal laws had little impact on cities and their police
departments.
Alcohol was always the most popular means of intoxication, and after
World War I, the nation experimented with a national reform movement,
outlawing the sale and manufacture of alcohol, called Prohibition. During
the 1920s, most Americans stopped drinking, but there were many exam-
ples of drinking at illegal bars called speakeasies in urban areas. Speak-
easies became a central location for other illegal activities, including
gambling, prostitution, and drug use—mostly, opium and cocaine, but
after the war, an increasing amount marijuana also came in from Mexico.
Hollywood films during the 1920s frequently told stories of alcohol and
drug abuse in urban settings. This increased public support for prohibition
among rural folks, but it also created an impression of a wild “jazz age” in
urban settings. Most of the public pressure for reform was directed toward
alcohol during the 1920s, but there was also a growing awareness of a
potential drug problem as well.

Marijuana enforcement
In the midst of Prohibition, medical doctors continued to develop new
drugs. Amphetamines were discovered in the late 1880s but were not
widely developed as a stimulant and possible treatment for asthma until
the 1920s. Doctors were still uncertain as to exactly what amphetamines
did to the body, so during the 1930s they were prescribed for anything
from depression, weight gain, morning sickness, and narcolepsy to even as
a treatment of postintoxication hangovers.
Prohibition of alcohol was overturned at the federal level in 1933, but
many rural towns and counties continued to outlaw alcohol (some even do
so today). Alcohol could be consumed without intoxication, and public
102 Marijuana

reformers focused instead on marijuana and other drugs that always pro-
duced intoxication. The Federal Bureau of Narcotics was created in 1930
to enforce the laws that regulate the illegal use of opium and cocaine.
They were also the first national agency to notice the association between
marijuana and the criminal underworld, because it was often used and
sold at speakeasies.
Since it was previously used mostly in Mexico, southwestern border
states began passing laws regulating and criminalizing marijuana. The
Bureau of Narcotics proposed legislation to heavily regulate the growth,
manufacture, and sale of marijuana at the federal level. The Marihuana
Tax Act of 1937 placed very heavy regulations on Cannabis, eventually
leading all states to ban the drug as an anti-crime measure.

The 1950s’ pharmaceutical revolution

After World War II, new antidrug laws were passed that carried strong
sentences for dealers who illegally sold drugs for nonmedical purposes.
Opium, cocaine, heroin, and marijuana were targeted most. By the late
1950s, these laws were changed to also include illegal use of amphetamines.
At the same time, after the war, the medical community shifted from
research into wartime traumas to peacetime family practice. In the early
1950s, scientists finally understood how to isolate and synthesize hor-
mones to provide new treatment options for hundreds of conditions, from
heart disease to diabetes, cancer, and reproductive and development dis-
orders. Doctors were suddenly able to give pills to cure ailments that had
previously been untreatable.
During the 1950s, medical psychiatrists developed new sedatives to
cope with depression and mental illnesses. They also experimented with
new treatments for schizophrenia using the hallucinogenic properties of
certain mushrooms. This resulted in the invention of lysergic acid dieth-
ylamide (LSD) and later phencyclidine (PCP), which were intended to
treat psychological disorders. Each new medical development also created
new opportunities for abuse, when the drugs were used for recreational
instead of medical purposes.

The “War on Drugs”

The post–World War II baby boomers reached adulthood during the
1960s and began experimenting with recreational drug use more than any
previous generation in history. The growing drug culture reached national
attention, and the 1963 Presidential Commission on Narcotic and Drug
Marijuana Policy and the Law 103

Abuse recommended less emphasis on police enforcement and more focus

on drug rehabilitation. More federal resources were devoted to treating
drug addiction and less to law enforcement.
The number of baby boomers experimenting with illegal drugs contin-
ued to rise, and by 1969, Richard Nixon launched a successful campaign
on the promise that he would reduce public access to dangerous drugs
and more actively enforce existing drug laws. He was the first president
to call for a “War on Drugs.” During his first term, Congress passed the
Comprehensive Drug Abuse Prevention and Control Act of 1970, which
included the Controlled Substances Act (CSA).
The CSA replaced all preexisting federal drug laws and created a
new system for classifying drugs according to their risk of being abused,
their usefulness as a medical treatment, and their ability to be prescribed
safely. Marijuana was listed as a Schedule I drug along with cocaine and
heroin, because it was highly prone to abuse and was not currently used
as a medical therapy for any condition. Any use of Schedule I drugs was
considered abuse, because they had no medical value. The Bureau of
Alcohol, Tobacco, Firearms and Explosives (ATF) was also created to
enforce regulation of these laws. In 1973, the Drug Enforcement Agency
(DEA) was created specifically to concentrate on fighting the War on
Drugs.
During the 1980s, President Reagan redoubled efforts to crack down
on illegal drug use, with greater attention to keeping schools free from
recreational drug use. Shortly after the United States adopted a national
approach to drug enforcement, British lawmakers also adopted a similar
strategy. The British Misuse of Drugs Act established similar classification
systems in 1971.

Conclusion
Marijuana has been cultivated since ancient times, but it has never been
used by a large percentage of any population. Drug abuse was largely
unknown as a social problem until the rise of global trade routes and
new large industrial cities during the 18th and 19th centuries. Cannabis
grown for rope, cloth, and other textiles was legal, but marijuana used for
recreational drug purposes was always limited by social pressures. Mari-
juana was eventually outlawed along with other drugs that were abused
for nonmedical purposes as soon as they became noticeable as a social
problem in urban areas. The modern American movement to legalize rec-
reational drug use (including marijuana) is unique. As of the early 2020s,
it is unclear what the long-term results of such laws will be.
104 Marijuana

34. My state legalized marijuana, so can I still get arrested

for using, growing, buying, or selling it?

Many states have passed laws that legalize marijuana for medical use and,
in some cases, for recreational use. The Tenth Amendment to the U.S.
Constitution allows states to decide for themselves how to deal with
matters that are not explicitly provided for under other sections of the
Constitution. Drug enforcement and most other criminal codes are not
explicitly mentioned in the Constitution, so states are left to decide how
to handle these issues.
That means that each state establishes its own rules and criteria for
growing, selling, or using marijuana. Almost all states require growers to
register and pay a tax to obtain a grower’s license. States that only allow
medical marijuana require users to see a doctor to be screened before they
can receive a prescription (or, in many states, a marijuana card). In states
where recreational use is legal, users must be over the age of 21. These
provisions are common, but each state may choose to change or modify
specific requirements whenever they like.
Users may still be arrested for marijuana even if they live in states
where Cannabis is legal. If only medical marijuana is legal, then users
without a doctor’s prescription or without their marijuana card may face
fines. Depending on the state, underage users or anyone barred from using
marijuana due to criminal convictions, court injunctions, or some other
reason may also be prosecuted for taking marijuana—even if recreational
marijuana is legal in their state.
Some states, like California, Oregon, and Nevada allow users to grow
and use marijuana without a grower’s license as long as it is intended for
personal use. Almost every state, though, requires retailers to register and
pay taxes for the right to commercially sell Cannabis in any form. Most
states will prosecute illegal sellers who provide marijuana or other THC
extracts without authorization. Illegal vendors are routinely arrested in
California for failure to abide by the registration process, pay licensing
fees, or for selling their products without checking age or other restrictions.
Marijuana may be legal in your state, but growing marijuana for drug
purposes continues to be illegal at the federal level. As of the 2020s, it
was still classified as a Schedule I drug, which means it is highly prone
to abuse, it is not currently used as therapeutic treatment, and there are
no established medical protocols in place to ensure it can be used safely.
The 2018 Farm Bill allowed farmers to grow Cannabis for its cannabidiol
(CBD) content because the FDA approved a CBD extract (Epidiolex)
Marijuana Policy and the Law 105

as a treatment for two rare forms of epilepsy that affects very young chil-
dren. However, under the Controlled Substances Act of 1970, marijuana
remains illegal to buy, sell, or grow for its tetrahydrocannabinol (THC)
content without specific authorization for select growers to cultivate and
use it for research purposes.
Generally, the federal Drug Enforcement Agency (DEA) does not pursue
and arrest marijuana cases in states where marijuana is legal. This policy
depends on the directives of the current presidential administration. In 2013,
under President Obama, the U.S. deputy attorney general issued a memo
stating that federal agencies would not prosecute marijuana cases. In 2018,
under President Trump, the Department of Justice (DOJ) issued another
memo stating that it would enforce all federal laws regarding marijuana. In
2021, under President Biden, the DOJ rescinded their previous memo. In
any administration, anyone who tries to transport marijuana across state
lines is considered a drug trafficker and is liable to arrest and prosecution.

35. Is it illegal to buy marijuana products online?

Marijuana remains illegal at the federal level, and any transport of illegal
drug products over state lines is a form of drug trafficking. If the online
retailer resides in another state, then they (and you) could be liable to
prosecution if the drug is shipped across state lines. Marijuana retailers
who use the internet to advertise may deliver products within their own
state, and (depending on the state), such purchases could be legal.
Each state chooses how to regulate marijuana, whether for medical use
or for recreational use. Typically, in states where medical marijuana is
legal, users must be able to demonstrate to online retailers that they are
legally able to use the drug. The same is true for recreational use of mari-
juana. It is very difficult to prove that an online buyer is over 21 years of
age, so most legal marijuana dispensaries do not provide online options.
Nevertheless, some states (including Arizona, California, Colorado, and
New York) allow marijuana delivery services to people with approved cer-
tification and identification.
Marijuana products that do not contain tetrahydrocannabinol (THC)
may be legal at the federal level and often do not require any medical pre-
scriptions or age requirements. Products that contain cannabidiol (CBD)
or textiles made from hemp do not contain more than 0.3% THC and are
legal at the federal level and in almost every state. These are often legally
available online.
106 Marijuana

The FDA warns users that online retailers are unregulated. That
means there is no guarantee that any drug or supplement will contain the
advertised ingredients. Consumers cannot easily analyze CBD and other
marijuana-derived products to determine quality or effectiveness. Many
products advertise themselves as “hemp” or “cannabis derived” but may
not actually contain any marijuana or cannabinoid elements. In other
cases, online retailers may try to sell actual marijuana products that are
illegal. Consumers always take a risk when they purchase products online,
but the risk is increased if they unintentionally buy illegal products that
cross state lines, which could trigger federal and state law enforcement.

36. Has legalization of marijuana ended

the illegal drug trade?

In theory, legalizing marijuana would end the illegal drug trade because
users could buy their marijuana through legal dispensaries and not have to
risk arrests, poor quality, or violent encounters with criminal drug dealers.
In practice, however, in every state where marijuana has been legalized,
the illegal marijuana trade has increased (not decreased).
The reasons are simple. Legal marijuana is usually more expensive than
illegal marijuana. States that legalize marijuana use for medical or recre-
ational use always include some process for controlling the growth, dis-
tribution, and sale of the drug. Just like buying or selling alcohol requires
special licenses, so too growing and selling marijuana (and other mari-
juana products) all require licenses. This increases the price. In addition,
retailers also pay for advertising and the retail storefront. Adding all the
taxes and fees together, the final user pays as much as three to four times
the original price. Colorado collected $1.6 billion from marijuana sales
between 2014 and 2020. Illinois collected $175 million in 2020 alone.
That means that buyers in Illinois spent $175 million over and above the
actual price of the product.
In 2021, the California legislature considered a $100 million bailout
plan to help legal marijuana sellers compete. California’s United Canna-
bis Business Association reported there were three times as many illegal
suppliers as legal ones. The Massachusetts Cannabis Commission reported
that about 80% of the states’ marijuana sales occurred illegally in private
clubs where home-growers brought their supplies to sell to other users. In
every state where recreational marijuana was legalized, the illegal mari-
juana trade has increased.
Another reason why legalization does not decrease illegal sales is
due to the nature of marijuana. It is highly susceptible to psychological
Marijuana Policy and the Law 107

addiction. Since legalization, marijuana has become more potent, and the
number of marijuana products has increased significantly. As marijuana
becomes more socially acceptable, the frequency of use also increased.
Between 1992 and 2014, the number of daily marijuana users increased
772%. Between 2014 and 2020, after recreational legalization, the num-
ber of daily users increased 200%. The demand for a drug increases as the
rates of dependency and daily use increases. If prices are higher at legal
retail shops than they are through illegal dealers, then buyers usually go
to the dealers.
When fewer resources are dedicated to drug enforcement, then there are
also fewer police available to crack down on illegal dealers. As rates of mari-
juana use continue to increase nationally, the overall demand for marijuana
increases locally. This increases the rate of interstate marijuana trade (which
is always illegal). As the number of legal users in one state grows, the demand
for marijuana spills over into neighboring states where marijuana is illegal.
Washington and Oregon legalized marijuana early in the 1990s (medical
use) and 2010s (recreational use), but Idaho did not legalize marijuana for
either use. Idaho reported a 665% increase in marijuana seizures in 2017,
the year after Oregon made it easier to open legal marijuana shops. In 2020,
there were three times as many marijuana shops in Oregon as there were
McDonald’s fast food restaurants, so marijuana use increased significantly
across the state. The high demand for and use of marijuana in Oregon then
spilled over to neighboring Idaho, where marijuana remains illegal. The ille-
gal trade between states, and the illegal market in Idaho also increased.
Advocates for marijuana legalization argue that if marijuana was legal in
every state, then the demand would balance out between regions and ille-
gal markets would decline. Opponents for marijuana legalization argue that
increasing use of marijuana creates an increase in demand, and unless mari-
juana is given out free, the legal markets will always be more expensive than
illegal dealers. Opponents also argue that marijuana users also use other drugs
that are not legalized (especially opioids and amphetamines). If the national
demand for legal marijuana increases, then the illegal drug trade also increases
overall. Statistical evidence supports the claim that legalization of any drug
(including marijuana) also increases the demand for all drugs.

37. How does marijuana policy reflect current political or

moral ideologies?

A nation’s drug policy reflects more than just medical concerns. There are
also moral and social issues that raise ethical questions that do not always
lead to easy answers.
108 Marijuana

In terms of medical policy, the basic questions are these: How does a
country ensure its citizens have access to drugs that are safe and reliable?
How do lawmakers ensure that unsafe or dangerous drugs are kept away
from those who are not informed enough to know better, like children?
In a free society, we also consider questions that recognize individual free-
dom. Should patients be allowed to experiment with drug treatments,
even if the drugs are dangerous (or involve some risk)? Should others be
allowed to experiment with drugs even when they are not sick? What are
the social costs of recreational drug use? Questions of liberty also spark
corresponding questions of civic responsibility. What are the costs to soci-
ety if my recreational drug use prevents me from serving as a productive
member? Is it fair to the rest of society if my recreational activity creates
burdens that other people must pay for, like increased health-care costs,
law enforcement costs, or mental health costs?
When making or changing drug policies, lawmakers must consider the
collective values and priorities of the people who voted them into office.
The answer to these questions is not easy, but whenever we make a law
that relates to drug use, we are answering them. If our marijuana policies
begin to change, then that means that our nation’s political and moral
ideologies are also changing.

Drug use and culture war

Federal and state marijuana policies are part of a larger cultural war
between opposing political and moral ideologies. An ideology is a set of
values that people use to answer difficult questions, like the ones above.
Political ideologies refer to the values that people hold with regard to the
government. Should the government mostly focus on what you are not
allowed to do? Or should it focus more on protecting the rights of what
individuals are allowed to do? For drug policy, that means asking whether
the government should forbid all dangerous drugs or whether it should
provide people with enough information about the dangers of particular
drugs to make their own judgments? Other questions ask whether the fed-
eral or state governments have moral authority in enforcing drug laws or
in deciding whether marijuana is legal and in what forms.
Moral ideologies refer to the way we decide those boundaries between
individual freedom and individual responsibility. Do my actions hurt oth-
ers? How do my actions reflect my personal character? Should I follow
social rules even if I do not want to? In terms of drug policy, that means
asking whether legal recreational drug use creates bad examples for chil-
dren, leading them to making bad choices that hurt their character. Does
Marijuana Policy and the Law 109

legalizing marijuana make the society less polite, less respectful, and does
it make people less likely to exercise personal self-restraint? Does the gov-
ernment have an obligation to protect the nation’s moral health? Peo-
ple have different answers to these questions based on their political and
moral ideologies.
Theoretically, there could be as many different viewpoints as there are
individuals, but as a practical matter, most people tend to gravitate toward
groups that they agree with. In the 21st century, the United States has
become polarized on matters of political and moral values, which means
that most people tend to fall on one side or another of two main divisions,
and there are fewer people who fall in between. Political parties (Demo-
crats, Republicans, or independents) are voting groups that share agree-
ment (mostly) on certain political values. Religious affiliation (Christian,
Jewish, Moslem, Agnostic, Atheist, etc.) usually represents shared moral
convictions—different religious denominations often agree on many of
the same principles, but not always. In a democratic society, people are
usually drawn together by both their political and moral values to form
alliances that increase the power of their collective votes.
When the main election issues are social or moral based, then polit-
ical affiliations are less important than shared moral or economic val-
ues. Sometimes Democrats join with Republicans on moral issues (like
abortion, gender issues, or drug policies), yet remain divided on other
political issues (like whether laws should be state based or federal based).
In a polarized society, the exact nature of the two opposing sides is hard
to define because they might include similar political parties, religious, or
other affiliations. Nevertheless, the cultural divide can be very strong, and
if it is divided mostly along moral lines, then that is called a culture war.
Marijuana policy is part of the larger culture war because questions
about whether or not people should be allowed to take drugs for recre-
ational use are moral based. These policies may involve related questions
about medical safety or health needs, but at the root, the decision to legal-
ize or criminalize marijuana reflects values about individual freedom and
the importance of moral choices. If the nation shared a common consen-
sus on moral issues, then marijuana policies would not be controversial.
However, when these questions are presented to lawmakers in a polarized
society, they draw vocal debates from all groups.

Morality of recreational drugs

Recreational drug use is a moral question mostly because drugs change
the way people behave and think. A drunk person cannot think clearly,
110 Marijuana

making it difficult for them to distinguish between a good and bad choice.
The same is true when a user gets high on marijuana—their judgment is
confused, and their inhibitions are lowered. From a moral perspective,
people who are intoxicated (from any drug) are less able to restrain their
actions and to make moral choices. Some of the moral issues involved with
legalizing marijuana are that it may undermine society’s moral health.
Alcohol is legal in every state for users over the age of 21. Recreational
marijuana is legal in only some states. Both alcohol and marijuana can
impair moral reasoning while under the influence. Yet unlike alcohol,
marijuana also stimulates a sense of euphoria and is a mild hallucinogenic.
The user may not realize that their judgment is impaired, and they may
even feel confident about their risky decisions after they are no longer
high.
Supporters of legal marijuana argue that the damaging effects on moral
reasoning are always temporary and are no more dangerous than the
intoxicating effects of alcohol. They argue that if alcohol is legal under
controlled conditions (for adults over age 21 who are not driving), then
marijuana should also be legal under similar constraints.
Opponents argue that marijuana is very different from alcohol. First,
users can drink alcohol at low levels without ever becoming drunk, while
a marijuana user will always be impaired after each use. Second, drunk
users may make a poor decision, but the next day, they will feel bad about
it. Because of its mild hallucinogenic effects, a user high on marijuana
may not realize they made a poor decision even after they have sobered
up. Some research suggests marijuana may permanently impact moral rea-
soning, though more research is needed to answer the question with cer-
tainty. The root moral question is whether or not it matters that someone
chooses to impair their moral judgment. It is at that level that most people
are divided on the question of legal marijuana.

Morality of drug habits

Recreational drug use can also impair moral judgment by creating bad
habits. Users who are trained to seek out instant gratification rather than
commit themselves to the hard work required to achieve longer-term sat-
isfaction are developing habits that avoid personal self-restraint.
Opponents to recreational drug use argue that it is immoral to pursue
pleasure for its own sake without also developing a corresponding sense
of responsibility to balance it out. If marijuana users take the drug to seek
pleasure to avoid taking responsibility, then it produces moral problems
that affect society as a whole. If many members of a society chose to avoid
Marijuana Policy and the Law 111

problems, then the problems would increase with fewer people able to
solve them.
Supporters of recreational drug use argue that individual decision-making
is unconnected to social responsibility. They argue that there are many
different views on morality, and society should not impose a single moral
code on any individual. Instead, the only consideration is whether drugs
pose specific health risks and immediate threats to others. If a drug addict
chooses to drop out of society, then it is their decision alone and does not
harm anyone else.
The debate about individual freedom creates another issue. If rec-
reational drug use is always freely chosen, then it only affects the user.
However, drug use often leads to drug addiction. By definition, substance
abuse means the individual user has tried to quit and is unable to do so.
Therefore, an addict does not have the freedom to say no to their drug
temptations. Addiction is very common with drug use because drugs help
people avoid immediate problems. Behavioral psychologists argue that
most addictions are caused by users who are faced with difficult situa-
tions but then develop habits of escape. The temporary effects of using
the drug (or other addictive behavior) help the user forget and avoid the
difficult underlying issue. Addiction of any kind (drugs or gambling or
pornography) almost always impacts personal relationships and job per-
formance because the user becomes obsessed with using and avoids diffi-
cult problem-solving.
For many people, there is a moral difference between recreational drug
use and substance abuse. Not all recreational drug use leads to addiction,
but substance abuse always begins with recreational drug use at some
point. Casual use turns into an addiction when the user develops a habit
of instant gratification, which makes other longer-term alternatives more
difficult to follow—even if the alternative path is safer and healthier to
self and to others. Those who oppose legal recreational marijuana use
usually also oppose other forms of recreational drug use. They tend to
emphasize the dangers of addiction and argue that users do not make free
choices when they are enslaved by the overwhelming desire to take their
drug. They point to criminalization and drug treatment programs as two
methods for protecting the public from dangerous substances.
Those who oppose recreational drug use on moral grounds argue that
bad habits will result in bad addictions. Those who support recreational
drug use argue that such moral decisions should always be left to the
individual alone. That is why supporters mostly focus on the immedi-
ate euphoric experience of the drug and rarely emphasize the dangers
of impaired judgment or the social costs of addiction. Some marijuana
112 Marijuana

supporters do not believe marijuana carries any danger at all. Instead, they
focus their arguments on the consequence of criminalization and how
imprisonment affects individual opportunities and community dynamics.

Historical trends
The baby boomer generation is neither mostly on one side nor the other
of the culture war. The same generation that first experimented and pop-
ularized marijuana use during the 1960s was also the same generation that
launched President Reagan’s “War on Drugs” campaign during the 1980s
to protect their children. Baby boomers are strongly involved with both
Democrat and Republican Parties, they are in religious churches (Cath-
olics, Protestants, Jews, Muslims, etc.), and they are also in the nonreli-
gious groups. They do not reflect any single ideology but are themselves
divided along larger cultural lines.
Nevertheless, the baby boomer generation helped bring a wide variety
of moral questions for political debate, which eroded the previous moral
consensus. During the 1960s and 1970s, the parents of the baby boomers
shared strong concern that marijuana and other drugs were threatening the
potential of younger generations. During the 1980s, they aligned with the
moral conservatives within the baby boomer generation to preserve the
cultural moral values of individual self-restraint and civil responsibil-
ity. This coalition resulted in a strong antidrug campaign based on law
enforcement that significantly lowered drug use among teens, and it rep-
resented more traditional views of morality and politics.
During the same period, however, the moral and social liberals within
the baby boomer generation promoted alternative cultural values of col-
lective responsibility, social egalitarianism, and increased government
support for shared social resources. They did not support the antidrug
campaign and publicly condemned the increased rate of drug arrests and
incarceration among inner-city youth. The shift from Reagan and Bush
administrations to the Clinton and the later Obama administrations also
reflected a shift in these cultural coalitions, resulting in greater divisions
between Republicans and Democrats on most moral issues. By the 2010s,
Republicans and Democrats were mostly on opposite sides on the issue of
drug enforcement policies.
At the same time, religious affiliation generally declined between the
baby boomer generation and their children and grandchildren. Among
the post–baby boomer generations, fewer people attend religious services
each week, and fewer members identify with traditional religious denom-
inations. That means that many of the post–baby boomer generations do
Marijuana Policy and the Law 113

not rely on their religious identity to guide their moral decision-making

and are instead guided more by other political or economic affiliations. By
the 2010s, the liberal side of the baby boomers had forged a new coalition
with the less religious sectors of the younger generations. Nevertheless,
the conservative side of the baby boomers remains just as active, and as
new coalitions were formed, the political contests of the 2010s and 2020s
became deeply polarized.
The wave of state-based laws legalizing recreational marijuana use
reflects the political success of the more liberal side of these new coali-
tions. It is not clear how long the current coalition will last or whether
there will likely be a shift in some new directions in the future. As long
as society is polarized along moral and cultural lines, it is very difficult to
predict future trends because there are few points of common agreement,
and the success of one side often comes at the loss of the other. Long-term
questions about recreational drug use will likely shift back and forth until
some common cultural consensus is reached or until the natural social
consequences of long-term addiction become more widely felt.

38. Have other drug-related policy movements been

affected by the movement to regulate marijuana?

The movement to legalize medical marijuana added greater pressure for

the movement to legalize recreational marijuana use and to legalize other
drugs that were traditionally regulated through strict law enforcement.
A majority of states approved the medical use of marijuana, but only a
minority of states legalized recreational use. The federal government con-
tinues to prohibit marijuana for anything but nondrug use, but all these
policies are under debate.
The public pressure to legalize marijuana both reflects and encourages
other drug-related policies. During the past 30 years, most cultural trends
promote greater reliance on chemical and digital solutions for routine
medical, psychological, and social problems. These technological changes
impact individuals on a daily basis. Not everyone is in agreement, but the
current cultural trends suggest greater vulnerability to dependency and
less individual self-reliance.

ADHD and psychotropic therapies

The first medicines used to treat psychological disorders were developed
after World War II and used to treat psychosis and depression. Psychotropic
114 Marijuana

drugs are medications that alter mood. By the 1950s, doctors frequently
prescribed drugs to treat anxiety in adults. They also used newly devel-
oped drugs to treat children who appeared to be suffering from hyperki-
netic reaction disorder, which was an early name for attention deficit/
hyperactivity disorder (ADHD). ADHD has since become the most com-
monly diagnosed behavioral condition in children, affecting almost 7%
of all children. ADHD symptoms were later redefined as a lifelong con-
dition affecting both children and adults. Until the early 2000s, the most
common treatment was Ritalin (methylphenidate) and Adderall (mixed
amphetamine/dextroamphetamine salts), which are drugs that can regu-
late mood and behavior.
The antidrug campaign of the 1980s taught students to “just say no”
to illegal drugs (especially alcohol, marijuana, cocaine, and crack). At
the same time, record numbers of students diagnosed with ADHD were
also prescribed psychotropic drugs to treat their symptoms. ADHD can-
not be reliably diagnosed using objective standards of measurements such
as brain scans, genetic tests, or testing for hormone deficiencies. There are
no drugs to treat the cause of the disorder because scientists have not yet
identified any biological causes. Therefore, ADHD medications can only
treat behavior symptoms (not the cause of those symptoms).
During the same time that students were told not to take drugs for
recreational purposes, a large percentage of them were nevertheless being
prescribed drugs to treat behavioral conditions. In the late 1990s and early
2000s, there was less opposition to using marijuana as a potential remedy
for mood and anxiety issues. Even if no medical authority proscribes such
drugs, the generations growing up in the 1980s and 1990s were more com-
fortable looking for drug treatments to solve social or interpersonal issues.
In 2016, a national survey indicated between 60% and 73% of antide-
pressants and other drugs (including marijuana) were prescribed without
a psychiatric diagnosis. In many cases, marijuana is self-prescribed to treat
perceived conditions.

Steroids
While psychotropic drugs were being developing during the 1950s, other
scientists were also isolating drugs that could potentially enhance phys-
ical and athletic performance. Anabolic steroids are hormones the body
uses to grow tissues and create muscles. The most familiar steroid is tes-
tosterone, which (when combined with physical exercise) can increase
muscle mass in specific areas on the body.
Marijuana Policy and the Law 115

Testosterone was first successfully isolated and replicated in a lab

during the late 1950s, but rumors spread that communist nations had
been secretly giving some sort of artificial performance-enhancing drugs
(PEDs) to their Olympic athletes as early as 1952. Using artificial drugs to
compete in sports is mostly viewed as unfair. Since then, professional and
amateur sports associations have been struggling with how to recognize,
regulate, and enforce prohibitions against PEDs by competing athletes.
Some very famous sports figures were implicated in steroid-use scan-
dals, including Sammy Sosa and Mark McGwire who competed for top
home-run records in a single season in 1997 and 1998 and were later
exposed as having used steroids to reach their records. Ben Johnson and
Marion Jones both won Olympic track-and-field medals, which were later
forfeited due to steroid abuse. Perhaps most famous was the seven-time
winner of the Tour de France cycling race, Lance Armstrong, who lost all
his records and $75 million in endorsement deals after admitting to using
PEDs for every race.
The unfortunate examples of these and other famous sports figures have
not reduced the amount of drug use among professional and amateur ath-
letes. A 2015 survey reported that as many as three million athletes have
used PEDs and 10 times as many high school athletes admitted to using
steroids in the 2010s as in the 1990s. Many athletes fear that if they do
not take PEDs, they face an unfair disadvantage against the athletes who
do. More than 60% of athletes believe that PED use should be a personal
decision of the user. Fans of professional sports may be concerned about
the legitimacy of new world-record holders, but at the same time, they
also want to see faster, stronger, and more effective athletes on the field.
The prevalence of PEDs even among high school students has in some
ways normalized the idea of using drugs to solve social problems. Amateur
and professional athletics associations continue to struggle with regulat-
ing drug use, but in noncompetitive fields, the use of drugs for recreational
purposes has generally become more common.

Cosmetics and antiaging

In addition to competitive athletes, the film and entertainment sectors
also routinely use steroids and other PEDs for cosmetic purposes, so they
can look stronger on screen. In addition to the chemical enhancements,
modern digital technology also allows actors to look younger and more
physically perfect on screen, in ways that are often impossible to achieve
in real life.
116 Marijuana

Famous actors use drugs to appear more attractive and, therefore, more
likely to receive higher-paying acting jobs in film. Unfortunately, millions
of these actors’ fans, while never acting in films themselves, often imitate
their favorite celebrities’ practices, including their PED use. The explo-
sion of social media avenues during the 2010s created entire industries
that manipulate and customize publicly displayed images so that anyone
can appear to be something they are not in real life. It is not uncommon
for people of all ages to invest money and other resources into plastic sur-
gery, PEDs, and other treatments to make their real-life bodies appear as
close as possible to the virtual images posted in social media.
The social pressure to appear young and beautiful also fueled a growing
industry into antiaging drugs and practices. Since the 2000s, billions of
dollars have been invested each year in new research aimed at potentially
treating death and aging as if they were diseases that could be cured through
medical treatment. The effort to find biological solutions is matched by a
continuing effort to mask age and physical deficiencies through cosmetics
and digital enhancement. Each of the industries reflects certain cultural
priorities that promote health, happiness, and well-being through the rec-
reational use of drugs and technologies.
Antiaging technologies cannot stop aging, and there is no treatment
for death. Cosmetic enhancement through PEDs, surgery, or digital recon-
struction does not change the nature and character of the person under-
neath. Yet many people spend much time and money in pursuit of quick
solutions that would otherwise take time, genetics, and physical habits to
achieve (if they could ever be achieved). These cosmetic priorities nat-
urally influence (and are influenced by) public views on marijuana use.

Conclusion
Our modern world is filled with an almost endless array of distractions,
from digital technologies to recreational drug use. Most social interac-
tions are filtered through the lens of technology. Around 85% of Amer-
icans report being online every day, and nearly a third of adults report
being online “almost constantly.” Only 7% of the American population
is never online. In the 2020s, most people interact with their friends
and colleagues over some form of digital medium. It is not surprising
that the greatest shift in cultural values with regard to recreational drug
use occurred between 2005 and 2020, which is right around the same
time as the technological revolution in social media, handheld comput-
ing devices, and the emergence of massively multiplayer online gaming
environments.
Marijuana Policy and the Law 117

There is a relationship between the growing and increasing presence of

artificial digital media and the constant pursuit of distraction and avoid-
ance in real-life interactions. In 2019, technology firms reported that 90%
of Americans avoid direct phone calls and prefer to use asynchronous
forms of communication (texting, email, etc.) rather than communicate
directly or face-to-face. If recreational drug use is engaged in as a way to
avoid difficult daily stressors, then marijuana can seem very normal if we
develop other habits of social interaction that are also filtered through dig-
itally enhanced tools. There are fewer opportunities in the modern world
to experience the world directly, without any technological or medical
aids at all. For some people, it may seem normal to use drugs to manage
their mood and attitudes, rather than rely on traditional problem-solving
skills based on interpersonal communication and relationships.
Marijuana has not caused these social changes. The movements to
legalize Cannabis for medical use and recreational use did not cause the
increasingly busy world. Nor would it be accurate to say that the busy
world is solely responsible for the increased willingness to take marijuana.
Nevertheless, there is a strong correlation between the two cultural shifts.
 Case Studies

1. MARYCLAIRE’S VAPING OVERDOSE

MaryClaire is 16 years old and attends a public high school in a small farm-
ing community of about 5,000 people. Her parents are college educated
and were born in the area. They both have good jobs that pay middle-
income salaries, and MaryClaire lives in a comfortable home. MaryClaire
has two older brothers who are one grade apart. Her brothers are very
close, and after graduating high school, they went to the same university
in the state’s capital city. MaryClaire sees her brothers from time to time
and hears their stories about quirky professors, difficult assignments, and
many weekend parties with their friends. They do not tell her all the
details of what happens at these parties, but they do share stories about
drinking and the stupid stunts their friends play when they become drunk.
Despite hearing about these stories, she does not really know what the
“college parties” are actually like. She suspects there may also be some
mild drug use and casual sexual relationships, but her brothers would
never tell her about those details of their college lives.
MaryClaire is not an honor student, but she earns fairly good grades
and has a few friends whom she hangs around with, though no one whom
she is really close to. She does not feel that she is very popular and often
feels insecure about the way she looks and the way she speaks and acts
in front of other people. She has a lot of contacts on her social media
accounts, and these contacts frequently share pictures and videos of
120 Marijuana

exciting activities and interactions with other people. She often feels left
out and thinks that nothing in her life compares to the posts she sees. She
often wishes she was included more.
MaryClaire has never been to a high school party with drinking and
has never taken any drugs before, but she is not unaware of the party
scene. She has a smartphone and spends much time on gaming sites. She
does not really play the games, but she loves chatting with other players.
She uses a fake name when chatting in these online spaces, which makes
her feel more anonymous and safe. MaryClaire sometimes spends hours
chatting and swapping memes, videos, and pictures. Sometimes people
send her sexual messages and talk about parties or drug use or other activ-
ities that she has never participated in real life. Mostly, she ignores those
messages, but occasionally, she pretends she is someone else and talks
about things that she imagines other people are doing—like what she
thinks her brothers may be doing or what she may have seen other people
do on the internet but has never done herself. Even though MaryClaire
has never actually met with her online chat friends, she often feels closer
to them than she does to the people she goes to school with and sees
every day.
During her high school junior year, MaryClaire was asked out to the
Home Coming Dance by a boy she barely knew, but who hung out with
a more popular crowd. She was excited because this was the sort of thing
she used to pretend to do when chatting with her online friends. After
spending weeks getting ready, she was picked up by her date and driven to
the dance. She quickly found herself among a dozen other teens she had
never met and who were from a nearby school. She tried to act like every-
one else, but the other girls were clearly more experienced. At one point,
she and the other girls went into the school bathroom together, and one
of them took out her water bottle and informed MaryClaire it was actually
filled with alcohol. Another girl pulled out an e-cigarette and offered it
to MaryClaire. MaryClaire hesitated, but the other girls laughed at her
saying that it was only marijuana and that it would only make her “loosen
up” and laugh a little more. MaryClaire did not want to appear to be too
afraid to try new things, so she accepted, thinking that marijuana was less
dangerous than alcohol.
MaryClaire took her first draw from the vaping pen and starting
coughing. Her friends laughed at her for being so innocent, so she took
another draw even though she already felt dizzy. She felt her heart begin
to race almost immediately, and she felt confused. Within a half hour, she
began to feel sick to her stomach; she grew paranoid that her friends had
tricked her into taking poison and fell into a panic attack. She also started
Case Studies 121

vomiting uncontrollably, fell down on the floor, and thrashed around with
convulsions. Her friends alerted the school chaperone, and an ambulance
was called. MaryClaire did not know that she had taken a very concen-
trated form of THC, and she accidentally overdosed. She spent several
days in the hospital, the police investigated the incident, and her parents
were called to attend her. She eventually returned home and recovered
from her physical symptoms, but she was suspended from school, and the
psychological trauma caused her to withdraw even more from real-life
interactions with others.

Analysis
MaryClaire is not rich, nor is she poor. Marijuana users may be found
in any social class and community setting. They are not limited to any
racial, regional, or demographic group. MaryClaire did not intend to
take marijuana at the dance but did so in response to pressure from her
friends. Peer pressure is the most common reason why high school teens
try marijuana for the first time, though family influence (parents and
siblings) also play a major role in a teen’s first use. Her suspicions about
the college parties her brothers attended likely reassured MaryClaire
that drinking and vaping were normal social activities. MaryClaire has
very little actual experience with parties or with direct socialization
with friends in any situation, but she is heavily influenced by expecta-
tions she learned from her social media outlets. She knows that she is
inexperienced, but she believes that participating in the sorts of social
activities that other people talk about will make her less nervous. Family
experiences, combined with her personal insecurities, make MaryClaire
more vulnerable to pressure from her friends. The final factor in her
decision-making was MaryClaire’s belief that marijuana is safer than
smoking and drinking and that vaping is safer than smoking marijuana.
In fact, marijuana is just as risky as binge drinking, and vaping is more
dangerous than smoking because the THC-extract dose is unpredictable.
Like many people, MaryClaire’s reaction to marijuana was unexpected.
She fell into a panic because she did not expect the rapid heart rate,
dizziness, or general sense of confusion. Vaping pens more easily lead to
overdoses due to their potential for very high concentrations of THC.
Vomiting and convulsions are common side effects of overdosing. Mary-
Claire faces school suspension even though marijuana is legal in Oregon
because recreational marijuana is not legal for teen use in any state, and
most school districts will suspend students for illicit vaping at school
events.
122 Marijuana

2. ALEX’S USE OF MEDICAL MARIJUANA

Alex is 56 years old and was diagnosed with stage IIA Hodgkin’s lym-
phoma disease, which is a cancer that is most commonly treated through
chemotherapy and has a high recovery rate. He was scheduled for six
rounds of chemotherapy over the span of 12 weeks. Alex did not feel
many side effects from his cancer, but the chemotherapy treatments were
very difficult for him. He lost his hair 10 days after the first round, but
the most troubling symptoms were related to the intense nausea that he
experienced during the first two or three days after treatment. He also
noticed he was easily bruised, his mouth developed sores, and he felt more
aches and pains during routine activities and was more easily tired. These
symptoms combined together made Alex less interested in eating food,
and he began to lose weight. The doctor warned him that the side effects
of chemotherapy built up over time and that they would likely get worse
as the treatment cycle progressed.
The doctor prescribed a medicine that was supposed to help with his
nausea, but Alex did not feel that it was working. He talked to friends and
searched online to find out if there were other supplemental treatments
that he could take to better manage his symptoms from the chemother-
apy. Alex lived in California, and the most frequently cited remedy was
marijuana. Dozens of online websites he visited claimed that marijuana
would encourage his appetite and provide relief for the aches and pains.
Some websites claimed it could help with nausea and might even help
fight the cancer itself. Marijuana is legal in his state and could be taken
with or without a prescription.
Alex’s oncologists (the cancer doctor) did not recommend he take
marijuana because they feared it would complicate his respiratory and
immune system during treatments. They assured him that it would not
help fight the cancer directly, but they admitted it could help increase
his appetite after his treatments. They recommended other drugs that he
could try, but Alex smoked marijuana as a teenager and felt more com-
fortable taking that option rather than experimenting with some other
drug that he had no experience with. The doctor signed the prescription
for a marijuana card after Alex indicated he was willing to accept the
potential risks. Marijuana is not covered by his insurance, and though
medical marijuana is less expensive than the other legal varieties he could
find at the local shops in his town, the variety of options was also more
limited. His friends suggested he just buy from a private dealer, but Alex
purchased from a legal medical dispensary because it was cheaper than
the other legal recreational marijuana shops and more reliable than the
Case Studies 123

private (illegal) dealers. He eventually purchased a variety of marijuana

that was higher in CBD and slightly lower in THC.
Since Alex had taken marijuana before, he experienced no surprises
when he smoked it after his second round of treatments. The marijuana
did not make him any less nauseous, but it did help pass the time during
the first two or three days after his treatment, and he felt more at ease. His
mouth sores were unaffected, and in fact, the smoking seemed to irritate
his mouth. He also seemed to feel even more tired than usual. He slept a lot
more, so he did not notice that he was still not eating very much. While he
was awake, Alex was able to take small snacks about an hour after taking
the marijuana, but his stomach was still very sensitive, and he mostly chose
to fall back asleep. By the third day after treatment, he began to feel better
and did not seem to need the marijuana to encourage his appetite.
Alex reported his reactions to the oncologist before his third treat-
ment. The doctor asked if he thought the marijuana was helping or hurt-
ing or had little effect either way. Alex said that he had been expecting
the marijuana to be more pleasant, because he always remembered taking
it with friends at parties when he was younger. The experience was much
more different when he was taking it alone and already feeling sick. In
some ways the marijuana seemed to help dull the general experience, but
in other ways, he felt that it was just another drug that made him feel
confused and sleepy. He was not sure if it was being helpful or not.
Alex tried the marijuana again after his third treatment, and the results
were mostly the same. The main difference was that his nausea seemed
to have gotten a little worse, but he could not tell if that was from the
chemotherapy or from the marijuana. He liked that the marijuana seemed
to make him want to sleep more but also felt his sleep was less restful.
Alex wondered if he would be just as likely to sleep from the effects of
the chemotherapy drugs alone. He spoke to his oncologist and was told
that the marijuana did not appear to be hurting his cancer treatment, but
it was also not going to help. The marijuana would only treat the symp-
toms from the chemotherapy. Alex had to decide if the positive benefits
outweighed the side effects. In the end, he decided to stop using the mar-
ijuana for his last few treatments because it seemed to add to his sense of
feeling overly drugged.

Analysis
Alex may appear to be a prime candidate for a prescription of medi-
cal marijuana. The 2017 report of the National Academies of Science,
124 Marijuana

Engineering, and Medicine indicated there was limited evidence to sup-

port the use of marijuana to encourage appetites for patients suffering
from weight loss following chemotherapy treatments. The report cited
“limited evidence,” but since online websites are not regulated by any
reliable authority, they often make claims about benefits that have not
been proven by any reputable scientific study. Marijuana does not treat
any disease, but it might encourage appetites for certain people. Alex’s
decision to take medical marijuana is not unreasonable, but online
reports increased his expectations for a successful remedy. States may
legalize the use of marijuana for medical and/or recreational use, but it
is still prohibited at the federal level. For that reason and because the
FDA has not recognized that marijuana can safely and effectively treat
any disease, insurance companies will not pay for medical marijuana.
Regulation costs, quality assurance tests, and taxes make recreational
marijuana more expensive than medical marijuana (which has a lower
tax rate), but legal marijuana is almost always more expensive than
illegal marijuana sold through illegal vendors who do not pay taxes or
licensing fees. The specific effects of marijuana are largely determined
by expectations and surrounding environment. Marijuana may some-
times increase patients’ appetites, but individual reactions vary from
patient to patient. The effects of chemotherapy will often overwhelm
the effects of marijuana, so patients are not guaranteed to feel noticeable
relief, though they may feel increased cognitive issues like confusion and
paranoia. Cancer patients who were regularly taking marijuana prior to
their diagnosis, will often continue to take marijuana as a supplemental
treatment during their chemotherapy. Patients who are not already used
to regularly smoking marijuana may try the drug for potential relief, but
they often discontinue use as chemotherapy treatments progress because
marijuana can increase mental confusion and become an added source
of anxiety.

3. EMILY ACCIDENTALLY DRIVES UNDER

THE INFLUENCE
Emily is 22 years old and lives in Oregon where marijuana is legal for both
medical and recreational use. She began taking marijuana while in high
school, though she does not consider herself a heavy user. She does not
smoke cigarettes, but she will drink alcohol with her friends on weekends,
and she will often take marijuana if it is available, but she does not often
seek it out. She prefers to eat brownies that have been baked with mari-
juana, and if she is at a party and has already had a few drinks, then she
Case Studies 125

rarely says no if marijuana brownies are offered to her. She estimates that
she takes marijuana only once or twice a month, and sometimes she can
go several months without having any at all.
Emily is very careful not to drive after drinking. She has a small frame
of just over five feet tall and weighs about 110 pounds. She knows that
one drink will usually make her feel warm, and two drinks will make her
feel a little buzzed. If she drinks more than two drinks, then she waits at
least an hour per drink before she gets behind the wheel. Emily is very
concerned about getting pulled over by the police, and she does not want
to hurt anyone by drunk driving.
On one night at a party, Emily consumed two drinks in an hour, and
then someone brought out marijuana brownies. These were purchased
at a local marijuana shop, and she had not tried them before. She ate
one brownie over the course of about five minutes and felt no effects,
and absent-mindedly, she ate another. She was still feeling some of the
warmth from the alcohol, and as the party progressed, she forgot about the
brownies and stopped drinking completely. She was planning on leaving
the party early. About an hour later, she felt like the effects of the alcohol
had worn off and she still did not yet notice any effects from the brownies,
so she decided to leave the party and drive home for the evening.
On her way home, Emily began to feel a growing sense of relaxation
and euphoria, and she realized that the brownies were beginning to take
effect. She was used to taking marijuana, so she did not feel impaired or
dizzy. She thought she would be fine if she continued driving as long as she
was careful. About 30 minutes later, Emily felt very relaxed and noticed
that she was nearing home much sooner than expected. There was a green
light ahead that had just turned yellow. She thought she was safe, so she
put her foot on the accelerator in order to make the light before it turned
completely red. As she passed through the intersection, a car from across
seemed to have sped up and passed right in front of her. She heard a loud
crashing sound, saw the hood of her car crumple under the impact, and
felt the airbag deploy in her face. She lost track of what she could see but
felt the car spin around the intersection once or twice. She seemed to
have been driving faster than she thought, and when her car finally came
to a rest, Emily could see that the other car was deeply crushed on the pas-
senger side. She looked around her own car and realized her windshield
was cracked and folded and her legs were trapped behind the dashboard.
She could not feel her feet, but she could move her fingers. She lost con-
sciousness before the police and ambulance arrived.
Emily woke up in the hospital with doctors by her bed. They told her
that she was in an accident, though at the time, she could not remember
126 Marijuana

what had happened. Her legs were in casts, and her right arm was in a sling.
She drifted in and out of sleep but eventually awoke with a police officer
next to her bed. They informed her that though her blood alcohol level
was below legal intoxication, her THC levels were higher than legally
permissible. Because she was involved in an accident, they extracted a
blood sample and tested for other drugs. They estimated that her THC
levels at the time of the accident were much higher than what they were
at the time of the blood test. Nevertheless, she was still cited for driving
under the influence.

Analysis
Alcohol affects people differently depending on their size and weight, but
it usually leaves the bloodstream at a regular rate. Marijuana also affects
people differently but is not always related to size and weight. Habitual
use, even if only once or twice a month, may result in users feeling they
are in more control of their motor functions and reaction times than they
actually are. The combination of alcohol and marijuana usually com-
pounds the effects of impairment. If the marijuana user already has THC
stored in their fat cells, then they may not always notice the effects of
marijuana even if they do notice the effects of alcohol beginning to wear
off. Edible forms of marijuana take longer to take effect, and depending
on how often the user consumes the drug, the effects may not be imme-
diately noticeable until up to 60–90 minutes. Marijuana brownies come
in a wide variety of doses depending on the amount and potency of the
THC concentrate used in the baking. Some brownies may end up being
much more potent than others. People who drive under the influence
of marijuana often feel more confident than they would be if they were
driving drunk. Yet the marijuana typically increases their willingness to
take risky chances. Impaired drivers are twice as likely to be in an accident
than drivers who have not taken alcohol or other drugs. THC dissipates
quickly in air passages, and the levels of intoxication are best measured
through blood samples immediately following an accident. Those levels
can decline quickly if more than an hour has passed between an acci-
dent and the blood extraction. Most states will automatically take a blood
sample if there is an accident that appears to involve some intoxication.
The admissibility of the evidence depends on the circumstances and the
amount of probable cause given for testing the blood. More often than
not, the blood samples are admitted into evidence, and the driver is con-
victed based on that evidence.
Case Studies 127

4. CHARLES IS SELF-MEDICATING
Charles is a 37-year-old professional photographer who is moderately
successful. His work is well received, but he often finds the job stress-
ful because he feels uncomfortable in the social settings where he most
often works—like wedding parties and other large public gatherings. He
also worries that he may not be creative enough to satisfy his clients and
sometimes turns clients away because he does not want to become over-
whelmed by the increasing expectations. Charles’s mother took medica-
tions to manage bouts of depression for much of her life, but he has never
been formally diagnosed with her disorder. He began seeing a therapist
when he was in his early twenties because he feels lonely from time to
time, and he finds it helpful to talk to someone. He has never developed
a successful long-term relationship with a partner, but he believes it is
because he has not met the right person. For the most part, Charles feels
he is in control of his life.
Charles has smoked marijuana for most of his adult life. He started as a
senior in high school as a way to celebrate with friends. At that time, he
only smoked occasionally because he thought marijuana helped to loosen
him up to become more sociable. After high school, when he started
working professionally, Charles began smoking marijuana more often as
a way of relaxing after stressful events. He does not like tobacco or ciga-
rettes and feels they are more dangerous than marijuana. He also drinks
infrequently. He is uncomfortable in bars and nightclubs, and he believes
that alcohol makes him feel more depressed. He usually smokes marijuana
at home by himself because he feels it helps improve his mood even when
he is alone. Charles asked his therapist to sign off on a marijuana card
as soon as it was legalized for medical use. He did not really believe he
needed it as a medical treatment, but he wanted to have the opportunity
to buy marijuana legally without fear of legal trouble.
As a rule, Charles does not smoke before his photo sessions, but he
often does so afterward. He has developed a routine, which includes
smoking almost every day. Charles does not feel he has a drug problem
because his smoking does not interfere with his job, nor does it seem to
worry his friends. He has never tried to quit because he believes marijuana
helps him to cope with daily stress, and it keeps him from falling into
more serious anxiety disorders like his mother experienced.
When Colorado legalized marijuana for recreational use, Charles did
not initially change his smoking habits. Within a few months, though,
he found out that there were many more options in recreational mar-
ijuana shops, even though the price was less expensive in the medical
128 Marijuana

dispensaries. He stopped using his marijuana card and began experiment-

ing with the different recreational varieties. Smoking marijuana became
a sort of a hobby for Charles, and he thinks of himself as someone with
special expertise on the subject. He spends much time on websites read-
ing news and opinion pieces on the latest trends, and he frequently posts
comments. He has experimented with a variety of THC forms, including
vaping, edibles, and tinctures, but he always returns to his daily routine of
smoking marijuana.
Charles did not believe he was smoking more marijuana than he did
before his state legalized recreational use, but he does notice that he is
smoking more intense varieties. He is aware that he has developed a
greater tolerance for stronger doses, but he feels like he has strategies for
managing the effects. He alternates between stronger and weaker blends,
but Charles rarely interrupts his daily smoking routine. Since full legal-
ization, he also no longer feels embarrassed to talk about his hobby. He
feels certain that most of his friends also take marijuana in some form
from time to time, even if they do not talk about it. Charles still meets
with a therapist because he continues to experience stress from his job,
and he still feels lonely and insecure in his personal relationships, just as
he always had. Since full legalization, though, he no longer views his mar-
ijuana use as part of a treatment plan. He believes it helps keep his daily
anxiety under control, but he does not feel he is taking marijuana because
he needs it. Instead, Charles feels it has become part of his preferred life-
style, similar to the way his therapy and his job have become normal parts
of his weekly routine.
Though Charles does not feel stigma from either the therapy or the
marijuana use, he frequently worries that the marijuana laws of his state
may change. He follows the national news and is very concerned about
political trends that seem to target his smoking. He does not understand
why more people do not support marijuana use, and he often feels that
people are actively trying to prevent him from enjoying his lifestyle. He
will turn down photo shoots if he thinks the client opposes marijuana
legalization. He is very active online promoting marijuana as an alterna-
tive lifestyle choice. Charles has no plans to change his routine.

Analysis
The probability of developing anxiety disorders may be influenced by
family history, but the diagnosis of a parent does not mean the children
will suffer from the same conditions. Common situations of stress caused
by work or personal relationships do not necessarily imply an anxiety
Case Studies 129

disorder. When states began legalizing marijuana for medical use, many
users who obtained a marijuana card did so for recreational purposes, not
always for medical purposes. Most marijuana users do not believe they
have a problem and are often convinced marijuana helps them even if
others can see dependency. Legalization of recreational marijuana usually
leads to an increase of use among nonusers but may not always increase
the frequency of use among habitual users. In either case, the increased
market competition often leads to more potent varieties of Cannabis.
Habitual marijuana users can learn to adapt to the effects of the drug,
so they can consume it frequently without it interfering with their daily
routines. Tolerance and coping skills can lessen the perceived effects of
the drug on the user. The hallucinogenic effects of marijuana often lead
to delusions of grandeur, where the user believes they are gifted with spe-
cial wisdom and knowledge that nonusers do not know. Marijuana usually
increases anxiety issues, but users tend to blame other causes. Marijuana
also increases feelings of paranoia and persecution, causing users to fear
that other people are attacking them in some way.

5. AUGUST’S CONTAMINATED CBD

August is a 19-year-old barista who lives in New York City. She moved
out of her parents’ home a year earlier to share an apartment with four of
her friends from high school. She and her friends wanted to experience
the city life before they decided on which direction they wanted to go
with their futures. Her family gave her some money to start with, and they
pay for her phone, but she mostly takes care of herself and her own bills.
She earns enough tips to pay her way for most activities, but she never has
much extra money to spend.
August does not think of herself as a marijuana user, though she usually
vapes THC about once or twice a week. She mostly puts nicotine in her
vaping pen, and since she cannot vape while she works, she usually only
takes it out with friends in the evening. Mostly, August thinks of herself
as being open to new experiences. She does not consider THC a serious
drug. She frequently talks about her future plans for school and considers
her year in New York City as part of her extended education in the real
world. She and her friends have no intention of living there forever.
August is very active in social media, and when she is not working,
she likes to go to dance clubs once or twice a week. Since she is under
21, she is limited to certain nights at legal bars and concert halls, but she
has experimented with a few illegal dance parties (raves) that she heard
about online. She just wanted to see what they were like. They were a
130 Marijuana

little too crowded for her, and she did not feel safe. She and her friends
prefer the legal music venues that cater to under-21 crowds. August has
access to alcohol because people will offer to buy her drinks, but she gen-
erally avoids drinking or getting drunk because she is afraid the alcohol
will slow her down. She mostly wants to experience the excitement of
the nights. She and her friends will occasionally take other drugs, and she
frequently vapes nicotine, CBD, and sometimes, THC. She owns a couple
of vaping pens in different colors, and she treats them as a fashion acces-
sory. August has taken Ritalin and ecstasy (or Molly) a few times, but she
tries to stay away from what she thinks are the more dangerous drugs like
methamphetamines, LSD, and cocaine. She just wants to enjoy the music
scene and does not want to become a drug addict. If she takes ecstasy, it is
because one of her friends gave her a pill at some point during the night.
She does not hang around with drug dealers, and she has never paid for
those drugs directly.
Recreational marijuana was illegal in New York when she arrived, but
August knows that the police are only concerned about the other drugs.
She buys her nicotine pods for her vape pen at a local grocery store, and
she buys flavored CBD vape juice from a vape shop down the street. She
alternates between CBD and nicotine so that she does not become overly
dependent on the nicotine pods. Vaping products are legal in New York
for anyone 18 years or older, but August heard that the state may legalize
recreational marijuana, which could mean they might also raise the buying
age for CBD and other vaping products up to 21. She likes vaping the CBD
and believes it helps her relax. She also likes the nicotine because it pro-
vides a quick lift. She treats it like a cup of coffee and uses the CBD as a sort
of vitamin. She does not consider either of them to be dangerous, and she
wants to ensure she continues to have access to both. She is very concerned
that the government will make it harder for her to buy before she turns 21.
August searched online for websites that sold CBD, nicotine, and THC
pods and mailed them directly to her door. She found many sites that
describe their products, but she realized it was harder than she thought to
buy directly online without a marijuana card or some other proof of her
age. One of her friends told her about a guy who buys vaping pods and
other marijuana products legally so that he can sell them to his friends
who are too young to buy. He did not charge too much extra, and the
friend thought he was a good guy. She offered to buy some for August the
next time they met up. Since she found it hard to buy online, August gave
money to her friend to buy some CBD juice and some THC pods for her
vaping pens. She did not want to buy drugs, but she just wanted to try it out
and see if she could continue to supply her vaping pens if the laws changed.
Case Studies 131

August’s friend brought home a bottle of strawberry-flavored CBD

juice, which said it was made from “100% Natural CBD Extracts.” It was
a brand that she had seen online and was advertised as providing a very
light buzz but was lighter than traditional THC. She tried it out later
that night. She did not expect to feel much, but this dose made her start
coughing, and she felt dizzy and sick to her stomach. She fell to the floor
and started convulsing. Her friends called 9-1-1, and she was rushed to
the hospital. They gave the bottle of the vaping juice to the doctors to be
tested, and they later found out that it was contaminated with a synthetic
THC compound mixed with rat poison. August survived the episode, but
she heard a news report that many other people had also taken the con-
taminated CBD oil and were also rushed to the hospital. Some of them
did not survive.

Analysis
Most high school students do not believe that marijuana is a danger-
ous drug, and they believe vaping is safer than smoking. About 90% of
youths aged 17–24 who participate in the urban dance club culture take
drugs of some sort, and more than two-thirds take multiple drugs at once
(polydrug use). Some of the most popular are ecstasy, methamphetamine,
cocaine, and opioids. These are frequently mixed with THC to moderate
the effects of the high. Most teens do not see themselves as drug users
when they are only experimenting occasionally. Most drug users do not
see themselves becoming addicted. Many states that legalize recreational
use of marijuana often follow the legislation with more rigid controls over
age requirements. The same states often add more restrictive controls
on other legal products, especially tobacco, alcohol, and flavored vaping
products. Online vendors are not regulated by the FDA, and though users
can buy illegally, it is somewhat difficult and requires users to use spe-
cial apps that are potential risky. Private sellers (illegal dealers) have no
safeguards at all. They sell based on their reputations, but they may not
always know what they are selling. Illegally purchased products are often
counterfeited, which means sellers may use real bottles with real labels,
but add other, cheaper ingredients. Some forms of CBD oils that are mar-
keted online and are illegally sold through private vendors are intended
to produce THC-like effects. They are often contaminated with synthetic
THC or other drugs but still marketed as CBD. The CDC issued warnings
about contaminated vaping products that sent hundreds of people to the
emergency room.
 Glossary

Addiction: Any dependency on substances or behaviors that is so strong

that the affected individual is unable to stop using the substance, or
engaging in the behavior, even when they know it is harmful to them-
selves or to others.

Amotivational Syndrome: A pattern of behaviors resulting from a gen-

eral loss of motivation for initiating or completing tasks, even if those
tasks are important to self, family, or other loved ones.

Amphetamines: A drug that stimulates the central nervous system, mak-

ing the neural messages respond more quickly. Known as “speed” or
“uppers,” these drugs also stimulate dopamine, which makes them
highly addictive. In its crystal form, they are known as methamphet-
amine (“Meth”). Amphetamines are listed as Schedule II drugs and are
illegal without a prescription.

Anabolic Steroids: The group of hormones involved with reproduction

that helps to build body tissues. The most popularly recognized ana-
bolic steroid is testosterone, which can be synthesized and replicated
in many forms to increase muscle mass. They can be psychologically
addictive and are listed as Schedule III drugs and are illegal without a
prescription.
134 Glossary

Anxiety: A general fear or nervousness about future consequences.

Attention Deficit/Hyperactivity Disorder (ADHD): A sustained pat-

tern of behaviors characterized by an inability to focus attention that is
often combined with an inability to remain calm or to restrain actions
(called impulsiveness). Originally identified as a childhood condition
but is now also more common among adults.

Baby Boomer: The name given to the generation of Americans born after
World War II, between 1945 and 1955. For many decades, baby boom-
ers formed the largest single age group in the American population.

Binge Drinking: Drinking alcohol quickly enough to induce a blood

alcohol concentration to the point of legal intoxication (0.08). For
normal-weight males, this usually involves drinking two to three drinks
per hour (less is required for normal-weight females).

Bipolar Disorder: A psychological disorder characterized by unusual

swings in mood, energy, and motivation levels. Also known as manic-
depressive illness, bipolar disorder is identified by patterns of behav-
ior that alternate between high energy (mania) and low points
(depression).

Blackout: A condition that may follow extensive alcohol or drug use,

when the user may not remember long periods of time during their
intoxication, despite being awake and active.

Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF): An

agency with the U.S. Department of Justice (DOJ) responsible for
enforcing the laws regulating the distribution, sales, and manufacture
of alcohol, tobacco, and firearms, including explosives.

Cannabidiol (CBD): One of the chemical compounds found in Canna-

bis plants that does not produce intoxicating or mind-altering effects.
Typically found mostly in hemp varieties, CBD has recently become
popular as a potential medical ingredient due to its association with
marijuana.

Cannabinoid Hyperemesis Syndrome: One of the symptoms that occur

after marijuana overdosing, which involves frequent and severe
Glossary 135

vomiting. The condition was relatively unknown prior to the devel-

opment of THC concentrates. The popularity of vaping and high-
concentration marijuana edibles has made the condition one of the
more common reasons for marijuana-related emergency room visits
since the early 2000s.

Cannabis-Friendly: An adjective to describe doctors who are willing to

prescribe marijuana as a medical treatment, even when they suspect it
may be mostly used for recreational purposes.

Cannabis Indica (or C. Indica): A variety of the Cannabis plant that is

short with more green leaves and flowers, which originated from Cen-
tral Asia. It includes high levels of both THC and CBD in a more equal
ratio. Most modern Cannabis plants have been interbred to combine
multiple varieties.

Cannabis Sativa (or C. Sativa): A variety of the Cannabis plant that

is taller with thinner leaves, which originated from Eastern Asia. It
includes higher levels of THC and lower levels of CBD in an unequal
ratio. Most modern Cannabis plants have been interbred to combine
multiple varieties.

Cannabis Use Disorder: Another way of describing marijuana addiction.

Marijuana is not physically addictive, but it can be highly addictive
psychologically, which means users may be unable to stop using even
when it becomes harmful to self and others. Physical characteristics of
Cannabis use disorder include problems with memory, attention, and
diminished learning capacity.

Carcinogens: Any substance that is believed to lead to cancer. Scien-

tists do not know with certainty that anything is always carcinogenic.
Instead, they identify strong correlations with certain substances and
higher than normal frequency of certain cancers in people who were
exposed to those substances.

CB1 and CB2 Receptors: Neural receptors that are naturally shaped to
respond to cannabinoid compounds found in marijuana and CBD prod-
ucts. CB1 receptors are mostly found in the brain, and they respond
most to THC compounds, resulting in the intoxicating and mind-
altering effects of the drug. CB2 receptors may be found throughout
136 Glossary

the nervous system, and they appear to balance out the effects of CB1
stimulation. They are most responsive to CBD compounds. Scientists
do not know the exact functions of either receptor.

Cell Receptor: A protein located on cell membranes that allows cer-

tain compounds to enter the cell and activate certain functions. The
shape of each cell receptor determines which chemical compounds are
allowed into the cell.

Centers for Disease Control and Prevention (CDC): The government

agency within the U.S. Department of Health and Human Services
that is responsible for tracking health statistics and making recommen-
dations for protecting the public health.

Central Nervous System: That part of the human body that includes the
brain and the spinal cord. It is the primary means by which the brain
communicates with the various organs, muscles, and tissues of the body.

Cognitive Behavioral Therapy: A therapeutic treatment plan that

focuses on teaching users to better control their urges and avoid behav-
iors that can lead to addiction.

Commission on Narcotic and Drug Abuse (1963): A presidential com-

mission that marked a shift in drug enforcement policies by placing
more attention on the treatment and rehabilitation of users and less
emphasis on the prosecution of users (through jail terms).

Controlled Substances Act(1970): A federal law that classified all drugs

into five categories based on the potential for abuse, their potential
for medical usefulness, and the extent of practices that guarantee safe
use and distribution of the drug. This law marks a turning point in
drug enforcement policy because it combined all the previous rules and
regulations related to legal and illegal drugs into a single enforcement
system.

Convergent Thinking: The ability to sort through many different options

and arrive at a single solution to a problem.

Culture War: The nonviolent conflict between at least two distinct

worldviews on matters related to morality, politics, and faith. Political
Glossary 137

parties can separate groups over matters of economics and political pri-
orities, but a culture war involves larger distinctions that may cross
party lines and often include core differences on matters related to the
meaning of life, virtue, and moral order.

Dabs: Concentrated forms of THC extracted from the Cannabis plant

and used in vaping machines or in edible products (like baked goods
or candies). Some dabs may have concentrations of THC very close to
100%. High concentrations of THC are the most frequent cause for
marijuana-related emergency room visits.

Delusions of Grandeur: A delusion is a false belief that is not supported

by obvious evidence or rational explanation. A delusion of grandeur
is the false belief that one is superior to those around them in intelli-
gence, cleverness, wisdom, and power. It is a form of hallucination that
is common with marijuana use and may stay in place even after other
intoxicating effects have faded away.

Dependency: When related to drug use or other behaviors, a dependency

refers to the inability for someone to live their lives without using the
drug or engaging in the behavior without great discomfort.

Detox Programs: An addiction treatment program that separates the user

from the source of their addiction long enough that the substances (or
behavioral urges) are removed from their system. These treatment pro-
grams allow users to develop new habits without the use of the drug or
other destructive behaviors.

Divergent Thinking: The ability to consider multiple options to solve a

problem without concern for a single ultimate solution. Divergent think-
ing requires convergent thinking to ensure effective problem-solving.

Dopamine: A type of neurotransmitter that communicates sensations of

pleasure and satisfaction to the brain. It is part of the reward system in
our brain that influences what we like, what we want to do, and how we
learn. It plays an important role in human motivation.

Dravet Syndrome: A very rare and severe form of epilepsy that afflicts
very young children. Dravet syndrome is the only condition for which
the FDA has approved the therapeutic use of CBD as treatment.
138 Glossary

Dronabinal: A synthetic form of THC that has been approved by the

FDA to encourage appetites in patients suffering from extreme weight
loss due to physical causes. It comes in the form of a capsule and lasts
about three to four hours. It is a Schedule II drug that is illegal to take
without a prescription.

Drug Abuse: Any use of any drug to the extent that it harms the self or
others.

Drug Enforcement Agency (DEA): The government agency within the

U.S. Department of Justice (DOJ) that is responsible for policing and
enforcing the regulations controlling the illegal use and distribution of
controlled substances as defined by the Controlled Substances Act (1970).

Drug Trafficker: Someone who engages in illegal drug trade and/or who
transports (potentially legal) drugs over state lines where they may be
illegal.

Drunk: A term used to describe the condition of being intoxicated by

alcohol.

E-cigarettes: Electronic devices that raise the temperature of a substance

(called a dab) to the point above evaporation but below the point
where paper burns. These devices “vaporize” the substance without
burning them and are used for “vaping.” E-cigarettes may be used for
nicotine products or for THC or other drugs. E-cigarettes are one of the
most common causes of marijuana overdosing.

Ecstasy (MDMA): A form of methamphetamine taken as a pill or in

liquid form that alters mood and perception as a mild hallucinogen.
Also known as “molly,” it is often associated with parties and dance
clubs. It is frequently used with other drugs, including marijuana, and
is often contaminated with other drugs such as cocaine and heroin, and
overdosing may be fatal. Ecstasy is a Schedule I drug and is illegal to use
without a prescription.

Edibles: Refers to any food or drink that includes THC. Edibles may
include baked goods, candies (like gummies), or drinks. Edibles often
contain very high concentrations of THC and are one of the leading
causes of marijuana overdosing.
Glossary 139

Endocannabinoid System: The set of neurotransmitters and receptors

within the central nervous system that appear to maintain chemical
homeostasis within the body in reaction to changes in the physical
environment. This system responds to THC and triggers dopamine
reactions as well as many other reactions that are not entirely known
or understood by scientists.

Endorphin: A type of hormone that is released in response to pain or

physical stress. They provide temporary pain relief and encourage a
feeling of well-being. Drugs that artificially trigger the release of endor-
phins (such as opioids) can be highly addictive and often lead to fatal
overdoses.

Epidiolex: The brand name of an FDA-approved form of CBD extract

used to treat Dravet syndrome.

Euphoria: An emotional reaction marked by a sense of great happiness

or an exhilarated sense of well-being. Usually used to describe artificial
drug-induced conditions.

Executive Functions: The highest level of brain functions that include

the ability to make decisions, the use of short-term (working) memory,
and learning. Executive functions involve free will and choices delib-
erately made by the individual. Impairment of the executive functions
results in a limited ability to control decisions, make judgments, or
learn.

Federal Bureau of Narcotics: Created in 1930 as an agency within the

U.S. Treasury Department, the Narcotics Bureau was responsible for
enforcing federal drug laws. The agency was moved over to the Depart-
ment of Justice (DOJ) and renamed the Drug Enforcement Agency
after the passage of the Controlled Substances Act of 1970.

Feedback Loop: Refers to the way various organs communicate the results
of biochemical reactions back to the source to ensure homeostasis (bal-
ance) within the body. Feedback loops tell the body when enough
chemicals have been released and when more chemicals are needed.
There are thousands of types of natural feedback loops within various
systems of the body that ensure healthy management of our hormones
and the nervous system.
140 Glossary

Fetal Alcohol Syndrome (FAS): A condition brought about through

exposure to alcohol while a baby is developing in the mother’s womb.
It is characterized by brain damage, learning difficulties, and prob-
lems with growth development. The defects caused by FAS cannot be
reversed.

Flat Affect: Refers to the general lack of emotional response. Habitual

marijuana use may produce flat affect, which means users show little or
no emotion to events that ought to stimulate some response.

Food and Drug Administration (FDA): A U.S. agency responsible for

protecting the public health by monitoring the safety and effectiveness
of food, drugs, and medical products sold in the United States. The
FDA is separate from the DEA in that it monitors safety but does not
enforce the laws against illegal trade of controlled substances.

Gamma-Aminobutyric Acid (GABA): A neurotransmitter that inhibits

certain actions within the central nervous system, including the release
of dopamine. THC indirectly triggers the release of dopamine by limit-
ing the release of GABA.

Gateway Drug: Any drug that may encourage users to engage in drug
abuse because it appears to be less harmful than other more addic-
tive or harmful drugs. Gateway drugs do not force users to take other
drugs, but they can train users to become desensitized to the dangers of
drug use. Marijuana is a gateway drug. Most users who are addicted to
harder drugs began their drug use with marijuana, which they initially
believed to be harmless.

Grower’s License: Refers to the state tax required for Cannabis farmers to
grow marijuana or hemp crops. Anyone who fails to obtain a grower’s
licenses is an illegal farmer, even if they operate in states where mari-
juana is legal.

Hallucinogenic: Any substance that produces artificial sensations that

are not natural to their sensory organs. Hallucinations may include
hearing voices that are not there, seeing colors or images that are not
real, or believing ideas or fears that have no rational basis. Marijuana
is a mild hallucinogenic that impacts the sense of time, visual percep-
tions, emotional feelings, and beliefs (including paranoia).
Glossary 141

Hangover: A condition that follows intoxication from alcohol. Common

symptoms include headaches, weakness, nausea, sensitivity to light and
sound, and general aches.

Harrison Narcotics Act (1914): One of the first federal laws regulat-
ing the sale and transportation of drugs (initially, opium and cocaine)
across state lines. The law was expanded many times over the course
of the 20th century as new drugs were developed and introduced into
American culture that threatened public health. The final comprehen-
sive approach to federal drug enforcement occurred with the passage of
the Controlled Substances Act of 1970.

Hashish: A form of marijuana that is processed in a way that concentrates

the levels of THC into a thick waxy substance. Hashish was originally
eaten, but later vaporized or smoked as new devices were invented.
Hashish was the first attempt to isolate and concentrate the intoxicat-
ing elements of Cannabis. Its use was mostly limited to the Middle East
until the early 20th century, when its use spread through trade routes
around the world and into the United States.

Hemp: A variety of Cannabis used primarily for the production of textiles

(cloth) and rope, with very long, woody stems. Grown mostly from
Cannabis sativa, hemp played a significant role in European cloth man-
ufacture for ships (canvas and ropes). Due to its low THC content,
most hemp farmers were unaware of the drug potential of their crops.

Hemp Farming Act (2018): A federal law that legalized the production
of hemp crops with THC content less than 0.3%. Modern hemp farm-
ers grow it mostly for CBD extraction. The Hemp Farming Act passed
Congress following the FDA approval of a purified form of CBD to
treat Dravet syndrome.

Homeostasis: Refers to a state of balance within the human body, which

keeps all internal systems within relatively constant levels despite
changes introduced from outside the body. Homeostasis depends heav-
ily on the many feedback loops within each system.

Ideology: A set of ideas or beliefs shared by a broad group of people. Ide-

ologies may be based on political ideas, economic ideas, religious ideas,
or any other ideas that people believe are important in their lives.
142 Glossary

In-Patient Treatment: Refers generally to addiction treatment programs

that require the patient to live in a facility away from home. Such
programs usually involve direct medical supervision and include coun-
seling options.

Isomer: Molecules that have the same atomic formula but have different
shapes. It is the molecular shape that often determines the functions of
a biochemical compound because the different shapes fit into different
cell receptors.

Kief: Refers to the residue left over after marijuana buds have been sifted
and processed. In the 1990s, marijuana growers began processing the
kief to create additional THC extracts that were used for dabs and
edibles.

Lysergic Acid Diethylamide (LSD): A hallucinogenic drug originally

developed to treat schizophrenia. It was later used in the late 1950s
as a recreational drug and spread through college campuses in the
early 1960s resulting in its widespread criminalization within a few
years. LSD frequently leads to permanent psychosis. Also known
as “acid,” LSD is a Schedule I drug and is illegal to use without a
prescription.

Marihuana Tax Act (1937): The first federal law to explicitly regulate the
manufacture and sale of marijuana. Previously, individual states along
the Mexican border had prohibited marijuana sales as the problem of
drug use became associated with crime in their states. The Bureau of
Narcotics recommended a federal law after marijuana became more
noticeably associated with crime in large cities during the 1930s.

Marijuana Card: Any state where marijuana for medical use is legal,
requires a Marijuana Card that certifies that the user has a doctor’s
recommendation to use the drug. In states where recreational mari-
juana is legal, users may still require a Marijuana Card if they want to
access state-approved medical marijuana dispensaries. Marijuana cards
are taxed.

Marijuana-Induced Psychosis: Psychosis is a condition where the suf-

ferer is disconnected from the real world through hallucinations and
delusions and who often express themselves with disorganized speech
or confused behaviors or by simply ceasing all communication entirely.
Glossary 143

Outside observers are unable to rationally communicate with psychotic

sufferers. Marijuana may induce psychosis in users already predisposed
to mental illness. Marijuana use is involved in about half of all patients
diagnosed with psychosis or schizophrenia.

Metabolism: Refers to the chemical processes occurring within the

human body when food or other nutrients are broken down into their
biochemical components to keep the organs and other bodily functions
operating.

Misuse of Drugs Act (1971): The British equivalent of the Controlled

Substances Act of 1970, which was also adopted by most British Com-
monwealth Nations. It creates a comprehensive schedule of drugs
according to their susceptibility to abuse, their potential for medical
use, and the existing practices in place to ensure safe distribution and
use.

Nabilone: A synthetic form of THC that was approved by the FDA to

treat the symptoms of nausea and vomiting associated with cancer
treatments. It is intended to be prescribed only when all other treat-
ments have failed, but it is frequently prescribed “off label” according
to patient preference. It is a Schedule II drug and is illegal to take
without a prescription.

Nervous Disorder: Any psychiatric disorder characterized by anxiety

as a primary symptom. Physical symptoms include racing heart rates,
increased sense of fear or anxiety, and a prevailing sense of danger.
Common nervous disorders include panic attacks, post-traumatic stress
disorder (PTSD), obsessive-compulsive disorder, social anxiety dis-
order, and other phobias. Nervous disorders are frequently associated
with substance abuse.

Neurons: The individual cells that are aligned in sequences connect-

ing the central nervous system as the primary communication system
between the brain and various parts of the body.

Neurotransmitters: The chemical compounds that span the gap between

neurons within the nervous system. Different chemical compounds will
bind with different neural receptors that allow chemical messengers to
travel along the same neural network without interfering with each
other.
144 Glossary

Nicotine: The main active ingredient found in tobacco plants. Nicotine

is poisonous at even small doses but is generally consumed in extremely
low doses through the inhalation of smoke or vaporized through special
nicotine dabs. Nicotine is a stimulant and addictive, but it does not
alter perceptions or induce intoxication.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): A class of drugs

used to treat mild aches, pains, and fevers by decreasing inflammation.
Popular NSAID products include aspirin, naproxen, and ibuprofen.
They are not regulated as controlled substances and are sold over the
counter without a prescription. Many NSAIDs can provide the same
level of pain relief as marijuana.

Off-Label Use: Refers to the practice of using a prescription drug for a

purpose that it was not originally intended to treat. Doctors have some
discretion as to how to prescribe medication for off-label use. Approx-
imately 20% of legal prescriptions are given for off-label purposes.
Marijuana is almost always prescribed off label since the FDA has not
approved its use to treat any disease directly.

Opioids: A class of drugs derived from the poppy plant, which include
opium, heroin, amphetamines, and a variety of prescription pain
relievers (such as oxycodone, hydrocodone, and fentanyl). These drugs
are primarily prescribed to relieve moderate to severe pain. They are
highly addictive and are currently the leading cause of death due to
drug overdoses. They are classified as Schedule II drugs and are illegal
to take without a prescription.

Paranoia: A psychotic disorder in which the sufferer believes they are

being persecuted. Usually involves fear or distrust of others and often
includes delusions of grandeur. Paranoia is a common side effect of
marijuana use.

Patch: A small bandage infused with drugs that can be transmitted

through the skin into the bloodstream at a constant rate. Often used
to deliver consistent doses over a long period of time. May be used for
a wide variety of drugs, including nicotine, opioids, and THC or CBD
concentrates.

Performance-Enhancing Drugs (PEDs): Any class of drug used to

increase the natural capacities of athletic performance. Originally
dominated mostly by anabolic steroids that increase muscle mass, PEDs
Glossary 145

also include drugs that increase oxygen levels and reaction times. PEDs
are banned by most sports associations.

Phencyclidine (PCP): A veterinary tranquilizer originally used for large

animals (likes horses). Produces hallucinogenic effects and became a
recreational drug in the 1960s, known as “Angel Dust.” It frequently
leads to psychosis and violent behaviors. It is often combined with
marijuana and tobacco and is psychologically addictive with no cur-
rent medical use in humans. It is a Schedule II drug that is illegal to use
without a prescription.

Polarized Society: When society becomes divided between two opposing

viewpoints that there is little middle ground left to find common agree-
ment. A culture war often results from a polarized society.

Polydrug Use: When a user takes more than one recreational drug at the
same time. Marijuana and alcohol are both the most common drugs
used in combination with others. Polydrug combinations are responsi-
ble for most overdose deaths.

Posttraumatic Stress Disorder (PTSD): A nervous disorder caused by

a traumatic event and usually characterized by nightmares, flashbacks,
and severe anxiety when the memory of the trauma is triggered by
related events.

Primed for Addiction: A biological condition in which the brain chemis-

try is altered to make it more receptive for dopamine stimulation. Usu-
ally caused by drug abuse (including marijuana use) at young ages. Youth
who were primed for addiction are many times more likely to develop
addictions of any substance throughout the course of their adult lives.

Prohibition (Eighteenth Amendment): A federal amendment to the

U.S. Constitution that prohibited the manufacture and sale of alcohol.
States and local districts also passed similar laws restricting alcohol.
The federal amendment lasted from 1920 to 1933 when it was repealed
by the Nineteenth Amendment. During that time period, users who
purchased alcohol illegally often gathered together in central locations
(speakeasies) where other illegal drugs were also sold.

Proposition 215 (1996): The California statewide initiative that legal-

ized the medical use of marijuana. It was combined with a popular
civil rights initiative (Proposition 209), which helped to ensure large
146 Glossary

turnouts to the polls. California became the first state to legalize mari-
juana for medical use and to create a bureaucratic system to regulate it.

Psychoactive: Any ingredient within a substance that affects the mind,

mood, or other mental processes.

Psychosis: A mental state characterized by a break from reality, usually

involving hallucinations, paranoia, or other delusions. Any psychosis
may be temporary or long term depending on the cause of the break.

Psychotropic: Refers to any affect from a substance that alters mood, per-
ception, or behaviors. Almost all mood-enhancing drugs are psycho-
tropic by definition.

Pure Food and Drug Act (1906): The federal law passed in 1906 to
protect the public from harmful drugs or foods. The law was partially
inspired by Upton Sinclair’s book The Jungle, which exposed problems
within the meatpacking industry. The same law also targeted adver-
tisements for drugs that falsely claimed to cure any ailment. This law
created the Food and Drug Administration and eventually led to the
Harrison Narcotics Act (1914).

Relapse: Refers to situations when a substance abuser returns to the

source of their addiction during their treatment process. In most addic-
tion programs, relapse is considered an expected stage of the treatment
cycle, and long-term counseling programs are used to deal with poten-
tial relapse.

Schedule I Drugs: The most strictly controlled category of drugs listed

under the Controlled Substances Act of 1970. These drugs are most
prone to addiction and have the least medical value with the fewest
practical safeguards guaranteeing safe distribution and use. Marijuana
is listed as a Schedule I drug, alongside heroin, LSD, ecstasy (MDMA)
and mescaline, which is another hallucinogenic drug.

Self-Medicate: When a user chooses to treat their ailments without doc-

tor’s supervision or without a prescription. Marijuana is frequently jus-
tified by users as a form of self-medication for stress and anxiety.

Shaman: Often known as a “medicine man,” shamans were individuals

who lived on the margins of society and served as conduits between
Glossary 147

the material physical world and the unseen spiritual world. Shamans
often used herbs and other plants to treat ailments, produce halluci-
nations, and for other ritualistic purposes. In ancient times, marijuana
was mostly used as a drug in limited extents for these purposes.

Sinsemilla: A form of marijuana harvested from unpollinated female

plants. These include higher than normal levels of THC-rich resins,
which are used for more potent marijuana buds. Many marijuana farm-
ers tend to clone their plants so that they can harvest sinsemilla with-
out the need for producing new seeds for replanting.

Social Anxiety Disorder: A type of nervous disorder that is characterized

by unusual fear and anxiety in social situations, based on the patient’s
belief that others are continually judging and watching them. Mari-
juana often increases symptoms of social anxiety disorder, even though
sufferers frequently self-medicate using marijuana as a preferred treat-
ment option.

Speakeasy: An illegal bar that served alcoholic drinks during the Prohibi-
tion era. Speakeasies were also places where other illegal activities took
place, including gambling, prostitution, and drug dealing. Speakeasies
helped bring marijuana into large urban areas, which helped create the
initial association between marijuana and the criminal underworld.

Synaptic Gap: The tiny space between neurons in the nervous system.
Neurotransmitters must pass the synaptic gap in order to communi-
cate information from one neuron to the next. Most drugs affect the
nervous system at the point of the synaptic gap by interfering with
neurotransmitters or neuroreceptors.

Synthetic Marijuana: A chemical substance created in a laboratory to

mimic the effects of THC. The first versions were legally sold as incense
under the brand names of “Spice” and “K2.” They were marketed as
marijuana substitutes, but their widespread use led to a rash of severe
drug overdose reactions, including deaths. Though later outlawed,
these products continue to be used illegally as recreational drugs.

T-Breaks: Short for “tolerance break.” Marijuana users can develop toler-
ance to the dopamine effects of THC, resulting in a decline in the gen-
eral euphoric feelings. Users may take T-breaks for up to six months by
avoiding marijuana and shifting to alcohol as the main source of their
148 Glossary

intoxication in the hope of regaining the original marijuana experi-

ence. T-breaks are a sign of a substance abuse disorder.

Tenth Amendment: The Tenth Amendment to the U.S. Constitution

states that any power that is not expressly designated to the federal
government will remain with the state government. That is how state
legislatures can choose to legalize marijuana even when it remains ille-
gal at the federal level. The power of most criminal enforcement is not
explicitly listed in the Constitution.

Tetrahydrocannabinol (THC): The primary psychoactive ingredient in

the Cannabis plant that produces the mind-altering effects that mar-
ijuana is mostly known for. It is one of more than 100 psychoactive
compounds found in the plant.

Tincture: A liquid solution usually containing alcohol and some other

drug component. THC tinctures are packaged in small bottles and are
administered with eye droppers under the tongue, or drops are added
directly to foods. Tinctures may contain very high concentrations of
THC and may be contaminated with other drugs.

Tolerance: Refers to the gradually decreasing effects of a drug after

repeated uses. Tolerance may be caused by biochemical changes in neu-
ral receptors, or it may be learned through behavior adaptation. Toler-
ance may also be acute (short term) or chronic (long term). Marijuana
leads to both biochemical and learned tolerance and tends to be acute,
though it may become chronic for young users.

Vape Pens: Another term for an electronic cigarette that vaporizes

drug substances without burning the material. Vaping pens were ini-
tially marketed as a smokeless alternative to smoking tobacco but has
become a popular tool for ingesting a wide variety of drugs, including
CBD, THC, and polydrug combinations.

Vaping: Refers to the practice of ingesting drugs through e-cigarettes or

vape pens. Vaping has been targeted by the FDA and the CDC as a
dangerous activity that is prone to contamination and overdosing.
Vaping delivers very high concentrations of drugs, and the dabs fre-
quently contain a variety of other drugs in addition to that advertised
by the seller.
Glossary 149

War on Drugs: Refers to the presidential policy that stressed the impor-
tance of reducing drug abuse among teens. The first “War on Drugs”
campaign was initiated by President Richard Nixon after signing the
Controlled Substances Act of 1970. The most famous “War on Drugs”
was launched by President Ronald Reagan during the 1980s, with the
campaign slogan “Just Say No.” President Clinton stopped the “War on
Drugs” campaign in the 1990s, and it has not been rejuvenated.

Withdrawal Symptoms: The range of reactions that follows when habit-

ual users stop using a drug. Physical symptoms of withdrawal may
include reactions that require a doctor’s supervision, especially in cases
of chemical dependency. Less pronounced symptoms also follow psy-
chological addictions, but they may also exhibit mild physical reac-
tions. Withdrawal symptoms are a major reason why users relapse into
addiction.
 Directory of Resources

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154 Directory of Resources

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Directory of Resources 155

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Directory of Resources 157

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158 Directory of Resources

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160 Directory of Resources

ONLINE RESOURCES
Centers for Disease Control and Prevention (CDC) Resource Page on
“Marijuana and Public Health”
https://www.cdc.gov/marijuana/index.htm
This website includes information on the health effects, statistics, and
recommendations related to marijuana use, abuse, and addiction.

Drug Enforcement Agency (DEA) Marijuana Fact Sheet

https://www.dea.gov/factsheets/marijuana
This website includes information on the on the characteristics of mar-
ijuana, the various forms by which it is sold legally and illegally, and
the laws and penalties associated with enforcement.

Government-Sponsored Addiction Treatment Resource Locator

https://findtreatment.gov/
This website is a service of the Substance Abuse and Mental Health
Services Administration. It serves as one-stop resource for individuals
looking to find more information on treating substance abuse disorders.

Institute for Behavior and Health

https://www.ibhinc.org/
This website is hosted by an organization dedicated to the reducing
illegal drug use among teens.

The National institute on Drug Abuse (NIDA)

www.drugabuse.gov
The website includes a very large database on drug statistics, drug usage,
and recommendations for prevention and treatment of addiction disor-
ders. Specific pages on marijuana may be found at: https://www.drugabuse
.gov/drug-topics/marijuana
 Index

Absinthe, 21 on relationships, xvi, 111; long-

Abuse: changing definitions, 70–71; term political consequences, 113;
definition, 73, 81; psychological marijuana risk factors, 70–71; and
abuse from addiction, 97; signs of mental illness, xvi; moral consider-
marijuana abuse, 71–73; teen risk ations, 111; nature of dependence,
factors of marijuana versus alcohol, 63–67; opioid risk factors, 55; phys­
78 ical versus psychological, 64–65;
Acetaminophen, 55 public debate over correlations, 67;
Acquired immune deficiency syn- rates increasing after legalization,
drome (AIDS), potential THC 107; relative risks by drug, 76; role
treatments, 48–49, 50, 52, 53, 60 of tolerance, 34; social costs of, 60;
Acute tolerance, 65 symptoms of withdrawal, 64; THC
Adderall, 114 as therapy for, 48; theory of gateway
Addiction: behaviors, 64, 71–72; drugs, 67–68; treatment instead of
Cannabis use disorder, 34–35; causes punishment, 96; treatment options,
of, xxiv, 71–73; characteristics of 90; victims of, 20
typical marijuana patients seeking Addiction cycle, 66; dopamine effects,
treatment, 90; defined, 63–64; 36; relapse, 85, 90, 91
digital based, xvi; as distinct from Addiction risk factors: of alcohol, 68;
dependency, 66; as distinguished alcohol versus THC, 39–40; family
from casual use, 70–71; dopamine history, xxix, 73; of THC, 68; of
priming, 69; drug risk factors, 57; tobacco, 68
family risk factors, 73; impact Addiction treatment centers, 72;
on job performance, 111; impact clinician attitudes of marijuana, 25;
162 Index

ending marijuana use, 85; how to Arizona, marijuana delivery options,

find one, 90; instead of punishment 105
Addictive behaviors, 111 Armstrong, Lance, 115
Age, statistics of use, 16 Atomic structure, marijuana, 13
Alcohol: addiction, 71; causal use Attention deficit hyperactivity disor-
risks, 78; effects compared to THC, der (ADHD), 113–114; history of
36–40; intoxication effects, 78; treatment options, 114
marijuana interactions, 75; peer
pressure, 120–121; prohibition hist- Baby boomers: culture war, 112;
ory, 101–102; school intervention defined, 22; drug culture, 102–103;
programs, 114; state licensing, 106 influence on popular culture, 22;
Alcohol poisoning, xxviii; effects, 37; and marijuana use, 16–17, 18;
risks, 79 presidents, 23; religious affiliation
Alternatives to marijuana, 52–56 of, 112–113; trends in marijuana
Alzheimer’s disease, 61 use, 22–23
Amateur experimentation, 14 Bankruptcy, 96
American drug enforcement, Biden, Joseph, 105
100–102 Binge drinking: compared to marijuana
American Heart Association, 48 use, 79, 121; defined, 78; risk factor
American Journal of Psychiatry, 84 for addiction, 68
American Psychological Association, Biochemistry: alcohol effects, 36–37;
64; genetics role in addiction, 73; of CBD, 40; emotional reactions,
recommendations on marijuana, 85; 27–28; process of addiction, 64;
risk factors for addiction, 70 reactions outside of perception, 42;
Amotivational syndrome, 36, 82; THC effects, 27; theory of toler-
defined, 82–83 ance, 42
Amphetamines: history of, 101–102; Bipolar disorder: defined, 84; risks
potential therapy options, 122–124; from marijuana, 48, 84, 85
use increase after marijuana legal- Body types, THC potency, 43
ization, 107 Brain damage, 35, 79; marijuana risk
Anti-aging cosmetics, 115–116 factors, 64–65, 71; potential long-
Antidepressants, potential THC ther- term marijuana effects, 110; from
apy, 48, 55–56 teen use, 73
Anti-drug culture, 23 Bureau of Alcohol, Tobacco, Firearms
Anxiety: defined, 49; medical treat- and Explosives (ATF), 103
ment history, 114; potential THC Bureau of Narcotics, 102; history, 94
treatments for, 48, 49–50; risk fac- Bush, George H. W., 112
tor case studies, 119–123, 127–129; Business risks: hemp farming, 7; mari-
risks from THC, 42 juana farming, 95–96
Anxiety disorders: abuse risk factors,
74; characteristics, 49; potential California: illegal vendors, 104;
THC therapy, 55; risks from mari- legalization, 18, 104; marijuana
juana, 84, 85 delivery options, 105; marijuana
Appetite encouragement, 53 retailer bailout, 106; medical
Index 163

marijuana case study, 122–124; Carcinogens, marijuana versus tobac-

proposition 215, 47 co, 77, 80
Canada, 51 Cardiovascular disease: complications
Cancer: potential therapies, 48, from smoking, 122–124; marijuana
122–124 (case study); risks from risks, 48, 88; risk factors of marijua-
marijuana versus tobacco, 77, na versus tobacco, 77, 80; tobacco
80, 88 risks, 88
Cannabidiol (CBD): animal research Casual use, dependency risks, 76
on, 59; as anticonvulsant, 40; Cell receptors, drug interactions, 13
chemical compounds, 12; clinical Center for Disease Control (CDC):
studies, 7; compared to THC, 59; correlation of marijuana with men-
effects, 5–6; effects on cognition tal illness, 84; estimated marijuana
and mood, 59; farming, 95; issues of use, 15; warnings against vaping,
quality consistency, 106; marketing, 58, 80
7, 12; moderating effects of THC, Central nervous system: impact of
34, 40–41, 60; online sales regu- edibles, 87; limits of scientist under-
lations, 105; overdose case study, standing, 42; potential long-term
129–131; physical effects of, 40–41; damage, 42–43; risks from marijua-
potential epilepsy therapy, 7, 52, na, 27–28, 31, 32–33, 34–35, 84,
54, 59; potential therapeutic uses 85; triggering intoxication, 59
of, 41; products, 7; reputation based Cesamet, 52
on marijuana, 5; varieties of, 7 Chemotherapy: limitations of THC
Cannabinoid hyperemesis syndrome, therapy, 47, 50, 52, 60, 122–124
38–39 (case study); potential THC ther-
Cannabinoid system, 13, 59; overstim- apy for side-effects, 52, 122–124;
ulation, 34; receptors, 38; triggering research of THC treatments, 47
intoxication, 43 Children, health risks from habitual
Cannabis: chemical compounds of, 59; family use, 83
cloning, 5; as nutritional supple- China, 99
ment, 3, 5–6, 8, 11, 12, 41; psycho- Chronic pain: defined, 49; non-THC
active elements of, 4–5; resin, 5; treatment options, 55, 56; potential
term coined by Greeks, 99; varieties THC treatments, 47, 49
for medical use, 34 Chronic pulmonary disease (COPD),
Cannabis farmers, 58 smoking risk factors, 77
Cannabis-friendly doctors, 51, 56, Chronic tolerance, 65
122–123 Clinton, William, 23–24; baby boom-
Cannabis plant, xxvii–xxvii, 3–6, 7, er reactions, 112; ending war on
8, 10, 11, 18–19, 21, 34, 40–41, 51, drugs, 57, 60; promoting research of
52, 58, 59, 67, 87, 93, 95, 98–99, medical marijuana, 60
100, 102, 103–104, 117, 129; cross- Cocaine, 67; addiction risk, 69–70, 71,
breeding, 4; genders, 4; indica, 3–4; 76; discovery, 21; history of regula-
sativa, 3–4 tion, 101–102; legalization move-
Cannabis use disorder: brain damage ment, 97; as Schedule I drug, 103;
risk, 35; role of tolerance, 34 school intervention programs, 114
164 Index

Codeine, 55 Criminalization: federal laws, 104;

Cognitive behavioral therapy, 90 history, xxix; morality of, 111;
Cognitive functions: developmental opposing viewpoints, 96–97; public
impairment risks, 76; impairment, pressure against marijuana, 103;
28–30, 31, 32–36; impairment rising from drug abuse trends, 21;
from alcohol versus THC, 39, 79; social implications, 112
impairment from addiction, 71; Cross-breeding: Cannabis types, 18;
impairment from alcohol, 36–37; THC content, 7, 18; THC to CBD
impairment from learned tolerance, ratios, 34
66; impairment from medical mar- Culture: dance clubs risk factors,
ijuana, 53; long term impairment, 75; social reactions to drug abuse,
34–35; short term impairment, 103
33–34 Culture war, 97–98; defined, 19;
Colorado: case study, 127–129; legal- reflection of technological depen-
ization, 95–96; marijuana delivery dency, 116–117; related to drug use,
options, 105; marijuana tax rev- 108–109
enues, 106 Cycle of dependency, 36, 50, 66
Comprehensive Drug Abuse Preven-
tion and Control Act, 103 Dabs, 5, 9, 18, 19, 31, 58, 75, 87;
Consumer confidence: inherent risks, defined, 9; in vaping, 9; variable
106; in THC concentrates, 58; potency, 75
THC quality, 58–59 Dance club culture, 75
Consumer risks, CBD products, 8 Death, risk of: from alcohol versus
Contaminants: risks from, 75; from marijuana use, 79–80; involving
smoking, 77, 80; in vaping case opioids, 55; from marijuana use,
study, 129–131 39, 86–90; overdose from edibles,
Contingency management, 90 80, 81; from polydrug overdose,
Controlled Substances Act, 23; hist- 75, 81; from poor decision-making,
ory, 94; marijuana criminalization, 79; from pre-existing conditions,
105; motivation for marijuana 87; related to potency, 87; smoking
research, 60; origins, 103; schedule versus vaping, 86; from synthetic
list, 56–57 marijuana, 58; risks versus causes,
Convergent thinking, from THC, 88–89; THC versus tobacco, 88
44–45 Delusions of grandeur: case study,
Cosmetic surgery, and drug culture, 127–129; effects of THC, 38, 44,
116 82, 85; long term effects, 85
Cotton, historic alternative to hemp, Dementia, potential THC therapy,
98 48, 61
Counterculture, promoting marijuana Democrat drug policies, 109
use, 23 Democrat views, 20; Biden, 23, 105;
Crime, related to addiction, 97 Clinton, 22–23, 24, 57, 60, 112;
Crime culture, associated with drug Obama, 135, 142
dealers, 106 Department of Health and Human
Criminal penalties, debates, 20 Services, addiction statistics, 72
Index 165

Department of Justice (DOJ), enforce- Drug classification, 94–95; schedules,

ment of marijuana cases, 105 xxix
Department of Transportation (DOT), Drug criminalization, reaction to fake
statistics of marijuana use, 24–25 doctors, 100–101
Dependency: risk factors, 71–73; risks Drug culture, 12, 119; associated with
of binge drinking versus alcohol, other vices, 101; baby boomer influ-
78, 80; teen use risk factors, 35 ence, 23; cosmetics, 116; encourag-
Depressants, survey of anti-depressant ing addiction, 20; historic trends,
usage, 114 18, 122; impact of habitual use, 83;
Depression: abuse risk factors, 74; case impact on families, 97; influence
study, 127–129; chemical therapy of ADHD diagnosis, 113–114; pro-
options, 102; marijuana risk factor, moted by baby boomers, 102–103;
56; potential THC therapy, 56; risks promoted through anti-aging
from marijuana, 84, 85 markets, 115–116; risk factor for
Diet and exercise, alternative to med- addiction, 67, 70; trends, 81
ical marijuana, 55, 56, 100 Drug dealers. See Illegal vendors
Digestive system disorders, potential Drug dealing, 23, 94, 106, 130
THC treatments, 60 Drug dependency, as distinct from
Divergent thinking, from THC, 44–45 addiction, 66
Dopamine: biochemistry, 29; effects, Drug effects: general explanation, 13;
xxix, 30; hyperstimulation risks, 43; similarities between THC and al-
overstimulation, 35–36; priming, cohol, 37–38; therapy and reaction,
69; role in addiction, 64; tolerance 14
risk factor, 75 Drug enforcement, difficulties at state
Doyle, Sir Arthur Conan, 21 level, 107
Dravet syndrome, CBD treatment Drug Enforcement Agency (DEA):
approval, 40 history, 94; marijuana research,
Driver impairment, alcohol versus 57; Medical Marijuana Report, 52;
THC, 39 non-enforcement for state growers,
Driving: impairment case study, 105; origins, 103; state enforce-
124–126; impairment from alcohol ment, 95
versus marijuana, 79–80; impair- Drug policy: defined, 107–108; influ-
ment risks of fatal accidents, 86, 88; enced by marijuana legalization,
legality, 31; marijuana impairment, 113–117; morality of, 107–113
71; under alcohol, 37 Drug research, process of, 59
Dronabinal, 52, 53, 58 Drug safety, history of, 100–101
Drug abuse: in ancient times, 99; Drug schedules, defined, 23
causes of public controversy, 93; Drug trafficking, 105, 107
defined by Schedule I classification,
103; medical drugs for recreational E-cigarettes, 5, 9; invention, 19
use, 102 Economic status, risk factors in addic-
Drug addiction: counseling, 66; social tion, 119
costs of, 97; trends of public aware- Ecstasy, 36, 57, 70, 75, 129–131 (case
ness, 21 study)
166 Index

Edibles: case study, 124–126; disorders, 85; and technological

drinks, 11; duration of effects, 31; dependence, 116–117
hashish, 10; health risks, 80; mar- Emotions: biochemistry, xvii, 5, 13,
ijuana types, 10–11; market share, 27–28, 32, 36, 40, 44, 84; impact of
11; statistics, 16; THC concentra- impairment on social relationships,
tions, 89; THC potency variability, 83
75, 86 Endocannabinoid receptors, impact of
Effects: of CBD, 40–41; on cognition CBD, 40
and mood, 59; cognitive impair- Endocannabinoid system, 29–30, 32,
ment, 32–36; delusions of grandeur, 40–42, 43–44; and emotions, 32;
38; differences between THC and impairment of cognition, 44
alcohol, 36–40; dopamine overstim- Endocrine system, 13
ulation, 35–36; drug experience, Epidiolex, FDA approval, 104–105
28–29; duration and body type, Epilepsy, treatment options, 105
43–44; duration and intensity, 33; Ethics, of experimental drug therapies,
of edibles, 11; explained, 14; indi- 108
vidual variations, 41–44; influenced Executive functions: defined, 33;
by attitudes, 32–33; long term on impairment, 33
cognition, 34–35; long term physi- Exercise, as medicine, 55, 56, 100
cal health risks of marijuana versus Experimentation, illegal, 18
alcohol, 79; of marijuana by form,
12; marijuana versus hard drugs, Fake doctors, 99–100
20; misperceptions, 33; related Family, disruption from addiction, 73
to motivation, 44–45; related to Family history: risk factor for ad-
problem solving, 44–45; of risk diction, case study, 127–129; risk
factors of abuse, 63–91; role of factor for mental illness, 84
frequency of use, 34; similarities of Farm Bill (2018), 19, 104
THC and opioids, 36; of smoking Fat storage, 31, 33, 34, 38, 68, 74, 80,
marijuana, 8; THC and anxiety, 28, 126
38, 50; THC and CBD, 34; THC Federal Drug Administration (FDA),
and imagination, 44–45; THC and regulations of CBD, 7
risky behaviors, 68; THC impact on Federalism, as drug policy, 108–109
moral judgment, 68; THC on appe- Fentanyl, 9; cause of death with THC,
tite, 38; THC on motor functions, 89; as pain reliever, 55; THC con-
30–32; THC variability, 30; unpre- taminant, 58
dictability, 28–29; user perceptions, Fetal development: risks from alcohol
82; of vaping, 8–9 versus marijuana, 79–80; risks from
Eighteenth Amendment (1919), 22 marijuana versus tobacco, 78
Elders, Joycelyn, 24 Fibromyalgia, potential THC treat-
Emergency room, statistics from ment, 47, 50, 61
vaping, 80 Flat affect, 36
Emotional escapism: abuse risk factor, Flax, historic alternative to hemp, 98
74; moral considerations of drug Food and Drug Administration
use, 111; risk factor for anxiety (FDA): approval of CBD, 40, 104;
Index 167

clinical experiments, 15; creation 56, 80–81, 85, 110, 129; marijuana
of, 21; evaluation of marijuana influenced perceptions, 36, 85;
risks, xxx; limits of Cannabis approv- misperceived effects, 50, 56;
al, 52; marijuana approval, xxviii; morality of, 110; related to imagi-
off label prescriptions, 51–52, 53, nation, 44; as ritual, 21; as therapy,
58; regulation of amateur experi- 102; user misperceptions of abuse,
ments, 15; regulation of CBD, 12, 81–82
41; regulations of marijuana, 10; Hangover, alcohol versus THC, 39
warnings about online sales, 106; Harrison Narcotics Act, history, 101
warnings against vaping, 58, 80 Harvard School of Public Health,
Free will, and addiction, 111 Drug Awareness Report, 76
Freud, Sigmund, 21 Hashish, 3, 4–5, 10–11, 18; vaped, 11
Health risks: of alcohol, 78–79; any
Gambling: as an addiction, xvi, 22, drug, 14; binge drinking, 78; cancer,
30, 64–65, 71, 101; associated xxviii; compared to alcohol, xv–xvi,
with drug culture, 101; behavior 78–79; compared to alcohol and
addiction, 64–65; as a moral issue, tobacco, xxviii, 76–81; due to po-
111 tency, 19; of marijuana, 48, 79–80;
Gamma-aminobutyric acid (GABA), marijuana edibles, 11; marijuana
29, 42, 44 versus tobacco, 76–78; side-effects,
Gangland violence, 22–23 15; smoking marijuana, 14
Gateway drug, 20; in addition to mari- Hemp: as distinguished from marijua-
juana, 68; defined, 67–68; evidence na, 6; false advertising, 106; farming
for marijuana as, 67–70; opponents legislation, 19; historic uses, 98–99;
of theory, 67; as a probability, 68; versus synthetic fibers, 4; as textile,
risk factors for addiction, 70 xxii, 4, 103; textile sales by state,
Genetics: predisposition to addiction, 105
70, 73; user experience variations, Hemp farmers, 19; business risks, 7;
41 historic trends, 21; legality, 7; legal-
Glaucoma, potential THC therapy, ization for CBD, 104; regulations,
48, 50, 54, 61 7, 102
Government regulations, opposing Hemp Farming Act, 95
viewpoints in drug control, 97–98 Heroin, 67; addiction risk, 69–70, 71,
Greece, history of medicine, 99–100 76; as Schedule I drug, 103; discov-
ery of, 21; history of criminaliza-
Habitual use: alcohol risk factors, 78; tion, 102; legalization movement,
impact on relationships, 82–83; 97; not prescribed, 94
impact on user experience, 42 High. See Intoxication
Hallucination: homicide risk factor, Hippocrates, 100
89; from marijuana overdose, 87; History: alcohol most common drug,
marijuana risks versus tobacco risks, 99; criminalization of marijuana,
77, 80; risks of, 38 98–99; culture war trends, 112–113;
Hallucinogen: defined, 36; marijuana distinction of CBD and THC, 40;
characteristic, xxviii, 32, 41, 44, 50, drug enforcement, xxix; edibles,
168 Index

10–11; legalization and gateway drug Individual expectations, marijuana

theory, 67; legalization movement, effects case studies, 121–126
47–48; legalization of recreational Individual freedom: and drug
use, 24; marijuana and criminal un- policy, 108–109, 111; as liberty,
derworld, 102; marijuana awareness, 97–98
xxvii; marijuana potency trends, Insurance coverage, marijuana pre-
107; marijuana use in primitive soci- scriptions, 123–124
eties, 21; medical expertise, 99–100; Interstate commerce, 95;
medicine in 1950s, 102; perception marijuana, 105–107; narcotics
of marijuana as a drug, 93–94, 99; sales, 101
public popularity of marijuana, 21; Intoxication: alcohol versus THC
public views on drug use, 20; of experience, 36–38; stages induced
smoking marijuana, 10–11; social by alcohol, 37; stages induced by
reactions to drug abuse, 99–100; tex- THC, 37–38; stages of, 37–38;
tile development, 98–99; trends of thresholds by body type, 125; user
recreational use, 21; use of psycho- perceptions, 38
tropic drugs, 113–114 Isolation: risk factor for addiction,
Hodgkin’s lymphoma, potential thera- 120; side effect of habitual
pies, 122–123 marijuana use, 82, 83
Hollywood: portrayal of marijua-
na, 101; promoting drug culture, Jazz Age, associations with vice,
115–116 101–102
Hormones, drug reactions, 13, 27, 32, Johnson, Ben, 115
102, 114 Jones, Marion, 115
HU-210, 12 Judgment: impairment alcohol versus
Hydrocodone, 55 THC, 39, 79–80; impairment and
death risks, 89; impairment from
Idaho, impact of legalization in THC, 34, 44–45, 76, 80, 81; im-
neighbor states, 107 pairment impact on relationships,
Ideologies, defined, 108–109 82; long-term impairment risks,
Illegal vendors, 8, 9, 10, 12, 15, 22; 86, 110; as a moral issue, 109–110;
case studies, 123, 129–131; versus THC impairment as addiction risk
legal vendors, 106–107; online factor, 68
sales, 106; potency trends, 86; “Just Say No” Campaign, xvi, 23;
quality control, 58–59; role and childhood behavioral therapies,
in drug classification, 94–95; 114
sales statistics, 16; statement
enforcement, 104 K2. See Synthetic marijuana
Illinois, marijuana tax revenues, 106 Kief, 11
Immunity, marijuana side effects, 122
Impulse control, THC effects, 34 Learned tolerance, 65, 79, 82; case
Indica, Cannabis, 3, 18 study, 124–126; impact of
Individual accountability, as a moral impairment on social
issue, 109–111 relationships, 83
Index 169

Learning: impairment from marijuana, business pressures, 18–19; byprod-

33, 35, 48; impairment risks, 76, 80; ucts, 4–5; and cancer, 15; chemical
in teens use, 73 compounds, 13; combustion point,
Legalization: alcohol by state, 110; 6–7, 9; and counterculture, 23; and
baby boomer influence, 113; in criminal behavior, 25; criminal-
Canada, 51; CBD sales by state, ization, 22; described, 3–6; drinks,
105; controversies, 96–97; correlat- 11; and driving, xxviii; edibles,
ed with rates of addiction, 66–67; 10; effects on judgment, xxviii;
edibles, 10, 11; federal limits, 95; effects versus hard drugs, 20; forms
hemp textiles, 105; history trends, of consumption, 5–6, 9, 11, 15, 19,
18–19, 47–48; impact of illegal 80, 126, 128; as a gateway drug,
trade, 106–107; impact of potency xxix; as hallucinogenic, xxviii;
trends, 86; increased incidents of and imagination, xv; intoxication,
death, 86; influenced by techno- 12–15; meaning of the term, 3;
logical trends, 116–117; influences from Mexico, 21; misconceptions,
on other health issues, 113–117; xxvii–xxx; perceived effects, 50;
marijuana policies, 6, 93–117; plant life cycle, 4; potency (historic
medical marijuana by state, 105; tends), 18–19; primitive use, 21;
movement, 24; myths, xv–xvi, products, 6–7; psychoactive forms,
xvii; opposing viewpoints, 20, 6; research history, 56–57; research
96–97; origins of marijuana trends, 18–19; seeds, 3, 4, 5; sym-
movement, 103; policies related to bols, 5–6; textiles vs. synthetic, 6;
moral health, 25; of prescriptions, user statistics, 51; varieties, 3–4; as
94–95; presidential endorsement, weed, 5, 12
23; recreational use, 58; risks of Marijuana abuse disorder, xvii, xxix;
addiction, 72; state laws, 104–105; social effects, 81–83
synthetic marijuana, 11; teen use, Marijuana card, 9, 51, 58, 104, 122,
73, 120–121; through promotion of 127–129 (case study), 130
medical use, 60; tracking marijua- Marijuana dispensaries: case stud-
na use, 16; viewpoints based on ies, 122–124, 124–126, 127–129;
enforcement issues, 107 impact of illegal vendors, 106–107;
Lifestyle choices: addiction risk verification of identity, 105
factors, 71–73; addiction treatment Marijuana farming, 95; expenses and
options, 90; risk factors of abuse, risks, 106–107; grower’s license,
73–74; risks of death, 88 104; historic misconceptions, 98;
Liver, damage from marijuana versus regulations, 104–105; for research
alcohol, 79–80 purposes, 105
Lysergic Acid Diethylamide (LSD), Marijuana induced psychosis, 84
57; defined, 23; invention, 102 Marijuana policy, part of culture war,
109
Marihuana Tax Act, 102 Marijuana research: dangers of teen
Marijuana: actual use statistics, use, 57; removing marijuana stigma,
15–17; association with crime, xxx, 60; teen use, 57
24–25; business expenses, 106–107; Marijuana safety, xxviii
170 Index

Marijuana use disorder, 72; as an Mental illness: chemical therapy op-

addiction, 66; correlations with tions, 102; correlations with abuse,
multiple addictions, 90; impact on 83–86; correlation with marijuana,
social economic status, 83 84; family history risk factors, 74;
Marinol, 52 habitual teen use, 85; risk factors
Market share: of edibles, 11; marijua- for addiction, 70–71; risk factors in
na sales statistics, 16 dependency, 66; risks from tobacco,
Massachusetts Cannabis Commission, 77; statistics on teen use correla-
106 tions, 35
McGwire, Mark, 115 Metabolism: defined, 43–44; delayed
Medical marijuana, 47–61; actual effect of edibles, 86; impact on tol-
usage, 48–51; as emotional thera- erance, 74–75; liver damage, 80
py, 114; as gateway to recreational Methamphetamines, 67; addiction
use, 24; CBD to THC ratios, 58; risk, 70, 71, 76; legalization move-
compared to NSAID medicines, 49; ment, 97
compared to opioids, 49; contro- Methylenedioxymethamphetamine
versies, 96–97; experimentation, (MDMA, ecstasy), 36, 57, 70, 75,
52; forms, 9–10; history, 24; history 129–131 (case study); marijuana
of legalization, 47–48; individual interactions, 75
treatment preference, xxviii, 14, Mexico, source of marijuana as drug,
50, 52–53; justification for recre- 101–102
ational use, 51; off-label use, 52; Misuse of Drugs Act (UK), 103
political debates, 24; primitive uses, Moral conservatives, 112–113
21; reasons for prescriptions, 50; Moral habits, defined, 110–111
research history, 57; research into Moral health, 109–110; related to
potential therapies, 60–61; sources drug use, 109–110
of controversy, 93–94; treatment Moral ideologies, defined, 108–109
limitations, 49–50 Moral issues, defined, 109
Medical marijuana report, 47–48 Morality: of anti-aging cosmetics,
Medical policy, ethical considerations, 116; of performance enhancing
108–109 drugs, 115; of recreational drug use,
Medical research: medical marijuana, 109–110; reflected in drug policies,
50; public pressure for THC, 60; 107–113; viewpoints explained,
THC versus CBD, 59 110–111
Medicine: history of, 99–100; primi- Morphine, 55; discovery, 21; history,
tive, 21 101
Megestrol, 53 Mortality. See Death, risk of
Memory: impairment from alcohol, Motivation, risk factor for abuse,
78; impairment from THC, 13, 31, 74–75
33, 34–35, 37, 41, 48, 50, 53, 61, Motivational enhancement therapy,
71, 73, 76, 79–80 90
Mental health: marijuana risks, 76; Motor functions, impairment alcohol
potential THC therapies, 61; risks versus THC, 39
of marijuana, 80 Motor skills, impairment, 30–31
Index 171

Multiple sclerosis (MS): defined, 54; 16; misconceptions about gateway

non-THC therapies, 54, 61 poten- drugs, 67; promoting marijuana use,
tial THC treatments, 47–48, 49, 50 51; sales of marijuana, 105–106;
Mushrooms, as hallucinogen, 99 source of addiction treatment cen-
ters, 90–91; source of misinforma-
Nabilone, 52 tion, 48–49; sources for marijuana
Narcotics, defined, 94 information, 122, 124
National Academies of Science, Opioid system, biochemistry, 29
Engineering, and Medicine, 47–48; Opioids: and drug culture, 101; history
medical efficacy, 123–124 as medicine, 100–101; marijuana
National Alliance on Mental Illness, as addiction therapy, 61; marijuana
84 interactions, 75; therapy recom-
National Institute of Drug Addiction mendations, 55; use increase after
(NIDA), 90; annual surveys, 16; marijuana legalization, 107
gateway drug definition, 67–68 Oregon: in case studies, 121–123,
National Institute of Health, 82 124–126; deregulation of marijuana
Nausea: case studies, 122–124; po- vendors, 107; impact of legalization
tential THC therapy, 47, 50, 52, on Idaho, 107; legalization, 96–97;
60–61; withdrawal symptoms, 29, marijuana laws, 104; underage mari-
39, 64, 72 juana laws, 121
Nervous disorders: defined, 53; poten- Overdose: of alcohol, 37; death risks,
tial THC therapy, 54, 61 30; deaths, 9; from edibles, 75, 80,
Neurotransmitters, dopamine hyper- 86–87; marijuana, 10; marijuana
stimulation, 69 symptoms, 87; mortality risks, 86;
Nevada, marijuana laws, 104 statistics, 16; symptoms from syn-
New York: legalization case study, thetic marijuana, 12, 87; of THC,
129–131; marijuana delivery op- 38; from vaping, 120–121
tions, 105 Over-the-counter (OTC) pain reliev-
Nicotine, health risks, 76–77 ers, 49, 55
Nixon, Richard, 23; war on drugs, 103 Oxycodone, 55
Non-smoking, THC delivery meth-
ods, 14 Pain relief, history of, 100–101
Nonsteroidal anti-inflammatory Panic attack: homicide risks, 89; from
(NSAID) drugs, 49, 55; alternative marijuana overdose, 87; overdose
to THC, 55 side effects, 120–121; potential side
effect of marijuana, 77, 80, 82, 84;
Obama, Barack: baby boomer suicide risks, 89
reactions, 112; non-enforcement of Paranoia: case study, 127–129; de-
federal laws, 105 fined, 84; effects of casual use, 34,
Off-label: defined, 52; marketing, 52; 38, 82, 83, 84, 120–121; from mari-
treatments, for depression, 56; use, juana overdose, 87; THC effects, 34
51–52 Patches, 10; effects, 8
Online: addictions, 116–117; illegal Patient preference: avoiding diet and
THC sales, 59; marijuana sales, exercise, 56; medical marijuana, 14
172 Index

Peer pressure: in case studies, 120–123, potential THC therapy, 48–49, 50,
129–131; risk factor for abuse, 74 61; THC ineffectiveness, 85
Penalties, marijuana laws, 104–106 Post-treatment programs, 91
Perceptions: effect of THC on imagi- Potency: by delivery method, 18;
nation, 44; impact of habitual use, history since legalization, 107; of
33; impairment from alcohol, 37; marijuana, 18; risk factor for abuse,
influence of tolerance, 39; placebo 74–75, 76; THC in dabs, 9
effect of THC, 49; relative to pain, Presidential Commission on Narcotic
49; THC effects, 32–33 and Drug Abuse, 102–103
Performance enhancing drugs (PEDs), Prohibition, of alcohol, 22
115–116 Proposition 215, California Legaliza-
Pharmaceutical revolution, 102–103 tion, 47
Pharmacology, historic trends, 21 Prostitution: associated with drug
Phencyclidine (PCP), invention, 102 culture, 101; as vice, 22, 101
Physical addiction, 63; defined, 64 Psychoactive, drug characteristics, 76,
Physical dependency: marijuana 80
versus alcohol, 78, 80; marijuana Psychological addiction: alcohol
versus tobacco, 77, 80 versus THC, 39–40, 78, 80; behav-
Pipes, types, 8 iors, 71–73; defined, 64; dopamine
Polarized society: baby boomers influ- hyperstimulation, 45; dopamine
enced, 112–113; defined, 109 priming, 69; limited drug therapies,
Police detection, 31–32 91; risk factors for, 57, 63; THC risk
Police enforcement, marijuana laws, 24 factor, 50, 53; tobacco versus THC,
Political affiliation, drug policy, 112 77, 80
Political debates: on marijuana, 20; Psychological dependency, xxix;
over marijuana legalization, 24; symptoms, 30
reasons for promoting marijuana, 76 Psychological disorders, potential
Political ideologies, related to drug THC therapy, 55
use, 108–109 Psychosis: defined, 84; marijuana as
Political parties, viewpoints on drug treatment option, 61; from mari-
policy, 109 juana overdose, 87; risk factor for
Polydrug use, 58; abuse risk factor, abuse, 74; risks from marijuana, 38,
75; addiction risks, 81; case studies, 48, 84; risks from tobacco, 77; risks
124–126, 129–131; impact on of, 36, 76, 80; suicide risk factor, 89
relationships, 83; increase after Psychotherapy, alternative to marijua-
marijuana legalization, 107; leading na, 56
cause of death, 39, 55; opioids and Psychotropic drugs, therapeutic uses,
alcohol, 25; tolerance risks, 43 113–114
Popular culture: defined by media, 20; Public access, historic trends of THC,
promoting marijuana use, 18 19
Pornography: behavioral addiction, Public attitudes: case study, 127–129;
64–65; as a moral issue, 111 potential of medical marijuana, 52;
Post-traumatic stress disorder (PTSD): of THC intoxication, 44
marijuana use as causal factor, 85; Public demand, vaping influence, 19
Index 173

Public nuisance, marijuana versus costs, 108–109; sources of public

tobacco, 77–78 controversy, 93
Public opinion: attitudes of CBD Recreational marijuana use: amateur
as therapy, 40–41; attitudes of experimentation, 14; increasing
moral health risks, 25; attitudes of illegal sales, 106–107; legalization,
recreational drug-use, 21; attitudes 95; legalization following medic-
of treatment centers, 25; attitudes al use legalization, 60, 96–97; in
on legalization, 24; attitudes to primitive societies, 21
marijuana, 19–25; awareness of Regulation: hemp farming, 19; no
marijuana health risks, 23, 76; controls on CBD, 106; of perform-
CBD reputation tied to marijuana ance enhancement drugs, 115
demand, 41; consensus, 24, 109, Rehabilitation, instead of punish-
112–113; culture war over values, ment, 103
97–98; on drug culture, 116; drug Relapses: cause of addiction, 85, 90;
use in sports, 115; drugs and vio- treatment cycle, 90–91
lence, 22, 25; impacting marijuana Relationships, marijuana impairment,
use, 107; influenced by legalization 82–83
movement, 113; marijuana as Religious affiliation: drug policy, 109,
gateway, 22; perceptions of drug 112; viewpoints on drug use, 109
controversy, 93–94; pressure for Republican drug policies, 109
marijuana research, 61; pressure for Republican views, 20; Bush, 23, 112;
new medicines, 100; that marijua- Nixon, 23, 103; Reagan, 23, 57,
na is harmless, 20; THC demand 103; Trump, 105
linked to CBD research, 60; types Risk-raking, THC effects, 31, 34, 39,
of, 19 64, 68, 72, 79–80, 81, 82, 110, 126
Public perception: alcohol versus Ritalin, 114
marijuana in case studies, 120–122,
127–131; of CBD due to marijuana Safety, drug regulations, 108–109
reputation, 12 Sativa, Cannabis, 3, 18
Pure Food and Drug Act, 100 Schedule classification system, origins,
103
Qin Shi Huang, Chinese emperor, 100 Schedule I drugs: defined, 56–57,
94–95, 96, 103; enforcement, 104;
Rate of action, marijuana, 8, 9 marijuana listing, 60; rationale for
Reagan, Nancy, 23 marijuana inclusion, 63
Reagan, Ronald, baby boomer reac- Schedule II drugs: defined, 94–95;
tions, 112 regulations, 94
Reagan, Ronald, war on drugs, 23, 57, Schedule III drugs, 57; defined, 94–95
60, 103, 112 Schedule IV drugs, 57; defined, 94–95
Recreational drug use: baby boom- Schedule V drugs, 57; defined, 94–95
er influence, 113; influenced Schizophrenia: chemical therapy
by technological dependence, options, 102; potential THC
116–117; opposing viewpoints, 111; treatments, 48; risks from
risk factors for depression, 56; social marijuana, 84, 85
174 Index

School intervention programs, Spice. See Synthetic marijuana

anti-drug campaigns, 114 State regulations, THC quality, 58–59
Schools, drug free zones, 103 Statistics: actual marijuana users,
Scientific revolution, medicine, 100 15–17; addiction risks, 72, 76;
Second-hand smoke, marijuana versus addiction risks of marijuana versus
tobacco, 77 alcohol, 81; age of use, 16–17; alco-
Seizure therapies, alternatives to hol poisoning, 79; binge drinking
CBD, 54 versus marijuana use, 78, 80–81;
Self-medication: case study, 127–129; cardiovascular risks from smok-
consumer confidence, 58; marijuana ing anything, 77; casual use and
as anti-depressant, 114; marijuana marijuana abuse, 75–76; casual use
for anxiety, 56; marijuana used for of alcohol, 78; childhood diagnosis
PTSD, 85; risks of abuse, 86; signs of behavior disorders, 114; crime
of addiction, 72 rates and drug use, 25; daily users
Serostim, 53 since legalization, 107; dependency
Sex, and drug use, 120 rates, 17; drug use in sports, 115;
Sexual behaviors, 72 edibles market share, 11; effects
Shamans, 21, 99–100; origins of, of “Just Say No,” 23; family abuse
99–100 and mental health risks, 83; forms
Silk, historic alternative to hemp, of marijuana consumption, 16;
98 historic trends, 17; illegal marijuana
Sinsemilla, 5 sales, 106–107; increase in demand
Smoking: teen use as risk factor for after state legalization, 106–107;
abuse, 74; and THC, 8–9 marijuana addiction rates, 66–67;
Sobriety tests, 32 marijuana and addiction treatment,
Social anxiety, marijuana prescrip- 25; marijuana potency trends, 18;
tions for, 51 marijuana sales, 16; marijuana tax
Social anxiety disorder, marijuana revenues by state, 106; marijuana
correlation, 84 use after legalization, 24; marijuana
Social costs: of public vice, 22; use and addictions to any drug,
recreational use, xxix 70; mortality trends from mari-
Social liberals, 112–113 juana use, 88; neurotransmitters,
Social media: promoting drug 28; overdose deaths, 16; psychosis
culture, 116, 119–120, 129–131 associated with schizophrenia, 84;
(case studies); role in promoting public dependency on technology,
marijuana, xvi 116–117; rates of fatal car acci-
Social reactions, related to drug pol- dents from marijuana and alcohol,
icy, 108–109 88; rates of suicide, 89; reasons for
Social relationships, signs of addic- marijuana use, 96; recreational use
tion, 72 after legalization, 51; reliability
Somatropin, 53 of surveys, 16; risks of death from
Sosa, Sammy, 115 cardiovascular disease, 87; teen use,
Speakeasies, during prohibition, 16–17; THC potency trends, 86;
101–102 trends of recreational use following
Index 175

medical legalization, 96–97; urban 65; impaired learning, 35; pressure

police cases of teen arrests, 75; use for marijuana research, 57; risk
after legalization, 17; use by gender, factors for addiction, 70, 71; risk
17; vaping emergencies from over- of later dependency, 17; statistics,
dose, 80 16–17; trends, 23
Steroids, contributing to drug culture, Temperance movement, history, 22
114–115 Tenth amendment, 95; federal limits,
Stimulants, defined, 94 104
Substance abuse. See Addiction Testosterone. See Steroids
Substance Abuse and Mental Health Tetrahydrocannabinol (THC): anx-
Services Administration, 91 iety side-effects, 50; with CBD,
Substance abuse disorder: impact on 40, 59, 61; compared to alcohol,
relationships, 82–83; social 80; compared to NSAID medi-
risks of alcohol versus marijuana, cines, 49; compared to opioids, 49;
79; suicide risk factor, 89; tolerance, concentrates, 8; described, 4; in
65 edibles, 27; effects, 6, 12, 30, 32,
Suicide: edibles overdose cases, 89; 37, 41, 44, 68; impact on moral
marijuana use as a risk factor, 48, judgment, 68; legalization, 16, 95,
89; risks from marijuana overdose, 105; limits as pain reliever, 49; long
80; as withdrawal symptom, 64 term impairment, 68; as medical
Surgeon general warnings, tobacco, 88 therapy, 48–49; potency, 18, 74, 86;
Surgeon general’s report on alcohol, potency trends, 86; recorded deaths
drugs, and health, 72 from overdosing, 87; regulation
Synaptic gap, drug effects, 27–28 of concentrates, 58; risk factors
Syndros, 52 of concentrations, 74–75; risks of
Synthetic marijuana, 8, 11–12, 58; death, 86; synthetic, xxviii, 52–53,
biochemistry, 42; risks of death, 87 58; varieties, 4, 74
Synthetic textiles, alternatives to Textiles: hemp sales, 105; historic uses
hemp, 98 of hemp, 98–99
Therapy, intended purposes of legal-
Taxation: increasing marijuana ization, 47–48
consumer price, 106; justification Tinctures: explained, 10; THC poten-
for legalization, 96; marijuana cy, 75
farming, 104 Tobacco: health risks, 76–78; teen use
T-break, 74–75 as risk factor for addiction, 68
Technology: impact on personal Tolerance: alcohol versus THC,
relationships, 120–121; influences 37; biochemistry, 42; case study,
on addiction, 113; promoting drug 127–129; defined, 34; dependen-
culture, 115–116, 117 cy risk factors, 74–75; dopamine
Teen use: addiction risk factors, 73, hyperstimulation, 65; effects on
76; binge drinking versus marijuana user experience, 82; flat affect, 36;
use, 78; criminal penalties, 104; de- habitual adaptation, 31; individual
veloping brains, 35; health risks, 76; variability, 74; psychological, 43; re-
impact of tolerance on dependency, lated to dosage, 74–75; risk factors
176 Index

in marijuana dependency, 65–66; Vaping: case studies, 121–123,

risks of alcohol versus marijuana, 129–131; CDC and FDA warnings,
79; role of frequency of use, 34; in 48; devices, 9; duration of effects,
teens, 65; types of, 65 31; FDA and CDC warnings, 58;
Tourette syndrome, potential THC Hashish, 11; health risks versus
treatments, 48 tobacco, 80; history, 9; origins,
Treatment options, 90–91; for mari- 15; overdose risks due to potency,
juana versus alcohol dependency, 87; statistics, 16; unpredictable
78 potency, 75, 120–121; without
Treatment research, 47–48; evidence combustion, 7
in support of, 47; insufficient evi- Vaporizers, explained, 8–9
dence for, 48 Vice, markets, 22
Trends: government support for treat- Video games, behavior addiction,
ment options, 25; public attitudes, 64–65
19–25; teen use, 81
Trump, Donald, enforcement of feder- War on drugs, 23, 57, 60; baby
al drug laws, 105 boomer reactions, 112; origins of,
Twentieth Amendment, 22 102–103
Washington: impact of legalization on
United Cannabis Business Idaho, 107; legalization, 95
Association, 106 Withdrawal, 29–30; physical symp-
Urban drug culture: case study, toms, 64, 72; psychological symp-
129–131; history, 101–102, toms, 64; suicide risk symptoms,
103 89; symptoms of dependency, 66;
User experience: of alcohol, 36–37; symptoms of depression, 85; unique
alcohol versus THC, 39; based on marijuana characteristics, 91
expectations, 42; different from Wool, historic alternative to hemp, 98
outside observations, 51; role of World Health Organization (WHO),
attitude, 32–33; variable reactions, estimated marijuana use, 15
41–44 World War I, and drug use, 22, 101
User preference, 122; case study, World War II, and drug use, 4, 22,
127–129 102, 113
About the Author

Aharon W. Zorea, PhD, is professor of history at the University of

Wisconsin–Platteville. His published works include other Greenwood/
ABC-CLIO titles, Finding the Fountain of Youth: The Science and Contro-
versy behind Extending Life and Cheating Death (2017), Steroids (Health
and Medical Issues Today) (2014), and Birth Control (Health and Medical
Issues Today) (2012), as well as In the Image of God: A Christian Response
to Capital Punishment (2000). He has been teaching for more than 20 years
and has written more than 60 articles on politics and legal and social
policy. Zorea holds a master’s from Purdue University and a doctorate in
policy history from Saint Louis University. His articles and recorded lec-
tures may be found through a variety of outlets online.