The science of drug abuse and addiction

Research overview from the National Institute of Drug Abuse and Addiction; current as at 2 January 2008

EFFECTS ON THE BRAIN

Scientists have learned a great deal about how THC (delta-9-tetrahydrocannabinol) acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to organs throughout the body, including the brain.

In the brain, THC connects to specific sites called cannabinoid receptors on nerve cells and influences the activity of those cells. Some brain areas have many cannabinoid receptors; others have few or none. Many cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thought, concentration, sensory and time perception, and coordinated movement⁴.

The short-term effects of marijuana can include problems with memory and learning; distorted perception; difficulty in thinking and problem solving; loss of coordination; and increased heart rate. Research findings for long-term marijuana abuse indicate changes in the brain similar to those after long-term abuse of other major drugs. For example, cannabinoid (THC or synthetic forms of THC) withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system⁵ and changes in the activity of nerve cells containing dopamine⁶. Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.

EFFECTS ON THE HEART

One study has indicated that an abuser’s risk of heart attack more than quadruples in the first hour after smoking marijuana⁷. The researchers suggest that such an effect might occur from marijuana’s effects on blood pressure and heart rate and reduced oxygen-carrying capacity of blood.

EFFECTS ON THE LUNGS

A study of 450 people found that those who smoke marijuana often but do not smoke tobacco have more health problems and miss more days of work than nonsmokers⁸. Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.

Even infrequent abuse can cause burning and stinging of the mouth and throat, often accompanied by a heavy cough. Someone who smokes marijuana regularly can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, a heightened risk of lung infections, and a greater tendency to obstructed airways⁹. Smoking marijuana possibly increases the likelihood of developing cancer of the head or neck. A study comparing 173 cancer patients and 176 healthy individuals produced evidence that marijuana smoking doubled or tripled the risk of these cancers¹⁰.

Marijuana abuse also has the potential to promote cancer of the lungs and other parts of the respiratory tract because it contains irritants and carcinogens^9,11. In fact, marijuana smoke contains 50-70% more carcinogenic hydrocarbons than tobacco smoke¹². It also induces high levels of an enzyme that converts certain hydrocarbons into their carcinogenic form—levels that can accelerate the changes that ultimately produce malignant cells¹³. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which increases the lungs’ exposure to carcinogenic smoke. These facts suggest that, puff for puff, smoking marijuana may be more harmful to the lungs than smoking tobacco.

OTHER HEALTH EFFECTS

Some of marijuana’s adverse health effects might occur because THC impairs the immune system’s ability to fight disease. In laboratory experiments that exposed animal and human cells to THC or other marijuana ingredients, the normal disease-preventing reactions of many of the key types of immune cells were inhibited¹⁴. In other studies, mice exposed to THC or related substances were more likely than unexposed mice to develop bacterial infections and tumours^15,16.

LEARNING AND SOCIAL BEHAVIOUR

Research clearly shows that marijuana has the potential to cause problems in daily life or make a person’s existing problems worse. Depression¹⁷, anxiety¹⁷, and personality disturbances¹⁸ have been associated with chronic marijuana use. Because marijuana compromises the ability to learn and remember information, the more a person uses marijuana the more he or she is likely to fall behind in accumulating intellectual, job, or social skills. Moreover, research has shown that marijuana’s adverse impact on memory and learning can last for days or weeks after the acute effects of the drug wear off^19,20,25.

Students who smoke marijuana get lower grades and are less likely to graduate from high school, compared with their nonsmoking peers^21,22,23,24. A study of 129 college students found that, among those who smoked the drug at least 27 of the 30 days before being surveyed, critical skills related to attention, memory, and learning were significantly impaired, even after the students had not taken the drug for at least 24 hours²⁰. These “heavy” marijuana abusers had more trouble sustaining and shifting their attention and in registering, organising, and using information than did the study participants who had abused marijuana no more than 3 of the previous 30 days.

So someone smoking marijuana every day could be functioning at a reduced intellectual level all the time.
More recently, the same researchers showed that the ability of a group of long-term heavy marijuana abusers to recall words from a list remained impaired for a week after quitting, but returned to normal within 4 weeks²⁵. Thus, some cognitive abilities may be restored in individuals who quit smoking marijuana, even after long-term heavy use.

Workers who smoke marijuana are more likely than their coworkers to have problems on the job. Several studies associate workers’ marijuana smoking with increased absences, tardiness, accidents, workers’ compensation claims, and job turnover. A study among postal workers found that employees who tested positive for marijuana on a pre-employment urine drug test had 55% more industrial accidents, 85% more injuries, and a 75% increase in absenteeism compared with those who tested negative for marijuana use²⁶. In another study, heavy marijuana abusers reported that the drug impaired several important measures of life achievement including cognitive abilities, career status, social life, and physical and mental health²⁷.

EXPOSURE DURING PREGNANCY

Research has shown that some babies born to women who abused marijuana during their pregnancies display altered responses to visual stimuli²⁸, increased tremulousness, and a hightched cry, which might indicate neurological problems in development²⁹. During the preschool years, marijuana-exposed children performed tasks involving sustained attention and memory more poorly than nonexposed children do^30,31. In the school years, these children are more likely to exhibit deficits in problem-solving skills, memory, and the ability to remain attentive³⁰.

ADDICTIVE POTENTIAL

Long-term marijuana abuse can lead to addiction for some people; that is, they abuse the drug compulsively even though it interferes with family, school, work, and recreational activities. Drug craving and withdrawal symptoms can make it hard for long-term marijuana smokers to stop abusing the drug. People trying to quit report irritability, sleeplessness, and anxiety³². They also display increased aggression on psychological tests, peaking approximately one week after the last use of the drug³³.

37 research references are available from NIDA.