A CLOSER LOOK: HOW CANNABIS IMPACTS OUR HEALTH

A CLOSER LOOK: HOW CANNABIS IMPACTS OUR HEALTH

A CLOSER LOOK: HOW CANNABIS IMPACTS OUR HEALTH Highlights from the National Academies of Sciences, Engineering, and Medicine report The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research1 THE LANDSCAPE IS CHANGING QUICKLY More people are using cannabis.2 More states are legalizing medical and recreational cannabis use.1

DEFINITIONS TO KNOW Cannabis is a broad term. It describes the different products that come from the Cannabis sativa plant, including marijuana (sometimes called pot or weed) and cannabinoids. THE CHALLENGE We need more information to understand the short- and long-term health effectsboth the

risks and benefitsof cannabis. A STEP FORWARD The National Academies of Sciences, Engineering, and Medicine (NASEM) developed a report that reviews the current research on cannabis use and its impact on peoples health. The report offers: An in-depth and broad review of the most recent research. Nearly 100 research conclusions about the health effects of cannabis and cannabis-based products. Recommendations to expand and improve cannabis research and data collection.

REPORT HIGHLIGHTS THERAPEUTIC BENEFITS Cannabis-based products, such as manmade cannabinoid-based medications, may help prevent and ease nausea caused by chemotherapy. For adults with multiple sclerosis-related muscle spasms, short-term use of certain man-made and cannabinoid-based medications improved their reported symptoms.

REPORT HIGHLIGHTS THERAPEUTIC BENEFITS (CONT.) WHAT YOU NEED TO KNOW ABOUT CANNABIS AND CHRONIC PAIN There's a lot of uncertainty around using cannabis for chronic pain. Cannabis-based products may help treat chronic pain in some adults, but more information is needed to know if pain relief from cannabis is any better or worse than other pain management options, such as over-the-counter drugs like ibuprofen or alternative treatments like occupational therapy.

More research is needed to know the specific indications, ideal doses, and how to avoid adverse effectssuch as headache, nausea, sleepiness, and dizzinessthat are related to medical cannabis use. REPORT HIGHLIGHTS CANCER RISK More research is needed to know if smoking cannabis increases a persons risk for certain cancers, including lung, head, and neck cancers.

REPORT HIGHLIGHTS CANCER RISK (CONT.) WHAT YOU NEED TO KNOW ABOUT CANNABIS AND LUNG CANCER Smoked cannabis has many of the same cancer-causing substances as smoked tobacco.3 Due to the risks it poses to lung health, experts strongly caution against smoking cannabis and tobacco products. More research is needed to know if smoking cannabis increases a persons risk for lung cancer. However, it is difficult to determine whether there is a link, because cannabis use often overlaps other

behaviors related to lung cancer, such as tobacco use. REPORT HIGHLIGHTS PREGNANCY Smoking cannabis during pregnancy is linked to lower birth weight in babies. More research is needed to know how cannabis use during pregnancy affects babies and their future health outcomes. REPORT HIGHLIGHTS

PREGNANCY (CONT.) WHAT YOU NEED TO KNOW ABOUT CANNABIS AND PREGNANCY The chemicals found in cannabis, including in edibles such as cookies, brownies, and candies, may be harmful for babies. Tetrahydrocannabinol (THC) can be passed through breast milk. More research is needed to understand the potential risk to babies. REPORT HIGHLIGHTS BRAIN HEALTH AND

FUTURE OUTCOMES Learning, memory, and attention are impaired after using cannabis, and the damage may last even after people stop using it. WHAT YOU NEED TO KNOW ABOUT CANNABIS AND BRAIN HEALTH Cannabis use directly affects the brain especially the parts responsible for memory, learning, attention, decision-making, coordination, emotions, and reaction time.

REPORT HIGHLIGHTS ADOLESCENTS AND YOUNG ADULTS Long-term cannabis use can have permanent effects on the developing brains of adolescents and young adults.5 REPORT HIGHLIGHTS ADOLESCENTS AND YOUNG

ADULTS (CONT.) WHAT YOU NEED TO KNOW ABOUT CANNABIS AND ADOLESCENTS Studies have shown that if an adolescent uses cannabis before the age of 16 and for a prolonged period, it can lead to a number of significant health problems. Teen cannabis users are more likely to become addicted to cannabis than people who start using the drug when they are older.6-9 Cannabis use can negatively affect adolescents and young adults health and well-being, including their school performance, education level, social relationships, and future employment and income.

REPORT HIGHLIGHTS DRIVING AND CAR CRASHES Cannabis use can impair driving. WHAT YOU NEED TO KNOW ABOUT CANNABIS AND DRIVING Driving under the influence of any substance, including cannabis, is dangerous. Cannabis, like alcohol, negatively affects skills needed

for safe driving.10-12 REPORT HIGHLIGHTS HEART ATTACK, STROKE, AND DIABETES RISK More research is needed to know if and how cannabis use is associated with heart attack, stroke, and diabetes. REPORT HIGHLIGHTS

HEART ATTACK, STROKE, AND DIABETES RISK (CONT.) WHAT YOU NEED TO KNOW ABOUT CANNABIS AND HEART ATTACKS The compounds in cannabis can affect the cardiovascular system. They can have effects on heart rate and blood pressure. Previous research has found a significant increase in the risk of heart attack in the hours after cannabis use.13-15 REPORT HIGHLIGHTS RESPIRATORY

DISEASE Smoking cannabis regularly can lead to greater risk of bronchitis, cough, and phlegm production. Symptoms generally improve when cannabis smokers quit. REPORT HIGHLIGHTS IMMUNE FUNCTION More research is needed to know how cannabis affects the immune system and its

ability to function normally. REPORT HIGHLIGHTS MENTAL HEALTH Cannabis use is associated with the development of schizophrenia and other psychoses (loss of reality). The risk is highest for the most frequent users.1 Heavy cannabis users are more likely to report thoughts of suicide than non-users. Long-term cannabis users are more likely to

develop social anxiety disorder than non-users. Frequent and long-term cannabis use may be linked to worsened symptoms in individuals with bipolar disorder. REPORT HIGHLIGHTS PROBLEM CANNABIS USE The more a person uses cannabis, the more likely they are to develop problem cannabis

use, such as cannabis use disorder, dependence, abuse, or other varying levels of hazardous or potentially harmful behavior. Starting cannabis use at a younger age increases the likelihood of developing problem cannabis use. REPORT HIGHLIGHTS PROBLEM CANNABIS USE

(CONT.) WHAT YOU NEED TO KNOW ABOUT CANNABIS AND ADDICTION Some think that cannabis is not truly addictive, but research shows that about 1 in 10 cannabis users will become addicted. For people who begin using before the age of 18, that number rises to 1 in 6.16,17 REPORT HIGHLIGHTS RISK OF USING OTHER SUBSTANCES AND DRUGS

There may be a link between using cannabis and becoming dependent on and/or abusing other substances, including alcohol, tobacco, and other illicit drugs. More research is needed to know if cannabis use leads to using other drugs. REPORT HIGHLIGHTS RISK OF USING OTHER SUBSTANCES AND DRUGS (CONT.)

WHAT YOU NEED TO KNOW ABOUT CANNABIS AND THE RISK OF USING OTHER SUBSTANCES AND DRUGS The concept of cannabis as a gateway drugwhere using cannabis leads a person to use other drugsgenerates a lot of controversy. Researchers have not found a definite answer yet. Anyone can become addicted to cannabis or other drugs. Factors like having family members who have had a drug problem, starting to use drugs at a young age, peer pressure, and drug availability all put someone at risk. SUMMARY AND KEY

TAKEAWAYS The NASEM report is a significant step forward. It highlights the need for more research on cannabis use and its impact on peoples health. The NASEM report helps shape the future of cannabis research by providing the following recommendations: Address current research gaps. Identify strategies to improve research quality and develop research standards and benchmarks. Highlight the potential for improvements in data collection efforts and the enhancement of surveillance capacity. Propose strategies to overcome current marijuana

research barriers. SUMMARY AND KEY TAKEAWAYS (CONT.) Please note that the reportwhile strongdid have limitations including: Overlooking some types of studies such as animal and toxicology studies. Conclusions often did not distinguish between studies focused on the entire cannabis plant versus isolated components of the plant. Methods used to perform the analysis were inconsistent

across topic areas in the report. FOR MORE INFORMATION, PLEASE VISIT: www.nationalacademies.org www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-ca nnabinoids-the-current-state REFERENCES 1. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda.

(2017). The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC: National Academies Press. https://doi.org/10.17226/24625 2. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Retrieved from https://store.samhsa.gov/shin/content/SMA17-5044/SMA17-5044.pdf 3. Moir, D., Rickert, W. S., Levasseur, G., Larose, Y., Maertens, R., White, P., & Desjardins, S. (2008). A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chemical Research in Toxicology, 21(2), 494502. https://doi.org/10.1021/tx700275p 4. Garry, A., Rigourd, V., Amirouche, A., Fauroux, V., Aubry, S., & Serreau, R. (2009). Cannabis and breastfeeding. Journal of Toxicology, 2009. https://doi.org/10.1155/2009/596149 5. Lisdahl, K. M., Gilbart, E. R., Wright, N. E., & Shollenbarger, S. (2013). Dare to delay? The impacts of adolescent alcohol and marijuana use onset on cognition, brain structure, and function. Frontiers in Psychiatry, 4(53).

https://doi.org/10.3389/fpsyt.2013.00053 6. Behrendt, S., Beesdo-Baum, K., Hfler, M., Perkonigg, A., Bhringer, G., Lieb, R., & Wittchen, H. U. (2012). The relevance of age at first alcohol and nicotine use for initiation of cannabis use and progression to cannabis use disorders. Drug and Alcohol Dependence, 123(13), 4856. http://doi.org/10.1016/j.drugalcdep.2011.10.013 7. Chen, C. Y., O'Brien, M. S., & Anthony, J. C. (2005). Who becomes cannabis dependent soon after onset of use? Epidemiological evidence from the United States: 20002001. Drug and Alcohol Dependence, 79(1), 1122. 8. Perkonigg, A., Goodwin, R. D., Fiedler, A., Behrendt, S., Beesdo, K., Lieb, R., & Wittchen, H. U. (2008). The natural course of cannabis use, abuse and dependence during the first decades of life. Addiction, 103(3), 439449. https://doi.org/10.1111/j.1360-0443.2007.02064.x 9. Silins, E., Horwood, L. J., Patton, G. C., Fergusson, D. M., Olsson, C. A., Hutchinson, D. M., . . . Mattick, R. P. (2014). Young adult sequelae of adolescent cannabis use: An integrative analysis. The Lancet Psychiatry, 1(4), 286293. https:// doi.org/10.1016/S2215-0366(14)70307-4

10. Hartman, R. L., Brown, T. L., Milavetz, G., Spurgin, A., Pierce, R. S., Gorelick, D. A., . . . Huestis, M. A. (2015). Cannabis effects on driving lateral control with and without alcohol. Drug and Alcohol Dependence, 154, 2537. https://doi.org/10.1016/j.drugalcdep.2015.06.015 REFERENCES (CONT.) 11. Hartman, R. L., & Huestis, M. A. (2013). Cannabis effects on driving skills. Clinical Chemistry, 59(3), 478492. https://doi.org/10.1373/clinchem.2012.194381 12. Lenne, M. G., Dietze, P. M., Triggs, T. J., Walmsley, S., Murphy, B., & Redman, J. R. (2010). The effects of cannabis and alcohol on simulated arterial driving: Influences of driving experience and task demand. Accident Analysis & Prevention, 42(3), 859866. https://doi.org/10.1016/j.aap.2009.04.021 13. Aronow, W. S., & Cassidy, J. (1974). Effect of marihuana and placebo-marihuana smoking on angina pectoris. New England Journal of Medicine, 291(2), 6567. https://doi.org/10.1056/NEJM197407112910203

14. Mittleman, M. A., Lewis, R. A,, Maclure, M., Sherwood, J. B., & Muller, J. E. (2001). Triggering myocardial infarction by marijuana. Circulation, 103(23), 28052809. 15. Sidney, S. (2002). Cardiovascular consequences of marijuana use. Journal of Clinical Pharmacology, 42(11 Suppl), 64S 70S. 16. Hall, W., & Degenhardt, L. (2009). Adverse health effects of non-medical cannabis use. The Lancet, 374(9698), 1383 1391. https://doi.org/10.1016/S0140-6736(09)61037-0 17. Lopez-Quintero, C., Prez de los Cobos, J., Hasin, D. S., Okuda, M., Wang, S., Grant, B. F., & Blanco, C. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence, 115(12), 120130. https://doi.org/10.1016/j.drugalcdep.2010.11.004

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