Marijuana is the most commonly abused illicit substance in the United States and also the most controversial. For some, cannabis is a dangerous substance, whose health risks include brain damage and a gateway to serious addiction problems, while others hail it as a wonder drug with countless health benefits! Even its legal status is unclear, with the federal government considering it illegal to possess while state governments legalize its medical and recreational use. This article attempts to address some of the common questions and misconceptions surrounding cannabis.

Question 1: I have seen something called CBD sold in stores recently. I heard that this is a cannabis product. Isn’t marijuana still illegal in New Jersey?

The cannabis plant, unlike pharmaceutical medicines, occurs naturally and contains hundreds of unique chemical compounds. The molecule that causes the intoxication or “high” associated with marijuana is called delta-9-tetrahydrocannabinol, commonly abbreviated as THC. Cannabidiol (CBD) is a different compound contained in the cannabis plant. It does not cause intoxication and is not addictive. It may even have therapeutic benefits for some psychiatric and medical conditions. Researchers have found that it may help with some psychiatric problems and many more studies are currently underway.

Question 2: I heard that marijuana is not really addictive. Is that true?

No, this is absolutely not true. Researchers have clearly demonstrated that marijuana is a physiologically addictive substance. This means people who use it regularly develop tolerance, meaning they require higher doses to achieve the same effect. Individuals who use cannabis on a consistent basis also experience a clear physical withdrawal syndrome. This includes irritability, insomnia, low appetite, headache, feeling achy and other symptoms.

People with a serious cannabis habit often have trouble quitting because they experience these symptoms when they try to stop using. Researchers are working to find a medication that can help deal with these symptoms, and several drugs have shown some promise.

Question 3: I heard that marijuana makes people become schizophrenic. Is that true?

The answer to this question is not clear. Acute intoxication with cannabis often causes psychotic symptoms (paranoia or hearing sounds or voices that are not real), but these usually pass once the intoxication passes. Some have argued that cannabis may also cause more serious and permanent psychotic illness in susceptible individuals. This is difficult to prove as millions of people smoke cannabis every year and only a small portion of these develop persistent psychotic illness. At the same time, many people develop severe psychotic illness and do not smoke cannabis.

An important thing for families to be aware of is that using increasing amounts of cannabis accompanied by social isolation can be warning “prodromal” symptoms. This refers to symptoms people experience before they experience a full psychotic illness.

This means if an individual in their late teens or early 20s is isolating themselves, talking less and smoking a lot of cannabis, this could be a warning sign of a more serious problem. These individuals should be evaluated by a mental health professional. Talk therapy, medication or both might be indicated. Early intervention can decrease the likelihood that these individuals will go on to develop more severe mental illness.

Question 4: Someone I know has been smoking a lot of cannabis. At what point should I try to get them to seek help?

If someone is using cannabis every day, all day long, chances are they need professional help. On the opposite extreme, a teenager who smokes a few puffs of cannabis at a party may not require special intervention.

For cases in between, the important question is not how much a person is using but how the use is impacting functioning and health. The important questions are: Is the drug negatively impacting the individual’s life and are they having a hard time stopping? If so, it would be best to seek out professional help.

Question 5: Can marijuana cause brain damage? Will it make me less smart if I smoke it?

We know that cannabis leads to decreased mental abilities in individuals who frequently use. The time spent caught up in cannabis addiction robs an individual of their ability to function at their full abilities and live life fully. Some believe that cannabis use also causes a permanent decline in mental abilities, particularly in people who smoke as children and adolescents. Others disagree based on recent studies that have found that individuals can return to a normal level of mental functioning after a period of extended abstinence.

Question 6: What about the states that have medical marijuana? Is there any evidence that cannabis can help with medical problems?

A recent report by the National Academy of Science reviewed the evidence on the medical uses of cannabis. The report found that cannabis has been shown to be beneficial for only a few illnesses. There is clear evidence for benefits on chemotherapy-induced nausea and the subjective feelings of stiffness in people with multiple sclerosis. In terms of other problems, like pain or seizures, more research is needed.

It should also be noted that if a drug is helpful in alleviating a problem, this doesn’t mean using it is a good idea. The benefits of cannabis for pain or anxiety might be outweighed by risk of addiction and tolerance. In making medical decisions people should consider the benefit of an intervention against its risks and in light of all alternatives. This should ideally be done with the help of a medical professional.

Question 7: Is vaping or eating cannabis safer than smoking the plant form?

Although the long-term risks of cancer are lower with vaporized or edible forms of cannabis, these forms carry other serious risks. They may actually be more addictive due to higher THC concentrations. The naturally occurring cannabis plant only contains about 3-15% THC. Edible, wax or liquid forms of cannabis may contain concentrations of THC of 40-80% or higher. Higher concentrations significantly increase the products’ effects on the brain and their addictive properties.

Edibles (foods that contain oils infused with cannabis) pose an additional danger due to their delayed onset of effects. Individuals who eat an edible product experience the full effects only an hour or more after ingestion. This can lead inexperienced users to eat large amounts of cannabis before the THC takes its full effect. The individual is exposed to very high doses that can lead to neurological problems, nausea, paranoia and psychosis and may require emergency medical care. For this reason, using the natural plant form of cannabis is actually safer than other forms of cannabis, at least in the short term.

Have more questions? The National Institute on Drug Abuse has more information on cannabis and other drugs. Visit https://www.drugabuse.gov/publications/drugfacts/marijuana

Matisyahu Shulman is an addiction psychiatrist and researcher at the New York State Psychiatric Institute and an assistant professor of clinical psychiatry at Columbia University Irving Medical Center. He also co-leads a free local support group for family members of individuals suffering from substance use disorders. For more information, email [email protected].