Recreational cannabinoid use: The hazards behind the “high”

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Applied Evidence

Recreational cannabinoid use: The hazards behind the “high”

J Fam Pract. 2016 November;65(11):770-773,778-779

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References

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Elevated rates of MI. Chronic effects may include oral health problems,¹⁶ gynecomastia, and changes in sexual function.¹⁷ Elevated rates of myocardial infarction, cardiomyopathy, limb arteritis, and stroke have been observed.¹⁸Synthetic cannabinoids have been associated with heart attacks and acute renal injury in youth;^19,20 however, plant-based marijuana does not affect the kidneys. In addition, high doses of plant-based marijuana can result in cannabinoid hyperemesis syndrome, characterized by cyclic vomiting and compulsive bathing that resolves with cessation of the drug.²¹

Cannabis users have a lower body mass index, better lipid parameters, and are less likely to have diabetes than their non-using counterparts.No major pulmonary effects. Interestingly, cannabis does not appear to have major negative pulmonary effects. Acutely, smoking marijuana causes bronchodilation.²² Chronic, low-level use over 20 years is associated with an increase in forced expiratory volume in one second (FEV₁), but this upward trend diminishes and may reverse in high-level users.²³ Although higher lung volumes are observed, cannabis does not appear to contribute to the development of chronic obstructive pulmonary disease, but can cause chronic bronchitis that resolves with smoking cessation.²² Chronic use has also been tied to airway infection. Lastly, fungal growth has been found on marijuana plants, which is concerning because of the potential to expose people to Aspergillus.^22,24

Cannabis and cancer? The jury is out. Cannabis contains at least 33 carcinogens²⁵ and may be contaminated with pesticides,²⁶ but research about its relationship with cancer is incomplete. Although smoking results in histopathologic changes of the bronchial mucosa, evidence of lung cancer is mixed.^22,25,27 Some studies have suggested associations with cancers of the brain, testis, prostate, and cervix,^25,27 as well as certain rare cancers in children due to parental exposure.^25,27

There are conflicting data about associations with head and neck squamous cell carcinoma,^25,27,28 bladder cancer,^25,29 and non-Hodgkin’s lymphoma.^25,30 Some studies suggest marijuana offers protection against certain types of cancer. In fact, it appears that some cannabinoids found in marijuana, such as cannabidiol (CBD), may be antineoplastic.³¹ The potential oncogenic effects of edible and topical cannabinoid products have not been investigated.