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Urits I, Charipova K, Gress K, et al. Adverse Effects of Recreational and Medical Cannabis. Psychopharmacol Bull. 2021;51(1):94-109
Urits, I., Charipova, K., Gress, K., Li, N., Berger, A. A., Cornett, E. M., Kassem, H., Ngo, A. L., Kaye, A. D., & Viswanath, O. (2021). Adverse Effects of Recreational and Medical Cannabis. Psychopharmacology bulletin, 51(1), 94-109.
Urits, Ivan, et al. "Adverse Effects of Recreational and Medical Cannabis." Psychopharmacology bulletin vol. 51,1 (2021): 94-109.
Urits I, Charipova K, Gress K, Li N, Berger AA, Cornett EM, Kassem H, Ngo AL, Kaye AD, Viswanath O. Adverse Effects of Recreational and Medical Cannabis. Psychopharmacol Bull. 2021 Jan 12;51(1):94-109. PMID: 33897066; PMCID: PMC8063125.
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Psychopharmacol Bull. 2021 Jan 12;51(1):94-109.

Adverse Effects of Recreational and Medical Cannabis.

Psychopharmacology bulletin

Ivan Urits, Karina Charipova, Kyle Gress, Nathan Li, Amnon A Berger, Elyse M Cornett, Hisham Kassem, Anh L Ngo, Alan D Kaye, Omar Viswanath

Affiliations

  1. Urits, MD, Berger, MD, Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Charipova, BS, Gress, BS, Georgetown University School of Medicine, Washington, DC. Li, BS, Medical College of Wisconsin, Wauwatosa, WI. Cornett, PhD, Louisiana State University Health Sciences Center, Department of Anesthesiology, New Orleans, LA. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Ngo, MD, MBA, Harvard Medical School, Boston, MA, Pain Specialty Group, Newington, NH. Kaye, MD, PhD, Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.

PMID: 33897066 PMCID: PMC8063125

Abstract

PURPOSE OF REVIEW: This comprehensive review discusses the adverse effects known today about marijuana, for either medical or recreational use. It reviews the role of cannabis in the treatment of chronic pain, cognitive and neurological adverse effects, special cases and addiction.

RECENT FINDINGS: Cannabinoids work through the endocannabinoids system and inhibit the release of GABA and glutamate in the brain, impact neuromodulation, as well as dopamine, acetylcholine and norepinephrine release. They affect reward, learning and pain. The use of cannabis is increasing nationally and world-wide for both recreational and medicinal purposes, however, there is relatively only low quality evidence to the efficacy and adverse effects of this. Cannabis and its derivatives may be used for treatment of chronic pain. They are via CB1 receptors that are thought to modulate nociceptive signals in the brain. CB2 receptors in the DRG likely affect pain integration in the afferent pathways, and peripherally CB2 also affects noradrenergic pathways influencing pain. A large proportion of users may see more than 50% of chronic pain alleviation compared with placebo. Cannabis affects cognition, most notably executive function, memory and attention, and may deteriorate the boundary between emotional and executive processing. Cannabis impairs memory in the short run, which become more significant with chronic use, and may also be accompanied by poorer effort, slower processing and impacted attention. It is generally believed that long-term use and earlier age are risk factor for neurocognitive deficits; neuroimaging studies have shown reduced hippocampal volume and density. Executive functions and memory are worse in adolescent users versus adults. Cannabis addiction is different and likely less common than other addictive substances, but up to 10% of users meet criteria for lifetime cannabis dependence. Addiction patterns may be linked to genetic and epigenetic differences. It is still unclear whether abstinence reverses patterns of addiction, and more research is required into this topic.

SUMMARY: Cannabis use has become more abundant for both medical and recreational use. It carries likely benefits in the form of analgesia, anti-emesis and improved appetite in chronic patients. The evidence reviewing adverse effects of this use are still limited, however, exiting data points to a clear link with neurocognitive deterioration, backed by loss of brain volume and density. Addiction is likely complex and variable, and no good data exists to support treatment at this point. It is becoming clear that use in earlier ages carries a higher risk for long-term deficits. As with any other drug, these risks should be considered alongside benefits prior to a decision on cannabis use.

Copyright © 1964–2019 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.

Keywords: addiction; cannabis use disorder; hippocampal volume; marijuana

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