At the 2016 Special Session of the United Nations General Assembly on the World Drug Problem (UNGASS), one Colorado mother and teacher tearfully claimed that cannabis was causing more traffic accidents, more emergency room visits, and even overdoses that were killing people in her state.
She’s not alone in her claims about the evils of cannabis. Studies including cannabis in mental health disorders have grown. The 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association contains definitions for three cannabis-related disorders not included in previous editions of the manual: cannabis intoxication, cannabis use disorder, and cannabis withdrawal.
Labeling and quality control issues that can result in harmful use of cannabis remain to be resolved. Ryan Vandrey, Ph.D. and associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, completed one study highlighting the issue. Out of 75 samples analyzed, 17 samples had THC content 10 percent over the amount listed on the label and 45 had significantly less THC than was listed. One product listed THC content at 1,000 milligrams when it actually had 1,236 milligrams. “This highlights the need for standardization,” he said. “This is unacceptable for any other medicine, so I’m not sure why it is acceptable for cannabis.”
People are also adulterating products to boost sales in dispensaries. In some cases, glass crystals were mixed with cannabis to make the trichomes sparkle to indicate a higher THC value.
All cannabis consumers, especially medical patients, need better science to help understand how and when to use cannabis and the signs of possible addiction or abuse.
“Cannabis is a drug of abuse and we have good science that demonstrates that,” Vandrey said. “It fits the profile of all of the other drugs of abuse in terms of people having withdrawal symptoms when they want to quit.”
“I think there is a segment of the population that has difficulty with cannabis,” said Marcel Bonn-Miller, the laboratory director for the Department of Veterans Affairs Substance & Anxiety Intervention Laboratory. “They need a voice just as much as anyone else and [need to] know that there are treatments available.”
He said that primarily what they have seen are behavioral symptoms. “There is strong evidence for decreased appetite and pervasive sleep problems during discontinuation of use,” he said. “Most symptoms happen within the first week of quitting. But there are some that continue on for a period of a month or more, like problems with sleep.”
Bonn-Miller said that there has been a sharp increase in the problematic use of cannabis with PTSD users since 2009. “We are seeing that with other drugs as well, but there has been an exponential rise in cannabis use problems.”
Researchers are discovering that there’s more to consider about cannabis even as the industry rushes forward with new ways of ingesting it. “There is no shortage of surprises when it comes to cannabis research,” said Jahan Marcu, Ph.D., senior scientist at Americans for Safe Access.
With the science of cannabis still in the discovery stage, the rising use of concentrates and dabs is a growing concern for researchers. “With super concentrated amounts of cannabis, it’s really like flooding your system,” Marcu said. There is no evidence that anyone has died from a toxic overdose, but Marcu still advises users to “tread lightly.”
Humans have experimented with cannabis in an extracted or concentrated form like hashish throughout history. “But even when Egyptians were using it, they had positive and negative words for cannabis,” Marcu said. “It was both a healer and soul stealer.”
People have mutations in their cannabinoid receptors that are associated with drug dependency, drug tolerance, anxiety, and other disorders, Marcu said. To find out what that means to cannabis consumers, research is being conducted in other countries to track how people react to cannabis over several years. “With more analytical equipment, we might find out that there is more than one type of THC with different types of potency, which has tremendous implications, especially for labeling,” Marcu said. “It could even be an inactive form of THC.”
People may be experiencing adverse reactions to cannabis because of a rare cannabinoid either not discovered or not completely understood, he elaborated. “This is something to keep in mind as new formulations are developed and new compounds are investigated,” Marcu said. “They may not behave as we normally think they should because some random cannabinoid was created as a result of bacterial metabolism. So we have to monitor these new cannabinoids that are popping up.”
Bonn-Miller said that the science is behind in terms of understanding the addiction potential of concentrates. “If I had to guess, I think the use of dabs and those other things might lead to greater rates of addiction,” he said. “That’s why we need to keep tracking use and making sure we are on top of it.”