Recreational cannabis is now legally available in 24 states and the District of Columbia. In all but three states, medical marijuana is available by prescription.
This relaxation of controls is due not only to the increasing informal use of the drug but also to its medicinal effects. Cannabinoids have been used in the treatment of chronic pain, anxiety, seizures, Parkinson’s Disease, sleep disorders, and other illnesses.
Marijuana has often been compared to alcohol, and like alcohol provides moderate sedation. Most users employ these substances responsibly.
However, both can lead to excessive intoxication and related dangers of falls and motor vehicle and other accidents. Both can lead to disabling drug dependence and vulnerability to other forms of substance abuse. They can incur serious toxic interactions when used with other drugs or medicines.
Chronic, excessive use can also affect memory, learning, and cognition over time. Continued smoking of marijuana can lead to respiratory illness.
Unlike alcohol, dosage standards of cannabis have not been established. Buying a bag of marijuana is not the same as buying a six-pack of Bud Light. Inconsistent composition and concentration of the product may vary significantly even from the same supplier, thus often making an individual’s response variable. Furthermore, available synthetic cannabinoids (sometimes identified as Spice or K2) are usually markedly more potent.
A significant risk factor of cannabis is induced psychosis, primarily schizophrenia. This hazard has been documented primarily during adolescence. I have evaluated patients with no previous or family history of mental illness who, after initial exposure to marijuana as teenagers, developed acute then persisting psychosis that was ultimately diagnosed as schizophrenia.
Since brain maturation, especially in the prefrontal cortex associated with cognition and impulse control, isn’t thought to be complete until the mid-twenties, adolescents are susceptible to developmental interference. Genetic analyses have recognized associations between increased risk for schizophrenia and cannabis use. Mutations in specific genes (Such as COMT, AKT1, and others) increase the likelihood of marijuana-induced psychosis.
In May 2024, the Department of Justice proposed changing the status of cannabis from a Schedule I drug to Schedule III. Schedule I drugs such as heroin and LSD are considered dangerous and abusable and are not allowed to be medically prescribed. Schedule III drugs include codeine, testosterone, anabolic steroids, and others that can be dispensed under appropriate conditions.
The Drug Enforcement Agency establishes these Schedules in cooperation with the Federal Drug Administration and Health and Human Services. Any change in Schedule designation would not supersede state laws of legalization, but would potentially encourage standardization practices, improved dispensing patterns, and research investigation.
All prescriptions, potions, tonics, and “natural” substances can have toxic and dangerous effects in individuals who may be genetically vulnerable. The increasing use of cannabis should be monitored to balance its salutatory effects against its potential for harm—especially among our young.
