4
Therapeutic Effects of Cannabis and Cannabinoids
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Chapter Highlights
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· In adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective antiemetics.
· In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.
· In adults with multiple sclerosis (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms.
"…The resulting therapeutic uses covered by this chapter are chronic pain, cancer, chemotherapy-induced nausea and vomiting, anorexia and weight loss associated with HIV, irritable bowel syndrome, epilepsy, spasticity, Tourette syndrome, amyotrophic lateral sclerosis, Huntington’s disease, Parkinson’s disease, dystonia, dementia, glaucoma, traumatic brain injury, addiction, anxiety, depression, sleep disorders, posttraumatic stress disorder, and schizophrenia and other psychoses. The committee is aware that there may be other conditions for which there is evidence of efficacy for cannabis or cannabinoids.” “…As such, it is important that the reader is aware that this report was not designed to reconcile the proposed harms and benefits of cannabis or cannabinoid use across chapters.”
CONCLUSION 4-1 There is substantial evidence that cannabis is an effective treatment for chronic pain in adults.
The NASEM study NOTED,“Combined with the survey data suggesting that pain is one of the primary reasons for the use of medical cannabis,…”
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CANCER
“Cancer is a broad term used to describe a wide range of related diseases that are characterized by an abnormal, unregulated division of cells; it is a biological disorder that often results in tumor growth.”
… “there is insufficient evidence to make any statement about the efficacy of cannabinoids as a treatment for glioma. However, the signal from the preclinical literature suggests that clinical research with cannabinoids needs to be conducted.”This does NOT mean marijuana does not reduce symptoms associated with cancer, or cancer treatments.
Are Cannabis or Cannabinoids an Effective Treatment for the Reduction of Chemotherapy-Induced Nausea and Vomiting?
4-4(b) There is insufficient evidence to support or refutethe conclusion that cannabinoids are an effective treatment for cancer-associated anorexia-cachexia syndrome and anorexia nervosa.
4-7(a) There is substantial evidence that oral cannabinoids are an effective treatment for improving patient-reported multiple sclerosis spasticity symptoms, but limited evidence for an effect on clinician-measured spasticity.
4-7(b) There is insufficient evidence to support or refute the conclusion that cannabinoids are an effective treatment for spasticity in patients with paralysis due to spinal cord injury.
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The NASEM study NOTED,“The oral THC preparations nabilone and dronabinol have been available for the treatment of chemotherapy-induced nausea and vomiting for more than 30 years (Grotenhermen and Müller-Vahl, 2012). They were both found to be superior to the placebo and equivalent to the available antiemetics at the time that the original trials were conducted.”
“There is some evidence for oral cannabinoids being able to increase weight in patients with the HIV-associated wasting syndrome and anorexia nervosa.”
“Cannabis has long been felt to have an orexigenic effect,”meaning: increases food intake.
When your loved one is dying from the effects cancer treatments has on them I am certain most people will trust the thousands of anecdotal reports.
Are Cannabis or Cannabinoids an Effective Treatment or Prevention for Traumatic Brain Injury or Intracranial Hemorrhage?
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CONCLUSION 4-15 There is limited evidence of a statistical association between cannabinoids and better outcomes (i.e., mortality, disability) after a traumatic brain injury or intracranial hemorrhage
Are Cannabis or Cannabinoids an Effective Treatment for Achieving Abstinence from Addictive Substances?
CONCLUSION 4-16 There is no evidence to support or refute the conclusion that cannabinoids are an effective treatment for achieving abstinence in the use of addictive substances.
The NASEM study NOTED,“However, given the limited number of studies and their small size, their findings do not definitively rule out the existence of an effect…,”but, this study noted a decrease in withdrawal symptoms when using THC for an exit from opioids.
Are Cannabis or Cannabinoids an Effective Treatment for the Improvement of Anxiety Symptoms?
CONCLUSION 4-17 There is limited evidence that cannabidiol is an effective treatment for the improvement of anxiety symptoms, as assessed by a public speaking test, in individuals with social anxiety disorders.
Are Cannabis or Cannabinoids an Effective Treatment to Reduce Depressive Symptoms?
The NASEM reported,“Three of the five trials were judged to have a high risk of bias and the other two as unclear risk.”
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Are Cannabis or Cannabinoids an Effective Treatment for Improving Sleep Outcomes?
CONCLUSION 4-19 There is moderate evidence that cannabinoids, primarily nabiximols, are an effective treatment to improve short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.
Are Cannabis or Cannabinoids an Effective Treatment for the Mental Health Outcomes of Patients with Schizophrenia or Other Psychoses?
CONCLUSION 4-21 There is insufficient evidence to support or refute the conclusion that cannabidiol is an effective treatment for the mental health outcomes in individuals with schizophrenia or schizophreniform psychosis
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It is important to note NASEM reported,“limited evidence due to the risk of bias.”
Is There an Association Between Cannabis Use and the Incidence of Testicular Cancer?
CONCLUSION 5-3 There is limited evidence of a statistical association between current, frequent, or chronic cannabis smoking and non-seminoma-type testicular germ cell tumors
The NASEM study NOTED,“Differences in the prevalence of cannabis use among participants who did and did not respond could bias the odds ratios calculated in these studies.”
Is There an Association Between Cannabis Use and the Incidence of Esophageal Cancers?
CONCLUSION 5-5 There is insufficient evidence to support or refute a statistical association between cannabis use and the incidence of prostate cancer, cervical cancer, malignant gliomas, non-Hodgkin lymphoma, penile cancer, anal cancer, Kaposi’s sarcoma, or bladder cancer.
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The NASEM also NOTED, “that the observational design of their study creates the potential for participation and response biases. Other limitations of the study include the failure to differentiate the risks for bladder cancer associated with current as opposed to former cannabis use, the lack of an evaluation of other potential risk factors for bladder cancer, and the fact that the study findings apply only to men.”
Is There an Association Between Parental Cannabis Use and the Incidence of Cancer in Offspring?
CONCLUSION 5-6 There is insufficient evidence to support or refute a statistical association between parental cannabis use and a subsequent risk of developing acute myeloid leukemia/ acute non-lymphoblastic leukemia, acute lymphoblastic leukemia, rhabdomyosarcoma, astrocytoma, or neuroblastoma in offspring.
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Is There an Association Between Cannabis Use and Acute Myocardial Infarction?
CONCLUSION 6-1
6-1(a) There is limited evidence of a statistical association between cannabis smoking and the triggering of acute myocardial infarction.
It is important to note that the NASEM study also NOTED,“smoking cannabis may put individuals, particularly those at high risk for cardiovascular disease, at increased risk for AMI,”and they also noted that the risk of AMI was approximately 4.8% greater when consuming which is within 1% of the risk for AMI during sexual intercourse.
6-1(b) There is no evidence to support or refute a statistical association between chronic effects of cannabis use and the risk of acute myocardial infarction.
Is There an Association Between Cannabis Use and Stroke?
CONCLUSION 6-2 There is limited evidence of a statistical association between cannabis use and ischemic stroke or subarachnoid hemorrhage.
It is important to note that NASEM reported these finding were based off information obtained through“the ICD-9-CM code 340.30, which includes both cannabis dependence and nondependent cannabis abuse. Current cannabis use was identified in 11,320 of 478,649 AIS events (2.4 percent). Tobacco use prevalence was higher in current cannabis users than in nonusers (64.4 percent versus 31.5 percent) as was cocaineuse (26.7 percent versus 3.1 percent).”
Is There an Association Between Cannabis Use and Metabolic Dysregulation, Metabolic Syndrome, Prediabetes, or Diabetes Mellitus?
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CONCLUSION 6-3
6-3(a) There is limited evidence of a statistical association between cannabis use and decreased risk of metabolic syndrome and diabetes.
6-3(b) There is limited evidence of a statistical association between cannabis use and increased risk of prediabetws.
7


Respiratory Disease
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“Environmental exposures are the leading causes of respiratory disease worldwide. Exposures to tobacco smoke and household air pollution consistently rank among the top risk factors not only for respiratory disease burden but also for the global burden of disease.”
Is There an Association Between Cannabis Use and Pulmonary Function?
CONCLUSION 7-1
7-1(a) There is moderate evidence of a statistical association between cannabis smoking and improved airway dynamics with acute use, but not with chronic use.
7-1(b) There is moderate evidence of a statistical association between cannabis smoking and higher forced vital capacity (FVC).
NASEM noted, “The majority of studies, including those evaluated in the systematic review, relied on self-report for cannabis smoking. Many studies failed to control for tobacco smoking and occupational and other environmental exposures…”
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Is There an Association Between Cannabis Use and COPD?
CONCLUSION 7-2
7-2(a) There is limited evidence of a statistical association between occasional cannabis smoking and an increased risk of developing chronic obstructive pulmonary disease (COPD) when controlled for tobacco use.
7-2(b) There is insufficient evidence to support or refute a statistical association between cannabis smoking and hospital admissions for COPD.
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These conclusions contradict the NASEM’s own finding.
They NASEM reported,“It is unclear whether regular cannabis use is associated with the risk of developing COPD or exacerbating COPD. Current studies may be confounded by tobacco smoking and the use of other inhaled drugs as well as by occupational and environmental exposures, and these studies have failed to quantify the effect of daily or near daily cannabis smoking on COPD risk and exacerbation. There is no evidence of physiological or imaging changes consistent with emphysema. The committee’s findings are consistent.” with those of a recent position statement from the American Thoracic Society Marijuana Workgroup which concluded that there was minimal impairment in light and occasional cannabis smokers when controlled for tobacco use and that the effects in heavy cannabis smokers remain poorly quantified.”
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Is There an Association Between Cannabis Use and Respiratory Symptoms, Including Chronic Bronchitis?
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CONCLUSION 7-3
7-3(a) There is substantial evidence of a statistical association between long-term cannabis smoking and worse respiratory symptoms and more frequent chronic bronchitis episodes.
7-3(b) There is moderate evidence of a statistical association between cessation of cannabis smoking and improvements in respiratory symptoms.
The NASEM study reported,“Cannabis smoking cessation was temporally associated with the resolution of chronic bronchitis symptoms, and a small feasibility study suggests that use of a vaporizer instead of smoking cannabis may lead to the resolution of respiratory symptoms,” and they also previously noted,Current studies may be confounded by tobacco smoking and the use of other inhaled drugs as well as by occupational and environmental exposures…”
Is There an Association Between Cannabis Use and Asthma?
CONCLUSION 7-4 There is no or insufficient evidence to support or refute a statistical association between cannabis smoking and asthma development or asthma exacerbation.
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8
Immunity
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Is There an Association Between Cannabis Use and Immune Competence in Individuals Without an Infectious Disease?
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CONCLUSION 8-1
8-1(a) There is limited evidence of a statistical association between cannabis smoking and a decrease in the production of several inflammatory cytokines in healthy individuals.
8-1(b) There is insufficient evidence to support or refute a statistical association between cannabis smoking and other adverse immune cell responses in healthy individuals.
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Meaning: without removing all environmental hazards they could not definitively link cannabis to any immunity disorders.
Is There an Association Between Cannabis Use and Immune Status in Individuals with HIV?
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CONCLUSION 8-2 There is insufficient evidence to support or refute a statistical association between cannabis or dronabinol use and adverse effects on immune status in individuals with HIV.
Is There an Association Between Cannabis Use and Susceptibility to Oral Human Papilloma Virus (HPV)?
CONCLUSION 8-4 There is insufficient evidence to support or refute a statistical association between regular cannabis use and increased incidence of oral human papilloma virus (HPV).
Is There an Association Between Cannabis Use and Aspergillus Infection?
“Research is needed…”
9
Injury and Death
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Is There an Association Between Cannabis Use and All-Cause Mortality?
CONCLUSION 9-1 There is insufficient evidence to support or refute a statistical association between self-reported cannabis use and all-cause mortality.
Is There an Association Between Cannabis Use and Occupational Injury?
CONCLUSION 9-2 There is insufficient evidence to support or refute a statistical association between general, nonmedical cannabis use and occupational accidents or injuries.
Is There an Association Between Cannabis Use and Motor Vehicle Crashes?
CONCLUSION 9-3 There is substantial evidence of a statistical association between cannabis use and increased risk of motor vehicle crashes.
The NASEM report also NOTED, “Two important methodological limitations of Rogeberg and Elvik (2016) were noted by other researchers (Gjerde and Morland, 2016). First, DUIC may have not just referred to acute intoxication. Indeed, many of the studies considered in this review scored case and control counts as positive using criteria that would also be satisfied by drivers with recent or regular cannabis use but who were neither intoxicated nor impaired while driving…”
Is There an Association Between Cannabis Use and Overdose Injuries or Death?
CONCLUSION 9-4
9-4(a) There is insufficient evidence to support or refute a statistical association between cannabis use and death due to cannabis overdose.
9-4(b) There is moderate evidence of a statistical association between cannabis use and increased risk of overdose injuries, including respiratory distress, among pediatric populations in U.S. states where cannabis is legal.
10
Prenatal, Perinatal, and Neonatal Exposure to Cannabis
Is There an Association Between Cannabis Use and Pregnancy Complications for the Mother?
CONCLUSION 10-1 There is limited evidence of a statistical association between maternal cannabis smoking and pregnancy complications for the mother.
The NASEM report also NOTED,“Despite identifying one good- to fair-quality systematic review addressing pregnancy complications for the mother, the findings of the review must be interpreted with caution.”
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Is There an Association Between Cannabis Use and Fetal Growth and Development?
CONCLUSION 10-2 There is substantial evidence of a statistical association between maternal cannabis smoking and lower birth weight of the offspring.
It is important to note that no expecting mother should consume anything that may potentially harm the baby; but, lower birth weight doesn’t necessarily mean the child isn’t going to developed properly.
Is There an Association Between Maternal Cannabis Use and Neonatal Conditions in the Infant?
CONCLUSION 10-3 There is limited evidence of a statistical association between maternal cannabis smoking and admission of the infant to the neonatal intensive care unit (NICU).
The NASEM study reported,“there appears to be no increase in length of neonatal stay.”
Is There an Association Between Maternal Cannabis Use and Later Outcomes for the Offspring?
CONCLUSION 10-4 There is insufficient evidence to support or refute a statistical association between maternal cannabis smoking and later outcomes in the offspring (e.g., sudden infant death syndrome, cognition/academic achievement, and later substance use).
11
Psychosocial
Is There an Association Between Cannabis Use and Learning?
11-1(a) There is moderate evidence of a statistical association between acute cannabis use and impairment in the cognitive domains of learning, memory, and attention.
11-1(b) There is limited evidence of a statistical association between sustained abstinence from cannabis use and impairments in the cognitive domains of learning, memory, and attention.
The NASEM study reported, “moderate to strong evidence for the acute (immediate) impact of cannabis use on memory. However, as with learning, there were limited to no data to support the association between the sustained effects of cannabis use after cessation and the cognitive domain of memory in the three systematic reviews that addressed this question.”
Is There an Association Between Cannabis Use and Academic Achievement and Education?
CONCLUSION 11-2 There is limited evidence of a statistical association between cannabis use and impaired academic achievement and education outcomes.
The NASEM report NOTED,“the primary literature cannot elucidate the mechanisms through which cannabis use may produce negative educational outcomes, although some have speculated that these outcomes may be related to cannabis’s effects on the brain, including cognitive impairment. In all of the primary research literature reviewed on the effects of cannabis on academic achievement, employment and income, as well as social relationships and other social roles, there were a number of limitations. Below, we summarize aspects of various studies that make it difficult to draw definitive conclusions regarding the causal relationships among cannabis use and the different psychosocial outcomes…"
Is There an Association Between Cannabis Use and Employment and Income?
CONCLUSION 11-3 There is limited evidence of a statistical association between cannabis use and increased rates of unemployment and/or low income.
The NASEM study also reported,“cannabis use has not been linked to outcomes such as labor market participation and unemployment.”
Is There an Association Between Cannabis Use and Social Functioning and Social Roles?
CONCLUSION 11-4 There is limited evidence of a statistical association between cannabis use and impaired social functioning or engagement in developmentally appropriate social roles.
The NASEM study reported, “The relationships among these variables are complex, as are the ways in which the specific variables of interest are measured.”Additionally, the report previously reported Social Anxiety Disorder symptoms have reduced with the use of cannabis.
12
Mental Health
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Is There an Association Between Cannabis Use and the Development of Schizophrenia or Other Psychoses?
CONCLUSION 12-1 There is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.
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This is a highly debated topic and it is very important to note that the NASEM report NOTED,“The limitations of the summarized studies include their reliance of self-reportfor cannabis use…,”and “it may be moderated by genetic factors.”There is no other way to link Schizophrenia or Psychoses to cannabis use. The report goes on to NOTE, "however, that within this specific ultra-high risk population, cannabis users were no more likely to develop psychosis than were those who had never tried cannabis.”
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“In addition, it is noteworthy to state that in certain societies, the incidence of schizophrenia has remained stable over the past 50 years despite the introduction of cannabis into those settings…”
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Is There an Association Between Cannabis Use and the Course or Symptoms of Schizophrenia or Other Psychoses?
CONCLUSION 12-2
12-2(a) There is moderate evidence that, among individuals with psychotic disorders, there is a statistical association between a history of cannabis use andbettercognitive performance.
12-2(b) There is limitedevidence of a statisticalassociationbetween cannabis use and an increasein positive symptoms of schizophrenia(e.g., hallucinations) among individuals with psychotic disorders.
12-2(c) There is moderate evidence fornostatistical association betweencannabisuse and worsening of negative symptoms of schizophrenia(e.g., blunted affect) among individuals with psychotic disorders.
Is There an Association Between Cannabis Use and the Development of Bipolar Disorder or Mania?
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CONCLUSION 12-3 There is limited evidence of a statistical association between cannabis use and the likelihood of developing bipolar disorder, particularly among regular or daily users.
Is There an Association Between Cannabis Use and the Development of Depressive Disorders or Symptoms?
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CONCLUSION 12-5 There is moderate evidence of a statistical association between cannabis use and a small increased risk for the development of depressive disorders.
The NASEM study reports,“that cannabis use, and particularly heavy cannabis use, is associated with a small increase in the risk of developing depressive disorders.”
Is There an Association Between Cannabis Use and Suicidal Ideation, Suicide Attempts, and Suicide?
CONCLUSION 12-7
12-7(a) There is moderate evidence of a statistical association between cannabis use and increased incidence of suicidal ideation and suicide attempts, with a higher incidence among heavier users.
12-7(b) There is moderate evidence of a statistical association between cannabis use and increased incidence of suicide completion.
The NAPSEM study NOTED,“Although the evidence seems to support a relationship between cannabis use and suicidality, particularly heavy cannabis use and suicidality, the limitations of the literature temper such findings. Several limitations should be noted, including the lack of homogeneity in the measurement of cannabis exposure, the lack of systematic controls for known risk factors, the short period of observation for suicidality, the variability in the covariates used to adjust for confounders, the differences in the dose–response analyses, and problems of small sample size. Additionally, as reported by the authors, some studies adjust for alcohol and other comorbidities, while in other studies there is no report of such adjustments.”
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Is There an Association Between Cannabis Use and the Development of Anxiety Disorders?
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CONCLUSION 12-8
12-8 (a) There is limited evidence of a statistical association between cannabis use and the development of any type of anxiety disorder, except social anxiety disorder.
12-8 (b) There is moderate evidence of a statistical association between regular cannabis use and increased incidence of social anxiety disorder.
These two conclusions along with previous conclusions, more specifically the conclusion the study found cannabis has on social anxiety disorder adds to the contradictions these two have on each other. The NASEM study made sure to NOTE,“Some of the limitations of these studies are that cannabis use was ascertained by self-report; that causality cannot be established because of the possibility of residual confounding; that the follow-up period was limited to 3 years; and that there was a high loss in the follow-up and limited power to detect small effects.”
Is There an Association Between Cannabis Use and the Course or Symptoms of Anxiety Disorders?
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CONCLUSION 12-9 There is limited evidence of a statistical association between near daily cannabis use and increased symptoms of anxiety.
The NASEM study,“warned, however, that the findings discussed above should be taken with caution since the mechanisms underlying these relations are still not clear.”
Is There an Association Between Cannabis Use and the Development of PTSD?
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CONCLUSION 12-10 There is no evidence to support or refute a statistical association between cannabis use and the development of posttraumatic stress disorder.
Is There an Association Between Cannabis Use and the Course or Symptoms of PTSD?
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CONCLUSION 12-11 There is limited evidence of a statistical association between cannabis use and increased severity of posttraumatic stress disorder symptoms among individuals with posttraumatic stress disorder.
13
Problem Cannabis Use
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Which Characteristics of Cannabis Use Are Associated with the Progression to Developing Problem Cannabis Use?
CONCLUSION 13-1 There is substantial evidence for a statistical association between increases in cannabis use frequency and the progression to developing problem cannabis use.
The NASEM study NOTED,“The limitations of these studies include the reliance on self-reported cannabis use, the fact that data were restricted to two time points of assessment separated by 3 years, and that the findings are based on epidemiological data obtained more than 10 years ago. A significant issue with relying on self-report methodologies to ascertain problem cannabis use is that this requires that the respondent have insight into the fact that cannabis is actually causing problems..,”
Are There Risk and Protective Factors for Developing Problem Cannabis Use?
CONCLUSION 13-2
Anxiety and Depression
13-2(a) There is limited evidence that childhood anxiety and childhood depression are risk factors for the development of problem cannabis use.
13-2(b) There is moderate evidence that anxiety, personality disorders, and bipolar disorders are not risk factors for the development of problem cannabis use.
13-2(c) There is moderate evidence that major depressive disorder is a risk factor for the development of problem cannabis use.
ADHD
13-2(d) There is moderate evidence that adolescent attention deficit hyperactivity disorder (ADHD) is not a risk factor for the development of problem cannabis use.
13-2(e) There is substantial evidence that stimulant treatment of ADHD during adolescence is not a risk factor for the development of problem cannabis use.
Biological Sex
13-2(f) There is moderate evidence that being male is a risk factor for the development of problem cannabis use.
Other Drug Use
13-2(g) There is moderate evidence that exposure to the combined use of abused drugs is a risk factor for the development of problem cannabis use.
13-2(h) There is moderate evidence that neither alcohol nor nicotine dependence alone are risk factors for the progression from cannabis use to problem cannabis use.
13-2(i) There is substantial evidence that being male and smoking cigarettes are risk factors for the progression of cannabis use to problem cannabis use.
Age
13-2(j) There is substantial evidence that initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use.
13-2(k) There is moderate evidence that during adolescence the frequency of cannabis use, oppositional behaviors, a younger age of first alcohol use, nicotine use, parental substance use, poor school performance, antisocial behaviors, and childhood sexual abuse are risk factors for the development of problem cannabis use.
Are There Risk and Protective Factors for Severity or Persistence of Problem Cannabis Use?
CONCLUSION 13-3
13-3(a) There is moderate evidence of a statistical association between the persistence of problem cannabis use and a history of psychiatric treatment.
13-3(b) There is substantial evidence of a statistical association between being male and the severity of problem cannabis use, but the recurrence of problem cannabis use does not differ between males and females.
13-3(c) There is moderate evidence of a statistical association between problem cannabis use and increased severity of posttraumatic stress disorder symptoms.
14
Cannabis Use and the Abuse of Other Substances
Is There an Association Between Cannabis Use and the Initiation of Use of Other Substances?
CONCLUSION 14-1 There is limited evidence of a statistical association between cannabis use and the initiation of tobacco use.
The NASEM study NOTED,“The data do not provide compelling evidence that cannabis is associated with the initiation of other drugs of abuse, although this is one possibility. Other possibilities that could explain these findings include easier access to cannabis than to other illicit substances…”
Is There an Association Between Cannabis Use and the Rates and Use Patterns of Other Substances?
CONCLUSION 14-2 There is limited evidence of a statistical association between cannabis use and changes in the rates and use patterns of other licit and illicit substances.
The NAPSEM study NOTED,“The limitations of these studies include their lack of generalizability due to their use of restricted study populations, their limited assessment of cannabis use, the lack of dose–response relationships, and the potential for self-report bias.”
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Is There an Association Between Cannabis Use and the Development of Other Substance Dependence or Other Substance Abuse Disorder?
CONCLUSION 14-3 There is moderate evidence of a statistical association between cannabis use and the development of substance dependence and/or a substance abuse disorder for substances, including alcohol, tobacco, and other illicit drugs. The development of problem cannabis use is described in Chapter 13 of this report.
The study does not claim CAUSATION, it reported “association…” which we know can be contributed to many different environmental triggers.
The WAR on MARIJUANA, and the decision to possess it has caused loss of life, as well as a reduction in the quality of life for millions of families. (imprisonment, detrimental legal fees and asset seizure)
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The governments decisions to eradicate the cannabis plant is associated with the increase in overdoses from pharmaceutical and home laboratory grade drugs. (black market marijuana is extremely easy to obtain and is sometimes laced with highly addictive substances)
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