Definitions

 Drug abuse: Any use of drugs that causes physical, psychological, economic,

legal, or social harm to the individual user or to others affected by the drug users
behavior.
 Drug intoxication: Changes in physiological functioning, psychological
functioning, mood states, cognitive processes, or all of these, as a consequence of
excessive consumption of a drug; usually disruptive.
 Drug addiction: Chronic disorder characterized by the compulsive use of a
substance resulting in progressive physical, psychological, or social harm to the user
and by continued use despite that harm.
 Psychological dependence: The emotional state of craving a drug either for its
positive effect or to avoid negative effects associated with its absence.
 Physical dependence: A physiological state of adaptation to a drug, usually
characterized by the development of tolerance to drug effects and the emergence of a
withdrawal syndrome during prolonged abstinence.

MARIJUANA

Marijuana remains the most widely abused illicit drug in the United States and
around the world. There remains significant controversy over the effects of the drug on
physical and mental health. However, marijuana is no longer considered a benign drug.
It has been shown to have negative effects on both physical and psychological health
and is associated with the possible development of tolerance, dependence and a
withdrawal syndrome.

The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol).

The membranes of certain nerve cells in the brain contain protein receptors
(cannabinoid) that bind to THC. Once securely in place, THC kicks off a series of
cellular reactions that ultimately lead to the high that users experience when they smoke
marijuana. 

What are the current slang terms for marijuana?

Terms from years ago, such as pot, herb, grass, weed, Mary Jane, and reefer,
are still used. You might also hear the names Aunt Mary, skunk, boom, gangster, kif, or
ganja. 
“Texas tea,” “Maui wowie,” and “chronic.”

The Drug

Marijuana is derived from the flowering tops and leaves of the plant Cannabis
sativa. The resinous oil is extracted. The THC content is highest in the flowering tops
and less in leaves, stems and seeds. Marijuana contains more than 60 cannabinoids
but the major psychoactive ingredient appears to be delta-9-tetrahydrocannabinol
(THC). Marijuana is usually smoked but may be eaten, brewed in tea or swollowed in a
pill form. Marijuana appears to stimulate dopamine pathways in the brain.

THC is primarily metabolized in the liver through the cytochrome P450 system.
Peak plasma levels of THC are reached within about 10 minutes of smoking marijuana.
Effects last about two to three hours. The drug is fat-soluble and thus can accumulate
for long periods in the body. Smoked marijuana has 5 to 10 times the bioavailability of
the ingested drug.

Interpretation of the urine drug screen depends somewhat on the level detected.

Level <20 ng/mL: Considered negative

Level of 20-50 ng/mL: May not distinguish recent use in the occasional user from past
use in long-term users

Level >50 ng/mL: May be detected in long-term users for up to 2 weeks after last use

Level >400 ng/mL: Indicates recent heavy use

Onset 12-17 yrs old

ETIOLOGY FOR DRUG USE AND ABUSE

Adolescent substance abuse is a complex phenomenon that includes diverse drugs,

diverse usage patterns and differing etiologies.

Stages of Drug Use

MacDonald (1987) suggested five stages of adolescent substance abuse, as follows:

Stage 0: Showing curiosity.

Stage 1: Learning about the drug-induced mood swings. The teen learns more about
use of drugs, but use is limited to group settings, usually on weekends. Peer pressure is
frequently intense and is a prime reason for continuance.

Stage 2: Seeking the drug-induced mood swings . Having learned that these drugs can
alleviate perceived pain and anxiety, the adolescent now seeks the highs of drug use.
The teen may acquire a supply of drugs and paraphernalia. The drugs are now used
more to relax than as part of the social scene. The teen becomes a regular weekend
and occasional weekday user. There may be a decrease in school performance and
abandonment of extracurricular interests.

Stage 3: Being preoccupied with the drug-induced mood swings. The teen loses control
of his or her life and is concerned only with getting high. The behavioral changes are
more pronounced and more obvious. New behaviors may also include stealing, school
truancy, and lying. Drug dealing, to obtain the money necessary for continued drug use,
may start.

Stage 4 : Burnout. At this point the teen is using drugs just to feel normal. Drugs may
no longer produce euphoria. "Zombies" and "space cadets" are common terms used by
adolescents to describe this group.

Marijuana may cause some parts of the body to react in different ways.

Questions Answers
Rapid Heartbeat -- up to how many beats per Marijuana can speed the heart rate
minute? Is it 100, 130 or 160? up to 160 beats per minute.

Dilated blood vessels -- can be seen in what part Dilated blood vessels make the
of the body? Is it the face, the eyes, the feet? whites of the eyes turn red.

A feeling of panic -- accompanied by what kind Panic feelings may be

of sensations? Is it sweating, dry mouth, accompanied by sweating, dry
breathing difficulties or all of these? mouth and trouble breathing.

Daily cough and more frequent chest colds very Tobacco smokers.
much like who? Is it tobacco smokers,
construction workers or the elderly?

Effects of intoxication include:

 Physical reactions: Increase in heart rate, a reddening of the

conjunctivae, dry mouth and throat, dilated pupils, sleepiness
 Distortion of time sense
 Auditory and visual enhancement or distortions
 Impaired learning and cognitive functions
 Increase in appetite
 Low to moderate dose: Euphoria, time distortion, increased talking,
and the reactions described above (item a)
 High dose: Mood fluctuations, depersonalization, and hallucinations
 Potential toxic reactions: Anxiety panic, organic brain syndrome,
psychoses, delusions, hallucinations, and paranoia
 Seizures: Marijuana may precipitate seizures in epileptic
individuals.
 Psychosis: Marijuana may precipitate psychotic episodes in
schizophrenic individuals.
 While marijuana can have affects on the cardiopulmonary, endocrine and other
systems the most controversial has been the amotivational syndrome: This proposed
syndrome consists of a state of passive withdrawal from usual work and recreational
activities following heavy marijuana use.

Maybe you've heard that in some people, marijuana can cause uncontrollable
laughter one minute and paranoia the next. That's because THC also influences
emotions, probably by acting on a region of the brain called the limbic system.

Some of THC's effects are useful in the world of medicine -- like preventing
nausea and blocking pain. The trick is for scientists to get these results without the
harmful effects.
Researchers recently found out the brain makes a chemical -- anandamide -- that
attaches to the same receptors as THC. This discovery may lead to the development of
medications that are chemically similar to THC but less harmful, and they may be used
for treating nausea and pain.

Signs and symptoms

o Impaired short-term memory (memory of recent events)--making it hard to learn
and retain information, particularly complex tasks.
o Slowed reaction time and impaired motor coordination—throwing off athletic
performance, impairing driving skills, and increasing the risk of injuries
o Altered judgment and decision making—possibly leading to high-risk sexual
behaviors, that could lead to the spread of HIV or other sexually transmitted
diseases.
o Increased heart rate by 20-100%--may increase the risk of heart attack, especially
in otherwise vulnerable individuals
o Altered mood--euphoria, calmness, or in high doses, anxiety, paranoia

Treatment

Treatment of marijuana use in the adolescent involves differentiation between the

experimental or occasional use and the abuse of marijuana. After initially experimenting
with marijuana, many adolescents do not use it again or use it very infrequently.
However, physicians should not overlook the negative effects of marijuana use in
adolescence. Frequent marijuana use can interfere with the cognitive, emotional, and
social development of adolescence. Deterioration in school performance, family and
social problems, accidents, and legal difficulties suggest the need for intervention and
treatment.