Journal of the American Academy of Child & Adolescent Psychiatry
RESEARCH UPDATE REVIEWIs the Party Over? Cannabis and Juvenile Psychiatric Disorder: The Past 10 Years
Section snippets
PHARMACOLOGY
Marijuana is a mixture of dried, shredded leaves, stems, seeds, and flowers of the hemp plant (Cannabis sativa). Cannabis is a term that refers to marijuana and other preparations made from the same plant. The primary psychoactive constituent of marijuana is Δ9-tetrahydrocannabinol (THC), although plants have more than 60 cannabinoids. THC in smoked marijuana is absorbed through the lungs and arrives at the brain within minutes. THC taken orally takes 1 to 3 hours to reach the brain.
THC
LONG-TERM TRENDS IN USE
There are many surveys showing that use of cannabis among young people is high. However, they differ methodologically and are difficult to compare with each other, across populations or over time. Few countries monitor cannabis use on a regular basis with similar methodology. One exception is the Monitoring the Future Study, which began in 1976, has continued yearly, and gives information not only about frequency of use but also about long-term trends in a large national sample of high school
Withdrawal
DSM-IV does not list cannabis withdrawal as a disorder because its “clinical significance is uncertain” (American Psychiatric Association, 2000). Skeptics highlight that the long half-life of THC is not consistent with a withdrawal syndrome, which typically appears after a few hours (Smith, 2002). Budney et al. (2001) assessed in their homes 12 daily marijuana users who did not use other illicit drugs on 16 consecutive days during which they smoked marijuana as usual, abstained from smoking,
IS CANNABIS A “GATEWAY” DRUG?
Robins et al. (1970) reported that early use of cannabis was associated with later heroin use. Subsequent studies have confirmed that youths who lived in the last third of the 20th century usually followed a sequence in their use of substances: from alcohol and tobacco to marijuana to other drugs such as cocaine and heroin (Kandel, 2002; Reboussin and Anthony, 2001). Several theories have been advanced to explain this phenomenon, which has significant clinical and policy implications and as
PRENATAL EXPOSURE
Cannabinoids cross the placenta, but plasma concentration in the fetus is lower, approximately one-third of the mother's. THC passes into the breast milk and concentration in breast milk is higher than in plasma. Even though many women refrain from using when they become pregnant (Chen and Kandel, 1998), a substantial number of children are bound to be exposed to cannabinoids prenatally and during breastfeeding, given the frequency of marijuana use among females of child-bearing age.
As a group,
COGNITIVE IMPAIRMENT
Numerous single-dose studies have shown that THC produces a dose-dependent reduction in performance on laboratory tasks measuring memory, attention, reaction time, and motor control. There is also growing evidence from experimental and epidemiological studies that recent marijuana use reduces driving ability and increases the risk of car crashes, particularly when drivers consume both alcohol and marijuana (for reviews, see Ramaekers et al., 2004; Solowij, 1998). However, most of the data
EDUCATIONAL ATTAINMENT
There are considerable data showing that marijuana use is associated with poor school performance, lower grades, less satisfaction with school, worse attitudes toward school, and poorer school attendance (Brook et al., 2003; Jones and Heaven, 1998; Lynskey and Hall, 2000; Novins and Mitchell 1998; Resnick et al., 1997). Cannabis use is also higher among school dropouts and is associated with later unemployment (Brook et al., 2002a; Swaim et al., 1997). There are several possible explanations
Depression and Anxiety
The association between cannabis use, depression, and anxiety disorders has received little attention until recently. Panic attacks and other anxiety symptoms are common, particularly among female users (Thomas, 1996), but there is a noteworthy lack of good data on the link between anxiety disorders and marijuana use.
It has been postulated that depressive symptoms may lead individuals to initiate and to persist using marijuana. Some suggested that cannabis has antidepressant activity, whereas
TREATMENT
The number of people, mostly young men, seeking professional help in European Union countries and the United States for problems related to cannabis use is increasing, overall and in comparison with other drugs (Rigter and van Laar, 2002). In the United States in 2002, 21% of all persons treated for marijuana misuse were 12 to 17 years of age. Cannabis was the drug involved in more than half of those who sought treatment for substance misuse in this age group (Substance Abuse and Mental Health
CONCLUSIONS
The past 10 years have seen a welcome increase in the amount and quality of research on the mental health consequences of cannabis use. The most important advances have been provided by large, long-term, community-based prospective studies that have allowed moving beyond cross-sectional associations to examine causal relationships. Some of these studies meet the criteria for causality: graded dose–response associations, size of association, persistence after taking confounders into account,
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Supported in part by PHS career development award MH01792 to Dr. Martin. The authors thank David Fergusson and section editor Eugene V. Beresin for their comments and suggestions on earlier drafts of this manuscript.
Disclosure: Dr. Rey serves on the advisory board for Strattera (Eli Lilly) and Concerta (Janssen Cilag).