The assertion that Cannabis is highly addictive ignores firm evidence. The most authoritative review comparing addictiveness of drugs rates physical dependence on a scale of 0–3.3 Heroin is ranked 3; tobacco, barbiturates and benzodiazepines, 1.8; alcohol, 1.6; and Cannabis, 0.8. Cannabis may, of course, be a pathway to more addictive drugs if obtained from illegal sources that also offer powerful alternatives.
The view that Cannabis carries no risk likewise ignores much published evidence.4 Recent Australian and New Zealand longitudinal studies show significant social, behavioural, educational and mental problems with frequent use of Cannabis by young people (aged 15–25 years). Psychosis occurred more frequently following long-term heavy use than among non-users, but no schizophrenia was noted in this study.5 A recent review of the evidence implicating Cannabis in the development of schizophrenia found only that it can accelerate its expression at an earlier age and may aggravate existing schizophrenia. Of course, non-users also develop schizophrenia.6 Others have identified heavy Cannabis use in the young as a possible factor in later psychosis, without specifying schizophrenia.7
Australians, together with citizens in the United States and New Zealand, are the world’s greatest users of Cannabis per head of population.8 Prohibition has failed to prevent widespread use and young people report that they can readily access it.9 Young people need to be strongly dissuaded, on health grounds, from frequent or even regular use of Cannabis, but this has little relevance to Cannabis used for medical purposes or the debate surrounding it. Potential medical users are often, for example, in the later stage of a battle with painful cancer, finding problems with morphine, other analgesics and nausea with chemotherapy. Others seek relief from painful conditions such as muscle spasm in multiple sclerosis. Cannabis is believed to reduce seizures in Dravet syndrome, a rare genetic myoclonic epileptic encephalopathy beginning in infancy.10 Most parents of affected children (84%) report much lessened frequency or abolition of seizures with medical cannabis. They should have continuing access to it until trials using purified cannabidiol (CBD), believed to be the active component for these children, provide a superior agent.
We are behind the times on medical cannabis. Currently, 23 states in the US have legalised use of cannabis for medical conditions, as has Canada since 2001. Other countries approving it include Israel, Holland and the Czech Republic. Portugal, in 2001, removed penalties for personal possession and use of all illicit drugs, but with rigorous administrative processes to handle problem use. Eliminating prohibition is not a disaster if there are sensible processes to control drug-related harms.11
An Australian and US study found that removal of legal action and possible imprisonment for possession and use makes no difference to the patterns of use of cannabis.12 World Health Organization mental health surveys of 17 countries found that “countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones”.13 There is no rational basis for the view that weakening prohibition to permit use for medical conditions would lead to a surge in general use.
Cannabis has at least two important active elements: δ-9-tetrahydrocannabinol (THC) and CBD. The former is responsible for the high of intense comfort and pleasure when presented to the brain in sufficient quantum. Its presence is greatly enhanced by heating marijuana above 170°C, as in a (water pipe), converting the inactive precursor THC-A to THC. THC infused at high dose can produce a powerful euphoria but also hallucinations and other psychotic effects in some normal individuals, followed by complete recovery.14 CBD, on the other hand, does not give a high but has other effects including suppression of nausea and pain. It counteracts some of the effects of THC.15 The plant Cannabis sativa has more than 100 alkaloids with potential to influence the cannabis receptors CB1 and CB2, which respond to normal cannabinoids.16
Response to cannabis varies from person to person, partly due to genetic variation among users.17 The content of THC and CBA varies among different strains of marijuana. Some users vary the type of plant they use to benefit from these different effects.