For federal Updates H.R.8454 — 117th Congress (2021-2022Shown Here:
Public Law No: 117-215 (12/02/2022)
Medical Marijuana and Cannabidiol Research Expansion Act
This act establishes a new, separate registration process to facilitate research on marijuana.
Specifically, the act directs the Drug Enforcement Administration (DEA) to follow specified procedures to register (1) practitioners to conduct marijuana research, and (2) manufacturers to supply marijuana for the research.
The act allows certain registered entities (including institutions of higher education, practitioners, and manufacturers) to manufacture, distribute, dispense, or possess marijuana or cannabidiol (CBD) for the purposes of medical research. Additionally, the act directs the DEA to register manufacturers and distributors of CBD or marijuana for the purpose of commercial production of an approved drug that contains marijuana or its derivative.
Finally, the act includes various other provisions, including provisions that
- require the DEA to assess whether there is an adequate and uninterrupted supply of marijuana for research purposes;
- prohibit the Department of Health and Human Services (HHS) from reinstating the interdisciplinary review process for marijuana research;
- allow physicians to discuss the potential harms and benefits of marijuana and its derivatives (including CBD) with patients; and
- require HHS, in coordination with the National Institutes of Health and relevant federal agencies, to report on the therapeutic potential of marijuana for various conditions such as epilepsy, as well as the impact on adolescent brains and on the ability to operate a motor vehicle.
Cannabis (Marijuana)https://nida.nih.gov/research-topics/cannabis-marijuana#cannabis-adolescents
- Cannabis refers to the dried leaves, flowers, stems, and seeds of the cannabis plant. The plant has many different chemical compounds, including tetrahydrocannabinol (THC), which has intoxicating—mind altering—effects.
- Cannabis products with THC can cause changes in mood, thoughts, and perceptions of reality. These products can also cause harmful health effects on the brain and other parts of the body. In recent years, there have been big increases in the variety of cannabis products and how much THC they have, as well as a greater variety of ways people can consume them. Unless mentioned otherwise, the information on this webpage is about cannabis products with THC.
- NIDA funds research on the health effects of cannabis products, including impacts on the developing brain and on mental health. The institute also supports research on prevention and treatments for cannabis use disorder, the potential therapeutic uses of cannabis, and the public health impacts of cannabis policies.
What are the long-term health risks of cannabis use?
Cardiovascular Effects
Cannabis can increase heart rate and blood pressure right after use. Some research shows an association between long-term cannabis use and an increased risk of stroke, heart attack, and arrythmias.35,36 However, more research is needed to determine if there is a direct connection between cannabis use and cardiovascular disease, or if other factors are involved.37
Gastrointestinal Problems
These include cannabinoid hyperemesis syndrome (CHS), which is when a person has nausea, vomiting, and abdominal pain after long-term, heavy cannabis use.38 Other potential gastrointestinal issues include acid reflux, pancreatitis, and peptic ulcer disease.39
Increased Cancer Risk
Research has linked the use of cannabis products with an increased likelihood of developing head, neck, or throat cancer,40 particularly in people who smoke cannabis
What is the relationship between cannabis use and mental health?
Frequent or heavy cannabis use has been linked to problems in cognitive functions like learning and memory, attention, processing speed, perceptual motor function, and language.42,43,44,45
Some evidence has linked cannabis use to earlier onset of psychosis in people with genetic risk factors for psychotic disorders, including schizophrenia, as well as worse symptoms in people who already have these conditions. The association between heavy cannabis use and schizophrenia has been found to be especially strong in young males compared to females. Cannabis intoxication can also induce a temporary psychotic episode in some people, especially at high doses. Experiencing such an episode may be linked with developing a psychotic disorder later in life.46
Some research has also shown an increased risk of depression in people who use cannabis during adolescence.47 Research has also linked cannabis use with suicidal thoughts and behaviors among teens48 and military veterans in the United States.49,50
While people with mental health disorders and related symptoms are more likely to use cannabis,51 many factors that influence mental health—such as genes, trauma, and stress—also influence how likely someone is to use drugs, including cannabis. Given these related genetic and environmental vulnerabilities, additional data from prospective, longitudinal research (studies that measure participants’ health over long periods of time) are needed to determine whether, to what extent, and for whom cannabis may cause or contribute to poor mental health outcomes.
Does cannabis use affect driving?
Studies have found that using cannabis may affect a person’s ability to drive.76 It is the drug most frequently found in the blood of drivers involved in motor vehicle crashes, including fatal ones.77 A number of research analyses have found that the risk of being involved in a crash increased after cannabis use.76,78,79 However, a study conducted by the National Highway Traffic Safety Administration found no significant increased crash risk attributable to cannabis use.80
https://www.nhtsa.gov/risky-driving/drug-impaired-driving#the-issue-marijuana-impairs
How does cannabis use impact adolescents?
Adolescence is an important period of brain development, and cannabis use may influence the brain in ways that could lead to long-term harmful effects.81,82 Studies show that regular, heavy cannabis use in adolescence is associated with negative effects on working memory, processing speed,83 verbal memory,84 and academic functioning.85 It is also associated with negative effects on educational attainment, employment, and income in young adulthood.86 https://abcdstudy.org/?s=cannabis
Cannabis use at a young age has also been linked to other mental health conditions, including the likelihood of developing psychosis87 and to developing cannabis use disorder later in life.
The NIDA-funded Monitoring the Future survey measures drug and alcohol use and related attitudes among adolescent students nationwide. Find recent survey data related to cannabis use here. NIDA supports the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®), which follows nearly 12,000 children ages 9 and 10—before substance use typically begins—into young adulthood. https://abcdstudy.org/?s=cannabis
The ABCD Study® explores the effects of environmental, social, genetic, and other biological factors on the developing adolescent brain. This study will provide critical insights into risk and resilience factors for cannabis and other substance use to inform future prevention interventions. See ABCD Study® results on cannabis exposure for more information. https://abcdstudy.org/?s=cannabis
How does cannabis use impact older adults?
Are some cannabis products safe and effective medicines?
How is NIDA researching cannabis?
CANNABIS USE DISORDER
Addiction (Marijuana or Cannabis Use Disorder)
Some people who use marijuana will develop marijuana use disorder, meaning that they are unable to stop using marijuana even though it’s causing health and social problems in their lives.
- One study estimated that approximately 3 in 10 people who use marijuana have marijuana use disorder.1
- Another study estimated that people who use cannabis have about a 10% likelihood of becoming addicted.2
- The risk of developing marijuana use disorder is greater in people who start using marijuana during youth or adolescence and who use marijuana more frequently.3
The following are signs of marijuana use disorder 4:
- Using more marijuana than intended
- Trying but failing to quit using marijuana
- Spending a lot of time using marijuana
- Craving marijuana
- Using marijuana even though it causes problems at home, school, or work
- Continuing to use marijuana despite social or relationship problems.
- Giving up important activities with friends and family in favor of using marijuana.
- Using marijuana in high-risk situations, such as while driving a car.
- Continuing to use marijuana despite physical or psychological problems.
- Needing to use more marijuana to get the same high.
- Experiencing withdrawal symptoms when stopping marijuana use.
People who have marijuana use disorder may also be at a higher risk of other negative consequences, such as problems with attention, memory, and learning.
Some people who have marijuana use disorder may need to use more and more marijuana or greater concentrations of marijuana over time to experience a “high.” The greater the amount of tetrahydrocannabinol (THC) in marijuana (in other words, the concentration or strength), the stronger the effects the marijuana may have on the brain.5,6 The amount of THC in marijuana has increased over the past few decades.6
In a study of cannabis research samples over time, the average delta-9 THC (the main form of THC in the cannabis plant) concentration almost doubled, from 9% in 2008 to 17% in 2017.7 Products from dispensaries often offer much higher concentrations than seen in this study. In a study of products available in online dispensaries in 3 states with legal non-medical adult marijuana use, the average THC concentration was 22%, with a range of 0% to 45%.8 In addition, some methods of using marijuana (for example, dabbing and vaping concentrates) may deliver very high levels of THC to the user.6,9
Researchers do not yet know the full extent of the consequences when the body and brain are exposed to high concentrations of THC or how recent increases in concentrations affect the risk of someone developing marijuana use disorder.6References
Page last reviewed: October 19, 2020
Content source: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
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If you are marijuana affected and experience BLACK/WHITE thinking, or become irritated while reading this, with a tendency to see marijuana as “ALL GOOD”, you may have an abuse/misuse problem. Take the following quiz to learn more.
Have you misused or abused drugs other than those responsibly prescribed and used for medical reasons? * | Yes No |
Do you misuse more than one drug or alcohol concurrently without medical notification, consideration, or authorization of all parties? * | Yes No |
Are you unable to stop taking drugs (within medical recommendations) when you want to? * | Yes No |
Have you had serious side effects as the result of illicit or irresponsible medically prescribed drug misuse? * | Yes No |
Have you lied to your medical provider or mischaracterized your condition to obtain and misuse medications * | Yes No |
Do you feel bad or guilty about your drug misuse or escalating drug use costs that take away from healthful activities? * | Yes No |
Have you neglected your family relationships because of illicit or RX drug misuse or drug culture involvement? * | Yes No |
Have you engaged in activities with legal consequences in order to fund RX or illicit drug misuse? * | Yes No |
If you answered yes to any of these questions, you would benefit from professional treatment. Please call for help 719-465-7850 or visit Marijuana Anonymous World Services Contacts MA members and interested members of the public are invited to contact us with suggestions, questions, and general inquiries. Call or text MA World Services at: +1 (800) 766-6779 | |
Cannabis Use Disorder DSM-5, 305.20, 304.30

DSM-5 Category: Substance-Related Disorders
Introduction
Delta-9-THC (Delta-9-TetraHydrocannabinol) is a psychoactive compound contained in the plant Cannabis Sativa, which is one the most widely abused illicit drugs in the United States. The buds, stems, seeds, and leaves of the cannabis plant all contain varying amounts of Delta-9-THC, (National Institute of Drug Abuse, 2014), with the highest concentrations typically in the bud. The typical methods of administration are inhalation of smoke or steam, or PO administration. All of the parts of the plant can be dried and smoked in a pipe, hand-rolled cigarette (joint), or a hollowed-out cigar (blunt). The plant matter is also exposed to steam, and the steam is inhaled in a method referred to as vaporizing. The plant matter can be taken PO and is typically baked into brownies or chocolate chip cookies. Gummy candies that contain Delta-9 THC are also consumed. Resinous oil called Hashish, or more commonly, hash, can also be extracted and introduced into baked goods, or butter used in the production of baked goods.
Cannabis use produces reward and dependence, and withdrawal symptoms upon cessation of use. Its regular use can result in varying degrees of impairment. The designation of the drug is typically cannabis, although the active ingredient is Delta-9-THC (American Psychiatric Association, 2013).It’s use is widely accepted by a subculture of users, who do not see the use as problematic, and will rationalize and justify use.
Cannabis has an affinity for CB1 (Cannabinoid Receptors Type 1) receptors, which are located in the central nervous system, specifically in the frontal cortices and the thalamus. The CB1 Binding produces the psychoactive effects of cannabis (Lazenka, 2014).
Symptoms of Cannabis Use Disorder
According to the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), the criteria for Cannabis Use Disorder is as follows:
Use of cannabis for at least a one year period, with the presence of at least two of the following symptoms, accompanied by significant impairment of functioning and distress:
Difficulty containing use of cannabis- the drug is used in larger amounts and over a longer period than intended.
Repeated failed efforts to discontinue or reduce the amount of cannabis that is used
An inordinate amount of time is occupied acquiring, using, or recovering from the effects of cannabis.
Cravings or desires to use cannabis. This can include intrusive thoughts and images and dreams about cannabis, or olfactory perceptions of the smell of cannabis, due to preoccupation with cannabis.
Continued use of cannabis despite adverse consequences from its use, such as criminal charges, ultimatums of abandonment from spouse/partner/friends, and poor productivity.
Other important activities in life, such as work, school, hygiene, and responsibility to family and friends are superseded by the desire to use cannabis.
Cannabis is used in contexts that are potentially dangerous, such as operating a motor vehicle.
Use of cannabis continues despite awareness of physical or psychological problems attributed to use- e.g., anergia, amotivation, chronic cough.
Tolerance to Cannabis, as defined by progressively larger amounts of cannabis are needed to obtain the psychoactive effect experienced when use first commenced, or, noticeably reduced effect of the use of the same amount of cannabis
Withdrawal, defined as the typical withdrawal syndrome associated with cannabis, or cannabis or a similar substance is used to prevent withdrawal symptoms.
The status of the disorder can be further qualified as follows:
Early remission
Sustained remission
An additional specifier for the status of the disorder is:
In a Controlled Environment, e.g. a treatment facility or correctional facility where access to cannabis is limited.
The severity of the disorder is also noted, depending on the number of symptoms noted:
Mild – Two or Three Symptoms
Moderate- Four or five symptoms
Severe- Six or more symptoms (American Psychiatric Association, 2013).
Risk Factors for Cannabis Use Disorder
Risk factors identified in the DSM-5 include: A family history of chemical dependence and a history of Conduct Disorder or Antisocial Personality Disorder are noted as risk factors. Other risk factors are described in the DSM-5 are low SES (Socio-Economic Status), history of tobacco smoking, unstable/abusive family, other family members who smoke cannabis, and poor academic performance.
(American Psychiatric Association, 2013). However, it could be speculated these factors are correlational rather than causal. The DSM-5 also notes that the local ease of access to cannabis is a risk factor, (American Psychiatric Association, 2013) for individuals who are inclined to use cannabis. A drug-tolerant culture as a risk factor for use, as conformity to social norms, has been established as a powerful influence on behavior.
The onset of Cannabis Use Disorder
The DSM-5 notes that most users begin in early adolescence or as young adults (American Psychiatric Association, 2013).
Differential Diagnosis in Cannabis Use Disorder
Depression can present with symptoms of anergia, amotivation, short-term memory deficits, and difficulty concentrating. In a young person, who fits the demographic of a cannabis user, parents or others may attribute the symptoms to cannabis use and denial, particularly if the adolescent cannot articulate their feelings. To rule out other disorders, in addition to meeting the diagnostic criteria listed above, diagnosis of use can be determined through enzyme immunoassay testing of a urine sample for cannabinoid metabolites. The presence of metabolites can indicate recent use, and if quantitative testing is done, the levels of metabolites can be measured, indicating the relative amount of cannabis recently used.
Comorbidity of Cannabis Use Disorder
There is a number of long-term health risks associated with Cannabis Use Disorder. Inhaling the smoke from burnt vegetation, whether it is tobacco leaves or cannabis, is harmful. Use of cannabis by smoking can result in long term, comorbid health problems involving:
The Respiratory system- COPD (Chronic Obstructive Pulmonary Disease), chronic inflammation of the upper respiratory tract, bronchitis, and damage to cilia, which can increase frequency and severity of common upper respiratory infections such as rhinovirus and influenza.
The Cardiovascular system- elevated heart rate and blood pressure, which can adversely affect individuals with pre-existing heart disease.
The Reproductive system- multiple effects in both men and women, although the clinical impact is not well understood.
Increased risk of cancers of the lungs, oral cavity, esophagus, and associated structures.
(California Society for Addiction Medicine, 2011)
Treatment of Cannabis Use Disorder
The DSM-5 does not specify treatment options for Cannabis Use Disorder (American Psychiatric Association, 2013). Cannabis Use Disorder is treatable by individual or group therapy following the REBT (Rational Emotive Behavior Therapy) model, (Albert Ellis Institute, 2014) as well as psycho-education, self–help groups, and lifestyle changes. REBT can assist the recovering user to recognize dysfunctional thought patterns and replace them with adaptive thinking and to recognize, tolerate and manage their emotions, rather than using cannabis for mood management. Psycho-education can challenge fallacious beliefs about cannabis, which can make use perceived as benign, and provide concrete, didactic information about the nature of addiction in general. Self-help or 12-step groups are an important component of recovery to provide support and accountability and to maintain motivation. They are also a means of changing associations and developing healthier relationships.
It is widely accepted in the addiction treatment community that changing associations in a critical part of recovery. This refers to no longer associating with those that are actively using substances, and making connections with sober, responsible, goal-oriented individuals who can model pro-social behavior, offer encouragement to remain abstinent, express social disapproval for use, and generally support the individual in their recovery while holding them accountable for their actions.
Prognosis of Cannabis Use Disorder
For many, cannabis use will not exceed the mild form of the disorder, and they will use it typically during their teens and early twenties. As an individual ages, expectations for their conduct both internally and externally dictated, will change. By the late twenties, most young Americans have completed their education, and are embarking on a career, and family of procreation. This entails responsibilities, which will outweigh the reward from cannabis use, and their use will either be discontinued or be reduced to a sub-clinical level in terms of frequency and quantity, with negligible impact on their functioning.
For others, use of cannabis will remain heavy in terms of frequency and quantity, and the subcultural norms justifying and rationalizing use will be embraced. Long-term use of cannabis is associated with an amotivational syndrome. The effects of cannabis are subtle and insidious, unlike other illicit substances. The use of heroin, crack cocaine, or alcohol can rapidly cause life to become unmanageable. There tends to be a lack of obvious and dramatic effects from smoking cannabis, but rather a gradual slide into amotivation, indifference, and apathy. Goals will not be met, and new goals will not be established, important day-to-day tasks will not be completed, and responsibilities will be gradually neglected. Overall, quality of life will be impaired, and the individual will not reach their potential.
If an individual embraces treatment, the prognosis is excellent. Some will recognize that their use of cannabis is preventing goal achievement, but are unable to stop on their own due to the intrinsic reward properties of cannabis. Many individuals are coerced into treatment by either the criminal justice system or family members exerting pressure on them to meet age-expected behavior. A major treatment challenge can be convincing someone that his or her use is problematic. The combination of cultural tolerance and acceptability of cannabis, misconceptions and fallacies fueled by abundant misinformation available on line, and among users, and the apathy and indifference-inducing effects of the drug itself can make a motivation to quit challenging.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.
California Society for Addiction Medicine (2011). The Adverse effects of marijuana (for health care professionals). Retrieved October 28, 2014, from http://www.csam-asam.org/adverse-effects-marijuana-healthcare-professionals
Lazenka, M. (2014). Everything you wanted to know about cannabinoids: Pharmacology of THC. Science 2.0. Retrieved October 30, 2014 from http://www.science20.com/internal_struggle_of_the_mind/blog/everything_you_wanted_to_know_about_cannabinoids_pharmacology_of_thc-138539
National Institute of Drug Abuse. (2014). Drugfacts: marijuana. Retrieved October 28, 2014, from http://www.drugabuse.gov/publications/drugfacts/marijuana
https://www.nhtsa.gov/risky-driving/drug-impaired-driving#the-issue-marijuana-impairs
Cannabis (Marijuana)https://nida.nih.gov/research-topics/
safetrip.org
Contents
- Effects of Edibles by Dosage and Tolerance
- Edibles Dosage Guide
- Edibles Duration of Effects
- 1. Weed edibles, particularly high doses, can lead to anxiety
- 2. It’s really easy to eat too much – you’ll be fine, but it might be uncomfortable
- 3. Start with 5mg of THC or less.
- 4. Don’t redose until you’ve waited 2 hours
- 5. You might not get high the first 1-3 times
- 6. If you took too much: Tell a friend to read the “bad trip” guide and help you
- 7. Cautions
- References
Effects of Edibles by Dosage and Tolerance
Desired effect level1 | Minimal tolerance | Some tolerance (smoke 1-3x/week) | Tolerance (daily smoker) |
---|---|---|---|
Mild | 2-4 mg | 3-7 mg | 4-10 mg |
Medium | 3-8 mg | 4-12 mg | 6-15 mg |
Strong | 5-15 mg | 10-20 mg | 15-30 mg |
Edibles Dosage Guide
Tolerance | THC mg2 |
---|---|
Users with no tolerance | 1.5 – 5 mg |
Users who smoke multiple times per week | 2 – 12 mg |
Users who regularly eat edibles and have tolerance to edibles | 10 – 30 mg |
High tolerance to edibles | 30 – 60 mg |
Very high tolerance to edibles | 60 – 100 mg+ |
Edibles Duration of Effects
A graph from a 1980 research paper showing how long you’ll stay high for:

In this experiment, participants still felt a little bit high after 6 hours, though not close to peak levels.4
1. Weed edibles, particularly high doses, can lead to anxiety
Possible strategies to reduce anxiety from cannabis edibles (anecdotal reports):
- Take CBD at the same time or beforehand
- Take L-Theanine
See also this post about cannabis anxiety.
2. It’s really easy to eat too much – you’ll be fine, but it might be uncomfortable
Read the packet. Make sure you know if it’s X mg of THC per serving, and how many “things” are in a serving.
3. Start with 5mg of THC or less.
As a very rough approximation, smoking a 1⁄2 gram standard joint by yourself would lead to similar levels of highness as a 10 mg THC edible.
5mg will get most people without a tolerance “solidly high” – perhaps a 7-9⁄10.
Even doing 2mg will get people without a tolerance high – at this dosage you may still find it reasonably easy to have conversations with people, and as the dosage goes beyond 5mg conversing will get increasingly difficult for most people.
👍 If you don’t have experience with altered states of consciousness or are concerned about possible anxiety, try 2mg of THC for your first 3 times, and then try 5mg, before going any higher.
If 5mg isn’t enough, wait 2 hours to make sure it’s taken effect, and then try taking another 5mg. Don’t add on 10mg – you’ll still have much of the 5mg in your system.
If 5mg wasn’t enough, next time start with 7.5mg or 10mg – don’t jump to 20mg. It would be even smarter to try 5mg two more times, as about 40% (anecdotal reports) of weed users find it hard to get high the first few times they use.
4. Don’t redose until you’ve waited 2 hours
If you’re on a full stomach, it may take 1.5 hours before you start feeling pretty high and 2 hours or more for full effects.
It might be more like 1 hour before feeling pretty high and 1.5 hours for full effects on an empty stomach (anecdotal reports).
5. You might not get high the first 1-3 times
We don’t really know exactly why this is, though it seems to be a commonly reported occurrence.
Try a low dosage a few times first before going above 5mg – you might be taking the perfect dose, but you’re just experiencing the “first time user tolerance” effect of weed.
6. If you took too much: Tell a friend to read the “bad trip” guide and help you
Symptoms of a moderate to intense high (doesn’t necessarily mean you took too much):
- Increased (and more noticable) heart rate
- Dry mouth
- Paranoia / anxiety
No-one has ever died from overdosing on marijuana.5
If you have paranoia/anxiety and want to reduce it, try any of the following:
- Watch this video: Alan Watts: The Mind is a Vicious Circle
- Watch this video: Bob Ross, The Joy of Painting (credit to /u/Damnaged and all others on /r/LSD)
- Ask a friend to read this guide to help make you more comfortable.
Remember, the main effect of taking too much is just paranoia. Thousands of people take too much weed each year, they feel really uncomfortable for up to ~12 hours, and then they all feel fine again.
Guide to help someone having a bad trip (including if you’ve eaten too much edible weed).
7. Cautions
- Perhaps don’t use weed at all, or at least don’t use often if you are under the age of 21 (perhaps even more important if under age of 18). Research is pretty inconclusive, though better to be safe than sorry.
- Consider avoiding weed if you have psychosis, or schizophrenia, or first-degree relatives with psychotic illnesses like schizophrenia or Bipolar
- Avoid daily use or high potency cannabis products as some researchers have found that these are associated with an increase in the risk of psychosis6
- Don’t drive while high
- If it’s illegal to smoke where you are, be aware that the biggest risk of using weed on your future/your health is the legal risk, so consider waiting until it’s legal or decriminalized where you are
References
- The Local Crop [return]
- http://www.marijuanasurvivalguide.com/ [return]
- https://psychonautwiki.org/wiki/Cannabis [return]
- http://onlinelibrary.wiley.com/doi/10.1038/clpt.1980.181/abstract [return]
- https://www.mpp.org/marijuana-is-safer/ [return]
- https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30048-3/fulltext [return]