Marijuana and Neurology

Marijuana and neurology:-

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New dosage limits for medical marijuana: but where's the science?
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New dosage limits for medical marijuana: but where's the science?

CMAJ. 2007 Sep 11;177(6):556-7

Authors: Comeau P

PMID: ( marijuana and neurology ) 17846434 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Predictors of marijuana use in adolescents before and after licit drug use: examination of the gateway hypothesis.
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    Predictors of marijuana use in adolescents before and after licit drug use: examination of the gateway hypothesis.

    Am J Psychiatry. 2006 Dec;163(12):2134-40

    Authors: Tarter RE, Vanyukov M, Kirisci L, Reynolds M, Clark DB

    OBJECTIVE: The authors investigated whether the transition from licit drug use to marijuana use is determined by particular risk factors, as specified by the gateway hypothesis. They also evaluated the accuracy of the "gateway sequence" (illicit drug use following licit drugs) for predicting a diagnosis of substance use disorder. METHOD: Boys who consumed licit drugs only (N=99), boys who consumed licit drugs and then transitioned to marijuana use (gateway sequence) (N=97), and boys who used marijuana before using licit substances (alternative sequence) (N=28) were prospectively studied from ages 10-12 years through 22 years to determine whether specific factors were associated with each drug use pattern. The groups were compared on 35 variables measuring psychological, family, peer, school, and neighborhood characteristics. In addition, the utility of the gateway and alternative sequences in predicting substance use disorder was compared to assess their clinical informativeness. RESULTS: Twenty-eight (22.4%) of the participants who used marijuana did not exhibit the gateway sequence, thereby demonstrating that this pattern is not invariant in drug-using youths. Among youths who did exhibit the gateway pattern, only delinquency was more strongly related to marijuana use than licit drug use. Specific risk factors associated with transition from licit to illicit drugs were not revealed. The alternative sequence had the same accuracy for predicting substance use disorder as the gateway sequence. CONCLUSIONS: Proneness to deviancy and drug availability in the neighborhood promote marijuana use. These findings support the common liability model of substance use behavior and substance use disorder.

    PMID: ( marijuana and neurology ) 17151165 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Cut to marijuana research sends strong message.
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    Cut to marijuana research sends strong message.

    CMAJ. 2006 Dec 5;175(12):1507-8

    Authors: Comeau P

    PMID: ( marijuana and neurology ) 17146080 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • The association between marijuana smoking and lung cancer: a systematic review.
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    The association between marijuana smoking and lung cancer: a systematic review.

    Arch Intern Med. 2006 Jul 10;166(13):1359-67

    Authors: Mehra R, Moore BA, Crothers K, Tetrault J, Fiellin DA

    BACKGROUND: The association between marijuana smoking and lung cancer is unclear, and a systematic appraisal of this relationship has yet to be performed. Our objective was to assess the impact of marijuana smoking on the development of premalignant lung changes and lung cancer. METHODS: Studies assessing the impact of marijuana smoking on lung premalignant findings and lung cancer were selected from MEDLINE, PSYCHLIT, and EMBASE databases according to the following predefined criteria: English-language studies of persons 18 years or older identified from 1966 to the second week of October 2005 were included if they were research studies (ie, not letters, reviews, editorials, or limited case studies), involved persons who smoked marijuana, and examined premalignant or cancerous changes in the lung. RESULTS: Nineteen studies met selection criteria. Studies that examined lung cancer risk factors or premalignant changes in the lung found an association of marijuana smoking with increased tar exposure, alveolar macrophage tumoricidal dysfunction, increased oxidative stress, and bronchial mucosal histopathologic abnormalities compared with tobacco smokers or nonsmoking controls. Observational studies of subjects with marijuana exposure failed to demonstrate significant associations between marijuana smoking and lung cancer after adjusting for tobacco use. The primary methodologic deficiencies noted include selection bias, small sample size, limited generalizability, overall young participant age precluding sufficient lag time for lung cancer outcome identification, and lack of adjustment for tobacco smoking. CONCLUSION: Given the prevalence of marijuana smoking and studies predominantly supporting biological plausibility of an association of marijuana smoking with lung cancer on the basis of molecular, cellular, and histopathologic findings, physicians should advise patients regarding potential adverse health outcomes until further rigorous studies are performed that permit definitive conclusions.

    PMID: ( marijuana and neurology ) 16832000 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana use by tobacco smokers and nonsmokers: who is smoking what?
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    Marijuana use by tobacco smokers and nonsmokers: who is smoking what?

    CMAJ. 2006 May 9;174(10):1399

    Authors: Leatherdale ST, Ahmed R, Kaiserman M

    PMID: ( marijuana and neurology ) 16682703 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Challenges of marijuana research.
    Related Articles

    Challenges of marijuana research.

    Brain. 2006 May;129(Pt 5):1081-3

    Authors: Ponto LL

    PMID: ( marijuana and neurology ) 16627464 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana use is associated with a reorganized visual-attention network and cerebellar hypoactivation.

    Marijuana use is associated with a reorganized visual-attention network and cerebellar hypoactivation.

    Brain. 2006 May;129(Pt 5):1096-112

    Authors: Chang L, Yakupov R, Cloak C, Ernst T

    Attention and memory deficits have been reported in heavy marijuana users, but these effects may be reversible after prolonged abstinence. It remains unclear whether the reversibility of these cognitive deficits indicates that chronic marijuana use does not alter cortical networks, or that such changes occur but the brain adapts to the drug-induced changes. Blood oxygenation-level dependent (BOLD) functional MRI (fMRI) was performed in 24 chronic marijuana users (12 abstinent and 12 active) and 19 age-, sex- and education-matched control subjects during a set of visual-attention tasks with graded levels of difficulty. Neuropsychological tests were also administered on each subject. The two marijuana user groups showed no significant difference in usage pattern (frequency or duration of use, age of first use, cumulative joints used, averaged >2000 joints) or estimated cumulative lifetime exposure of Delta-9-tetrahydrocannabinol (THC) (mean 168 +/- 45 versus 244 +/- 135 g). Despite similar task and cognitive test performance compared with control subjects, active and abstinent marijuana users showed decreased activation in the right prefrontal, medial and dorsal parietal, and medial cerebellar regions, but greater activation in various frontal, parietal and occipital brain regions during the visual-attention tasks (all with P < or = 0.001, corrected, cluster level). However, the BOLD signals in the right frontal and medial cerebellar regions normalized with duration of abstinence in the abstinent users. Active marijuana users, with positive urine tests for THC, showed greater activation in the frontal and medial cerebellar regions than abstinent marijuana users and greater usage of the reserve network (regions with load effect), suggesting a neuroadaptive state. Both earlier age of first use and greater estimated cumulative dose of THC exposure were related to lower BOLD signals in the right prefrontal region and medial cerebellum. The altered BOLD activation pattern in the attention network and hypoactivation of the cerebellum suggest neuroadaptive processes or alteration of brain development in chronic marijuana users. These changes also may be related to marijuana-induced alteration in resting cerebral blood volume/flow or downregulation of cannabinoid (CB1) receptors. The greater activation in the active compared with abstinent marijuana users demonstrates a neuroadaptive state in the setting of active marijuana use, while the long-term chronic effect of marijuana on the altered brain network may be reversible with prolonged abstinence.

    PMID: ( marijuana and neurology ) 16585053 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Response to the American Academy of Pediatrics report on legalization of marijuana.
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    Response to the American Academy of Pediatrics report on legalization of marijuana.

    Pediatrics. 2005 Nov;116(5):1256-7; author reply 1257

    Authors: Warf C

    PMID: ( marijuana and neurology ) 16264017 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • New medicinal marijuana rules ease onus on physicians.
    Related Articles

    New medicinal marijuana rules ease onus on physicians.

    CMAJ. 2005 Aug 30;173(5):473

    Authors: Sibbald B

    PMID: ( marijuana and neurology ) 16129861 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • US Supreme Court says no to medical marijuana.
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    US Supreme Court says no to medical marijuana.

    BMJ. 2005 Jun 18;330(7505):1408

    Authors: Hopkins Tanne J

    PMID: ( marijuana and neurology ) 15961803 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • The epidemiology of alcohol, marijuana, and cocaine use among Mexican American, Puerto Rican, Cuban American, and other Latin American eighth-grade students in the United States: 1991-2002.
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    The epidemiology of alcohol, marijuana, and cocaine use among Mexican American, Puerto Rican, Cuban American, and other Latin American eighth-grade students in the United States: 1991-2002.

    Am J Public Health. 2005 Apr;95(4):696-702

    Authors: Delva J, Wallace JM, O'Malley PM, Bachman JG, Johnston LD, Schulenberg JE

    OBJECTIVES: We compared trends in and correlates of marijuana use, cocaine use, and heavy alcohol use for adolescents of Mexican American, Puerto Rican, Cuban, and other Latin American heritage in the United States. METHODS: We used/examined data from nationally representative samples of eighth-grade Hispanic students who participated in the Monitoring the Future study during the years 1991-2002 (n=24235). RESULTS: Drug use was significantly higher among boys and adolescents of almost all Hispanic ethnicities who did not live with both parents. In addition, drug use differed considerably according to ethnic group on language first spoken, parental education, urbanicity, and region. CONCLUSIONS: A better understanding of the homogeneity and heterogeneity of drug use patterns within and between Hispanic groups should assist in the development of prevention programs.

    PMID: ( marijuana and neurology ) 15798132 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Risk factors predicting changes in marijuana involvement in teenagers.
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    Risk factors predicting changes in marijuana involvement in teenagers.

    Arch Gen Psychiatry. 2005 Mar;62(3):311-9

    Authors: van den Bree MB, Pickworth WB

    BACKGROUND: Marijuana use during adolescence has various adverse psychological and health outcomes. It is poorly understood whether the same risk factors influence different stages in the development of marijuana involvement. OBJECTIVE: To establish which risk factors best explain different stages of marijuana involvement. DESIGN: Data were collected at 2 points using computer-assisted personal interview (wave 1 and wave 2 were separated by 1 year). Twenty-one well-established risk factors of adolescent substance use/abuse were used to predict 5 stages of marijuana involvement: (1) initiation of experimental use, (2) initiation of regular use, (3) progression to regular use, (4) failure to discontinue experimental use, and (5) failure to discontinue regular use. Data were analyzed using logistic regression analysis. PARTICIPANTS: Middle school and high school students (N = 13 718, aged 11-21 years) participating in the National Longitudinal Study of Adolescent Health (Add Health). RESULTS: Three risk factors (own and peer involvement with substances, delinquency, and school problems) were the strongest predictors of all stages. Their combined presence greatly increased risk of initiation of experimental (odds ratio, 20) and regular (odds ratio, 87) marijuana use over the next year. Personality, family, religious, and pastime factors exerted stage-specific, sex-specific, and age-specific influences. CONCLUSIONS: Assessment of substance, school, and delinquency factors is important in identifying individuals at high risk for continued involvement with marijuana. Prevention and/or intervention efforts should focus on these areas of risk.

    PMID: ( marijuana and neurology ) 15753244 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Legalization of marijuana: potential impact on youth.

    Legalization of marijuana: potential impact on youth.

    Pediatrics. 2004 Jun;113(6):e632-8

    Authors: Joffe A, Yancy WS, ,

    This technical report provides historical perspectives and comparisons of various approaches to the legal status of marijuana to aid in forming public policy. Information on the impact that decriminalization and legalization of marijuana could have on adolescents, in addition to concerns surrounding medicinal use of marijuana, are also addressed in this report. Recommendations are included in the accompanying policy statement.

    PMID: ( marijuana and neurology ) 15173547 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Legalization of marijuana: potential impact on youth.

    Legalization of marijuana: potential impact on youth.

    Pediatrics. 2004 Jun;113(6):1825-6

    Authors: Joffe A, ,

    As experts in the health care of children and adolescents, pediatricians may be called on to advise legislators concerning the potential impact of changes in the legal status of marijuana on adolescents. Parents, too, may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical purposes or to decriminalize possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization, and the accompanying technical report (available online) reviews what is currently known about the relationship between adolescents' use of marijuana and its legal status to better understand how change might influence the degree of marijuana use by adolescents in the future.

    PMID: ( marijuana and neurology ) 15173518 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Prevalence of marijuana use disorders in the United States: 1991-1992 and 2001-2002.
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    Prevalence of marijuana use disorders in the United States: 1991-1992 and 2001-2002.

    JAMA. 2004 May 5;291(17):2114-21

    Authors: Compton WM, Grant BF, Colliver JD, Glantz MD, Stinson FS

    CONTEXT: Among illicit substance use disorders, marijuana use disorders are the most prevalent in the population. Yet, information about the prevalence of current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marijuana use disorders and how prevalence has changed is lacking. OBJECTIVE: To examine changes in the prevalence of marijuana use, abuse, and dependence in the United States between 1991-1992 and 2001-2002. DESIGN, SETTING, AND PARTICIPANTS: Face-to-face interviews were conducted in 2 large national surveys conducted 10 years apart: the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey ([NLAES] n = 42,862) and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions ([NESARC] n = 43,093). MAIN OUTCOME MEASURES: Rates of past year marijuana use, abuse, and dependence. RESULTS: Among the adult US population, the prevalence of marijuana use remained stable at about 4.0% over the past decade. In contrast, the prevalence of DSM-IV marijuana abuse or dependence significantly (P =.01) increased between 1991-1992 (1.2%) and 2001-2002 (1.5%), with the greatest increases observed among young black men and women (P<.001) and young Hispanic men (P =.006). Further, marijuana use disorders among marijuana users significantly increased (P =.002) in the absence of increased frequency and quantity of marijuana use, suggesting that the concomitant increase in potency of delta-9-tetrahydrocannabinol (Delta9-THC) may have contributed to the rising rates. CONCLUSIONS: Despite the stability in the overall prevalence of marijuana use, more adults in the United States had a marijuana use disorder in 2001-2002 than in 1991-1992. Increases in the prevalence of marijuana use disorders were most notable among young black men and women and young Hispanic men. Although rates of marijuana abuse and dependence did not increase among young white men and women, their rates have remained high. The results of this study underscore the need to develop and implement new prevention and intervention programs targeted at youth, particularly minority youth.

    PMID: ( marijuana and neurology ) 15126440 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Cerebellar infarction in adolescent males associated with acute marijuana use.
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    Cerebellar infarction in adolescent males associated with acute marijuana use.

    Pediatrics. 2004 Apr;113(4):e365-70

    Authors: Geller T, Loftis L, Brink DS

    OBJECTIVE: To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients. DESIGN: A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years. SETTING: Inpatient and intensive care hospitalization units managing children and adolescents. SUBJECTS: Male adolescent patients with ischemic cerebellar stroke after use of marijuana. DIAGNOSTIC INVESTIGATIONS: Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects). RESULTS: Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures. CONCLUSIONS: Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity.

    PMID: ( marijuana and neurology ) 15060269 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Sustained increased consumption of cigarettes, alcohol, and marijuana among Manhattan residents after september 11, 2001.
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    Sustained increased consumption of cigarettes, alcohol, and marijuana among Manhattan residents after september 11, 2001.

    Am J Public Health. 2004 Feb;94(2):253-4

    Authors: Vlahov D, Galea S, Ahern J, Resnick H, Kilpatrick D

    We compared reports of increased substance use in Manhattan 1 and 6 months after the September 11, 2001, terrorist attacks. Data from 2 random-digit-dial surveys conducted 1 and 6 months after September 11 showed that 30.8% and 27.3% of respondents, respectively, reported increased use of cigarettes, alcohol, or marijuana. These sustained increases in substance use following the September 11 terrorist attacks suggest potential long-term health consequences as a result of disasters.

    PMID: ( marijuana and neurology ) 14759935 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Pharmacies, not MDs, should distribute medicinal marijuana: chair.
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    Pharmacies, not MDs, should distribute medicinal marijuana: chair.

    CMAJ. 2003 Oct 14;169(8):823

    Authors: Sibbald B

    PMID: ( marijuana and neurology ) 14557332 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Summaries for patients. Does marijuana affect viral loads in people with HIV?
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    Summaries for patients. Does marijuana affect viral loads in people with HIV?

    Ann Intern Med. 2003 Aug 19;139(4):I44

    Authors:

    PMID: ( marijuana and neurology ) 12965999 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Canadian doctors question marijuana for medicinal use.
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    Canadian doctors question marijuana for medicinal use.

    BMJ. 2003 Jul 19;327(7407):122

    Authors: Spurgeon D

    PMID: ( marijuana and neurology ) 12869437 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Canadian government is attacked for plan to legalise marijuana.
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    Canadian government is attacked for plan to legalise marijuana.

    BMJ. 2003 Jun 7;326(7401):1232

    Authors: Spurgeon D

    PMID: ( marijuana and neurology ) 12791726 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Shared genetic risk of major depression, alcohol dependence, and marijuana dependence: contribution of antisocial personality disorder in men.
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    Shared genetic risk of major depression, alcohol dependence, and marijuana dependence: contribution of antisocial personality disorder in men.

    Arch Gen Psychiatry. 2002 Dec;59(12):1125-32

    Authors: Fu Q, Heath AC, Bucholz KK, Nelson E, Goldberg J, Lyons MJ, True WR, Jacob T, Tsuang MT, Eisen SA

    BACKGROUND: Little is known about genetic factors that underlie the interrelationships among antisocial personality disorder (ASPD), major depression (MD), alcohol dependence (AD), and marijuana dependence (MJD). We examined the contribution of genetic effects associated with ASPD to the comorbidity of MD and substance use disorders. METHODS: The Vietnam Era Twin Registry is a general population registry of male veteran twins constructed from computerized Department of Defense files and other sources. A telephone diagnostic interview was administered to eligible twins from the Registry in 1992. Of 5150 twin pairs who served on active military duty during the Vietnam era, 3360 pairs (1868 monozygotic and 1492 dizygotic) in which both members completed the pertinent diagnostic interview sections were included. The main outcome measures were lifetime DSM-III-R ASPD, MD, AD, and MJD. RESULTS: Structural equation modeling was performed to estimate additive genetic, shared environmental, and nonshared environmental effects common and specific to each disorder. The heritability estimates for lifetime ASPD, MD, AD, and MJD were 69%, 40%, 56%, and 50%, respectively. Genetic effects on ASPD accounted for 38%, 50%, and 58% of the total genetic variance in risk for MD, AD, and MJD, respectively. After controlling for genetic effects on ASPD, the partial genetic correlations of MD with AD and with MJD were no longer statistically significant. Genetic effects specific to MD and AD and familial effects specific to MJD remained statistically significant. Nonshared environmental contributions to the comorbidity in these disorders were small. CONCLUSIONS: In this sample, the shared genetic risk between MD and both AD and MJD was largely explained by genetic effects on ASPD, which in turn was associated with increased risk of each of the other disorders.

    PMID: ( marijuana and neurology ) 12470129 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • US government cannot revoke licences of doctors who recommend marijuana.
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    US government cannot revoke licences of doctors who recommend marijuana.

    BMJ. 2002 Nov 9;325(7372):1058

    Authors: Josefson D

    PMID: ( marijuana and neurology ) 12428610 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Effects of marijuana on young adults.
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    Effects of marijuana on young adults.

    CMAJ. 2002 Aug 6;167(3):233; author reply 234

    Authors: Shrier I

    PMID: ( marijuana and neurology ) 12186161 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Effects of marijuana on young adults.
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    Effects of marijuana on young adults.

    CMAJ. 2002 Aug 6;167(3):233; author reply 234

    Authors: Yong PJ

    PMID: ( marijuana and neurology ) 12186160 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Effects of marijuana on young adults.
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    Effects of marijuana on young adults.

    CMAJ. 2002 Aug 6;167(3):233; author reply 234

    Authors: Mamen M

    PMID: ( marijuana and neurology ) 12186159 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Current and former marijuana use: preliminary findings of a longitudinal study of effects on IQ in young adults.

    Current and former marijuana use: preliminary findings of a longitudinal study of effects on IQ in young adults.

    CMAJ. 2002 Apr 2;166(7):887-91

    Authors: Fried P, Watkinson B, James D, Gray R

    BACKGROUND: Assessing marijuana's impact on intelligence quotient (IQ) has been hampered by a lack of evaluation of subjects before they begin to use this substance. Using data from a group of young people whom we have been following since birth, we examined IQ scores before, during and after cessation of regular marijuana use to determine any impact of the drug on this measure of cognitive function. METHODS: We determined marijuana use for seventy 17- to 20-year-olds through self-reporting and urinalysis. IQ difference scores were calculated by subtracting each person's IQ score at 9-12 years (before initiation of drug use) from his or her score at 17-20 years. We then compared the difference in IQ scores of current heavy users (at least 5 joints per week), current light users (less than 5 joints per week), former users (who had not smoked regularly for at least 3 months) and non-users (who never smoked more than once per week and no smoking in the past two weeks). RESULTS: Current marijuana use was significantly correlated (p < 0.05) in a dose-related fashion with a decline in IQ over the ages studied. The comparison of the IQ difference scores showed an average decrease of 4.1 points in current heavy users (p < 0.05) compared to gains in IQ points for light current users (5.8), former users (3.5) and non-users (2.6). INTERPRETATION: Current marijuana use had a negative effect on global IQ score only in subjects who smoked 5 or more joints per week. A negative effect was not observed among subjects who had previously been heavy users but were no longer using the substance. We conclude that marijuana does not have a long-term negative impact on global intelligence. Whether the absence of a residual marijuana effect would also be evident in more specific cognitive domains such as memory and attention remains to be ascertained.

    PMID: ( marijuana and neurology ) 11949984 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Should physicians support the medical use of marijuana? No: evidence of its safety and efficacy is weak. Counterpoint.
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    Should physicians support the medical use of marijuana? No: evidence of its safety and efficacy is weak. Counterpoint.

    West J Med. 2002 Mar;176(2):77

    Authors: Voth EA

    PMID: ( marijuana and neurology ) 11897722 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Should physicians support the medical use of marijuana? Yes: it can be effective when all else fails. Point.

    Should physicians support the medical use of marijuana? Yes: it can be effective when all else fails. Point.

    West J Med. 2002 Mar;176(2):76

    Authors: Eidelman WS

    PMID: ( marijuana and neurology ) 11897721 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana: a decade and a half later, still a crude drug with underappreciated toxicity.
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    Marijuana: a decade and a half later, still a crude drug with underappreciated toxicity.

    Pediatrics. 2002 Feb;109(2):284-9

    Authors: Schwartz RH

    In 1984, I published in this journal a review entitled "Marijuana: A Crude Drug With a Spectrum of Underappreciated Toxicity." In the introduction to that article, I disclosed that our son Keith, who was 15 years old at the time, was in a long-term, modified outpatient adolescent drug and alcohol rehabilitation program because he had become dependent on marijuana with its associated behavioral, interpersonal, scholastic, and antisocial problems. Keith and most of his friends had experimented several times with LSD, beer, and several other drugs but never used injection drugs. Marijuana was clearly Keith's drug of choice and the only drug he used with regularity. Approximately 1 year later, Keith graduated from the treatment program. He completed the early aftercare component, relapsed several times, and completed a 4-month refresher drug rehabilitation program in another state. Nine years after admission to the first rehabilitation program, Keith finally attained some adult goals. Now 34 years old, he has been drug-free for 10 years. He is the president and owner of a successful discount cellular phone business that he started. More important, a decade ago, he reestablished an excellent and close relationship with his parents. As far as I can tell, Keith remains drug-free except for an occasional beer.

    PMID: ( marijuana and neurology ) 11826208 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • CMPA warns doctors of risks associated with prescribing marijuana.
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    CMPA warns doctors of risks associated with prescribing marijuana.

    CMAJ. 2002 Jan 8;166(1):83

    Authors: Wharry S

    PMID: ( marijuana and neurology ) 11800259 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Guidelines for prescribing medical marijuana.
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    Guidelines for prescribing medical marijuana.

    West J Med. 2001 Nov;175(5):305-6

    Authors: Voth EA

    PMID: ( marijuana and neurology ) 11694470 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana abstinence effects in marijuana smokers maintained in their home environment.
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    Marijuana abstinence effects in marijuana smokers maintained in their home environment.

    Arch Gen Psychiatry. 2001 Oct;58(10):917-24

    Authors: Budney AJ, Hughes JR, Moore BA, Novy PL

    BACKGROUND: Although withdrawal symptoms are commonly reported by persons seeking treatment for marijuana dependence, the validity and clinical significance of a marijuana withdrawal syndrome has not been established. This controlled outpatient study examined the reliability and specificity of the abstinence effects that occur when daily marijuana users abruptly stop smoking marijuana. METHODS: Twelve daily marijuana smokers were assessed on 16 consecutive days during which they smoked marijuana as usual (days 1-5), abstained from smoking marijuana (days 6-8), returned to smoking marijuana (days 9-13), and again abstained from smoking marijuana (days 14-16). RESULTS: An overall measure of withdrawal discomfort increased significantly during the abstinence phases and returned to baseline when marijuana smoking resumed. Craving for marijuana, decreased appetite, sleep difficulty, and weight loss reliably changed across the smoking and abstinence phases. Aggression, anger, irritability, restlessness, and strange dreams increased significantly during one abstinence phase, but not the other. Collateral observers confirmed participant reports of these symptoms. CONCLUSIONS: This study validated several specific effects of marijuana abstinence in heavy marijuana users, and showed they were reliable and clinically significant. These withdrawal effects appear similar in type and magnitude to those observed in studies of nicotine withdrawal.

    PMID: ( marijuana and neurology ) 11576029 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Much ado about marijuana.
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    Much ado about marijuana.

    CMAJ. 2001 Sep 4;165(5):525

    Authors: Howlett M

    PMID: ( marijuana and neurology ) 11563199 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Much ado about marijuana.
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    Much ado about marijuana.

    CMAJ. 2001 Sep 4;165(5):525

    Authors: Carranza J

    PMID: ( marijuana and neurology ) 11563198 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Much ado about marijuana.
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    Much ado about marijuana.

    CMAJ. 2001 Sep 4;165(5):523, 525

    Authors: Jones C

    PMID: ( marijuana and neurology ) 11563197 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Much ado about marijuana.
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    Much ado about marijuana.

    CMAJ. 2001 Sep 4;165(5):523

    Authors: Voth EA

    PMID: ( marijuana and neurology ) 11563196 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Much ado about marijuana.
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    Much ado about marijuana.

    CMAJ. 2001 Sep 4;165(5):523

    Authors: Hajela R

    PMID: ( marijuana and neurology ) 11563195 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • A primer for patients' use of medicinal marijuana.
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    A primer for patients' use of medicinal marijuana.

    CMAJ. 2001 Aug 7;165(3):329

    Authors: Sibbald B

    PMID: ( marijuana and neurology ) 11517655 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Medical marijuana: the continuing story.
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    Medical marijuana: the continuing story.

    Ann Intern Med. 2001 Jun 19;134(12):1159-62

    Authors: Kane B

    PMID: ( marijuana and neurology ) 11412075 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Triggering myocardial infarction by marijuana.
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    Triggering myocardial infarction by marijuana.

    Circulation. 2001 Jun 12;103(23):2805-9

    Authors: Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE

    BACKGROUND: Marijuana use in the age group prone to coronary artery disease is higher than it was in the past. Smoking marijuana is known to have hemodynamic consequences, including a dose-dependent increase in heart rate, supine hypertension, and postural hypotension; however, whether it can trigger the onset of myocardial infarction is unknown. METHODS AND RESULTS: In the Determinants of Myocardial Infarction Onset Study, we interviewed 3882 patients (1258 women) with acute myocardial infarction an average of 4 days after infarction onset. We used the case-crossover study design to compare the reported use of marijuana in the hour preceding symptoms of myocardial infarction onset to its expected frequency using self-matched control data. Of the 3882 patients, 124 (3.2%) reported smoking marijuana in the prior year, 37 within 24 hours and 9 within 1 hour of myocardial infarction symptoms. Compared with nonusers, marijuana users were more likely to be men (94% versus 67%, P<0.001), current cigarette smokers (68% versus 32%, P<0.001), and obese (43% versus 32%, P=0.008). They were less likely to have a history of angina (12% versus 25%, P<0.001) or hypertension (30% versus 44%, P=0.002). The risk of myocardial infarction onset was elevated 4.8 times over baseline (95% confidence interval, 2.4 to 9.5) in the 60 minutes after marijuana use. The elevated risk rapidly decreased thereafter. CONCLUSIONS: Smoking marijuana is a rare trigger of acute myocardial infarction. Understanding the mechanism through which marijuana causes infarction may provide insight into the triggering of myocardial infarction by this and other, more common stressors.

    PMID: ( marijuana and neurology ) 11401936 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana: federal smoke clears, a little.

    Marijuana: federal smoke clears, a little.

    CMAJ. 2001 May 15;164(10):1397, 1399

    Authors:

    PMID: ( marijuana and neurology ) 11387904 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Blockade of effects of smoked marijuana by the CB1-selective cannabinoid receptor antagonist SR141716.
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    Blockade of effects of smoked marijuana by the CB1-selective cannabinoid receptor antagonist SR141716.

    Arch Gen Psychiatry. 2001 Apr;58(4):322-8

    Authors: Huestis MA, Gorelick DA, Heishman SJ, Preston KL, Nelson RA, Moolchan ET, Frank RA

    BACKGROUND: SR141716, a recently developed CB1 cannabinoid receptor antagonist, blocks acute effects of Delta-9-tetrahydrocannabinol (THC) and other CB1 cannabinoid agonists in vitro and in animals. These findings suggest that CB1 receptors mediate many of the effects of marijuana, but this has not been evaluated in humans. METHODS: Sixty-three healthy men with a history of marijuana use were randomly assigned to receive oral SR141716 or a placebo in an escalating dose (1, 3, 10, 30, and 90 mg) design. Each subject smoked an active (2.64% THC) or placebo marijuana cigarette 2 hours later. Psychological effects associated with marijuana intoxication and heart rate were measured before and after antagonist and marijuana administration. RESULTS: Single oral doses of SR141716 produced a significant dose-dependent blockade of marijuana-induced subjective intoxication and tachycardia. The 90-mg dose produced 38% to 43% reductions in visual analog scale ratings of "How high do you feel now?" "How stoned on marijuana are you now?" and "How strong is the drug effect you feel now?" and produced a 59% reduction in heart rate. SR141716 alone produced no significant physiological or psychological effects and did not affect peak THC plasma concentration or the area under the time x concentration curve. SR141716 was well tolerated by all subjects. CONCLUSIONS: SR141716 blocked acute psychological and physiological effects of smoked marijuana without altering THC pharmacokinetics. These findings confirm, for the first time in humans, the central role of CB1 receptors in mediating the effects of marijuana.

    PMID: ( marijuana and neurology ) 11296091 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Canada acts on marijuana and tobacco.
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    Canada acts on marijuana and tobacco.

    BMJ. 2001 Apr 21;322(7292):948

    Authors: Spurgeon D

    PMID: ( marijuana and neurology ) 11312223 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • US considers medical role for marijuana.
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    US considers medical role for marijuana.

    BMJ. 2001 Apr 7;322(7290):817

    Authors: Josefson D

    PMID: ( marijuana and neurology ) 11290630 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Television campaigns and adolescent marijuana use: tests of sensation seeking targeting.
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    Television campaigns and adolescent marijuana use: tests of sensation seeking targeting.

    Am J Public Health. 2001 Feb;91(2):292-6

    Authors: Palmgreen P, Donohew L, Lorch EP, Hoyle RH, Stephenson MT

    OBJECTIVES: This study evaluated the effectiveness of targeted televised public service announcement campaigns in reducing marijuana use among high-sensation-seeking adolescents. METHODS: The study used a controlled interrupted time-series design in 2 matched communities. Two televised antimarijuana campaigns were conducted in 1 county and 1 campaign in the comparison community. Personal interviews were conducted with 100 randomly selected teenagers monthly in each county for 32 months. RESULTS: All 3 campaigns reversed upward developmental trends in 30-day marijuana use among high-sensation seekers (P < .002). As expected, low-sensation seekers had low use levels, and no campaign effects were evident. CONCLUSIONS: Televised campaigns with high reach and frequency that use public service announcements designed for and targeted at high-sensation-seeking adolescents can significantly reduce substance use in this high-risk population.

    PMID: ( marijuana and neurology ) 11211642 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Variation in youthful risks of progression from alcohol and tobacco to marijuana and to hard drugs across generations.
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    Variation in youthful risks of progression from alcohol and tobacco to marijuana and to hard drugs across generations.

    Am J Public Health. 2001 Feb;91(2):225-32

    Authors: Golub A, Johnson BD

    OBJECTIVES: Much research has documented that youthful substance use typically follows a sequence starting with use of alcohol or tobacco or both and potentially proceeding to marijuana and then hard drug use. This study explicitly examined the probabilities of progression through each stage and their covariates. METHODS: A secondary analysis of data from the National Household Survey on Drug Abuse (1979-1997) was conducted with particular sensitivity to the nature of substance use progression, sampling procedures, and reliability of self-report data. RESULTS: Progression to marijuana and hard drug use was uncommon among persons born before World War II. The stages phenomenon essentially emerged with the baby boom and rose to a peak among persons born around 1960. Subsequently, progression risks at each stage declined. Progression risks were also higher among younger initiators of alcohol, tobacco, or marijuana use. CONCLUSIONS: The recent increase in youthful marijuana use has been offset by lower rates of progression to hard drug use among youths born in the 1970s. Dire predictions of future hard drug abuse by youths who came of age in the 1990s may be greatly overstated.

    PMID: ( marijuana and neurology ) 11211630 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Ottawa seeks source of medical marijuana.
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    Ottawa seeks source of medical marijuana.

    CMAJ. 2000 Jul 11;163(1):74

    Authors: Sullivan P

    PMID: ( marijuana and neurology ) 10920737 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Self-reported medical use of marijuana: a survey of the general population.
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    Self-reported medical use of marijuana: a survey of the general population.

    CMAJ. 2000 Jun 13;162(12):1685-6

    Authors: Ogborne AC, Smart RG, Adlaf EM

    PMID: ( marijuana and neurology ) 10870496 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Necrotizing pulmonary granulomata in a marijuana smoker.
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    Necrotizing pulmonary granulomata in a marijuana smoker.

    Chest. 2000 May;117(5):1511-5

    Authors: Cunnington D, Teichtahl H, Hunt JM, Dow C, Valentine R

    We describe the case of a heavy marijuana and tobacco smoker who presented with progressive exertional dyspnea of 2 months' duration, and bilateral nodular lung infiltrates. Examination of the lung fields was normal, and lung function tests showed mild airflow obstruction with moderately reduced gas transfer. BAL returned green-black fluid consisting predominantly of macrophages laden with carbon pigment. Thoracoscopic lung biopsy showed miliary necrotizing granulomata with an alveolar exudate of carbon-laden macrophages within macroscopically blackened lung. The differential diagnosis of pulmonary granulomata in this patient is discussed.

    PMID: ( marijuana and neurology ) 10807846 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • The dynamics of alcohol and marijuana initiation: patterns and predictors of first use in adolescence.
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    The dynamics of alcohol and marijuana initiation: patterns and predictors of first use in adolescence.

    Am J Public Health. 2000 Mar;90(3):360-6

    Authors: Kosterman R, Hawkins JD, Guo J, Catalano RF, Abbott RD

    OBJECTIVES: This study, guided by the social development model, examined the dynamic patterns and predictors of alcohol and marijuana use onset. METHODS: Survival analysis and complementary log-log regression were used to model hazard rates and etiology of initiation with time-varying covariates. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age. RESULTS: Alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years. CONCLUSIONS: This study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother.

    PMID: ( marijuana and neurology ) 10705852 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana: medical implications.
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    Marijuana: medical implications.

    Am Fam Physician. 1999 Dec;60(9):2583-8, 2593

    Authors: Hubbard JR, Franco SE, Onaivi ES

    Over 50 percent of people will use marijuana sometime in their life. While intoxication lasts two to three hours, the active ingredient in marijuana, delta-9-tetrahydro-cannabinol, can accumulate in fatty tissues, including the brain and testes. Adverse effects from marijuana use include decreased coordination, epithelial damage to the lungs, increased risk of infection, cardiovascular effects and cognitive deficits. Unexplained behavior changes, altered social relationships and poor performance at school or work can signify a drug problem. Treatment requires a combination of education, social support, drug monitoring and attention to comorbid medical and psychiatric conditions.

    PMID: ( marijuana and neurology ) 10605993 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • A step ahead of the law, "Compassion Club" sells marijuana to patients referred by MDs.
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    A step ahead of the law, "Compassion Club" sells marijuana to patients referred by MDs.

    CMAJ. 1999 Oct 19;161(8):1024

    Authors: Kent H

    PMID: ( marijuana and neurology ) 10551203 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • The risks for late adolescence of early adolescent marijuana use.
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    The risks for late adolescence of early adolescent marijuana use.

    Am J Public Health. 1999 Oct;89(10):1549-54

    Authors: Brook JS, Balka EB, Whiteman M

    OBJECTIVES: The purpose of this study was to assess the relation of early adolescent marijuana use to late adolescent problem behaviors, drug-related attitudes, drug problems, and sibling and peer problem behavior. METHODS: African American (n = 627) and Puerto Rican (n = 555) youths completed questionnaires in their classrooms initially and were individually interviewed 5 years later. Logistic regression analysis estimated increases in the risk of behaviors or attitudes in late adolescence associated with more frequent marijuana use in early adolescence. RESULTS: Early adolescent marijuana use increased the risk in late adolescence of not graduating from high school; delinquency; having multiple sexual partners; not always using condoms; perceiving drugs as not harmful; having problems with cigarettes, alcohol, and marijuana; and having more friends who exhibit deviant behavior. These relations were maintained with controls for age, sex, ethnicity, and, when available, earlier psychosocial measures. CONCLUSIONS: Early adolescent marijuana use is related to later adolescent problems that limit the acquisition of skills necessary for employment and heighten the risks of contracting HIV and abusing legal and illegal substances. Hence, assessments of and treatments for adolescent marijuana use need to be incorporated in clinical practice.

    PMID: ( marijuana and neurology ) 10511838 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • American Academy of Pediatrics. Committee on Substance Abuse. Marijuana: A continuing concern for pediatricians.
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    American Academy of Pediatrics. Committee on Substance Abuse. Marijuana: A continuing concern for pediatricians.

    Pediatrics. 1999 Oct;104(4 Pt 1):982-5

    Authors: Heyman RB, Anglin TM, Copperman SM, Joffe A, McDonald CA, Rogers PD, Shah RZ, Armentano M, Boyd GM, Czechowicz D

    Marijuana, the common name for products derived from the plant Cannabis sativa, is the most common illicit drug used by children and adolescents in the United States.(1) Despite growing concerns by the medical profession about the physical and psychological effects of its active ingredient, Delta-9-tetrahydrocannabinol, survey data continue to show that increasing numbers of young people are using the drug as they become less concerned about its dangers.(1)

    PMID: ( marijuana and neurology ) 10506247 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.
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    Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.

    Arch Pediatr Adolesc Med. 1999 Aug;153(8):838-44

    Authors: Boyer CB, Shafer MA, Teitle E, Wibbelsman CJ, Seeberg D, Schachter J

    OBJECTIVE: To determine the role of sociodemographic risk markers and behavioral risk factors associated with sexually transmitted diseases (STDs) in sexually experienced youth seeking care at an urban, general health maintenance organization teen clinic. DESIGN: Cross-sectional. PARTICIPANTS: A consecutive, racially and ethnically diverse sample of 285 sexually experienced youth who were preponderantly female (58.6%) and who were aged 16.7 years on average. METHODS: All participants completed a self-report questionnaire and were screened for Chlamydia trachomatis using the ligase chain reaction technique and for Neisseria gonorrhoeae and other STDs using conventional methods. RESULTS: Many of these youth were at high risk for STDs, having a self-reported history of sex with multiple partners (49.1%), sex with a new partner (42.5%), inconsistent use of condoms (71.9%), and frequent substance use (24.5% used marijuana 1-2 times per week or more). Sexually transmitted disease screening revealed that 11.6% of the participants had 1 or more STDs. A logistic regression analysis to determine the best model for predicting STDs indicated that youth who are African American (odds ratio, 3.34; 95% confidence interval, 1.52-7.35), had sexual partners who were 2 or more years older (odds ratio, 2.63, 95% confidence interval, 1.22-5.67), and used marijuana 1 to 2 times or more per week (odds ratio, 2.27; 95% confidence interval, 1.01-5.13) were more likely to have STDs at screening. CONCLUSIONS: A brief sociodemographic and behavioral risk assessment that includes these factors may be useful for clinicians in deciding when to screen for STDs in sexually active youth seeking care for reasons not related to reproductive health.

    PMID: ( marijuana and neurology ) 10437757 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • The role of parents in protecting Colombian adolescents from delinquency and marijuana use.
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    The role of parents in protecting Colombian adolescents from delinquency and marijuana use.

    Arch Pediatr Adolesc Med. 1999 May;153(5):457-64

    Authors: Brook JS, Brook DW, De La Rosa M, Whiteman M, Montoya ID

    OBJECTIVES: To identify general and differentiating risk and protective factors from domains of culture and ecology, peer, family, and personality, related to adolescent delinquency and marijuana use, and to study the protective role of the parent-child mutual attachment in offsetting cultural and ecological risk factors, leading to less delinquency and marijuana use. DESIGN: Cross-sectional analyses of interview data collected in Colombia. PARTICIPANTS: A total of 2837 Colombian adolescents, 12 to 17 years of age. SETTING: Adolescents were interviewed in their homes. MAIN MEASURES: Independent variables included measures from 4 domains: culture and ecology, peer, family, and personality. The dependent variables were delinquency and marijuana use. RESULTS: Several risk factors, such as tolerance of deviance and sensation seeking, were similarly related to both delinquency and marijuana use, suggesting that a common cause underlies the propensity to engage in different deviant behaviors. Some risk factors were more involved in delinquency and other risk factors were more highly related to the adolescent's marijuana use. Finally, when violence is endemic and illegal drugs are readily available, a close parent-child bond was capable of mitigating these risk factors, leading to less marijuana use and delinquency. CONCLUSIONS: The findings have implications for public health policy related to interventions in countries in which violence and drug use are prevalent. The results point to interventional procedures aimed at adolescents vulnerable to marijuana use and delinquency as well as efforts aimed at specific vulnerabilities in these areas. For example, reducing the risk factors and enhancing the protective factors for marijuana use and delinquency may result in less adolescent marijuana use and delinquency.

    PMID: ( marijuana and neurology ) 10323624 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Familial transmission of substance dependence: alcohol, marijuana, cocaine, and habitual smoking: a report from the Collaborative Study on the Genetics of Alcoholism.
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    Familial transmission of substance dependence: alcohol, marijuana, cocaine, and habitual smoking: a report from the Collaborative Study on the Genetics of Alcoholism.

    Arch Gen Psychiatry. 1998 Nov;55(11):982-8

    Authors: Bierut LJ, Dinwiddie SH, Begleiter H, Crowe RR, Hesselbrock V, Nurnberger JI, Porjesz B, Schuckit MA, Reich T

    BACKGROUND: Alcoholism and substance dependence frequently co-occur. Accordingly, we evaluated the familial transmission of alcohol, marijuana, and cocaine dependence and habitual smoking in the Collaborative Study on the Genetics of Alcoholism. METHODS: Subjects (n=1212) who met criteria for both DSM-III-R alcohol dependence and Feighner definite alcoholism and their siblings (n=2755) were recruited for study. A comparison sample was also recruited (probands, n=217; siblings, n=254). Subjects were interviewed with the Semi-Structured Assessment for the Genetics of Alcoholism. The familial aggregation of drug dependence and habitual smoking in siblings of alcohol-dependent and non-alcohol-dependent probands was measured by means of the Cox proportional hazards model. RESULTS: Rates of alcohol, marijuana, and cocaine dependence and habitual smoking were increased in siblings of alcohol-dependent probands compared with siblings of controls. For siblings of alcohol-dependent probands, 49.3% to 50.1% of brothers and 22.4% to 25.0% of sisters were alcohol dependent (lifetime diagnosis), but this elevated risk was not further increased by comorbid substance dependence in probands. Siblings of marijuana-dependent probands had an elevated risk of developing marijuana dependence (relative risk [RR], 1.78) and siblings of cocaine-dependent probands had an elevated risk of developing cocaine dependence (RR, 1.71). There was a similar finding for habitual smoking (RR, 1.77 in siblings of habitual-smoking probands). CONCLUSIONS: Alcohol, marijuana, and cocaine dependence and habitual smoking are all familial, and there is evidence of both common and specific addictive factors transmitted in families. This specificity suggests independent causative factors in the development of each type of substance dependence.

    PMID: ( marijuana and neurology ) 9819066 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Medical marijuana.
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    Medical marijuana.

    West J Med. 1998 Jun;168(6):540-3

    Authors: Marmor JB

    Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several conditions for which there may be therapeutic benefit from marijuana use and that merit further research. Marijuana should be held to the same evaluation standards of safety and efficacy as other drugs (a major flaw in Proposition 215) but should not have to be proved better than current medications for its use to be adopted. The therapeutic window for marijuana and THC between desired effect and unpleasant side effects is narrow and is a major reason for discontinuing use. Although the inhaled route of administration has the benefit of allowing patients to self-titrate the dose, the smoking of crude plant material is problematic. The NIH panel recommended that a high priority be given to the development of a controlled inhaled form of THC. The presence of a naturally occurring cannabinoid-receptor system in the brain suggests that research on selective analogues of THC may be useful to enhance its therapeutic effects and minimize adverse effects.

    PMID: ( marijuana and neurology ) 9656007 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Explaining recent increases in students' marijuana use: impacts of perceived risks and disapproval, 1976 through 1996.
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    Explaining recent increases in students' marijuana use: impacts of perceived risks and disapproval, 1976 through 1996.

    Am J Public Health. 1998 Jun;88(6):887-92

    Authors: Bachman JG, Johnson LD, O'Malley PM

    OBJECTIVES: Marijuana use among high school seniors increased during most of the 1970s, decreased throughout the 1980s, and has been increasing again during the 1990s. Earlier analyses of the classes of 1976 through 1986 attributed the historic trends during that period to specific changes in views about marijuana. This study examined whether recent increases in marijuana use among seniors and among students in earlier grades reflect similar processes. METHODS: Multivariate regression analyses were conducted on data from large annual nationwide surveys of high school seniors from 1976 through 1996 (approximate n = 61,000) and 8th and 10th graders from 1991 through 1996 (n's = 87,911 and 82,475, respectively). RESULTS: Individual lifestyle factors (grades, truancy, religious commitment, evenings out for recreation) correlated substantially with marijuana use but did not explain the historic changes in marijuana use. Rather, decreases in perceived risk of harmfulness and in disapproval can account for the recent increases in all 3 grades and for earlier decreases among seniors. CONCLUSIONS: These findings indicate that perceived risks and disapproval are important determinants of marijuana use. Accordingly, prevention efforts should include realistic information about risks and consequences of marijuana use.

    PMID: ( marijuana and neurology ) 9618614 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in US birth cohorts since 1919.
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    Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in US birth cohorts since 1919.

    Am J Public Health. 1998 Jan;88(1):27-33

    Authors: Johnson RA, Gerstein DR

    OBJECTIVES: This study examined recent trends in initiation of psychoactive drug use. METHODS: Data from the 1991 through 1993 National Household Surveys on Drug Abuse were used to compare the percentages of US cohorts born from 1919 through 1975 who began using drugs before the ages of 15, 21, and 35. RESULTS: Initiation of cigarette smoking by males peaked in the 1941-1945 cohort, then declined steadily. For females, early smoking initiation rose through the 1951-1955 cohort and then stabilized. Initiation of alcohol use was less common than smoking for pre1950 cohorts but increased steadily, approaching cigarette use for cohorts born in the early 1970s. Only 2% of teenagers born in 1930-1940 tried marijuana; half the teenagers born in 1956-1965 did so. The percentage initiating marijuana use declined in the 1980s, more so among young adults than among teenagers. The use of cocaine and other illicit drugs echoed the rise of marijuana use but peaked later and showed less evidence of subsequent decline. Sex differences declined over time for every drug. CONCLUSIONS: Cohorts born since World War II have had much higher rates of illicit drug use initiation, but trends have varied by drug type, possibly reflecting changes in relative prices.

    PMID: ( marijuana and neurology ) 9584029 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Airway inflammation in young marijuana and tobacco smokers.
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    Airway inflammation in young marijuana and tobacco smokers.

    Am J Respir Crit Care Med. 1998 Mar;157(3 Pt 1):928-37

    Authors: Roth MD, Arora A, Barsky SH, Kleerup EC, Simmons M, Tashkin DP

    Forty healthy young subjects, ages 20 to 49 yr, underwent videobronchoscopy, mucosal biopsy, and bronchial lavage to evaluate the airway inflammation produced by habitual smoking of marijuana and/or tobacco. Videotapes were graded in a blinded manner for central airway erythema, edema, and airway secretions using a modified visual bronchitis index. The bronchitis index scores were significantly higher in marijuana smokers (MS), tobacco smokers (TS), and in combined marijuana/tobacco smokers (MTS), than in nonsmokers (NS). As a pathologic correlate, mucosal biopsies were evaluated for the presence of vascular hyperplasia, submucosal edema, inflammatory cell infiltrates, and goblet cell hyperplasia. Biopsies were positive for two of these criteria in 97% of all smokers and for three criteria in 72%. By contrast, none of the biopsies from NS exhibited greater than one positive finding. Finally, as a measure of distal airway inflammation, neutrophil counts and interleukin-8 (IL-8) concentrations were determined in bronchial lavage fluid. The percentage of neutrophils correlated with IL-8 levels and exceeded 20% in 0 of 10 NS, 1 of 9 MS, 2 of 9 TS, and 5 of 10 MTS. We conclude that regular smoking of marijuana by young adults is associated with significant airway inflammation that is similar in frequency, type, and magnitude to that observed in the lungs of tobacco smokers.

    PMID: ( marijuana and neurology ) 9517614 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Legalize use of marijuana for medical purposes, MDs and patients plead.
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    Legalize use of marijuana for medical purposes, MDs and patients plead.

    CMAJ. 1998 Feb 10;158(3):373-5

    Authors: Gray C

    As debate about the legalization of marijuana continues in Canada, physicians are joining the fray. Ottawa family physician Don Kilby is working hard to make it easier for ill patients to use the marijuana that alleviates their symptoms. A recent case in Toronto indicates that the courts are starting to share these views.

    PMID: ( marijuana and neurology ) 9484265 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Medicinal uses of marijuana.
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    Medicinal uses of marijuana.

    Ann Intern Med. 1997 Dec 15;127(12):1134-5

    Authors: Lapey JD

    PMID: ( marijuana and neurology ) 9412331 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Medicinal uses of marijuana.
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    Medicinal uses of marijuana.

    Ann Intern Med. 1997 Dec 15;127(12):1134; author reply 1135

    Authors: O'Connell TJ

    PMID: ( marijuana and neurology ) 9412330 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Medicinal uses of marijuana.
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    Medicinal uses of marijuana.

    Ann Intern Med. 1997 Dec 15;127(12):1134; author reply 1135

    Authors: Bayer R

    PMID: ( marijuana and neurology ) 9412329 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana and cocaine impair alveolar macrophage function and cytokine production.
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    Marijuana and cocaine impair alveolar macrophage function and cytokine production.

    Am J Respir Crit Care Med. 1997 Nov;156(5):1606-13

    Authors: Baldwin GC, Tashkin DP, Buckley DM, Park AN, Dubinett SM, Roth MD

    Use of marijuana and cocaine is on the rise in the United States. Although pulmonary toxicity from these drugs has occasionally been reported, little is known about their effects on the lung microenvironment. We evaluated the function of alveolar macrophages (AMs) recovered from the lungs of nonsmokers and habitual smokers of either tobacco, marijuana, or crack cocaine. AMs recovered from marijuana smokers were deficient in their ability to phagocytose Staphylococcus aureus (p < 0.01). AMs from marijuana smokers and from cocaine users were also severely limited in their ability to kill both bacteria and tumor cells (p < 0.01). Studies using NG-monomethyl-L-arginine monoacetate, an inhibitor of nitric oxide synthase, suggest that AMs from nonsmokers and tobacco smokers were able to use nitric oxide as an antibacterial effector molecule, while AMs from smokers of marijuana and cocaine were not. Finally, AMs from marijuana smokers, but not from smokers of tobacco or cocaine, produced less than normal amounts of tumor necrosis factor-alpha, granulocyte-macrophage colony-stimulating factor, and interleukin-6 when stimulated in culture with lipopolysaccharide. In contrast, the production of transforming growth factor-beta, an immunosuppressive cytokine, was similar in all groups. These findings indicate that habitual exposure of the lung to either marijuana or cocaine impairs the function and/or cytokine production of AMs. The ultimate outcome of these effects may be an enhanced susceptibility to infectious disease, cancer, and AIDS.

    PMID: ( marijuana and neurology ) 9372683 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Tracheobronchial histopathology in habitual smokers of cocaine, marijuana, and/or tobacco.
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    Tracheobronchial histopathology in habitual smokers of cocaine, marijuana, and/or tobacco.

    Chest. 1997 Aug;112(2):319-26

    Authors: Fligiel SE, Roth MD, Kleerup EC, Barsky SH, Simmons MS, Tashkin DP

    BACKGROUND: Marijuana and alkaloidal cocaine ("crack") are the two most commonly smoked substances in the United States after tobacco. While regular tobacco smoking has been found to be associated with extensive microscopic alterations in bronchial mucosa, little information is available concerning the effect of crack cocaine and marijuana on tracheobronchial histopathology. STUDY OBJECTIVE: To determine the relative impact of smoked substances (cocaine, marijuana, and tobacco) alone and in combination on the histopathology of the tracheobronchial mucosa and to assess whether the effects of habitual smoking of two or more substances (cocaine, marijuana, and/or tobacco) are additive. DESIGN: Observational cohort study. SUBJECTS: Fifty-three nonsmoking control subjects (NS), 14 current, habitual smokers of crack cocaine only (CS), 40 current, regular smokers of marijuana only (MS), 31 regular smokers of tobacco only (TS), 16 current smokers of both cocaine and marijuana (CMS), 12 current smokers of both cocaine and tobacco (CTS), 44 current smokers of both marijuana and tobacco (MTS), and 31 current smokers of cocaine, marijuana, and tobacco (CMTS). METHODS: After preliminary screening evaluation, including a detailed respiratory and general health questionnaire and routine pulmonary function studies, subjects underwent fiberoptic bronchoscopy with endobronchial biopsies of the mucosa of the primary carina and randomly selected secondary or tertiary carinae. Biopsy specimens were processed for light microscopy, stained with hematoxylin-eosin or periodic acid-Schiff, and examined to assess epithelial, basement membrane, and submucosal alterations by one or two pathologists who were masked to the smoking status of the subject. RESULTS: Smokers of cocaine, marijuana, or tobacco alone all exhibited more frequent abnormalities than NS in 10 (CS) or all 11 (MS and TS) of the histopathologic features assessed. For most features, MS and TS showed significantly more frequent alterations than NS (p < or = 0.02), while CS showed significantly more frequent abnormalities than NS in only three features (p<0.05) and nearly significant differences from NS in two additional features (p < or = 0.09). Alterations were noted most frequently in CTS (six features) and MTS (three features), while abnormalities were relatively infrequent in CMS. For 10 features, MTS had more frequent alterations than MS and TS. With a single exception, CMTS did not show more frequent alterations than CTS or MTS. CONCLUSION: Marijuana and tobacco smoking each produces significant bronchial mucosal histopathology and the effects of marijuana and tobacco appear additive. Cocaine appears to lead to fewer significant bronchial mucosal alterations than marijuana or tobacco when smoked alone and does not add to the changes associated with marijuana. When smoked together with tobacco, however, cocaine appears to augment the bronchial injury caused by tobacco smoking.

    PMID: ( marijuana and neurology ) 9266864 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Medicinal applications of delta-9-tetrahydrocannabinol and marijuana.

    Medicinal applications of delta-9-tetrahydrocannabinol and marijuana.

    Ann Intern Med. 1997 May 15;126(10):791-8

    Authors: Voth EA, Schwartz RH

    The use of crude marijuana for herbal medicinal applications is now being widely discussed in both the medical and lay literature. Ballot initiatives in California and Arizona have recently made crude marijuana accessible to patients under certain circumstances. As medicinal applications of pure forms of delta-9-tetrahydrocannabinol (THC) and crude marijuana are being considered, the most promising uses of any form of THC are to counteract the nausea associated with cancer chemotherapy and to stimulate appetite. We evaluated the relevant research published between 1975 and 1996 on the medical applications, physical complications, and legal precedents for the use of pure THC or crude marijuana. Our review focused on the medical use of THC derivatives for nausea associated with cancer chemotherapy, glaucoma, stimulation of appetite, and spinal cord spasticity. Despite the toxicity of THC delivered in any form, evidence supports the selective use of pure THC preparations to treat nausea associated with cancer chemotherapy and to stimulate appetite. The evidence does not support the reclassification of crude marijuana as a prescribable medicine.

    PMID: ( marijuana and neurology ) 9148653 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana use and mortality.
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    Marijuana use and mortality.

    Am J Public Health. 1997 Apr;87(4):585-90

    Authors: Sidney S, Beck JE, Tekawa IS, Quesenberry CP, Friedman GD

    OBJECTIVES: The purpose of this study was to examine the relationship of marijuana use to mortality. METHODS: The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991. RESULTS: Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar. CONCLUSIONS: Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women.

    PMID: ( marijuana and neurology ) 9146436 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Testing reckless drivers for cocaine and marijuana.
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    Testing reckless drivers for cocaine and marijuana.

    N Engl J Med. 1994 Aug 25;331(8):518-22

    Authors: Brookoff D, Cook CS, Williams C, Mann CS

    BACKGROUND. Driving under the influence of intoxicating drugs other than alcohol may be an important cause of traffic injuries. We used a rapid urine test to identify reckless drivers who were under the influence of cocaine or marijuana. METHODS. We conducted a consecutive-sample study in Memphis, Tennessee, in the summer of 1993. Subjects arrested for reckless driving who were not apparently impaired by alcohol (did not have an odor of alcohol, tested negative on breath analysis, or both) were tested for cocaine and marijuana at the scene of arrest. The results of the drug tests were compared with clinical evaluations of intoxication made at the scene by a police officer. RESULTS. A total of 175 subjects were stopped for reckless driving, and 150 (86 percent) submitted urine samples for drug testing at the scene of arrest. Eighty-eight of the 150 (59 percent) tested positive: 20 (13 percent) for cocaine, 50 (33 percent) for marijuana, and 18 (12 percent) for both drugs. Ninety-four of the 150 tested drivers were clinically considered to be intoxicated, and 80 of them (85 percent) tested positive for cocaine or marijuana. The intoxicated drivers had a broad range of affects and appearances. Nearly half the drivers intoxicated with cocaine performed normally on standard sobriety tests. CONCLUSIONS. Over half of the reckless drivers who were not intoxicated with alcohol were found to be intoxicated with other drugs. Toxicologic testing at the scene is a practical means of identifying drivers under the influence of drugs and is a useful adjunct to standard behavioral sobriety testing.

    PMID: ( marijuana and neurology ) 8041419 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Detecting children's passive exposure to cocaine and marijuana.
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    Detecting children's passive exposure to cocaine and marijuana.

    Am J Public Health. 1994 Apr;84(4):675-6

    Authors: Bhushan V, Ng S, Spiller D, Gang H, Inamdar S

    PMID: ( marijuana and neurology ) 8154580 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Lymphocytic subpopulation profiles in bronchoalveolar lavage fluid and peripheral blood from tobacco and marijuana smokers.
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    Lymphocytic subpopulation profiles in bronchoalveolar lavage fluid and peripheral blood from tobacco and marijuana smokers.

    Chest. 1994 Mar;105(3):847-52

    Authors: Wallace JM, Oishi JS, Barbers RG, Simmons MS, Tashkin DP

    The effect of heavy, habitual marijuana use compared with tobacco smoking on the composition of bronchoalveolar and peripheral blood lymphocytic phenotypes was examined. Bronchoalveolar lavage (BAL) and peripheral blood (PB) samples were taken from 14 nonsmokers (NS), 14 tobacco smokers (TS), 19 heavy, habitual marijuana smokers (MS), and 9 marijuana and tobacco smokers (MTS). In BAL fluid, marijuana use was associated with significantly higher alveolar macrophage concentrations, whereas tobacco smoking was associated with significantly higher alveolar macrophage, as well as higher bronchoalveolar lymphocyte and neutrophil concentrations. The bronchoalveolar T-lymphocytic phenotypic profiles of marijuana users differed from those of tobacco smokers. Tobacco, not marijuana, was found to have a significant effect toward lower percentages of bronchoalveolar CD4 cells, toward higher concentrations of bronchoalveolar CD8 cells, and toward lower bronchoalveolar CD4:CD8 ratios. Marijuana use had a significant effect toward lower percentages of bronchoalveolar CD8 cells. In peripheral blood, marijuana, but not tobacco, use was associated with significantly higher percentages of CD4 cells, lower percentages of CD8 cells, and higher CD4:CD8 ratios. These findings suggest that tobacco and marijuana have effects on bronchoalveolar and peripheral blood immunoregulatory T-lymphocytic subpopulations that differ in type or magnitude.

    PMID: ( marijuana and neurology ) 7907538 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Holiday gynecomastia related to marijuana?
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    Holiday gynecomastia related to marijuana?

    Ann Intern Med. 1993 Aug 1;119(3):253

    Authors: Dardick KR

    PMID: ( marijuana and neurology ) 8323105 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Is frequent marijuana smoking harmful to health?
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    Is frequent marijuana smoking harmful to health?

    West J Med. 1993 Jun;158(6):635-7

    Authors: Tashkin DP

    PMID: ( marijuana and neurology ) 8337871 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Health care use by frequent marijuana smokers who do not smoke tobacco.

    Health care use by frequent marijuana smokers who do not smoke tobacco.

    West J Med. 1993 Jun;158(6):596-601

    Authors: Polen MR, Sidney S, Tekawa IS, Sadler M, Friedman GD

    Even though marijuana smoke contains carcinogens and more tar than tobacco smoke and marijuana intoxication has been implicated as a risk factor for injuries, relatively little epidemiologic evidence has identified marijuana use as a risk factor for ill health. This study is the first to examine the health effects of smoking marijuana by comparing the medical experience of "daily" marijuana smokers who never smoked tobacco (n = 452) with a demographically similar group of nonsmokers of either substance (n = 450). Marijuana smoking status was determined during multiphasic health checkups at Kaiser Permanente medical centers between July 1979 and December 1985. Medical records were reviewed for as long as 2 years after the checkups. Frequent marijuana smokers had small increased risks of outpatient visits for respiratory illnesses (relative risk [RR] = 1.19; 95% confidence interval [CI] = 1.01, 1.41), injuries (RR = 1.32; CI = 1.10, 1.57), and other types of illnesses (RR = 1.09; CI = 1.02, 1.16) compared with nonsmokers; their risk of being admitted to a hospital was elevated but not statistically significant (RR = 1.51; CI = 0.93, 2.46). Analyses were adjusted for sex, age, race, education, marital status, and alcohol consumption. Daily marijuana smoking, even in the absence of tobacco, appeared to be associated with an elevated risk of health care use for various health problems.

    PMID: ( marijuana and neurology ) 8337854 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Alcohol, cigarette, and marijuana use among fourth-grade urban schoolchildren in 1988/89 and 1990/91.
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    Alcohol, cigarette, and marijuana use among fourth-grade urban schoolchildren in 1988/89 and 1990/91.

    Am J Public Health. 1993 Jan;83(1):111-4

    Authors: Bush PJ, Iannotti RJ

    A public-school-based epidemiological survey of fourth-grade students in Washington, DC, was performed in 1988/89 (n = 4675) and 1990/91 (n = 4678). Comparisons of data for the two periods revealed that the lifetime prevalence of self-reported alcohol use, alcohol use without parental knowledge, and smoking more than a puff of cigarettes declined; marijuana use and cigarette experimentation did not. Seven variables were associated with use. Declines were observed in perceived peer pressure to use; seeing a family member/friend selling drugs; and being offered alcohol, cigarettes, or marijuana by peers. No declines were observed in family use, perceived friends' use, being bothered a lot if best friends use, or seeing someone else selling drugs.

    PMID: ( marijuana and neurology ) 8417594 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Acculturation and marijuana and cocaine use: findings from HHANES 1982-84.
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    Acculturation and marijuana and cocaine use: findings from HHANES 1982-84.

    Am J Public Health. 1990 Dec;80 Suppl:54-60

    Authors: Amaro H, Whitaker R, Coffman G, Heeren T

    We examined the relation between acculturation and illicit drug use among Hispanics in the United States employing data from the 1982-84 Hispanic Health and Nutrition Evaluation Survey (HHANES). Across all Hispanic groups, acculturation into US society, as reflected in English language use, was associated with higher rates of illicit drug use even after sociodemographic variables such as gender, age, income, and education were considered. Significant interactions between language and education indicated that the predominant use of English was more strongly associated with marijuana and cocaine use among Mexican Americans and Puerto Ricans of lower educational attainment than among those of higher educational attainment. Significant interactions between language use and other factors such as sex, marital status, and place of birth were also associated with marijuana and cocaine use. These results suggest that the experience of acculturation, especially as it relates to drug use, is closely tied to the social and economic context in which an individual lives.

    PMID: ( marijuana and neurology ) 9187583 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Physicians' attitudes toward the legalization of marijuana use.
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    Physicians' attitudes toward the legalization of marijuana use.

    West J Med. 1989 Jun;150(6):714-7

    Authors: Linn LS, Yager J, Leake B

    We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.

    PMID: ( marijuana and neurology ) 2750164 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Fatal aspergillosis associated with smoking contaminated marijuana, in a marrow transplant recipient.
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    Fatal aspergillosis associated with smoking contaminated marijuana, in a marrow transplant recipient.

    Chest. 1988 Aug;94(2):432-3

    Authors: Hamadeh R, Ardehali A, Locksley RM, York MK

    A 34-year-old man presented with pulmonary aspergillosis on the 75th day after marrow transplant for chronic myelogenous leukemia. The patient had smoked marijuana heavily for several weeks prior to admission. Cultures of the marijuana revealed Aspergillus fumigatus with morphology and growth characteristics identical to the organism grown from open lung biopsy specimen. Despite aggressive antifungal therapy, the patient died with disseminated disease. Physicians should be aware of this potentially lethal complication of marijuana use in compromised hosts.

    PMID: ( marijuana and neurology ) 3293934 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Respiratory effects of cocaine "freebasing" among habitual users of marijuana with or without tobacco.
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    Respiratory effects of cocaine "freebasing" among habitual users of marijuana with or without tobacco.

    Chest. 1987 Oct;92(4):638-44

    Authors: Tashkin DP, Simmons MS, Coulson AH, Clark VA, Gong H

    Use of cocaine by smoking its alkaline precursor ("freebasing") has become increasingly prevalent. Recent studies of small numbers of cocaine users suggest that freebasing frequently causes cough, dyspnea, and abnormalities in diffusing capacity (DCO), although these findings could have been due to concomitant use of other drugs. We therefore evaluated the relationship between cocaine use by freebasing and chronic respiratory symptoms and lung dysfunction in a large sample of habitual smokers of marijuana with or without tobacco who denied intravenous drug abuse. The findings suggested that, among habitual marijuana smokers, "moderate" cocaine smoking damaged both large and small airways, as reflected by functional changes that were independent of concomitant marijuana use and appeared to be synergistic with the effects of tobacco. On the other hand, no adverse influence of cocaine smoking on the pulmonary microcirculation was demonstrated in our sample of freebase users.

    PMID: ( marijuana and neurology ) 3652749 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Maternal marijuana use and neonatal outcome: uncertainty posed by self-reports.
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    Maternal marijuana use and neonatal outcome: uncertainty posed by self-reports.

    Am J Public Health. 1986 Jun;76(6):667-9

    Authors: Hingson R, Zuckerman B, Amaro H, Frank DA, Kayne H, Sorenson JR, Mitchell J, Parker S, Morelock S, Timperi R

    To assess the validity of self-reported marijuana use during pregnancy, this study randomly allocated pregnant women into a group who were told their urine would be tested for marijuana, alcohol, and other drugs and another group not so tested. Women told they would be tested reported more marijuana use during pregnancy than did untested women. Moreover, urine assays identified more women who used marijuana during pregnancy than were willing to admit it in the interview even after being told their urine would be tested. No differences in reported drinking or cigarette smoking during pregnancy were found between tested and untested women.

    PMID: ( marijuana and neurology ) 3518499 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • The association of marijuana use with outcome of pregnancy.
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    The association of marijuana use with outcome of pregnancy.

    Am J Public Health. 1983 Oct;73(10):1161-4

    Authors: Linn S, Schoenbaum SC, Monson RR, Rosner R, Stubblefield PC, Ryan KJ

    We analyzed interview and medical record data of 12,424 women to evaluate the relationship between marijuana usage and adverse outcomes of pregnancy. Low birthweight, short gestation, and major malformations occurred more often among offspring of marijuana users. When we used logistic regression to control for demographic characteristics, habits, and medical history data, these relationships were not statistically significant. The odds ratio for the occurrence of major malformations among marijuana users was 1.36, higher than odds ratios for other exogenous variables, and the 95 per cent confidence interval was 0.97-1.91. More data are needed to establish firmly or rule out an association between marijuana usage and major malformations. Until more information is available, women should be advised not to use marijuana during pregnancy.

    PMID: ( marijuana and neurology ) 6604464 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Paraquat and marijuana: epidemiologic risk assessment.
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    Paraquat and marijuana: epidemiologic risk assessment.

    Am J Public Health. 1983 Jul;73(7):784-8

    Authors: Landrigan PJ, Powell KE, James LM, Taylor PR

    In March 1978, 13 (21 per cent) of 61 marijuana samples from the southwestern United States were found to be contaminated with the herbicide paraquat, a pulmonary toxin, in concentrations from 3 to 2,264 parts per million. The source of the contamination was an aerial spraying program in Mexico, supported indirectly by United States funds. To evaluate US exposure, a nationwide survey of the paraquat content of confiscated marijuana was conducted. The survey found 33 (3.6 per cent) of 910 marijuana specimens to contain detectable paraquat. In states adjacent to Mexico (Census Region VI), 23 (12.8 per cent) of 180 specimens were contaminated. Combustion testing indicated that approximately 0.2 per cent of paraquat on marijuana passes into smoke. From these data, we projected that 100-200 marijuana smokers in Census Region VI would be exposed by inhalation to 500 micrograms or more of paraquat per year, a dose judged to represent a health hazard; nationally, between 150 and 300 smokers were projected to have such exposure. Another 6,000 persons in Region VI and 9,000 nationally were projected to be at risk of exposure to between 100 and 499 micrograms of paraquat annually. The risk of paraquat exposure was greatest among those smokers who make one large purchase of marijuana per year. No clinical cases of paraquat poisoning were recognized among marijuana smokers during these studies, but no systematic national search for such cases was undertaken.

    PMID: ( marijuana and neurology ) 6859364 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Respiratory status of seventy-four habitual marijuana smokers.
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    Respiratory status of seventy-four habitual marijuana smokers.

    Chest. 1980 Nov;78(5):699-706

    Authors: Tashkin DP, Calvarese BM, Simmons MS, Shapiro BJ

    Previous studies of the long-term effects of habitual marijuana smoking on respiratory status and lung function have yielded conflicting results. In the present study, lung function tests obtained in 74 regular marijuana smokers (duration of smoking > two-five years; frequency of smoking three days/week to several times/day) who denied intravenous narcotic drug abuse were compared with similar tests performed in two groups of control subjects. One group consisted of individuals tested in a mobile laboratory who were computer-matched to the marijuana smokers for anthropometric characteristics and quantity and duration of tobacco smoking; the other group was comprised of 41 nonsmokers of marijuana who were tested in the same laboratory as the marijuana smokers. Paired and unpaired t analyses revealed lower values for specific airway conductance (-0.07 to -0.08 +/- 0.02; P < 0.001) in the marijuana smokers compared with either group of control subjects, but no differences in spirometric indices, closing volume or delta N2 750-1250. When non-tobacco smoking marijuana users (n = 50) were matched with either non-tobacco smoking or tobacco smoking control subjects, significant differences were again noted in specific airway conductance (P < 0.001) but not in spirometric tests, closing volume or delta N2 750-1250. These results suggest that habitual smoking of marijuana may cause mild, but significant, functional impairment predominantly involving large airways which is not detectable in individuals of the same age who regularly smoke tobacco. The clinical implications of these findings await further study.

    PMID: ( marijuana and neurology ) 7428453 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana warnings: new evidence against the "soft" drug.
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    Marijuana warnings: new evidence against the "soft" drug.

    Can Med Assoc J. 1980 Sep 20;123(6):575-80

    Authors: Korcok M

    PMID: ( marijuana and neurology ) 7437976 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Psychosocial correlates of marijuana use and problem drinking in a national sample of adolescents.
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    Psychosocial correlates of marijuana use and problem drinking in a national sample of adolescents.

    Am J Public Health. 1980 Jun;70(6):604-13

    Authors: Jessor R, Chase JA, Donovan JE

    Personality, environmental, and behavioral variables representing psychosocial risk factors for adolescent problem behavior were assessed in a 1974 national sample study of over 10,000 junior and senior high school students. Significant correlations were found with marijuana use, and the relationships held across differences in age, sex, and ethnic group membership. Greater involvement in marijuana use was associated with greater value on independence than on academic achievement, lower expectations for academic achievement, lesser religiosity, greater tolerance of deviance, less compatibility between friends and parents, greater influence of friends relative to parents, greater models and support for problem behavior, greater actual involvement in other problem behaviors such as drunkenness, and less involvement in conventional behavior such as attending church. Multiple regression analyses show that this pattern of psychosocial correlates accounts for over 50 per cent of the variation in marijuana use. The pattern is nearly identical to the pattern that accounts for problem drinking in these same adolescents. The similarity of the patterns of psychosocial risk, and the substantial correlations of marijuana use with problem drinking and with other problem behaviors, suggest that marijuana use is best seen as part of a syndrome of adolescent problem behavior. (Am J Public Health 70:604- 613,1980.)

    PMID: ( marijuana and neurology ) 7377436 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Patterns of marijuana use among public health students.
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    Patterns of marijuana use among public health students.

    Am J Public Health. 1975 Jun;65(6):613-21

    Authors: Seiden RH, Tomlinson KR, O'Carroll M

    PMID: ( marijuana and neurology ) 1130582 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Marijuana research.
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    Marijuana research.

    Can Med Assoc J. 1973 Apr 7;108(7):824 passim

    Authors:

    PMID: ( marijuana and neurology ) 4707227 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • The neurophysiological basis of the marijuana experience.
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    The neurophysiological basis of the marijuana experience.

    Can Med Assoc J. 1973 Jan 20;108(2):157-65

    Authors: Low MD, Klonoff H, Marcus A

    PMID: ( marijuana and neurology ) 4684623 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Research into marijuana.
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    Research into marijuana.

    Can Med Assoc J. 1973 Jan 20;108(2):127 passim

    Authors: Boothroyd WE

    PMID: ( marijuana and neurology ) 4684619 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Strategy and tactics of marijuana research.
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    Strategy and tactics of marijuana research.

    Can Med Assoc J. 1973 Jan 20;108(2):145-9 passim

    Authors: Klonoff H

    PMID: ( marijuana and neurology ) 4567765 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Neuropsychological effects of marijuana.
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    Neuropsychological effects of marijuana.

    Can Med Assoc J. 1973 Jan 20;108(2):150-6 passim

    Authors: Klonoff H, Low M, Marcus A

    PMID: ( marijuana and neurology ) 4405419 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • An ecosystems approach to the study of dangerous drug use and abuse with special reference to the marijuana issue.
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    An ecosystems approach to the study of dangerous drug use and abuse with special reference to the marijuana issue.

    Am J Public Health. 1972 Oct;62(10):1407-14

    Authors: Fisher G, Strantz I

    PMID: ( marijuana and neurology ) 5076155 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Confirmation of the presence of 11-hydroxy- 9-tetrahydrocannabinol in the urine of marijuana smokers.
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    Confirmation of the presence of 11-hydroxy- 9-tetrahydrocannabinol in the urine of marijuana smokers.

    Am J Public Health. 1972 Oct;62(10):1394-6

    Authors: Woodhouse EJ

    PMID: ( marijuana and neurology ) 5076153 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

  • Decriminalization, demythologizing, desymbolizing and deemphasizing marijuana.
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    Decriminalization, demythologizing, desymbolizing and deemphasizing marijuana.

    Am J Public Health. 1972 Aug;62(8):1151-2

    Authors: Curran WJ

    PMID: ( marijuana and neurology ) 4114706 [PubMed - indexed for MEDLINE ( marijuana and neurology )]

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