Abstract
With the advent of legalization of marijuana for medicinal and recreational purposes, and the increase use of marijuana, healthcare providers will be increasingly confronted with marijuana users as patients in clinical environments. While there is vast literature regarding the societal and mental health harms associated with marijuana use, there is a paucity of reviews of the potential consequences of marijuana use on physical health or medical conditions. We examine the recent literature on the physical harms associated with illicit and legal marijuana administration. We surveyed the peer-reviewed medical literature from 1998 to 2013 of studies assessing the association of marijuana use and physical diseases. We conclude that healthcare providers should be cognizant that the existing literature suggests that marijuana use can cause physical harm. However, evidence is needed, and further research should be considered, to prove causal associations of marijuana with many physical health conditions.
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Wall MM, Poh E, Cerda M, et al. Adolescent marijuana use from 2002 to 2008: higher in states with medical marijuana laws, cause still unclear. Ann Epidemiol. 2011;21:714–6.
Drug Enforcement Administration. Drug Scheduling. Available at http://www.justice.gov/dea/druginfo/ds.shtml. Accessed September 2013.
Eidelman WS. Should physicians support the medical use of marijuana? Yes: it can be effective when all else fails. Point West J Med. 2002;176:76.
Grinspoon L, Bakalar JB. Marihuana. The forbidden medicine. New Haven: Yale University Press; 1995.
Kassirer JP. Federal foolishness and marijuana. N Engl J Med. 1997;336:366–7.
Annas GJ. Reefer madness—the federal response to California’s medical-marijuana law. N Engl J Med. 1997;337:435–9.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.
United Nations Office on Drugs and Crime. World drug report 2012. New York: United Nations; 2012.
Pew Research Center. Majority now supports legalizing marijuana. Washington, DC: People Press; 2013.
Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the future national survey results on drug use: 2012 overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan; 2013.
Centers for Disease Control and Prevention (CDC). Youth risk behavior surveillance—United States, 2011. MMWR Morb Mortal Wkly Rep; 2012
American Society of Addiction Medicine. White Paper on state-level proposals to legalize marijuana. Available at http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2012/07/30/state-level-proposals-to-legalize-marijuana. Accessed September 2013.
Budney AJ, Moore BA. Development and consequences of cannabis dependence. J Clin Pharmacol. 2002;42(11 Suppl):28S–33S.
Gordon AJ, Gordon JM, Carl K, et al. Physical illness and drugs of abuse: a review of the evidence. Cambridge: Cambridge University Press; 2010.
Graham AW, Schultz TK, editors. Principles of addiction medicine. 2nd ed. Chevy Chase: American Society of Addiction Medicine; 1998.
Frances RJ, Miller SI, Mack AH, editors. Clinical textbook of addictive disorders. 3rd ed. New York: The Guilford Press; 2005.
Brick J, editor. Handbook of the medical consequences of alcohol and drug abuse. Binghamton: The Haworth Press; 2004.
Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009;374:1383–91.
Lee MJ. Marihuana and tobacco use in pregnancy. Obstet Gynecol Clin North Am. 1998;25:65–83.
Kuczkowski KM. Marijuana in pregnancy. Ann Acad Med Singapore. 2004;33:336–9.
Sundram S. Cannabis and neurodevelopment: implications for psychiatric disorders. Hum Psychopharmacol. 2006;21:245–54.
Behnke M, Eyler FD. The consequences of prenatal substance use for the developing fetus, newborn, and young child. Int J Addict. 1993;28:1341–91.
Schempf AH. Illicit drug use and neonatal outcomes: a critical review. Obstet Gynecol Surv. 2007;62:749–57.
Day NL, Richardson GA. Prenatal marijuana use: epidemiology, methodologic issues, and infant outcome. Clin Perinatol. 1991;18:77–91.
Hall W, Degenhardt L. Cannabis use and psychosis: a review of clinical and epidemiological evidence. Aust N Z J Psychiatry. 2000;34:26–34.
Friedman H, Pross S, Klein TW. Addictive drugs and their relationship with infectious diseases. FEMS Immunol Med Microbiol. 2006;47:330–42.
Klein TW, Friedman H, Specter S. Marijuana, immunity and infection. J Neuroimmunol. 1998;83:102–15.
Munckhof WJ, Konstantinos A, Wamsley M, et al. A cluster of tuberculosis associated with use of a marijuana water pipe. Int J Tuberc Lung Dis. 2003;7:860–5.
Oeltmann JE, Oren E, Haddad MB, et al. Tuberculosis outbreak in marijuana users, Seattle, Washington, 2004. Emerg Infect Dis. 2006;12:1156.
Krause G, Blackmore C, Wiersma S, et al. Marijuana use and social networks in a community outbreak of meningococcal disease. South Med J. 2001;94:482–5.
Finn R, Groves C, Coe M, et al. Cluster of serogroup C meningococcal disease associated with attendance at a party. South Med J. 2001;94:1192–4.
Liau A, di Clemente RJ, Wingood GM. Associations between biologically confirmed marijuana use and laboratory-confirmed sexually transmitted diseases among African American adolescent females. Sex Transm Dis. 2002;29:387–90.
Darling MR, Arendorf TM, Coldrey NA. Effect of cannabis use on oral candidal carriage. J Oral Pathol Med. 1990;19:319–21.
Darling MR, Arendorf TM. Review of the effects of cannabis smoking on oral health. Int Dent J. 1992;42:19–22.
Hezode C, Zafrani ES, Roudot-Thoraval F, et al. Daily cannabis use: a novel risk factor of steatosis severity in patients with chronic hepatitis C. Gastroenterology. 2008;134:432–9.
Ishida JH, Peters MG, Jin C, et al. Influence of cannabis use on severity of hepatitis C disease. Clin Gastroenterol Hepatol. 2008;6:69–75.
Hashibe M, Ford DE, Zhang ZF. Marijuana smoking and head and neck cancer. J Clin Pharmacol. 2002;42(11 Suppl):103S–7S.
Hashibe M, Straif K, Tashkin DP, et al. Epidemiologic review of marijuana use and cancer risk. Alcohol. 2005;35:265–75.
Mehra R, Moore BA, Crothers K, et al. The association between marijuana smoking and lung cancer: a systematic review. Arch Intern Med. 2006;166:1359–67.
Carriot F, Sasco AJ. Cannabis and cancer. Rev Epidemiol Sante Publique. 2000;48:473–83.
Zhang ZF, Morgenstern H, Spitz MR, et al. Marijuana use and increased risk of squamous cell carcinoma of the head and neck. Cancer Epidemiol Biomarkers Prev. 1999;8:1071–8.
Rosenblatt KA, Daling JR, Chen C, et al. Marijuana use and risk of oral squamous cell carcinoma. Cancer Res. 2004;64:4049–54.
Nieder AM, Lipke MC, Madjar S. Transitional cell carcinoma associated with marijuana: case report and review of the literature. Urology. 2006;67:200.
Chacko JA, Heiner JG, Siu W, et al. Association between marijuana use and transitional cell carcinoma. Urology. 2006;67:100–4.
Daling JR, Doody DR, Sun X, et al. Association of marijuana use and the incidence of testicular germ cell tumors. Cancer. 2009;115:1215–23.
Trabert B, Sigurdson AJ, Sweeney AM, et al. Marijuana use and testicular germ cell tumors. Cancer. 2011;117:848–53.
Lacson JC, Carroll JD, Tuazon E, et al. Population-based case–control study of recreational drug use and testis cancer risk confirms an association between marijuana use and nonseminoma risk. Cancer. 2012;118:5374–83.
Berthiller J, Lee YC, Boffetta P, et al. Marijuana smoking and the risk of head and neck cancer: pooled analysis in the INHANCE consortium. Cancer Epidemiol Biomarkers Prev. 2009;18:1544–51.
Aldington S, Harwood M, Cox B, et al. Cannabis use and cancer of the head and neck: case–control study. Otolaryngol Head Neck Surg. 2008;138:374–80.
Hashibe M, Morgenstern H, Cui Y, et al. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case–control study. Cancer Epidemiol Biomarkers Prev. 2006;15:1829–34.
Voirin N, Berthiller J, Benhaim-Luzon V, et al. Risk of lung cancer and past use of cannabis in Tunisia. J Thorac Oncol. 2006;1:577–9.
Aldington S, Harwood M, Cox B, et al. Cannabis use and risk of lung cancer: a case–control study. Eur Respir J. 2008;31:280–6.
Taylor III FM. Marijuana as a potential respiratory tract carcinogen: a retrospective analysis of a community hospital population. South Med J. 1988;81:1213–6.
Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Aust Dent J. 2005;50:70–4.
Darling MR, Arendorf TM. Effects of cannabis smoking on oral soft tissues. Community Dent Oral Epidemiol. 1993;21:78–81.
Thomson WM, Poulton R, Broadbent JM, et al. Cannabis smoking and periodontal disease among young adults. JAMA. 2008;299:525–31.
Lee MH, Hancox RJ. Effects of smoking cannabis on lung function. Expert Rev Respir Med. 2011;5:537–46. Expert review of marijuana-induced respiratory inflammation and dysfunction..
Hancox RJ, Poulton R, Ely M, et al. Effects of cannabis on lung function: a population-based cohort study. Eur Respir J. 2010;35:42–7. Large longitudinal styudy of marijuana users over 29-year period..
Pletcher MJ, Vittinghoff E, Kalhan R, et al. Association between marijuana exposure and pulmonary function over 20 years. JAMA. 2012;307:173–81. Twenty-year longitudinal study; more harm may be associated with heavy, long-term use than occasional marijuana use..
Tashkin DP. Smoked marijuana as a cause of lung injury. Monaldi Arch Chest Dis. 2005;63:93–100.
Tashkin DP. Airway effects of marijuana, cocaine, and other inhaled illicit agents. Curr Opin Pulm Med. 2001;7:43–61.
Tashkin DP. Pulmonary complications of smoked substance abuse. West J Med. 1990;152:525–30.
Tetrault JM, Crothers K, Moore BA, et al. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med. 2007;167:221–8.
Polen MR, Sidney S, Tekawa IS, et al. Health care use by frequent marijuana smokers who do not smoke tobacco. West J Med. 1993;158:596–601.
Taylor DR, Poulton R, Moffitt TE, et al. The respiratory effects of cannabis dependence in young adults. Addiction. 2000;95:1669–77.
Taylor DR, Fergusson DM, Milne BJ, et al. A longitudinal study of the effects of tobacco and cannabis exposure on lung function in young adults. Addiction. 2002;97:1055–61.
Moore BA, Augustson EM, Moser RP, et al. Respiratory effects of marijuana and tobacco use in a U.S. sample. J Gen Intern Med. 2005;20:33–7.
Stokes JR, Hartel R, Ford LB, et al. Cannabis (hemp) positive skin tests and respiratory symptoms. Ann Allergy Asthma Immunol. 2000;85:238–40.
Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol. 2002;42(11 Suppl):64S–70S.
Aryana A, Williams MA. Marijuana as a trigger of cardiovascular events: speculation or scientific certainty? Int J Cardiol. 2007;118:141–4.
Malinowska B, Baranowska-Kuczko M, Schlicker E. Triphasic blood pressure responses to cannabinoids: do we understand the mechanism? Br J Pharmacol. 2012;165:2073–88. Review of physiological cardiovascular effects related to cannabinoids..
Mittleman MA, Lewis RA, Maclure M, et al. Triggering myocardial infarction by marijuana. Circulation. 2001;103:2805–9.
Frost L, Mostofsky E, Rosenbloom JI, et al. Marijuana use and long-term mortality among survivors of acute myocardial infarction. Am Heart J. 2013;165:170–5. Eighteen-year follow-up of cardiovascular mortality in marijuana users..
Rodondi N, Pletcher MJ, Liu K, et al. Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study). Am J Cardiol. 2006;98:478–84.
Mukamal KJ, Maclure M, Muller JE, et al. An exploratory prospective study of marijuana use and mortality following acute myocardial infarction. Am Heart J. 2008;155:465–70.
Peyrot I, Garsaud AM, Saint-Cyr I, et al. Cannabis arteritis: a new case report and a review of literature. J Eur Acad Dermatol Venereol. 2007;21:388–91.
Disdier P, Granel B, Serratrice J, et al. Cannabis arteritis revisited—ten new case reports. Angiology. 2001;52:1–5.
Block RI, O'Leary DS, Ehrhardt JC, et al. Effects of frequent marijuana use on brain tissue volume and composition. Neuroreport. 2000;11:491–6.
Matochik JA, Eldreth DA, Cadet JL, et al. Altered brain tissue composition in heavy marijuana users. Drug Alcohol Depend. 2005;77:23–30.
Medina KL, Schweinsburg AD, Cohen-Zion M, et al. Effects of alcohol and combined marijuana and alcohol use during adolescence on hippocampal volume and asymmetry. Neurotoxicol Teratol. 2007;29:141–52.
Jager G, van Hell HH, De Win MM, et al. Effects of frequent cannabis use on hippocampal activity during an associative memory task. Eur Neuropsychopharmacol. 2007;17:289–97.
Jacobsen LK, Mencl WE, Westerveld M, et al. Impact of cannabis use on brain function in adolescents. Ann N Y Acad Sci. 2004;1021:384–90.
Pillay SS, Rogowska J, Kanayama G, et al. Cannabis and motor function: fMRI changes following 28 days of discontinuation. Exp Clin Psychopharmacol. 2008;16:22–32.
Chang L, Yakupov R, Cloak C, et al. Marijuana use is associated with a reorganized visual-attention network and cerebellar hypoactivation. Brain. 2006;129:1096–112.
Kanayama G, Rogowska J, Pope HG, et al. Spatial working memory in heavy cannabis users: a functional magnetic resonance imaging study. Psychopharmacology (Berl). 2004;176:239–47.
Tapert SF, Schweinsburg AD, Drummond SP, et al. Functional MRI of inhibitory processing in abstinent adolescent marijuana users. Psychopharmacology (Berl). 2007;194:173–83.
Gonzalez R. Acute and non-acute effects of cannabis on brain functioning and neuropsychological performance. Neuropsychol Rev. 2007;17:347–61.
Pope Jr HG, Gruber AJ, Yurgelun-Todd D. The residual neuropsychological effects of cannabis: the current status of research. Drug Alcohol Depend. 1995;38:25–34.
Grant I, Gonzalez R, Carey CL, et al. Non-acute (residual) neurocognitive effects of cannabis use: a meta-analytic study. J Int Neuropsychol Soc. 2003;9:679–89.
Zachariah SB. Stroke after heavy marijuana smoking. Stroke. 1991;22:406–9.
Geller T, Loftis L, Brink DS. Cerebellar infarction in adolescent males associated with acute marijuana use. Pediatrics. 2004;113:e365–70.
Finsterer J, Christian P, Wolfgang K. Occipital stroke shortly after cannabis consumption. Clin Neurol Neurosurg. 2004;106:305–8.
Herning RI, Better WE, Tate K, et al. Marijuana abusers are at increased risk for stroke. Preliminary evidence from cerebrovascular perfusion data. Ann N Y Acad Sci. 2001;939:413–5.
Moussouttas M. Cannabis use and cerebrovascular disease. Neurologist. 2004;10:47–53.
Zaretsky A, Rector NA, Seeman MV, et al. Current cannabis use and tardive dyskinesia. Schizophr Res. 1993;11:3–8.
Stracciari A, Guarino M, Crespi C, et al. Transient amnesia triggered by acute marijuana intoxication. Eur J Neurol. 1999;6:521–3.
Bonkowsky JL, Sarco D, Pomeroy SL. Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure. Pediatr Emerg Care. 2005;21:527–8.
Lozsadi DA, Forster A, Fletcher NA. Cannabis-induced propriospinal myoclonus. Mov Disord. 2004;19:708–9.
Malec J, Harvey RF, Cayner JJ. Cannabis effect on spasticity in spinal cord injury. Arch Phys Med Rehabil. 1982;63:116–8.
Schwartz LS, Taylor JR. Attitudes of mental health professionals toward alcoholism recognition and treatment. Am J Drug Alcohol Abuse. 1989;15:321–37.
Wilson WH, Ellinwood EH, Mathew RJ, et al. Effects of marijuana on performance of a computerized cognitive-neuromotor test battery. Psychiatry Res. 1994;51:115–25.
Rizzo M, Lamers CT, Sauer CG, et al. Impaired perception of self-motion (heading) in abstinent ecstasy and marijuana users. Psychopharmacology (Berl). 2005;179:559–66.
Messinis L, Kyprianidou A, Malefaki S, et al. Neuropsychological deficits in long-term frequent cannabis users. Neurology. 2006;66:737–9.
Ramaekers JG, Kauert G, van Ruitenbeek P, et al. High-potency marijuana impairs executive function and inhibitory motor control. Neuropsychopharmacology. 2006;31:2296–303.
Urey JC. Some ocular manifestations of systemic drug abuse. J Am Optom Assoc. 1991;62:832–42.
Levi L, Miller NR. Visual illusions associated with previous drug abuse. J Clin Neuroophthalmol. 1990;10:103–10.
Parikh RS, Parikh SR. Alternative therapy in glaucoma management: is there any role? Indian J Ophthalmol. 2011;59:S158–60.
NEI. NEI statement: glaucoma and marijuana use. Available at nei.nih.gov/news/statements/marij.asp. Accessed June 2013.
Crowe AV, Howse M, Bell GM, et al. Substance abuse and the kidney. QJM. 2000;93:147–52.
Vupputuri S, Batuman V, Muntner P, et al. The risk for mild kidney function decline associated with illicit drug use among hypertensive men. Am J Kidney Dis. 2004;43:629–35.
Thompson ST. Preventable causes of male infertility. World J Urol. 1993;11:111–9.
Ramos JA, Bianco FJ. The role of cannabinoids in prostate cancer: basic science perspective and potential clinical applications. Indian J Urol. 2012;28:9–14.
Close CE, Roberts PL, Berger RE. Cigarettes, alcohol and marijuana are related to pyospermia in infertile men. J Urol. 1990;144:900–3.
Johnson SD, Phelps DL, Cottler LB. The association of sexual dysfunction and substance use among a community epidemiological sample. Arch Sex Behav. 2004;33:55–63.
Simonetto DA, Oxentenko AS, Herman ML, et al. Cannabinoid hyperemesis: a case series of 98 patients. Mayo Clin Proc. 2012;87:114–9. Report of emerging under-reported consequence of marijuana use..
Buck GM, Sever LE, Batt RE, et al. Life-style factors and female infertility. Epidemiology. 1997;8:435–41.
Mueller BA, Daling JR, Weiss NS, et al. Recreational drug use and the risk of primary infertility. Epidemiology. 1990;1:195–200.
Crosby R, di Clemente RJ, Wingood GM, et al. Predictors of infection with Trichomonas vaginalis: a prospective study of low income African-American adolescent females. Sex Transm Infect. 2002;78:360–4.
Beigi RH, Meyn LA, Moore DM, et al. Vaginal yeast colonization in nonpregnant women: a longitudinal study. Obstet Gynecol. 2004;104:926–30.
Galiègue S, Mary S, Marchand J, et al. Expression of central and peripheral cannabinoid receptors in human immune tissues and leukocyte subpopulations. Eur J Biochem. 1995;232:54–61.
Ziring D, Wei B, Velazquez P, et al. Formation of B and T cell subsets require the cannabinoid receptor CB2. Immunogenetics. 2006;58:714–25.
Holly EA, Lele C, Bracci PM, et al. Case–control study of non-Hodgkin's lymphoma among women and heterosexual men in the San Francisco Bay Area, California. Am J Epidemiol. 1999;150:375–89.
Mohs ME, Watson RR, Leonard-Green T. Nutritional effects of marijuana, heroin, cocaine, and nicotine. J Am Diet Assoc. 1990;90:1261–7.
Matias I, Di MV. Endocannabinoids and the control of energy balance. Trends Endocrinol Metab. 2007;18:27–37.
Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–45.
Bostwick JM. Blurred boundaries: the therapeutics and politics of medical marijuana. Mayo Clin Proc. 2012;87:172–86.
Harris, G. Researchers find study of medical marijuana discouraged. New York Times. 1-19-2010. Accessed on July 7 2013.
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This material is the result of work supported with resources from, and the use of facilities at, the VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. The content of this work does not necessarily represent the views, opinions, or policies of the Department of Veterans Affairs or the United States government.
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Adam J. Gordon has received research support from National Institutes of Health, Department of Veterans Affairs, and Substance Abuse and Mental Health Services Administration and royalties from Cambridge University Press and UpToDate.
James W. Conley and Joanne M. Gordon declare that they have no conflict of interest.
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Gordon, A.J., Conley, J.W. & Gordon, J.M. Medical Consequences of Marijuana Use: A Review of Current Literature. Curr Psychiatry Rep 15, 419 (2013). https://doi.org/10.1007/s11920-013-0419-7
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DOI: https://doi.org/10.1007/s11920-013-0419-7